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Purpose Endometrial cancer (EC) is the most common gynecological malignancy and one of few cancers with an
increasing US mortality rate. Rural patients may have less access to specialty care affecting their receipt of surgery
and adequate lymphadenectomy (AL). We sought to assess rural–urban differences in EC surgery, lymphadenectomy,
and survival.
Methods We analyzed data from the Surveillance Epidemiology and End Results database on EC patients (2004–2013). We
performed univariate analyses to compare rural and urban patients on demographic and clinical characteristics and receipt
of nodal examination and AL. We assessed rural–urban differences in trends of receipt of AL, performed logistic regression
to evaluate differences in receipt of surgery, nodal examination, and AL, and performed survival analysis.
Results Rural patients were less likely to have any lymph nodes removed, had a smaller median number removed, and a
smaller proportion had AL. Even after controlling for established risk factors, rural patients had lower odds of lymph node
examination and adequate AL than urban patients and also had poorer survival.
Conclusions Future research should continue to assess the association between access to care and disparities in surgical care
and the effect of these disparities on survival.