Long-term oncologic outcomes of pulmonary metastasectomy for lung-confined recurrent endometrial cancer: a single-institution case series

Background Pulmonary recurrence in endometrial cancer is generally regarded as a manifestation of systemic disease and is primarily managed with systemic therapy. However, the clinical significance of lung-confined recurrent endometrial cancer and the role of pulmonary metastasectomy remain uncertain. Objective To evaluate the long-term oncologic outcomes of pulmonary metastasectomy in patients with lung-confined recurrent endometrial cancer and to explore whether lung-confined recurrence represents a clinically distinct pattern of recurrence. Study Design This retrospective single-institution case series included consecutive patients with lung-confined recurrent endometrial cancer who underwent pulmonary metastasectomy between January 2005 and July 2026. Clinicopathological characteristics, long-term oncologic outcomes, and perioperative outcomes were evaluated. Results Six patients underwent pulmonary metastasectomy for lung-confined recurrent endometrial cancer. The median interval from primary surgery to first pulmonary recurrence was 45.5 months (range, 19–227 months). Complete (R0) pulmonary resection was achieved in all patients without severe surgery-related adverse events. During a median follow-up of 103.5 months (range, 47–250 months) from primary surgery, all six patients remained alive, and five of six achieved durable disease-free status. Following the first pulmonary metastasectomy, one patient developed subsequent lung-confined recurrence and underwent repeat pulmonary metastasectomy, achieving additional long-term disease control. Notably, the two patients with synchronous bilateral pulmonary metastases also achieved durable disease-free survival following complete staged bilateral resection. Conclusion Pulmonary metastasectomy may provide durable long-term disease control in carefully selected patients with lung-confined recurrent endometrial cancer. Recognition of lung-confined recurrent endometrial cancer as a clinically distinct pattern of recurrence may support a shift from routine systemic therapy alone toward a more individualized multidisciplinary treatment strategy incorporating pulmonary metastasectomy.