The objective of the study was to assess the overall and disease free survival in patients with advanced (Stage III and IV) endometrial cancer who undergo cytoreductive surgery, and to assess the factors affecting recurrence in these patients.

80 patients with advanced endometrial cancer who were diagnosed and had undergone surgery in Regional Cancer Center, Thiruvananthapuram between 2008 and 2018 were included. Patients who underwent neoadjuvant chemotherapy or radiotherapy initially and surgery later were also included for analysis.

Mean age was 59.9 yrs. Patients with Stage III disease constituted 81.2% (n = 65) of the population whereas 18.8% (n = 15) had stage IV endometrial cancer. There were 53 patients (66.3%) with endometrioid histology whereas 12 (15%) had serous carcinoma, 6 (7.5%) had clear cell carcinoma and 9 (11.2%) had carcinosarcoma. Majority of the patients, 69 (86.3%) had primary surgery, while 11 (13.7%) had upfront chemotherapy or radiotherapy before surgery. Complete cytoreduction was achieved in 72 (90%) of the patients who underwent surgery. Adjuvant treatment was chemotherapy and radiation was given in 41 patients (51.2%), while 15 (18.8%) received chemotherapy alone and 18 (21.3%) received radiotherapy alone. Median follow up period was 92 months. Relapse occurred in 50 patients (62.5%) and death in 49 patients (61.2%). 5 year DFS was 39% and OS was 46.9%. Factors significantly correlating to recurrence on univariate analysis included age more than 60 years, non endometrioid histology, high grade, LVSI and pelvic nodal metastases. However on multivariate analysis, only non endometrioid histology was found to have a significant correlation with recurrence. Factors significantly correlating to survival were age more than 60 yrs, Pre op Albumin less than 4 g%, non endometrioid histology, high grade, presence of LVSI and site of recurrence in lung and para aortic lymph nodes. However on multivariate analysis, only non endometrioid histology was found to have a significant correlation with survival.

In carefully selected patients with advanced endometrial cancer, a combination of surgical cytoreduction with appropriate adjuvant treatment and neoadjuvant treatment when indicated gives good results with an acceptable morbidity and mortality and reasonable overall survival.