OPTIMAL SURGICAL CYTOREDUCTION IN PATIENTS WITH STAGE III AND STAGE IV ENDOMETRIAL CANCER: A STUDY OF MORBIDITY AND

N. Lambrou MD, R. Mirhashemi MD, H. Beach MD, L. Mendez MD, G. Ghurani MD, E. Salom MD, Z. Almeida MD, H. Averette MD, L. Twiggs MD, M. Penalver MD

   Objective: To evaluate survival and peri-operative morbidity in patients with Stage III and Stage IV endometrial carcinoma undergoing optimal versus suboptimal cytoreductive surgery.

   Methods: All patients with FIGO Stage III and Stage IV endometrial carcinoma who underwent surgical therapy at Jackson Memorial Hospital between 01/01/90 – 12/31/2000 were identified. Patient data were gathered retrospectively. Survival analysis and comparisons were performed using the Kaplan-Meier method, the log-rank test, and Chi-square analysis.

   Results: Eighty-four patients were identified; 60 patients with Stage III and 24 patients with Stage IV disease. Optimal cytoreduction was accomplished in 83% of patients (n=70) while 17% (n=14) had suboptimal cytoreduction (>1cm residual tumor). A significant survival advantage was associated with optimal cytoreduction (p<0.039). When stratified by stage, Stage III patients with optimal cytoreduction demonstrated significant survival advantage over Stage III patients with suboptimal cytoreduction (p<0.034). Optimal cytoreduction did not increase major and minor intra-operative or post-operative morbidity. SICU admissions and death < 30 days from surgery were associated with suboptimal cytoreductive surgery (p<0.0120, p<0.0037 respectively). Tumor involvement of the parametrium, adnexae, upper abdomen, and the presence of ascites at time of surgery were independent predictors of suboptimal resectability.

   Conclusion: Optimal cytoreduction in patients with Stage III and Stage IV endometrial cancer is not associated with an increase in peri-operative morbidity. Suboptimal cytoreduction is associated with increased morbidity and decreased survival.

   Key Words: Endometrial Cancer, Optimal Cytoreduction, Morbidity