Survival and perioperative outcomes of pelvic exenteration in primary advanced and recurrent endometrial carcinoma: A systematic review and meta-analysis

Objective: To assess survival and perioperative complications and mortality of pelvic exenteration (PE) in recurrent and advanced endometrial carcinoma (EC) patients. Methods: A systematic review and a meta-analysis was performed searching 7 electronic databases from their inception to May 2024 for all peer-reviewed studies that reported as a study outcome at least the 5 years-overall survival (OS) of PE in recurrent and/or advanced EC patients.Our outcomes were 5 year-OS from PE as primary outcome, and all extractable outcomes about PE survival [overall OS, 5 year- and overall disease specific survival (DSS), 5 year- and overall progression free survival (PFS)] and perioperative mortality and complications.Rates of survival outcomes and perioperative mortality and complications were calculated as individual and pooled estimates, with 95 % confidence intervals (CI).Subgroup analyses were planned for all study outcomes based on recurrent or advanced EC, separately. Results: 6 studies with 166 patients were included. In women underwent PE for advanced or recurrent EC, pooled rate was: 41.7 % (95 % CI: 25.6–57.8 %) for 5 year-OS; 30.4 % (95 % CI: 14.9–45.8 %) for 5 year-DSS; 26.6 % (95 % CI: 10.6–42.5 %) for overall DSS; 51.8 % (95 % CI: 25.6–78.0 %) for 5 year-PFS; 9.7 % (95 % CI: 5.7–16.1 %) for perioperative mortality; 56.1 % (95 % CI: 32.3–76.4 %) for perioperative complications. Subgroup analyses were suitable exclusively in the “recurrent EC” subgroup and showed even worsened outcomes. Conclusions: In women with advanced or recurrent EC, PE shows not encouraging survival outcomes, with relatively high rates of perioperative mortality and complications. These outcomes further worsened in the subgroup of only recurrent EC. However, they should be confirmed by more updated studies.