Endometrial cancer: predictors and oncological safety of tumor tissue manipulation

• Raquel Quintana-Bertó ^[9] ; Pablo Padilla-Iserte ^[9] ; Víctor Lago ^[9] ; Carmen Tauste ^[1] ; Berta Díaz-Feijoo ^[2] ; Silvia Cabrera ^[3] ; Reyes Oliver-Pérez ^[4] ; Pluvio J. Coronado ^[10] ; María Belén Martín-Salamanca ^[5] ; Manuel Pantoja-Garrido ^[6] ; Josefa Marcos-Sanmartin ^[7] ; Eduardo Cazorla ^[8] ; Cristina Lorenzo ^[11] ; José Ramón Rodríguez-Hernández ^[12] ; Fernando Roldán-Rivas ^[13] ; Juan Gilabert-Estellés ^[14] ; Juan Carlos Muruzábal ^[1] ; Antonio Cañada ^[15] ; Santiago Domingo ^[9]
  1. [1] Gobierno de Navarra

     Gobierno de Navarra

     Pamplona, España

     
  2. [2] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
  3. [3] Universitat Autònoma de Barcelona

     Universitat Autònoma de Barcelona

     Barcelona, España

     
  4. [4] Universidad Complutense de Madrid

     Universidad Complutense de Madrid

     Madrid, España

     
  5. [5] Hospital Universitario de Getafe

     Hospital Universitario de Getafe

     Getafe, España

     
  6. [6] Hospital Universitario Virgen Macarena

     Hospital Universitario Virgen Macarena

     Sevilla, España

     
  7. [7] General University hospital

     General University hospital

     Chequia

     
  8. [8] Hospital Universitario de Torrevieja

     Hospital Universitario de Torrevieja

     Torrevieja, España

     
  9. [9] Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València
  10. [10] Women’s Health Institute of the Hospital Clínico San Carlos, IdISSC, University Complutense, Madrid
  11. [11] Department of Obstetrics and Gynecology, Hospital Nuestra Señora de La Calendaria, Santa Cruz de Tenerife
  12. [12] Gynaecology and Obstetrics Department, University Hospital Virgen de La Arrixaca, El Palmar, Murcia
  13. [13] Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza
  14. [14] Department of Obstetrics and Gynecology, University General Hospital of València, València
  15. [15] Department of Biostatistics, Health Research Institute La Fe, València

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 5, 2024, págs. 1098-1105
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Purpose The 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.

    Methods We 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.

    Results A 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).

    Conclusion Whilst 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.