title: Evolution of surgical management of early-stage endometrial cancer.
abstract: OBJECTIVE
  We sought to examine the evolution of surgical care for early-stage endometrial cancers and factors affecting use of laparoscopy.
  
  
  METHODS
  Women with surgically managed early-stage endometrial cancer were divided into 2 groups corresponding to before and after addition of faculty with formal fellowship training in laparoscopic staging and access to a robotic surgery platform.
  
  
  RESULTS
  In all, 502 women were identified. Laparoscopic management increased from 24-69% between time periods (P < .0001). Performance of comprehensive surgical staging, and lymph node counts, increased (P < .0001) despite an increase in median body mass index (P = .001). A traditional "straight stick" technique was performed in 72% of laparoscopic cases during the later period. Laparoscopy patients had lower estimated blood losses and shorter hospital stays (each P < .0001) compared to laparotomy patients.
  
  
  CONCLUSIONS
  Addition of faculty with formal fellowship training in laparoscopic staging and access to a robotic surgery platform shifted management of early-stage endometrial cancer toward laparoscopy.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA. dboruta@partners.org
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
authors.forename: Christopher K
authors.initials: CK
authors.lastname: McCann
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Garrett
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D042241:Early Diagnosis; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods / Q000706:statistics & numerical data; D007813:Laparotomy / Q000193:education / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay; D008197:Lymph Node Excision / Q000193:education / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012371:Robotics / Q000193:education / Q000379:methods / Q000706:statistics & numerical data