Does minimally invasive surgery increase the incidence of lymphovascular space invasion and positive cytology in endometrial cancer?

Abstract PurposeTo evaluate the use of an intrauterine manipulator on the oncologic outcome of women who had minimally invasive surgery for endometrial cancer. MethodsRetrospective analysis of consecutive patients who were operated with or without the use of an intrauterine manipulator. Univariate and multivariate analysis were used to adjust for possible confounders. Results699 patients were included, of whom 220 (32.8%) were operated with an intrauterine manipulator. The median follow-up was 44 months (range, 29-67). Disease-free survival was similar between groups. 19 (8.8%) patients had positive cytology in the manipulator group vs. 21 (4.4%) in the comparison group (p=0.02). Total recurrence rate was similar between the groups (12.3% vs. 11.9%; p = 0.8). Vaginal vault recurrence was the most common site of recurrence with higher incidence in the manipulator group (4.5% vs. 1.3%; p=0.007). Sub-group analysis of patients who did not receive adjuvant treatment showed higher recurrence rate (8.3% vs. 3%; p=0.023) and worse disease-free survival (p=0.01) for the manipulator group. After controlling for other variables, the use of a manipulator did not affect the risk of recurrence for the whole cohort (HR, 1.28; 95% CI, 0.7-2.1, p=0.3) and for the sub-group of patients who did not receive adjuvant treatment (HR, 2.47; 95% CI, 0.8-7, p=0.08).ConclusionThe use of a manipulator during surgery for endometrial cancer increases the risk of positive cytology as well as vaginal vault recurrences, but it does not reduce the disease-free and overall survival of patients.

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Oncologic outcomes for patients with endometrial cancer who received minimally invasive surgery: a retrospective observational study

International Journal of Clinical Oncology ◽

10.1007/s10147-020-01744-4 ◽

2020 ◽

Vol 25 (11) ◽

pp. 1985-1994

Author(s):

Tomohito Tanaka ◽

Shoko Ueda ◽

Shunsuke Miyamoto ◽

Shinichi Terada ◽

Hiromi Konishi ◽

...

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Observational Study ◽

Minimally Invasive ◽

Invasive Surgery ◽

Retrospective Observational Study ◽

Oncologic Outcomes

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Utilization of Minimally Invasive Surgery in Endometrial Cancer Care

Obstetrics and Gynecology ◽

10.1097/aog.0000000000001180 ◽

2016 ◽

Vol 127 (1) ◽

pp. 91-100 ◽

Cited By ~ 48

Author(s):

Amanda N. Fader ◽

R. Matsuno Weise ◽

Abdulrahman K. Sinno ◽

Edward J. Tanner ◽

Bijan J. Borah ◽

...

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Cancer Care

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Role of Minimally Invasive Surgery in Gynecologic Oncology: An Updated Survey of Members of the Society of Gynecologic Oncology

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000450 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1121-1127 ◽

Cited By ~ 75

Author(s):

Lesley B. Conrad ◽

Pedro T. Ramirez ◽

William Burke ◽

R. Wendel Naumann ◽

Kari L. Ring ◽

...

Keyword(s):

Cervical Cancer ◽

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Robotic Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Single Port ◽

