title: Management of Stage I Endometrial Cancer in France: A Survey on Current Practice.
abstract: OBJECTIVE
  We conducted a survey to assess the performance of preoperative staging and the application of French surgical guidelines in women with presumed stage I endometrial cancer (EC).
  
  
  METHODS
  The survey included 26 questions about the number of patients in low-, intermediate-, and high-risk groups operated on in 2012, the proportion of patients upstaged or downstaged by the examination of the uterus, and the proportion of subsequent surgery for lymph node dissection.
  
  
  RESULTS
  Thirty-two (70 %) of the 46 French university hospitals responded to the questionnaire. Among 886 patients with EC treated, 661 had stage 1 EC. The rates of presumed preoperative type 1 low-, intermediate-, high-risk EC and type 2 EC were 310 (46.9 %), 218 (33 %), 39 (5.9 %), and 94 (14.2 %) respectively. Among 567 type 1 patients, 35 % were upstaged and 6 % were downstaged. Fair agreement was found between preoperative and postoperative risk assessment (κ = 0.37). Patients with presumed low- and intermediate-risk EC upstaged postoperatively to FIGO stage II/III were more likely to have a restaging operation than patients upstaged to type 1 high-risk FIGO stage I EC: 37/70 (52.8 %) versus 26/75 (34.6 %), p = 0.027. The proportions of patients undergoing the recommended subsequent pelvic and/or para-aortic lymph node dissection were low: 34/85 (40 %) and 47/145 (32.4 %) respectively. Lymph node samplings were mainly performed by laparoscopy: 31/34 (91.2 %) and 40/47 (85.1 %) for pelvic and para-aortic dissection respectively.
  
  
  CONCLUSIONS
  Our survey showed that the performance of preoperative assessment of FIGO stage I EC was moderate and that adherence to the guidelines was low.
authors.affiliation: Department of Gynecology and Obstetrics, Pellegrin University Hospital, 33076, Bordeaux, France, jean-luc.brun@chu-bordeaux.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Brun
authors.forename: Lobna
authors.initials: L
authors.lastname: Ouldamer
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
authors.forename: Tristan
authors.initials: T
authors.lastname: Gauthier
mesh_terms: D000368:Aged; D019468:Disease Management; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011795:Surveys and Questionnaires