Abstract
Background
Surgical management is the cornerstone in the treatment of endometrial cancer. However, there are many controversies involved in the management starting from what constitutes adequate staging to the type of adjuvant treatment. In India, surgeons from several specialties operate on patients with endometrial cancer and there is a lack of guideline-based practice which necessitates an audit on the quality of care offered to women with endometrial cancer.
Methods
The study was a questionnaire-based study conducted at various conference venues. The study participants included general surgeons, gynecologists, surgical oncologists and gynecologic oncologists who operate on endometrial cancer.
Results
There is an extensive variation in the management of endometrial cancer among practitioners and lack of consensus regarding lymphadenectomy and its extent during surgery. Also, the use of intraoperative frozen section and comprehensive staging is more commonly seen among oncosurgeons when compared to other specialties.
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Appendix
Appendix
Questionnaire: |
Demographics: practicing branch |
General surgery |
OBGYN |
Oncology |
Qualification: |
MS (general surgery) |
DGO/MS (OBG) |
MCh (surgical oncology) |
Others |
Work place: |
Government hospital |
Cancer center |
Private hospital/nursing home |
Others |
Number of subjects in a year: |
1–5 |
6–10 |
11–20 |
>20 |
Use of intraoperative frozen section Y/N |
Diagnosing myometrial invasion |
Routinely |
Occasionally |
Never |
Determining grade of tumor |
Routinely |
Occasionally |
Never |
Preferred preoperative imaging methods |
USG abdomen and pelvis |
USG abdomen and TVS |
CT scan |
MRI scan |
PET scan |
No preoperative imaging |
Commonly used route of surgery |
Laparotomy |
Laparoscopic |
Robotic |
Use of sentinel lymph node biopsy: Y/N |
Sending hysterectomy specimen for myometrial invasion to determine the extent of surgery: Y/N |
Surgical procedure in cases of early-stage endometrial cancer: |
Total hysterectomy with BSO |
Total hysterectomy with BSO with bilateral pelvic lymph node sampling |
Total hysterectomy with BSO with bilateral pelvic lymph node dissection |
Total hysterectomy with BSO with bilateral pelvic and paraaortic lymph node sampling |
Total hysterectomy with BSO with pelvic and paraaortic lymph node dissection up to IMA |
Total hysterectomy with BSO with pelvic and paraaortic lymph node dissection up to renal veins |
Total hysterectomy with BSO with tailoring extent of lymphadenectomy |
Others |
Preferred modality of treatment in following cases: |
Stage I : Type I, G1, < 50% myometrial invasion: |
Type I, G1, > 50% myometrial invasion: |
Type I, G2, < 50% myometrial invasion: |
Type I, G2, > 50% myometrial invasion: |
Type I, G3, < 50% myometrial invasion: |
Type I, G3, > 50% myometrial invasion: |
Type II endometrial cancers: |
Stage II: endometrial cancer with cervical involvement: |
Stage III |
Stage IV |
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Vidhyalakshmi, S., Maheshwari, A. & Balasubramani, L. Surgery in Endometrial Cancer: An Audit of Quality Across Centers in India. Indian J Gynecol Oncolog 17, 70 (2019). https://doi.org/10.1007/s40944-019-0312-3
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DOI: https://doi.org/10.1007/s40944-019-0312-3