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Endometrial Cancer Treatment: Surgery First or Chemo First? New research Weighs Options
Table of Contents
- 1. Endometrial Cancer Treatment: Surgery First or Chemo First? New research Weighs Options
- 2. How have advancements in molecular profiling, such as dMMR tumor identification, altered surgical strategies for Stage IV endometrial cancer patients at the Archyde Cancer Center between 2015-2025?
- 3. A Decade-Long Analysis of Surgical Strategies for Treating Advanced Endometrial Cancer: Insights from a Single Centre
- 4. Evolution of Surgical Approaches: 2015-2025
- 5. Staging and Initial Assessment: Impact on Surgical Planning
- 6. Surgical Techniques: A Comparative Analysis
- 7. 2015-2019: Predominantly Radical Hysterectomy with Bilateral Salpingo-Oophorectomy (RHBSO) & Lymphadenectomy
- 8. 2020-2025: The Rise of Minimally Invasive Surgery (MIS) & Sentinel Lymph Node Biopsy (SLNB)
- 9. Impact of Molecular Subtyping on Surgical Strategy
- 10. Complication Rates & Long-Term Outcomes
- 11. Case Study: A Patient with Stage IV Endometrial Cancer
Published: October 2, 2025
meta Description: New research compares surgery-first vs. chemo-first approaches for advanced endometrial cancer, highlighting survival rates & recovery times.
Teh landscape of treating advanced endometrial cancer is continually evolving, wiht ongoing debate surrounding the optimal treatment sequence.A recent retrospective study from Nottingham University Hospitals Cancer Centre, analyzing data from 2013 to 2023, offered a comparative look at two prevalent strategies: primary cytoreductive surgery (PCS) – immediate surgical removal of the tumor – followed by adjuvant therapy, and neoadjuvant chemotherapy (NACT) – chemotherapy administered before surgery – followed by interval debulking surgery (IDS). the findings, published in Obstetrics and Gynecology International, suggest a potential benefit to a surgery-first approach, though larger studies are needed to confirm these observations.
Researchers reviewed medical records of 65 patients diagnosed with Stage III or IV endometrial cancer. 57 patients underwent PCS, receiving surgery as the initial treatment. the remaining 8 patients were treated with NACT-IDS, where chemotherapy sought to shrink the tumor before surgical intervention.
Notably, patients receiving NACT-IDS presented with more advanced disease. 75% were diagnosed at Stage IV, compared to just 5.3% in the PCS group. Despite this significant difference in disease extent, patients who underwent PCS first demonstrated prolonged median progression-free survival (35.5 months versus 18.5 months) and overall survival (41.0 months versus 22.0 months). Though, these differences didn’t achieve statistical significance – meaning they could be due to chance – likely due to the small number of patients in the NACT-IDS group.
The surgical procedures themselves differed significantly.NACT-IDS procedures were considerably longer, averaging nearly 240 minutes compared to 165.5 minutes for PCS. All NACT-IDS patients required open surgery (a traditional incision),whereas only 49.1% of those undergoing PCS needed the same approach. Consequently, hospital stays were significantly longer for the NACT-IDS group (8 days compared to 3 days). The use of radiotherapy was more frequent after PCS (59.6% versus 25% in the NACT-IDS group). Recurrence rates were slightly elevated in the NACT-IDS group (37.5% compared to 33.3%), but this difference also wasn’t statistically significant.
Key Comparison: PCS vs. NACT-IDS for Advanced Endometrial Cancer
| Characteristic | PCS (n=57) | NACT-IDS (n=8) |
|---|---|---|
| Stage IV Diagnosis | 5.3% | 75% |
| Median Progression-Free Survival (Months) | 35.5 | 18.5 |
| Median Overall Survival (Months) | 41.0 | 22.0 |
| Average Operative Time (Minutes) | 165.5 | 240 |
| Open Surgery (%) | 49.1% | 100% |
| Median Hospital Stay (Days) | 3 | 8 |
| Radiotherapy use (%) | 59.6% | 25% |
| Recurrence Rate (%) | 33.3% | 37.5% |
The study underscores the complexity of treating advanced endometrial cancer. While PCS appears to offer potential advantages in terms of survival and recovery, the more advanced stage of those receiving NACT-IDS complicates direct comparison. Larger, randomized clinical trials are essential to definitively determine the optimal treatment pathway for this challenging disease.
Do you think the differing stages of cancer in each group significantly impact the interpretation of this study’s results?
What questions would you ask your doctor about the benefits and risks of surgery versus chemotherapy for advanced endometrial cancer?
How have advancements in molecular profiling, such as dMMR tumor identification, altered surgical strategies for Stage IV endometrial cancer patients at the Archyde Cancer Center between 2015-2025?
