Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists.
OBJECTIVE
Several controversies surround lymphadenectomy for endometrial cancer; surgical approach, who to stage, and the anatomic borders of the lymphadenectomy. The purpose of this study was to identify practice patterns among gynecologic oncologists when performing a lymph node evaluation during staging for endometrial cancer.


METHODS
A self-administered survey was sent via email to all SGO members on 3 occasions between 2/09 and 4/09. The survey addressed surgical approach, algorithms used to determine staging, and anatomic landmarks defining lymphadenectomy.


RESULTS
Four hundred and six members (40%) responded. Eighty-two percent completed fellowship and 14% were fellows. Thirty-four percent finished fellowship in 2000 or later. Eighty-five percent educate fellows/residents in either academic (65%) or private practice settings (20%). For a majority of cases 40% prefer laparotomy, 31% perform robotic surgery, and 29% use laparoscopy. Minimally invasive surgery was associated with university-based practice (p=0.048). Most (53%) never/rarely use frozen section to determine whether or not to perform lymphadenectomy. A majority perform staging on all grade 2 and grade 3 cancers (66% and 90%, respectively). When performing paraaortic lymphadenectomy, 50% of respondents use the IMA as the upper border and 11% take the dissection to the renal vessels. Participants who completed fellowship in 2000 or later were less likely to go to the renal vessels (p=0.002).


CONCLUSIONS
Current controversies in surgical staging for endometrial cancer are reflected in the practice patterns among gynecologic oncologists. At this point it is unclear if standardizing surgical practice patterns will improve outcomes for patients with endometrial cancer.
Soliman
Pamela T
PT
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1155 Herman Pressler CPB 6.3244, Unit 1362, Houston, TX 77030, USA. psoliman@mdanderson.org
Frumovitz
Michael
M
Spannuth
Whitney
W
Greer
Marilyn J
MJ
Sharma
Sheena
S
Schmeler
Kathleen M
KM
Ramirez
Pedro T
PT
Levenback
Charles F
CF
Ramondetta
Lois M
LM
D000465:Algorithms; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006176:Gynecology / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008495:Medical Oncology / Q000379:methods*; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'