Effects of surgical volumes on the survival of endometrial carcinoma

• This study showed no relation between surgical volumes and survival of endometrial cancer.
• At this moment there is insufficient evidence that concentration of care for women with endometrial cancer leads to improved survival.

ABSTRACTObjectiveThis study aims to assess whether surgical volume is related to survival among women with endometrial carcinoma.MethodsFor this population-based retrospective study, all women diagnosed with endometrial carcinoma between January 2005 and December 2010 were included as registered in the Netherlands Cancer Registry. Hospitals were divided into type of hospital: small general, large general, and oncological referral hospitals and into surgical volume: low (< 15/year), medium (15–24/year) and high (≥ 25/year) volume hospitals depending on the average annual number of surgeries for endometrial carcinoma during the study period. Primary outcome was relative survival related to hospital volume.ResultsOf 9133 women, 2596 (24.4%) were surgically treated in low volume hospitals, 3530 (38.7%) in medium volume hospitals and 3007 (32.9%) in high volume hospitals. In the Netherlands, low risk endometrial cancer is typically treated with simple hysterectomy and bilateral salpingo-oophorectomy whilst lymphadenectomy is only performed in high-risk endometrial cancer. Hospitals with high volumes treated relatively more women with high-risk and advanced stage tumors. After corrections for age, stage, histology, grade and type of hospital, no differences in relative survival were found by hospital volume in the total group or in the women with high-risk endometrial cancer, nor in women treated with complex surgery for endometrial cancer.ConclusionsIn this large population based study, no relation between surgical volumes and relative survival of endometrial cancer was observed. Based on this study, we conclude that at this moment there is insufficient evidence that concentration of care for women with endometrial cancer would lead to improved survival.