Patient characteristics
In total 595 endometrial cancer cases were analysed, of which 294
(49.4%) were a training case and 301 (50.6%) were not. 502 cases
(84.8%) were performed at the Royal Marsden Hospital and 92 cases
(15.5%) were performed at other hospitals within the Southwest Thames
Gynaecological Cancer Centre. Eighteen gynaecological oncology trainees
were trained in RAL surgery for endometrial cancer in a PBP manner.
Table 1 shows the baseline characteristics for training and non-training
cases. Training and non-training cases were similar in age (66 versus 67
years, p = 0.0946), ASA score (2 versus 2, p = 0.680) and Carlson
Comorbidity Index 10-year median survival estimates (21.6% versus
21.4%, p = 0.259). However, training cases had a lower BMI (30 versus
32 kg/m2, p = 0.016) than non-training cases and there
was a difference in distribution of WHO performance status (p = 0.026),
but post-hoc testing according to Bonferroni24rendered no significant differences.
No differences were found in median FIGO stage between training and
non-training cases (1 versus 1, p = 0.168), but training cases had
patients with a higher median histopathological grade (3 versus 2, p =
0.010) and a lower rate of endometrioid tumours (56.8% versus 69.1%, p
= 0.002*). Post-hoc testing showed a lower rate of grade 1 (33.9%
versus 45.6%, p = 0.004*) and a higher rate of grade 3 tumours (50.3%
versus 39.3%, p = 0.007*) in training cases. This resulted in a higher
percentage of adjuvant treatment in training cases (69.9% versus
59.6%, p = 0.034). The distribution of ESGO risk scores did not differ
between training and non-training cases (p = 0.078). More sentinel lymph
node dissections (77.2% versus 67.8%, p = 0.010) were performed in
training cases, which is possibly associated with the gradual increase
in training cases over time (37.2% in 2015 versus 55.3% in 2022)
accompanied with the simultaneous increase in sentinel lymph node
procedures (39.5% in 2015 versus 72.4% in 2022). The median number of
harvested lymph nodes (3 versus 3, p = 0.325), and rates of pelvic
(25.3% versus 29.2%, p = 0.276) and para-aortic lymphadenectomies
(0.3% versus 1.3%, p = 0.188) were comparable. Median follow-up in
months was comparable (25 versus 28 months, p = 0.140) between training
and non-training cases.