Conservative re‐treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: We can hope, at least

BackgroundIn women with recurrent disease who were conservatively treated for atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EEC), the reasons why conservative treatment was chosen persist and outcomes of performing a conservative re-treatment are unclear, as pooled estimates on oncologic outcomes of such a re-treatment are lacking.ObjectivesTo provide pooled estimates of oncologic outcomes of conservative re-treatment in women with recurrent AEH or EC.Search StrategyA systematic review and meta-analysis was performed by searching six electronic databases from their inception to March 2022.Selection CriteriaStudies that allowed extraction of data about oncologic outcomes of conservative re-treatment of women with recurrent AEH and EEC after a conservative treatment.Data Collection and AnalysisPooled prevalence of complete response (CR), poor response (PR), and recurrence after conservative re-treatment was calculated.Main ResultsFifteen studies (12 retrospective and 3 prospective) with 492 women (42.1% AEH and 57.9% EEC) were included in the systematic review, and 10 studies (8 retrospective and 2 prospective) were suitable for the meta-analysis. Pooled prevalence was 85.3% (95% confidence interval [CI] 77.0%-91.0%) for CR, 14.7% (95% CI 9.0%-23.0%) for PR, and 40.4% (95% CI 15.5%-71.4%) for recurrence.ConclusionsConservative re-treatment in AEH or EC recurrent women has a high CR rate and acceptable recurrence rate that might allow it to be considered a safe and viable option, at least as a first round of conservative treatment. Women with an unsatisfied desire for motherhood or with high surgical risk might avoid hysterectomy and attempt childbearing or spare high-risk surgery.Conservative re-treatment in women with recurrent AEH or EC may be considered a viable option, at least as a first round of conservative treatment.