Gynecologic Oncology ◽

Pelvic Lymphadenectomy ◽

Single Port Laparoscopy

ObjectivesTo evaluate the current patterns of use of minimally invasive surgical procedures, including traditional, robotic-assisted, and single-port laparoscopy, by Society of Gynecologic Oncology (SGO) members and to compare the results to those of our 2004 and 2007 surveys.MethodsThe Society of Gynecologic Oncology members were surveyed through an online or mailed-paper survey. Data were analyzed and compared with results of our prior surveys.ResultsFour hundred six (32%) of 1279 SGO members responded. Eighty-three percent of respondents (n = 337) performed traditional laparoscopic surgery (compared with 84% in 2004 and 91% in 2007). Ninety-seven percent of respondents performed robotic surgery (compared with 27% in 2007). When respondents were asked to indicate procedures that they performed with the robot but not with traditional laparoscopy, 75% indicated radical hysterectomy and pelvic lymphadenectomy for cervical cancer. Overall, 70% of respondents indicated that hysterectomy and staging for uterine cancer was the procedure they most commonly performed with a minimally invasive approach. Only 17% of respondents who performed minimally invasive surgery performed single-port laparoscopy, and only 5% of respondents indicated that single-port laparoscopy has an important or very important role in the field.ConclusionsSince our prior surveys, we found a significant increase in the overall use and indications for robotic surgery. Radical hysterectomy or trachelectomy and pelvic lymphadenectomy for cervical cancer and total hysterectomy and staging for endometrial cancer were procedures found to be significantly more appropriate for the robotic platform in comparison to traditional laparoscopy. The indications for laparoscopy have expanded beyond endometrial cancer staging to include surgical management of early-stage cervical and ovarian cancers, but the use of single-port laparoscopy remains limited.

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Minimally Invasive Surgery Rate as a Quality Metric for Endometrial Cancer

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2019.10.011 ◽

2020 ◽

Vol 27 (6) ◽

pp. 1389-1394

Author(s):

Rosa M. Polan ◽

Edward J. Tanner ◽

Emma L. Barber

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Quality Metric

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Under-utilization of minimally invasive surgery in the management of endometrial cancer: A Healthcare Cost and Utilization Project-National Inpatient Sample study (HCUP-NIS)

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.385 ◽

2015 ◽

Vol 137 ◽

pp. 154

Author(s):

A. Nickles Fader ◽

R. Matsuno ◽

A.K. Sinno ◽

E.J. Tanner ◽

K.C. Long ◽

...

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Healthcare Cost ◽

Invasive Surgery ◽

National Inpatient Sample

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Endometriumkarzinom: Wie Uterusmanipulatoren das Outcome in der minimal-invasiven Chirurgie beeinflussen

Karger Kompass Onkologie ◽

10.1159/000520994 ◽

2021 ◽

pp. 180-181

Author(s):

Ingolf Juhasz-Boess ◽

Patrick Molnar

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Confidence Interval ◽

Minimally Invasive ◽

Invasive Surgery ◽

International Federation ◽

Hazard Ratio ◽

Uterine Manipulator ◽

Gynecology And Obstetrics ◽

Pattern Of Recurrence

Background: There are limited data available to indicate whether oncological outcomes might be influenced by the uterine manipulator, which is used at the time of hysterectomy for minimally invasive surgery in patients with endometrial cancer. The current evidence derives from retrospective studies with limited sample sizes. Without substantial evidence to support its use, surgeons are required to make decisions about its use based only on their personal choice and surgical experience. Objective: To evaluate the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparent early-stage endometrial cancer. Study design: We performed a retrospective multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent early-stage endometrial cancer, treated with minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objective was to determine recurrence-free survival, overall survival, and the pattern of recurrence. Results: A total of 2661 women from 15 centers were included; 1756 patients underwent hysterectomy with a uterine manipulator and 905 without it. Both groups were balanced with respect to histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics stage, and adjuvant therapy. The rate of recurrence was 11.69% in the uterine manipulator group and 7.4% in the no-manipulator group (P<.001). The use of the uterine manipulator was associated with a higher risk of recurrence (hazard ratio, 2.31; 95% confidence interval, 1.27–4.20; P = .006). The use of uterine manipulator in uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics [FIGO] I-II) was associated with lower disease-free survival (hazard ratio, 1.74; 95% confidence interval, 0.57–0.97; P = .027) and higher risk of death (hazard ratio, 1.74; 95% confidence interval, 1.07–2.83; P = .026). No differences were found regarding the pattern of recurrence between both groups (chi-square statistic, 1.74; P = .63). Conclusion: In this study, the use of a uterine manipulator was associated with a worse oncological outcome in patients with uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.

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