Introduction/Background Since evidence questioned the safety of minimally invasive approaches in gynecological cancer,different risk factors have been sought that seem to worsen oncological results,among which is the use of the uterine manipulator.Our objective is to analyse how does uterine manipulator really affect overall survival or progression-free survival in endometrial cancer in a center which traditionally use it

Methodology Retrospective descriptive observational study including all patients diagnosed with endometrial cancer in the gynecology-oncology unit of CHUIMI from 2008 to 2018 with subsequent follow-up until 2021.Demographic variables,histological treats,intra-operatory data and relapse rate,location and current status of the patient were studied

Results 746 patients with endometrial cancer were included,among whom 676 were stages I and II(90.6%) and 70 were stages III and IV(9.4%).Focusing on stages I and II,566 were type I(83.7%) and 117(16.3%) were type II.All cases were treated by laparoscopy using RUMI-type uterine manipulator.Overall(all stages),the recurrence rate was 12.3%(92) with a death rate of 9.51%(71).In the early stages(I and II),the overall recurrence rate was 10.5%(71) with a death rate for these stages of 7.24% (49).Regarding histological type,in tumors type I in early stages the recurrence rate was 8.8%(50) while in type II tumors in early stages it was 19.1%(21).The most frequent type of recurrence in our sample is systemic,representing 38%(19) in type I(vs. vaginal vault recurrence in 26%(13)) and 81%(17) in type II(vs dome recurrence in 4.8%(1)).The median progression-free survival in early stages was 19 months in relapsed patients,with the earliest recurrences being in the vaginal vault(median 12 months)

Conclusion These data agree with those published in the literature and the overall survival rate as well as in the early stages are above 90%.Local recurrences can be explained by the use of the uterine manipulator,but nevertheless,other factors should be taken into account.We need more trials to know more about this issue