title: Nationwide analysis on surgical procedures for patients with endometrial cancer in Germany: results of the AGO pattern of care studies from the years 2013, 2009, and 2006.
abstract: OBJECTIVE
  In 2013, 2009, and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated the therapeutic approaches and the adherence to their guidelines for endometrial carcinoma (EC) in Germany. Here, we present the results concerning the surgical procedures.
  
  
  METHODS
  A questionnaire was developed and sent to 682 German gynecological departments in 2013 (775 in 2009 and 500 in 2006). The results were compared with the recommendations of the guideline and with each other.
  
  
  RESULTS
  Responses were available in 40.0 % in 2013, 33.3 % in 2009, and 35.8 % in 2006, respectively. Pelvic lymphadenectomy (LAN) was performed in accordance with the guidelines with some exceptions in 2013, 2009, and 2006, whereas paraaortic LAN was performed in accordance with the guideline only in 2009. Histological high-risk subtypes of EC received pelvic and paraaortic LAN in 2013, 2009, and 2006 in accordance with the guidelines with small exceptions. LAN for Patients, who were postoperatively upstaged or upgraded, was not conducted in accordance with the guidelines in 2013, 2009, and 2006. In 2013, 84.6 % of the participants offered the laparoscopic approach (LSA) for hysterectomy and bilateral salpingo-oophorectomy, 63.3 % for pelvic LAN, and 49.1 % for paraaortic LAN, respectively. More participants offered the LSA in 2013 compared to 2009 and 2006 (p values <0.014).
  
  
  CONCLUSIONS
  The paraaortic LAN, the LSA as well as the second operation on patients who had postoperatively been upstaged were not conducted in accordance with the guideline [CORRECTED]. Improvements concerning surgical treatment are possible and might lead to higher survival rates and a reduction of morbidity in patients with EC in Germany.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Mainz, Mainz, Germany, battist@uni-mainz.de.
authors.forename: Marco Johannes
authors.initials: MJ
authors.lastname: Battista
authors.forename: Marcus
authors.initials: M
authors.lastname: Schmidt
authors.forename: Nicole
authors.initials: N
authors.lastname: Rieks
authors.forename: Joscha
authors.initials: J
authors.lastname: Steetskamp
authors.forename: Isabel
authors.initials: I
authors.lastname: Sicking
authors.forename: Antje
authors.initials: A
authors.lastname: Lebrecht
authors.forename: Heinz
authors.initials: H
authors.lastname: Koelbl
authors.forename: Peter
authors.initials: P
authors.lastname: Mallmann
authors.forename: Gerald
authors.initials: G
authors.lastname: Hoffmann
authors.forename: Eric
authors.initials: E
authors.lastname: Steiner
mesh_terms: D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D009367:Neoplasm Staging; D013997:Time Factors