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ARE UTERINE MANIPULATORS HARMFUL IN MINIMALLY INVASIVE SURGERY (MIS) FOR ENDOMETRIAL CANCER? A RETROSPECTIVE COHORT STUDY.
Abstract
Objectives
To assess the oncological safety of uterine manipulators in apparent early-stage (FIGO I-II) endometrial cancer treated by MIS.
Methods
This is a single center retrospective study including patients who underwent endometrial cancer surgery for apparent early stage disease by either laparoscopy, robotics or laparoscopic assisted vaginal hysterectomy from 11-2012 to 12-2020. Data on manipulator type, isolated tumor cells (ITC), cytology, LVSI, free cancer cells in fallopian tubes (floaters), stage, histology and grade were collected. Primary outcome was cancer recurrence. Secondary outcome was disease specific death. Kaplan-Meier curves and multivariate logistic regression were used for statistical analysis.
Results
935 women with early-stage endometrial cancer were included; 794 (85%) had hysterectomy with uterine manipulator and 141 (15%) without, with a mean follow-up of 44,6 months (range 3-118). 84,7% had endometrioid histology, 84,5 % were grade 1 or 2 and 97,2% had stage I disease. Uterine manipulators were not associated with recurrence on univariate (OR 3,178; 95% CI, 0.984-10,261; p=0,0531) and multivariate analysis (OR 2,536; 95% CI 0,770-8,349; p=0,1259) and for disease specific death on both univariate (OR 1,88; 95% CI, 0.436-8,127; p=0,3970) and multivariate analysis (OR 0,770; 95% CI 0,158-3,741; p=0,7455), even when adjusted with adjuvant treatments and tumor characteristics. They were not associated with higher rates of positive cytology, LVSI and ITC. Intra-uterine balloon manipulators were associated with higher risk of floaters (OR 2.47; 95% CI, 1.17-5,23; p=0,0001).
Conclusions
Uterine manipulators in endometrial cancer MIS were not associated with higher recurrence rate and disease specific death in early-stage disease. Prospective trials must confirm our data.