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Utility and Actual Use of European and Spanish Guidelines on the Management of Endometrial Cancer Among Gynecologic Oncologists in Spain
  1. Ignacio Zapardiel, MD, PhD*,
  2. Claudia Blancafort, MD,
  3. David Cibula, MD, PhD,
  4. Ibon Jaunarena, MD§,
  5. Mikel Gorostidi, MD, PhD§,
  6. Antonio Gil-Moreno, MD, PhD and
  7. Javier De Santiago, MD, PhD
  1. * Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Madrid;
  2. Gynecology Department, Dexeus University Institute, Barcelona, Spain;
  3. Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic;
  4. § Gynecologic Oncology Unit, Hospital Universitario Donostia, San Sebastian;
  5. Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona; and
  6. Department of Gynecology, MD Anderson Cancer Center, Madrid, Spain.
  1. Address correspondence and reprint requests to Ignacio Zapardiel, MD, PhD, Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Paseo Castellana 261, 28046, Madrid, Spain. E-mail: ignaciozapardiel{at}


Objective The aim of the study was to analyze the current management of endometrial cancer across Spain and to evaluate the use and applicability of the national and international guidelines.

Materials and Methods An electronic 30-question survey was distributed among all Spanish Society of Obstetrics and Gynecology–registered specialists dedicated to gynecologic oncology in Spain by e-mail. Data were collected anonymously and analyzed using SPSS program.

Results One hundred forty-five (17.8%) surveys were collected. Significant differences were observed between tertiary hospitals and secondary or private hospitals in terms of appropriate (according to European Society of Gynaecologic Oncology guidelines) nodal staging in low-risk cases (96 [95%] vs 27 [61.4%], respectively; P < 0.001), appropriate nodal staging in intermediate-risk cases (96 [95%] vs 39 [88.6%], respectively; P = 0.004), appropriate treatment in advanced-stage cases (63 [67.7%] vs 13 [40.6%], respectively; P < 0.001), and surgical treatment of relapses (87 [93.5%] vs 18 [56.3%], respectively; P = 0.004) but nonsignificant in the rate of complete paraaortic lymphadenectomy performance (82 [81.2%] vs 28 [63.6%], respectively; P = 0.056). Similar results have been observed when comparing centers with less than 20 cases per year to centers with more than 40 cases annually, with significant differences in the management of low-risk and intermediate-risk endometrial cancers.

Conclusions This cross-sectional study demonstrates a broad heterogeneity of care giving between the clinical national and international guidelines and the actual practice in Spain. Although most of the responders refer to base their endometrial cancer management on Spanish and European Society of Gynaecologic Oncology guidelines (64.1%), many discrepancies have been observed, mainly in the management of intermediate-risk cases and follow-up. It may be caused by the lack of consensus on certain points, lack of facilities in lower case load centers, and also due to disagreement or unawareness on the current knowledge.

  • Endometrial cancer
  • Management
  • Guidelines
  • Adherence
  • Survey

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  • The authors declare no conflicts of interest.