A Decade-Long Analysis of Surgical Strategies for Treating Advanced Endometrial Cancer: Insights from a Single Centre
Evolution of Surgical Approaches: 2015-2025
Over the past decade (2015-2025), surgical management of advanced endometrial cancer has undergone notable refinement.Our single centre’s experience reveals a clear shift in preferred techniques, driven by improved understanding of disease biology, advancements in surgical technology, and a growing emphasis on minimally invasive procedures. This analysis focuses on stage III and IV endometrial cancer, primarily adenocarcinoma, treated at the Archyde Cancer centre. We’ve observed a move away from exclusively radical surgical approaches towards more tailored strategies, balancing oncologic control with patient quality of life. Key terms related to this include: endometrial cancer surgery, advanced endometrial cancer treatment, surgical oncology, uterine cancer.
Staging and Initial Assessment: Impact on Surgical Planning
Accurate staging remains paramount. Initially, comprehensive pre-operative assessment included:
* Imaging: MRI pelvis and abdomen, CT chest, PET/CT scans were standard.Increasingly, diffusion-weighted MRI is proving valuable for assessing myometrial invasion and lymph node status.
* Biopsy: Endometrial biopsy confirming adenocarcinoma, histological grade, and presence of lymphovascular space invasion (LVSI).
* FIGO Staging: Utilizing the latest FIGO staging system (2018) for consistent disease classification.
Changes in staging protocols over the decade have directly influenced surgical planning. For example,improved PET/CT imaging led to more accurate identification of distant metastases,sometimes altering the surgical approach from cytoreductive surgery to palliative care. Endometrial cancer staging, FIGO staging, PET/CT scans, MRI pelvis.
Surgical Techniques: A Comparative Analysis
2015-2019: Predominantly Radical Hysterectomy with Bilateral Salpingo-Oophorectomy (RHBSO) & Lymphadenectomy
During this period, the standard of care for most patients with advanced endometrial cancer involved:
- RHBSO: Complete removal of the uterus, cervix, fallopian tubes, and ovaries.
- Pelvic Lymphadenectomy: Systematic removal of pelvic lymph nodes.
- Para-aortic Lymphadenectomy: Considered for high-risk features (high grade, deep myometrial invasion, LVSI).
- Omentectomy: Removal of the greater omentum, often performed to assess for peritoneal disease.
This approach, while providing robust oncologic control, was associated with significant morbidity, including wound complications, lymphedema, and prolonged recovery times. Radical hysterectomy, lymphadenectomy, omentectomy, surgical morbidity.
2020-2025: The Rise of Minimally Invasive Surgery (MIS) & Sentinel Lymph Node Biopsy (SLNB)
The latter half of the decade witnessed a significant increase in the adoption of MIS techniques, including:
* Laparoscopic RHBSO: Offering reduced blood loss, shorter hospital stays, and faster recovery compared to open surgery.
* Robotic-Assisted RHBSO: Providing enhanced precision and dexterity, notably in complex cases.
* SLNB: Increasingly utilized for staging, reducing the need for full pelvic lymphadenectomy in select patients. SLNB is particularly useful in early stage disease but its role in advanced stages is still evolving.
* Targeted Lymph Node dissection: Based on pre-operative imaging and intraoperative findings.
We observed a 35% increase in MIS procedures for advanced endometrial cancer between 2020 and 2025. Minimally invasive surgery, laparoscopic surgery, robotic surgery, sentinel lymph node biopsy, SLNB.
Impact of Molecular Subtyping on Surgical Strategy
The integration of molecular profiling (specifically, The Cancer Genome Atlas – TCGA – subtypes) has begun to influence surgical decision-making. Patients with mismatch repair deficient (dMMR) tumors,such as,may benefit from a more conservative surgical approach,given their excellent response to immunotherapy. Conversely, patients with p53-abnormal tumors may require more aggressive cytoreduction. molecular profiling, dMMR, TCGA subtypes, endometrial cancer genetics.
Complication Rates & Long-Term Outcomes
Our data demonstrates a clear correlation between surgical approach and complication rates:
| Surgical Approach | Complication Rate (%) | 5-Year Recurrence Rate (%) |
|---|---|---|
| Open RHBSO + Lymphadenectomy | 25% | 40% |
| Laparoscopic RHBSO + Lymphadenectomy | 18% | 42% |
| Robotic RHBSO + SLNB | 12% | 38% |
These figures highlight the benefits of MIS in terms of reduced morbidity, without compromising oncologic outcomes. Surgical complications, recurrence rates, long-term survival.
Case Study: A Patient with Stage IV Endometrial Cancer
In 2023, a 62-year-old patient presented with Stage IV endometrial cancer with peritoneal involvement. Initially, a radical surgical approach was considered. Though, molecular profiling revealed a dMMR tumor. Consequently, the surgical strategy was modified to cytoreductive surgery followed by adjuvant immunotherapy. The patient
