Introduction/Background Since the LACC trial, multiple studies have confirmed the increased recurrence rate following minimally invasive surgery (MIS) compared to laparotomy in early-stage cervical cancer. There is an increased risk of peritoneal carcinomatosis also, which shows that contamination of the pelvis by tumor cells may be the explanation for the inferior oncologic outcome. We decided to identify the major mechanism for this possible contamination and used pelvic washing fluid HPV test during different steps of MIS

Methodology It is a prospective cohort study performed at the Hungarian National Institute of Oncology. For safety reasons, cervical cancer patients where MIS was proven to be oncologically inferior were excluded. Since February 2021 we included 25 patients who had hysterectomy performed by MIS due to high-grade cervical dysplasia following inadequate local excision. At the beginning of the operation, a cervical sample was taken with a cytobrush, followed by 30ml pelvic washing fluid samples collected at different steps of the hysterectomy: at the start of the operation, after application of manipulator and finally after closing the vaginal cuff. HPV DNA isolation, amplification, hybridization, and complete genotyping were performed.

Results Out of 25 patient’s cervical sample 21 was HPV positive. Examining these 21 patient’s samples, in 3 patients HPV positivity occurred after application of the manipulator and 15 cases became positive following colpotomy, all of them showing the same HPV genotypes as the cervical samples.

Conclusion Several research groups proposed that possible factors for the contamination of tumor cells might be the use of manipulator and performing intracorporeal colpotomy with pneumoperitoneum. Our results seem to support this hypothesis, the main contaminating step appears to be the opening of the vagina by MIS. We propose that analyzing pelvic washing fluid HPV and cytology can help to control the oncologic safety of protective techniques used during MIS for cervical cancer.

Disclosures .