Journal Article

Nationwide Analysis on Surgical Staging Procedures and Systemic Treatment for Patients With Endometrial Cancer in Germany

Sicking, Isabel, Rieks, Nicole, Steiner, Eric, Böhm, Daniel, Steetskamp, Joscha, Schmidt, Marcus, Battista, Marco Johannes, Seeger, Alexander, Koelbl, Heinz

2013

Overview

OBJECTIVEIn 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated therapeutic approaches for endometrial carcinoma (EC) in Germany. METHODS AND MATERIALSA questionnaire was developed and sent to 775 German gynecologic departments in 2009 (500 in 2006). The results of the questionnaires were compared with each other and with the recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie’s guideline. Subgroup analyses were performed, dividing the participating centers into small and large centers and into centers with less and more experience with EC. RESULTSResponses were available in 33.3% in 2009 and 35.8% in 2006. Comparing 2009 with 2006, it became apparent that peritoneal washing cytology was performed in 94.6% versus 86.9% (P = 0.008), pelvic lymphadenectomy (LAN) in 98.3% versus 95.3%, and paraaortic LAN in 90.2% versus 73.8% (P < 0.001) for endometrioid EC, and LAN for histologic high-risk subtypes of EC in 99.6% versus 94.2% (P = 0.001), respectively. In 2009, all these criteria met the recommendation of the guidelines. Reoperation for LAN after postoperative upstaging was performed in 66.1% versus 50.6% (P = 0.002), and adjuvant systemic treatment with chemotherapy and endocrine therapy was performed in 63.7% versus 48.8% (P = 0.003) and 25.7% versus 15.4% (P = 0.014), respectively. This showed nonadherence to the guidelines. Laparoscopic approach was performed in 30.4% versus 19.7% (P = 0.014) of the participating centers, respectively. In subgroup analysis, laparoscopic approach showed a significant difference between small centers (11.5%) and large centers (27.3%) in 2006 (P = 0.012). CONCLUSIONSGerman hospitals increasingly follow the guidelines concerning LAN and peritoneal washing cytology. However, recommendations concerning reoperating in upstaged patients and adjuvant treatment decisions do not meet the guidelines, thus underlining great uncertainties in this field of gynecologic oncology.

• Publisher: Copyright by IGCS and ESGO,Elsevier Limited
• Subject: Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Carcinoma, Endometrioid - diagnosis / Carcinoma, Endometrioid - pathology / Carcinoma, Endometrioid - surgery / Carcinoma, Endometrioid - therapy / Cellular biology / Data Collection / Diagnostic Techniques, Obstetrical and Gynecological - statistics & numerical data / Endometrial cancer / Endometrial Neoplasms - diagnosis / Endometrial Neoplasms - pathology / Endometrial Neoplasms - surgery / Endometrial Neoplasms - therapy / Female / Germany - epidemiology / Guideline Adherence - statistics & numerical data / Gynecologic Surgical Procedures - statistics & numerical data / Hospitals - statistics & numerical data / Humans / Laparoscopy / Lymph Node Excision - methods / Lymph Node Excision - statistics & numerical data / Multicenter Studies as Topic / Neoplasm Staging - methods / Professional Practice - standards / Professional Practice - statistics & numerical data / Surveys and Questionnaires