Evaluating Treatment Strategies in Advanced Endometrial Cancer: Primary Cytoreductive Surgery Versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery—A Ten‐Year Single‐Centre Experience

Introduction/Background: Management of advanced endometrial cancer (EC) presents a significant therapeutic challenge, with ongoing debate regarding optimal treatment sequencing. Primary cytoreductive surgeries (PCSs) with adjuvant therapy and neoadjuvant chemotherapy followed by interval Debulking surgery (NACT‐IDS) are both employed as treatment strategies. This study analyses outcomes of both treatment strategies in Nottingham University Hospitals Cancer Centre. Methodology: We conducted a retrospective cohort analysis of patients with advanced EC (FIGO Stages III‐IV) treated at our centre between 2013 and 2023. Patients who received either PCS with adjuvant therapy or neoadjuvant chemotherapy followed by interval Debulking surgery (NACT‐IDS) are included in the study. Data collection included demographic characteristics, treatment approaches, surgical parameters, and outcome measures. Primary outcomes were progression‐free survival (PFS) and overall survival (OS). Secondary outcomes included perioperative outcomes and recurrence patterns. Results: Treatment pathways included NACT‐IDS ( n = 8) and PCS with adjuvant therapy ( n = 57). Stage IV disease was notably more prevalent in patients who received NACT‐IDS therapy compared to the PCS group (75.0% versus 5.3%, p < 0.001). Analysis revealed a PFS duration of 18.5 months for NACT‐IDS patients, whilst PCS patients demonstrated a longer duration of 35.5 months (HR 1.18, 95% CI: 0.56–2.48, p = 0.328). Median OS was 22.0 months in the NACT‐IDS group versus 41.0 months in the PCS group (HR 1.35, 95% CI: 0.64–2.83, p = 0.145). Mean operative time was longer in the NACT‐IDS group (239.7 vs 165.5 min, p = 0.209). All NACT‐IDS procedures were performed via open laparotomy compared to 49.1% in the PCS group ( p < 0.001). Hospital stay was significantly longer in the NACT‐IDS group (median 8 vs 3 days, p = 0.036). Radiotherapy was administered to 25.0% ( n = 2) of NACT‐IDS patients and 59.6% ( n = 34) of PCS patients. Recurrence rates were higher in the NACT‐IDS group, 37.5%, compared to 33.3% in the PCS patients ( p = 0.823). Conclusion: This comprehensive analysis provides valuable insights into treatment outcomes and surgical parameters for advanced EC. Whilst the small sample size of the NACT‐IDS cohort limits the ability to draw definitive conclusions, the study provides meaningful evidence that can inform clinical decision‐making. The findings lay important groundwork for future prospective, multicentre studies aimed at optimising patient selection and treatment sequencing in this challenging disease.