Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy as salvage treatment for a late wound recurrence of endometrial cancer

Endometrial cancer (EC) is usually diagnosed at
an early stage, when surgery alone may be curative, but 20-
25% of patients with EC have higher-risk early-stage disease
requiring radiation therapy alone or in combination with
chemotherapy, in addition to surgery. Most EC relapses are
either pelvic or distant metastases and occur within the first
three years after hysterectomy. Laparotomy wound
recurrences of EC are extremely rare, and only a few cases
have been previously reported. We describe the unusual case
of a late wound recurrence from an EC surgically removed
10 years previously which was successfully treated by
cytoreductive surgery and hyperthermic intraperitoneal
chemotherapy (HIPEC) after response to a hormonal
therapy. Ten years after abdominal hysterectomy and
bilateral salpingo-oophorectomy, on computed tomographic
(CT) scan, a 70-year-old woman exhibited an abdominal
mass of 3.5 cm, strictly adherent to the abdominal rectal
muscle. CT-guided biopsy revealed estrogen- and
progesterone receptor-positive metastasis from EC and the
patient was treated with megestrole acetate. The whole body
18F-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/CT showed a marked metabolic response
at the single metastatic site, with no further metastases, and
the patient underwent surgical resection of the mass followed
by immediate HIPEC perfusion with cisplatin. No residual
macroscopic disease was present at the end of surgery and no complications occurred during the hospital stay. At 12-
month follow-up, the patient is alive without evidence of
disease. Although this approach is still being investigational
for peritoneal recurrence of EC, our report confirms its
feasibility and its promising results in highly selected
patients.