Introduction/Background*Hysterectomy with bilateral salpingo-oophorectomy with nodal analysis is the preferred primary management for the vast majority of patients with endometrial cancer.1 Microscopic evaluation of the fallopian tubes occasionally identifies free floating intraluminal cancer cells (FFICC) without an in situ or invasive tubal component.2 FFICCs have been recently reported in the literature to be associated with lower survival in high risk endometrial cancer histologies.3 The mechanism of action proposed involves exfoliation through the fallopian tubes and spillage into the peritoneal cavity leading to widespread metastatic potential.4 Although the significance of peritoneal cytology has historically been questioned and since removed from surgical staging, a positive correlation for FFICCs has been noted among patients with positive washings.5 Our study aims to determine the incidence of FFICC’s, risk factors as well as their prognostic significance.
Methodology A retrospective analysis was performed including all patients at our institution with a diagnosis of endometrial cancer who underwent surgical management between the years 2015 and 2018. Demographic and histopathologic variables were collected including stage, grade, lesion size, histologic subtype, and cytologic analyses. All recurrences, treatment plans, date of follow up and date of death were documented
Result(s)*A total of 481 patients were included. Median age was 63 (28-92) with median follow up of 32 months. FFICCs were identified in 14% of the total sample (endometrioid, n= 55 versus non-endometrioid histologies, n= 13). Patients who had a robotic vs abdominal hysterectomy had an increased risk of FFICCs with an odds ratio of 2.9 (p=0.016). Presence of FFICCs was not clearly associated with grade or stage. Positive cytology was associated with an odds ratio of 6.6 (p<0.001) for presence of FFICCs. A statistically significant (SS) decrease in overall survival (OS) was noted among patients with FFICCs (p=0.045), however progression free survival (PFS) was not found to be SS.
Conclusion*The presence of FFICCs may provide important prognostic information specifically with regard to determining adjuvant treatment in those with positive cytology and/or high risk histologies. In addition, the higher incidence among robotic hysterectomies may warrant a closer look at mode of uterine manipulation. Lack of difference in PFS with statistical significance in OS suggests either a difference in the pattern of recurrence or possibly in postoperative therapy.
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