{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T07:30:19Z","timestamp":1774510219513,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Endometrial cancer (EC) is the most common gynecological malignancy in Western countries. Although international guidelines recommend that patients with EC be treated at specialized oncology centers, many are still managed by general gynecologists. This study aimed to evaluate the influence of facility volume on treatment strategies and survival outcomes among EC patients. Methods: This is a retrospective multicenter study comparing 971 patients with EC treated at medium-volume centers (CVMs) (11\u201329 cases\/year) with 1431 patients treated at high-volume centers (CVAs) (\u226530 cases\/year). Patient characteristics were recorded, including age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, comorbidities, surgical approach, lymphadenectomy, total number of lymph nodes removed, number of positive lymph nodes, length of hospital stay, histological characteristics, ESMO-ESGO (European Society for Medical Oncology\u2013European Society of Gynaecological Oncology) classification system, adjuvant treatment, recurrence, progression-free survival (PFS), and overall survival (OS). Postoperative fever, hemoglobin changes, and blood transfusions were also reported. Results: Compared with patients treated at the MVCs, patients treated at the HVCs were younger (mean age, 65 vs. 66.4 years, p = 0.03) and had a lower rate of comorbidities (41% vs. 55%, p &lt; 0.001). Patients treated at HVCs were mostly in higher ESMO-ESGO recurrence risk classes (p &lt; 0.001), were treated mostly laparoscopically (58% vs. 47%, p &lt; 0.001) and had better staging (higher number of lymph nodes harvested (mean 19 vs. 11, p &lt; 0.001) and more peritoneal biopsies performed (27% vs. 14%, p &lt; 0.001). HVC patients had fewer complications and received less adjuvant therapy (40% vs. 50%, p &lt; 0.001) but, when treated, received chemotherapy more frequently, showed mostly loco-regional recurrences (34% vs. 14%) and fewer extra-abdominal recurrences (34% vs. 54%). HVC patients had better PFS and OS. Center volume was found to be an independent factor influencing PFS in multivariate analysis. Conclusions: All EC patients should be centrally managed to receive superior treatment to improve postoperative recovery and oncological outcomes, particularly for patients with more-aggressive tumors.<\/jats:p>","DOI":"10.3390\/cancers18071050","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:58:59Z","timestamp":1774357139000},"page":"1050","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Facility Volume on Therapy and Survival for Endometrial Cancer: A Retrospective Multicenter Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6537-1046","authenticated-orcid":false,"given":"Vincenzo Dario","family":"Mandato","sequence":"first","affiliation":[{"name":"Unit of Obstetrics and Gynecologic Oncology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3140-4772","authenticated-orcid":false,"given":"Anna Myriam","family":"Perrone","sequence":"additional","affiliation":[{"name":"Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero\u2013Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debora","family":"Pirillo","sequence":"additional","affiliation":[{"name":"Unit of Obstetrics and Gynecologic Oncology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gino","family":"Ciarlini","sequence":"additional","affiliation":[{"name":"Unit of Obstetrics and Gynecologic Oncology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, 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Monte","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vito Andrea","family":"Capozzi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Amadori","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Ospedale di Forl\u00ec, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruby","family":"Martinello","sequence":"additional","affiliation":[{"name":"Section of Obstetrics and Gynecology, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Rosati","sequence":"additional","affiliation":[{"name":"Gynecological and Obstetrical Unit, Infermi Hospital, 47923 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Stefanetti","sequence":"additional","affiliation":[{"name":"Gynecological and Obstetrical Unit, Infermi Hospital, 47923 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-5160","authenticated-orcid":false,"given":"Andrea","family":"Palicelli","sequence":"additional","affiliation":[{"name":"Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5487-0683","authenticated-orcid":false,"given":"Giacomo","family":"Santandrea","sequence":"additional","affiliation":[{"name":"Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Seracchioli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"},{"name":"Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero\u2013Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2324-5409","authenticated-orcid":false,"given":"Roberto","family":"Berretta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Aguzzoli","sequence":"additional","affiliation":[{"name":"Unit of Obstetrics and Gynecologic Oncology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, 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