Surgical management of advanced or recurrent endometrial cancer

The majority of patients with endometrial carcinoma are diagnosed with early stage disease where long-term survival is excellent. For patients who are found to have evidence of metastatic disease at the time of surgery there is a survival benefit to be gained if all gross evidence of disease can be resected. Even in cases where complete gross excision cannot be attained, surgical debulking to small volume residual disease leads to an improved prognosis compared to patients left with bulky residual disease. The treatment options for patients who develop recurrent disease after radiation therapy are limited. In carefully selected patients with isolated central recurrences, pelvic exenteration is the only potentially curable option. Further investigation into the techniques of intraoperative radiation therapy may increase the pool of patients for whom surgical based salvage therapy may be offered.