Endometrial cancer: predictors and oncological safety of tumor tissue manipulation

Autores de IIS La Fe

• Raquel Quintana Berto

  Autor

• Pablo Padilla Iserte

  Autor

• Víctor Lago Leal

  Autor

• Antonio José Cañada Martinez

  Autor

• Santiago Domingo Del Pozo

  Autor

Participantes ajenos a IIS La Fe

• Tauste, C
• Díaz-Feijoo, B
• Cabrera, S
• Oliver-Pérez, R
• Coronado, PJ
• Martín-Salamanca, MB
• Pantoja-Garrido, M
• Marcos-Sanmartin, J
• Cazorla, E
• Lorenzo, C
• Rodríguez-Hernández, JR
• Roldán-Rivas, F
• Gilabert-Estellés, J
• Muruzábal, JC
• SEGO Spain-GOG Grp

Grupos

• Medicina Fetal y Reproductiva

Abstract

PurposeThe main goal of this study is to assess the impact of tumor manipulation on the presence of lympho-vascular space invasion and its influence on oncological results.MethodsWe performed a retrospective multi-centric study amongst patients who had received primary surgical treatment for apparently early-stage endometrial cancer. A multivariate statistical analysis model was designed to assess the impact that tumor manipulation (with the use of uterine manipulator or preoperative hysteroscopy) has on lympho-vascular development (LVSI) in the final surgical specimen.ResultsA total of 2852 women from 15 centers were included and divided into two groups based on the lympho-vascular status in the final surgical specimen: 2265 (79.4%) had no LVSI and 587 (20.6%) presented LVSI. The use of uterine manipulator was associated with higher chances of lympho-vascular involvement regardless of the type used: Balloon manipulator (HR: 95% CI 4.64 (2.99-7.33); p < 0.001) and No-Balloon manipulator ([HR]: 95% CI 2.54 (1.66-3.96); p < 0.001). There is no evidence of an association between the use of preoperative hysteroscopy and higher chances of lympho-vascular involvement (HR: 95% CI 0.90 (0.68-1.19); p = 0.479).ConclusionWhilst performing common gynecological procedures, iatrogenic distention and manipulation of the uterine cavity are produced. Our study suggests that the use of uterine manipulator increases the rate of LVSI and, therefore, leads to poorer oncological results. Conversely, preoperative hysteroscopy does not show higher rates of LVSI involvement in the final surgical specimen and can be safely used.

© 2023. The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO).

Keywords

• Endometrial cancer; Hysteroscopy; Uterine manipulator; Oncological outcomes