Journal of the European Society for Gynaecological Endoscopy


ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma*†

A. Rodolakis1, G. Scambia2, F. Planchamp3, M. Acien4, A. Di Spiezio Sardo5, M. Farrugia6, M. Grynberg7,8,9, M. Paki┼ż10, K. Pavlakis11,12, N. Vermeulen13, G. Zannoni14, I. Zapardiel15, K. L. Tryde Macklon 16

1 Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
2 Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
3 Clinical Research Unit, Institut Bergonie, Bordeaux, France
4 Obstetrics and Gynecology Department, San Juan University Hospital, Miguel Hernández University, Alicante, Spain
5 Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Napoli, Campania, Italy
6 Spencer Private Hospitals, East Kent, UK
7 AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France
8 AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France
9 University Paris-Saclay, Saint-Aubin, France
10 Department for Gynecologic and Breast Oncology, University Medical Centre, Maribor, Slovenia
11 1st Pathology Department, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
12 Pathology Department, “IASO” Women’s Hospital, Athens, Greece
13 European Society of Human Reproduction and Embryology, Strombeek-Bever, Belgium
14 Department of Pathology, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
15 Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
16 Fertility Department, Copenhagen University Hospital, Copenhagen, Denmark


Uterine cancer, guideline, fertility preservation, endometrial carcinoma, oncofertility

†This article has not been externally peer reviewed. The manuscript has been approved by the Executive Committees/Boards of ESGO, ESHRE and ESGE.
*These guidelines were developed by ESGO, ESHRE and ESGE and are published concomitantly in the International Journal of Gynecological Cancer, Human Reproduction Open and Facts, Views, & Vision in ObGyn.
Initiated through ESGO the decision to develop multidisciplinary guidelines has been made jointly by the ESGO, ESHRE, and ESGE.
The ESGO has provided administrative support. The ESGO, ESHRE and ESGE are non-profit knowledgeable societies.

Published online: Mar 31 2023


Background: The standard surgical treatment of endometrial carcinoma (EC) consisting of total hysterectomy with bilateral salpingo-oophorectomy drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) provide comprehensive guidelines on all relevant issues of diagnosis and treatment in EC in a multidisciplinary setting. While also addressing work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility sparing treatment.

Objectives: To define recommendations for fertility-sparing treatment of patients with endometrial carcinoma.

Materials and Methods: ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of EC (11 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives.

Results: The multidisciplinary development group formulated 48 recommendations for fertility-sparing treatment of patients with endometrial carcinoma in four sections: patient selection, tumour clinicopathological characteristics, treatment and special issues.

Conclusions: These recommendations provide guidance to professionals caring for women with endometrial carcinoma, including but not limited to professionals in the field of gynaecological oncology, onco-fertility, reproductive surgery, endoscopy, conservative surgery, and histopathology, and will help towards a holistic and multidisciplinary approach for this challenging clinical scenario.

What is new? A collaboration was set up between the ESGO, ESHRE and ESGE, aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.

Supplementary data