Surgery for Recurrent Uterine Cancer: Surgical Outcomes and Implications for Survival-A Case Series

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Title: Surgery for Recurrent Uterine Cancer: Surgical Outcomes and Implications for Survival-A Case Series
Authors: Domenici, L
Nixon, K
Sorbi, F
Kyrgiou, M
Yazbek, J
Hall, M
Campbell, J
Gibbons, N
Park, W-HE
Gabra, H
Fotopoulou, C
Item Type: Journal Article
Abstract: OBJECTIVE: The purpose of this study was to describe the patterns of relapse in uterine cancer (UC) and the role of surgery in the recurrent setting. METHODS: We describe surgical and clinical outcomes of all patients who underwent surgery for recurrent UC in a gynecological oncology tertiary referral center between May 1, 2013, and April 30, 2016. Progression-free survival and overall survival were estimated using Kaplan-Meier methods with the surgery at relapse being the starting point. RESULTS: We evaluated 15 patients with a median age of 66 years. The predominant histology was the endometrioid variant (n = 11; 73.3%). The median interval between the end of previous treatment and relapse surgery was 24 months (range, 8-164). Locoregional pelvic recurrences were the most common type of recurrence (n = 13; 86.7%) with the para-aortic lymph node space being the most commonly affected extrapelvic site (13%). Patients predominantly presented with a multifocal pattern of relapse (n = 10; 66.7%) requiring multivisceral resections such as bowel (n = 7; 46.6%) and/or bladder/ureteric resections (n = 8; 53.3%) to achieve complete tumor clearance. All patients were operated tumor free with a 30-day major morbidity and mortality rate of 6.7% and 0%, respectively. Five patients (33.3%) received postoperative chemotherapy or radiotherapy. Five patients (33.3%) relapsed, and 3 died within a mean follow-up of 12.4 months (95% confidence interval [CI], 6.5-18.2). Two of those patients had a sarcoma.Mean progression-free survival and overall survival for the entire cohort postrelapse surgery was 21.7 months (95%CI, 13.9-29.5) and 26.0 months (95%CI, 18.4-33.7), respectively. Survival was significantly worse in patients with nonendometrioid histology (P < 0.0001). CONCLUSIONS: Surgery for UC relapse seems feasible with acceptable morbidity and high complete resection rates despite the multifocal patterns of relapse in a selected group of patients in a reference center for gynecological cancers. Larger scale studies are warranted to establish the value of surgery at relapse for UC.
Issue Date: 1-May-2017
Date of Acceptance: 2-Jan-2017
ISSN: 1525-1438
Publisher: Lippincott, Williams & Wilkins
Start Page: 759
End Page: 767
Journal / Book Title: International Journal of Gynecological Cancer
Volume: 27
Issue: 4
Copyright Statement: © 2017 Lippincott Williams & Wilkins, Inc. This is a non-final version of an article published in final form in: Domenici L, Nixon K, Sorbi F, Kyrgiou M, Yazbek J, Hall M, Campbell J, Gibbons N, Park W-HE, et al (2017). Surgery for Recurrent Uterine Cancer: Surgical Outcomes and Implications for Survival-A Case Series. International Journal of Gynecological Cancer: May 2017 - Volume 27 - Issue 4 - p 759–767.
Sponsor/Funder: Ovarian Cancer Action
Funder's Grant Number: N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
Uterine cancer
Oncology & Carcinogenesis
1112 Oncology And Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine

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