https://doi.org/10.1177/2284026520924500 Journal of Endometriosis and Pelvic Pain Disorders 1–8 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2284026520924500 journals.sagepub.com/home/pev JEPPD Journal of Endometriosis and Pelvic Pain Disorders Understanding pre-operative staging and surgical practice in advanced endometriosis: A survey of Canadian gynaecologists Andra Nica 1 , Grace Y. Liu 2 , Amanda Selk 3 and Jamie Kroft 2 Abstract Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist. Keywords Endometriosis, medical treatment, laparoscopy, surgical treatment, survey, advanced stage, surgical management Date received: 27 October 2019; accepted: 1 April 2020 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada 2 Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada 3 Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada 924500PEV 0 0 10.1177/2284026520924500Journal of Endometriosis and Pelvic Pain DisordersNica et al. research-article 2020 Original Research Article Corresponding author: Jamie Kroft, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Ste C703, Toronto, ON M4N 3M5, Canada. Email: jamie.kroft@sunnybrook.ca