Impact of uterine manipulator on oncological outcome in endometrial cancer surgery

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...

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Autores: Padilla-Iserte, P, Lago, V, Tauste, C, Diaz-Feijoo, B, Gil-Moreno, A, Oliver, R, Coronado, P, Martin-Salamanca, MB, Pantoja-Garrido, M, Marcos-Sanmartin, J, Gilabert-Estelles, J, Lorenzo, C, Cazorla, E, Roldan-Rivas, F, Rodriguez-Hernandez, JR, Sanchez, L, Muruzabal, JC, Hervas, D, Domingo, S, Spanish Soc Gynecology Obstet
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p10982
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/10982
Access Level:acceso abierto
Palabra clave:endometrial cancer
minimally invasive surgery
oncological safety
overall survival
recurrence
recurrence-free survival
uterine manipulator
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spelling Impact of uterine manipulator on oncological outcome in endometrial cancer surgeryPadilla-Iserte, PLago, VTauste, CDiaz-Feijoo, BGil-Moreno, AOliver, RCoronado, PMartin-Salamanca, MBPantoja-Garrido, MMarcos-Sanmartin, JGilabert-Estelles, JLorenzo, CCazorla, ERoldan-Rivas, FRodriguez-Hernandez, JRSanchez, LMuruzabal, JCHervas, DDomingo, SSpanish Soc Gynecology Obstetendometrial cancerminimally invasive surgeryoncological safetyoverall survivalrecurrencerecurrence-free survivaluterine manipulatorBACKGROUND: 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 nomanipulator 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 uterusconfined endometrial cancer (International Federation of Gynecology and Obstetrics I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.MOSBY-ELSEVIER2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/10982AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGYISSN: 00029378ISSNe: 10976868reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p109822026-06-11T12:45:17Z
dc.title.none.fl_str_mv Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
title Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
spellingShingle Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
Padilla-Iserte, P
endometrial cancer
minimally invasive surgery
oncological safety
overall survival
recurrence
recurrence-free survival
uterine manipulator
title_short Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
title_full Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
title_fullStr Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
title_full_unstemmed Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
title_sort Impact of uterine manipulator on oncological outcome in endometrial cancer surgery
dc.creator.none.fl_str_mv Padilla-Iserte, P
Lago, V
Tauste, C
Diaz-Feijoo, B
Gil-Moreno, A
Oliver, R
Coronado, P
Martin-Salamanca, MB
Pantoja-Garrido, M
Marcos-Sanmartin, J
Gilabert-Estelles, J
Lorenzo, C
Cazorla, E
Roldan-Rivas, F
Rodriguez-Hernandez, JR
Sanchez, L
Muruzabal, JC
Hervas, D
Domingo, S
Spanish Soc Gynecology Obstet
author Padilla-Iserte, P
author_facet Padilla-Iserte, P
Lago, V
Tauste, C
Diaz-Feijoo, B
Gil-Moreno, A
Oliver, R
Coronado, P
Martin-Salamanca, MB
Pantoja-Garrido, M
Marcos-Sanmartin, J
Gilabert-Estelles, J
Lorenzo, C
Cazorla, E
Roldan-Rivas, F
Rodriguez-Hernandez, JR
Sanchez, L
Muruzabal, JC
Hervas, D
Domingo, S
Spanish Soc Gynecology Obstet
author_role author
author2 Lago, V
Tauste, C
Diaz-Feijoo, B
Gil-Moreno, A
Oliver, R
Coronado, P
Martin-Salamanca, MB
Pantoja-Garrido, M
Marcos-Sanmartin, J
Gilabert-Estelles, J
Lorenzo, C
Cazorla, E
Roldan-Rivas, F
Rodriguez-Hernandez, JR
Sanchez, L
Muruzabal, JC
Hervas, D
Domingo, S
Spanish Soc Gynecology Obstet
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv endometrial cancer
minimally invasive surgery
oncological safety
overall survival
recurrence
recurrence-free survival
uterine manipulator
topic endometrial cancer
minimally invasive surgery
oncological safety
overall survival
recurrence
recurrence-free survival
uterine manipulator
description 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 nomanipulator 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 uterusconfined endometrial cancer (International Federation of Gynecology and Obstetrics I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/10982
url https://fisabio.portalinvestigacion.com/publicaciones/10982
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MOSBY-ELSEVIER
publisher.none.fl_str_mv MOSBY-ELSEVIER
dc.source.none.fl_str_mv AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
ISSN: 00029378
ISSNe: 10976868
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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