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242 The effect of intrauterine manipulator on oncological outcome in early-stage, low-grade endometrial cancer
  1. Yexin Ye1,2,
  2. Maite Timmermans3,2,
  3. Maaike A Van Der Aa2,
  4. Saskia Le Cessie3,
  5. Geertruida N Jonges1,
  6. Juliënne A Janse3 and
  7. Cornelis G Gerestein1
  1. 1University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
  3. 3Leiden University Medical Centre, Leiden, The Netherlands


Introduction/Background The primary treatment for early-stage, low-grade endometrioid endometrial cancer (EEC) is a total laparoscopic hysterectomy (TLH) with bilateral salpingo-oophorectomy. During this procedure, uterine manipulators are commonly used. Amongst the manipulators available, the majority possesses an intrauterine (IU) tip. Especially these IU manipulators provide the added advantage of optimal uterine mobilisation and enhanced exposure of the surgical field. However, the use of uterine devices for malignant diseases has been subject to controversy and may negatively affect the oncological outcome. This study evaluated the influence of the use of IU manipulators or non-IU manipulators on oncological outcome in early-stage, low-grade EEC. Mean outcome measures were recurrence of cancer, disease-free survival (DFS), overall survival (OS), site of recurrence, and manipulator preference according to type of hospital.

Methodology This retrospective, nationwide population-based study included all women with FIGO stage I, low-grade EEC who received TLH between 2010 and 2020 in the Netherlands. Patient data were identified from the Netherlands Cancer Registry. Data regarding hospital manipulator preferences were retrieved through an online survey. Patients were categorized based on hospital manipulator preference. Survival analyses were performed using univariable and multivariable cox regression analysis.

Results Of the total study population (N = 5,205), 1524 (29.3%) patients underwent surgery in hospitals that used non-IU manipulators and 3681 (70.7%) in hospitals that used IU manipulators. Recurrence of cancer was experienced by 195 patients, 49 (3.2%) in the non-IU group and 146 (4.0%) in the IU group. No significant difference in site of recurrence was observed (p=0.778). After adjusting for potential confounders, type of uterus manipulator did not affect DFS (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.78–1.11) and OS (HR 0.90, 95% CI 0.75–1.09).

Conclusion IU manipulators are not inferior to non-IU manipulators with respect to oncological outcome in early-stage, low-grade EEC.

Disclosures None declared.

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