Impact of optimal secondary cytoreductive surgery on survival outcomes in women with recurrent endometrial carcinoma: A systematic review and meta-analysis

Background: Management of recurrent endometrial carcinoma (EC) represents a challenge. Although a complete resection of visible disease at secondary surgery (R0) is recommended, the impact of R0 on survival outcomes is unclear and pooled data are lacking.

Objective: To quantitatively assess the impact of R0 on survival outcomes in women with EC recurrence.

Search strategy: A systematic review and meta-analysis was performed searching eight electronic databases from their inception up to January 2024.

Selection criteria: All peer-reviewed studies that assessed quantitatively the impact of R0 on survival outcomes in women at first EC recurrence were included.

Data collection and analysis: Hazard ratio (HR) with 95% confidence interval (CI) for death of any cause and secondary recurrent or progressive disease in women with EC recurrence who underwent R0 compared to non-optimal secondary surgical cytoreduction (R1) were pooled and assessed at both univariable and multivariable analyses.

Main results: Three studies with 442 patients were included. At univariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.451 (95% CI: 0.319-0.638) for death from any cause, and 0.517 (95% CI: 0.298-0.895; p = 0.019) for recurrent or progressive disease. At multivariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.447 (95% CI: 0.255-0.783; p = 0.005) for death from any cause, and 0.585 (95% CI: 0.359-0.952; p = 0.031) for recurrent or progressive disease.

Conclusion: In women with EC recurrence, R0 is an independent prognostic factor, decreasing the risk of death from any cause by approximatively 55%, and of recurrent or progressive disease by approximatively 40%, compared to R1.