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ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma
  1. Alexandros Rodolakis1,
  2. Giovanni Scambia2,
  3. François Planchamp3,
  4. Maribel Acien4,
  5. Attilio Di Spiezio Sardo5,
  6. Martin Farrugia6,
  7. Michael Grynberg7,8,9,
  8. Maja Pakiz10,
  9. Kitty Pavlakis11,12,
  10. Nathalie Vermeulen13,
  11. Gianfranco Zannoni14,
  12. Ignacio Zapardiel15 and
  13. Kirsten Louise Tryde Macklon16
  1. 1Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
  2. 2Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
  3. 3Clinical Research Unit, Institut Bergonie, Bordeaux, France
  4. 4Obstetrics and Gynecology Department, San Juan University Hospital, Miguel Hernández University, Alicante, Spain
  5. 5Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Napoli, Campania, Italy
  6. 6Spencer Private Hospitals, East Kent, UK
  7. 7AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France
  8. 8AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France
  9. 9University Paris-Saclay, Saint-Aubin, France
  10. 10Department for Gynecologic and Breast Oncology, University Medical Centre, Maribor, Slovenia
  11. 111st Pathology Department, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
  12. 12Pathology Department, "IASO" Women's Hospital, Athens, Greece
  13. 13European Society of Human Reproduction and Embryology, Strombeek-Bever, Belgium
  14. 14Department of Pathology, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  15. 15Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
  16. 16Fertility Department, Copenhagen University Hospital, Copenhagen, Denmark
  1. Correspondence to Professor Alexandros Rodolakis, Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens 115 28, Greece; a.rodolaki{at}


The standard surgical treatment of endometrial carcinoma, consisting of total hysterectomy with bilateral salpingo-oophorectomy, drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) provide comprehensive information on all relevant issues of diagnosis and treatment in endometrial carcinoma in a multidisciplinary setting. While addressing also work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility-sparing treatment.

A collaboration was set up between the ESGO, the European Society of Human Reproduction and Embryology (ESHRE), and the European Society for Gynaecological Endoscopy (ESGE), aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment (patient selection, tumor clinicopathological characteristics, treatment, special issues) in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.

ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (11 experts from across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified by a systematic search, was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives.

  • uterine cancer

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All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

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  • Contributors The development group (including all authors) is collectively responsible for the decision to submit for publication. Alexandros Rodolakis (chair), Kirsten Louise Tryde Macklon (chair), Giovanni Scambia (chair), François Planchamp (methodologist), and Nathalie Vermeulen (methodologist) wrote the first draft of the manuscript. All other contributors have actively given personal input, reviewed the manuscript, and have given final approval before submission. AR is guarantor.

  • Funding All costs relating to the development process were covered from ESGO, ESHRE, and ESGE funds. There was no external funding of the development process or manuscript production.

  • Competing interests GS has reported grants from MSD Italia S.r.l., advisory boards for Storz, Bayer, Astrazeneca, Metronic, TESARO Bio Italy S.r.l and Johnson & Johnson, and honoraria for lectures from Clovis Oncology Italy S.r.l. MG has reported advisory boards for Gedeon Richter and Merck; AR, FP, MA, ADSS, MF, MP, KP, NV, GZ,IZ and KLTM have reported no conflicts of interest.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Joint publication These guidelines were developed by ESGO, ESHRE, and ESGE and are published in the International Journal of Gynecological Cancer, Human Reproduction Open, and Facts, Views, & Vision in ObGyn.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.