Abstract
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.
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Data availability
All data are encripted in different databases provided by each center. If needed, each author should be contacted for further information.
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Acknowledgements
We want to thank the Spanish Society of Gynecology and Obstetrics Spain-GOG for endorsing this entire project. In addition, we also want to acknowledge A. Torné (University Hospital Clínic of Barcelona), A. Gil-Moreno (Vall d'Hebron University Hospital), C. Aghabayan (General University Hospital of Valencia) T. Marina and L. Matute (La Fe University and Polytechnic Hospital), L. Sánchez (University General Hospital of Ciudad Real) for their contribution and support.
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Conceptualization: RQ-B, PP-I and AC. methodology: RQ-B, PP-I and AC. validation: PP-I, VL, SD y AC. Formal analysis: PP-I and AC. Investigation: RQ-B and PP-I. Resources: RQ-B, PP-I, VL, CT, BD-F, SC, RO-P, P JC, MBM-S, MP-G, JM-S, EC, CL, JRR-H, FR-R, JG-E, JCM, AC and SD. Data curation: RQ-B, PP-I, VL, CT, BD-F, SC, RO-P, PJC, MBM-S, MP-G, JM-S, EC, CL, JRR-H, FR-R, JG-E, JCM, AC and SD. writing—original draft: RQ-B, PP-I and AC. writing—review & editing: RQ-B, PP-I, AC and SD. visualisation: RQ-B, PP-I, VL, CT, BD-F, SC, RO-P, PJC, MBM-S, MP-G, JM-S, EC, CL, JRR-H, FR-R, J G-E, JCM, AC and SD. supervision: PP-I, SD, VL and AC. project administration: RQ-B and PP-I.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee. This study was approved by the Hospital Universitari i Politècnic La Fe de València Research Ethics Committee (registration no. 2019/0075).
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Quintana-Bertó, R., Padilla-Iserte, P., Lago, V. et al. Endometrial cancer: predictors and oncological safety of tumor tissue manipulation. Clin Transl Oncol 26, 1098–1105 (2024). https://doi.org/10.1007/s12094-023-03310-6
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DOI: https://doi.org/10.1007/s12094-023-03310-6