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Treatment Preferences for Routine Lymphadenectomy Versus No Lymphadenectomy in Early-Stage Endometrial Cancer

 Jung-Yun Lee  ;  Kyunghoon Kim  ;  Yun Shin Lee  ;  Hyo Young Kim  ;  Eun Ji Nam  ;  Sunghoon Kim  ;  Sang Wun Kim  ;  Jae Weon Kim  ;  Young Tae Kim 
 Annals of Surgical Oncology, Vol.24(5) : 1336-1342, 2017 
Journal Title
 Annals of Surgical Oncology 
Issue Date
Adult ; Age Factors ; Aged ; Attitude of Health Personnel* ; Choice Behavior ; Disease-Free Survival ; Educational Status ; Endometrial Neoplasms/surgery* ; Female ; Humans ; Lymph Node Excision*/adverse effects ; Middle Aged ; Parity ; Patient Preference/statistics & numerical data* ; Risk Assessment ; Surveys and Questionnaires
Endometrial Cancer ; Lymphedema ; Recurrence Risk ; Discrete Choice Experiment ; Endometrial Cancer Patient
BACKGROUND: Debate on the value of lymphadenectomy continues in endometrial cancer. The aim of this study was to investigate patient and clinician preferences for routine lymphadenectomy versus no lymphadenectomy in the surgical management of endometrial cancer. METHODS: A discrete choice experiment and trade-off question were designed and distributed to 103 endometrial cancer patients and 90 gynecologic oncologists. Participant preferences were quantified with regression analysis using scenarios based on three attributes: 5-year progression-free survival and the rates of acute and chronic complication. A trade-off technique varying the risk of recurrence for no lymphadenectomy was used to quantify any additional risk of recurrence that these participants would accept to receive no lymphadenectomy instead of routine lymphadenectomy. RESULTS: On the basis of discrete choice experiment, the recurrence rate and lymphedema risk had a statistically significant impact on respondents' preference. The trade-off question showed that the median additional accepted risk of having no lymphadenectomy was 2.8% for gynecologic oncologists (0.5-14%) and 3.0% for patients (0.5-10%), but this difference was not significant (p = 0.620). Patients who were younger or had a higher education level or no history of delivery or shorter duration since diagnosis were prepared to accept higher additional risks of having no lymphadenectomy. CONCLUSIONS: Our results show that the majority of endometrial cancer patients and clinicians will accept a small amount of recurrence risk to reduce the incidence of lymphedema. Regarding preference heterogeneity among patients, our results show that it is important for surgeons to take a patient-tailored approach when discussing surgical management.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
김상운(Kim, Sang Wun) ORCID logo https://orcid.org/0000-0002-8342-8701
김성훈(Kim, Sung Hoon) ORCID logo https://orcid.org/0000-0002-1645-7473
김영태(Kim, Young Tae) ORCID logo https://orcid.org/0000-0002-7347-1052
남은지(Nam, Eun Ji)
이정윤(Lee, Jung-Yun) ORCID logo https://orcid.org/0000-0001-7948-1350
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