Impact of uterine manipulator on oncological outcome in endometrial cancer surgery

ABSTRACT Background There is limited data available to indicate whether oncologic 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(s) This study evaluates the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparently early-stage endometrial cancer. Study design We performed a retrospective multicentric study to assess the oncologic safety of uterine manipulator use in patients with apparently early-stage endometrial cancer, treated by minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, FIGO stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objectives were 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, FIGO 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 Conclusion(s) In this study, the use of a uterine manipulator was associated with a worse oncologic outcome in patients with uterus-confined endometrial cancer (FIGO I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.