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Nationwide Analysis on Surgical Staging Procedures and Systemic Treatment for Patients With Endometrial Cancer in Germany
  1. Marco Johannes Battista, MD*,
  2. Eric Steiner, PhD,
  3. Nicole Rieks, MD*,
  4. Joscha Steetskamp, MD*,
  5. Alexander Seeger, MD*,
  6. Isabel Sicking, MD*,
  7. Daniel Böhm, MD*,
  8. Marcus Schmidt, PhD* and
  9. Heinz Koelbl, PhD*
  1. *Department of Gynecology and Obstetrics, University Hospital Mainz of Johannes Gutenberg-University, Germany; and
  2. Department of Gynecology and Obstetrics, GP Ruesselsheim, Germany.
  1. Address correspondence and reprint requests to Marco Johannes Battista, MD, Department of Gynecology and Obstetrics, University Hospital Mainz, Langenbeckstr 1, D-55131 Mainz, Germany. E-mail: Battist{at}


Objective In 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated therapeutic approaches for endometrial carcinoma (EC) in Germany.

Methods and Materials A 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.

Results Responses 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).

Conclusions German 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.

  • Endometrial cancer
  • Patterns of care
  • Lymphadenectomy
  • Chemotherapy
  • Laparoscopic approach

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  • Eric Steiner, PhD, and Heinz Koelbl, PhD, are members of the Scientific Board Uterine Neoplasm of the Arbeitsgemeinschaft Gynäkologische Onkologie.

  • The authors declare no conflicts of interest.