Impact of surgical case volume on the accuracy of preoperative staging and compliance with the guidelines for the management of endometrial cancer

Abstract

Aim: To assess the impact of the surgical case volume on the accuracy of preoperative staging and compliance with the European Society of Medical Oncology (ESMO) guidelines for the management of endometrial cancer (EC).

Patients and methods: Centers were divided into those taking care of 20 or fewer EC cases, and those with more than 20 per year.

Results: Seventeen university teaching hospitals fully responded to the questionnaire. The differences between the preoperative assessment and postoperative risk groups were significant for all centers (p=0.001). However, this difference was not due to the volume of patients of centers (p=1.00). Lymphadenectomy was performed in 21% and 82% of patients in the ESMO low-risk and high-risk groups, respectively, without differences between centers overall and centers managing more or fewer than 20 ECs per year. For the ESMO intermediate-risk group, the difference was significant when taking all groups into account (p=0.02), but it was not significant between centers managing fewer than 20 ECs (85%) or more than 20 ECs (59%) per year (p=0.12).

Conclusion: The accuracy of preoperative staging in EC is not improved in centers managing more than 20 ECs per year. Lymphadenectomy practice in the presumed low- and high-risk groups was homogenous. In the presumed intermediate-risk group, lymphadenectomy practice is heterogeneous and centers managing more than 20 ECs tend to perform lymphadenectomy more frequently.

Keywords: Endometrial cancer; guidelines; lymphadenectomy; patient volume; preoperative staging.