Pelvic Exenteration for Recurrent Endometrial Cancer: A 15-Year Monocentric Retrospective Study

SIMPLE SUMMARY: The incidence of endometrial cancer is continuously rising within the last few decades. The diverse patient population impairs standardized procedures and asks for individualized treatment options. If patients already received or failed to respond to radio- or chemotherapy, secondary surgical procedures such as pelvic exenteration might be the only curative option. The heterogeneity of the published data is a big challenge for an interpretation of long-term survival after pelvic exenteration. This study retrospectively analyzed data of a homogenous patient population receiving pelvic exenteration. When complete cytoreduction was achieved, a substantial overall survival was measured. Declining morbidity and mortality rates support pelvic exenteration as a valid treatment option for carefully chosen patients with recurrent endometrial cancer. ABSTRACT: Treatment options for recurrent endometrial adenocarcinoma are limited. In those cases, secondary surgical procedures such as pelvic exenteration form the only possible curative approach. The aim of this study was analyzing the outcomes of patients who underwent pelvic exenteration during the treatment of recurrent endometrial cancer intending to identify prognostic factors. More than 300 pelvic exenterations were performed. Fifteen patients were selected that received pelvic exenteration for recurrent endometrial adenocarcinoma. Data regarding patient characteristics, indication for surgery, complete cytoreduction, tumor grading and p53- and L1CAM-expression were collected and statistically evaluated. Univariate Cox regression was performed to identify predictive factors for long-term survival. The mean survival after pelvic exenteration for the whole patient population was 22.7 months, with the longest survival reaching up to 69 months. Overall survival was significantly longer for patients with a curative treatment intention (p = 0.015) and for patients with a well or moderately differentiated adenocarcinoma (p = 0.014). Complete cytoreduction seemed favorable with a mean survival of 32 months in contrast to 10 months when complete cytoreduction was not achieved. Pelvic exenteration is a possible treatment option for a selected group of patients resulting in a mean survival of nearly two years, offering a substantial prognostic improvement.