Implementation of “Benign Tumor Board” to Enhance Multidisciplinary Surgical Management of Endometriosis and Predictors of Colorectal Surgeon Involvement

INTRODUCTION: Multidisciplinary tumor board conferences are used widely across oncologic specialties and reduce mortality and improve cross-disciplinary coordination. There has been less research on their impact for complex benign conditions. Advanced endometriosis presents unique challenges when bladder, ureters, bowel, or diaphragmatic involvement necessitate multidisciplinary surgical planning with radiologic imaging often triggering these discussions. We implemented a monthly “benign tumor board” (BTB) to coordinate care in complex endometriosis cases, including gynecologic surgeons, urologists, colorectal surgeons (CRS), and radiologists. OBJECTIVE: To evaluate if presurgical management and intraoperative consultations differed between patients presented at BTB, and to assess risk factors in predicting the need for CRS surgery assistance in the operating room. METHODS: This retrospective cohort study of all patients with surgically diagnosed endometriosis with preoperative MRI from 2/2021 to 3/2024. Data collected included sociodemographic variables, surgical history, preoperative subspecialty consultations (e.g., CRS), operative details, and endometriosis surgical stage. Patients were compared based on whether they were presented at BTB using chi-square and Fisher’s exact. Logistic regression was used to identify predictive factors for needing intra-op CRS surgical assistance. RESULTS: We included 123 patients: 63 (51.2%) were presented at benign tumor board, 60 (48.8%) were not. Patients presented at BTB were older (36.4±5.7 vs 32.5±7.8 years, p=0.002). BMI was 29±6.4 and not different by presentation at BTB. BTB patients were more likely to have a preoperative CRS consult (54% vs 8.3%, p≤0.001); there was no difference in preoperative general surgery or urology consults (Table 1). BTB patients had longer OR times (263.4±86.9 minutes vs 207.9±99.7 minutes, p=0.001), but length of stay was similar with >75% in both groups discharged same day. Unexpected intraoperative CRS consults were uncommon (BTB n=1 (1.6%) vs non-BTB n=5 (8.3%), p=0.109), though the rareness of this outcome precluded statistical significance in our sample size. Overall, there were 39 cases requiring CRS involvement. Logistic regression showed that increasing age, prior endometriosis surgery, endometrioma on MRI, and pre-op colonoscopy are the only significant predictors of requiring CRS surgical involvement (Table 2). CONCLUSIONS: Our findings suggest implementation of a BTB for complex endometriosis may aid coordinating multidisciplinary surgery and streamlining care. Additionally, women with MRI performed who were not presented at BTB were 5.57 times as likely to require an unexpected intra-op CRS consult, though the difference was not statistically significant due to sample size and rareness of the outcome. Significant predictors for CRS involvement included increasing patient age, prior endometriosis surgery, endometrioma on MRI, and pre-op colonoscopy. Understanding the risk of CRS involvement and potential bowel surgery is important in the context of endometriosis surgical planning for patients. The implementation of a multidisciplinary BTB conference allows enhanced patient care with facilitating thorough preoperative subspecialty evaluation and informed patient consent.Table 1Table 2