Introduction/Background Minimally invasive surgery is the standard approach in early-stage endometrial cancer according to evidence showing no compromise in oncological outcomes but lower morbidity compared to open surgery. However, there is limited data available on the oncological safety of the use of intrauterine manipulators in endometrial cancer.

Methodology This prospective multicenter study included endometrial cancer patients undergoing laparoscopic staging surgery with the use of an intrauterine manipulator. We obtained three different sets of peritoneal washings: at the beginning of the surgical procedure, after the insertion of the intrauterine manipulator and after the closure of the vaginal vault. The rate of positive peritoneal cytology conversion and its association with oncological outcomes was assessed (figure 1).

Results 124 patients were included. Clinicopathological data are provided in Table 1, mean follow-up was 120.7 (95% CI 116.2–125.2) months. Peritoneal cytology was negative in 98 (group 1) and positive in 26 patients (group 2). In group 2 sixteen patients presented with positive cytology at the beginning of the surgery (group 2a) and ten patients had positive cytology conversion during the procedure (group 2b). Group 1 showed the best recurrence-free survival, followed by group 2a, patients in group 2b had the worst oncological outcomes (log-rank, P= .002). In multivariable Cox regression analysis including myometrial invasion, FIGO stage, and nodal status, peritoneal cytology remained an independent predictor of both recurrence (HR 4.15, 95% CI 1.501 – 11.482, P= .006) and death (HR 2.92, 95% CI 1.218- 6.980, P= .016).

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Abstract 2022-RA-886-ESGO Figure 1

Conclusion 8.1% of endometrial cancer patients undergoing minimally invasive surgery with intrauterine manipulation showed positive peritoneal cytology conversion associated with significantly worse oncological outcome.