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EV419/#278  Tubal coagulation, Z-suture for external cervical os, and vaginal washing prevent cancer-cell spillage during minimally invasive surgery for endometrial cancer
  1. Kenro Chikazawa1,
  2. Ken Imai2,
  3. Tomoyuki Kuwata3 and
  4. Ryo Konno3
  1. 1Jichi Medical University Saitama Medical Center, &x3055;&x3044;&x305F;&x307E;&x5E02;&x5927;&x5BAE;&x533A;&x5929;&x6CBC;&x753A;, Japan
  2. 2Jichi Medical University Saitama Medical Center, Saitama, Japan
  3. 3Jichi Ika Daigaku Fuzoku Omiya Iryo Center: Jichi Ika Daigaku Fuzoku Saitama Iryo Center, Saitama, Japan

Abstract

Introduction This study aimed to investigate whether routine tubal ligation, vaginal washing, and Z-sutures at the external cervical os immediately before colpotomies prevent malignant peritoneal contamination during minimally invasive surgery (MIS).

Methods This single-center study included patients aged >20 years who underwent laparoscopy or laparotomy at our institution for preoperatively diagnosed endometrial cancer between December 2019 and July 2023. Patients were assigned to either the laparoscopy or laparotomy group, based on the performed procedure.

Results A total of 108 patients were identified using pre- and post-hysterectomy peritoneal cytology. MIS was performed in patients with early-stage cancer, including those with significantly small tumors (3.0 ± 1.6 cm vs. 4.1 ± 2.1 cm; P = 0.006), a low rate of positive lymphovascular invasion (16/82 [19.5%] vs. 11/26 [42.3%]; P = 0.021), and a low rate of positive lymph nodes (4/82 [4.9%] vs. 7/26 [26.9%]; P = 0.004). No significant differences were observed in positive initial cytology, peritoneal cytological contamination, or positive vaginal cytology between the groups. Positive vaginal cytology was significantly associated with the use of a uterine manipulator in the MIS group (25/30 [83.3%] vs. 26/52 [50.0%]; P = 0.004).

Conclusion/Implications Routine tubal ligation at surgery initiation, Z-suturing, and vaginal washing may reduce the risk of peritoneal cytological contamination. These measures should be considered in cases of uterine manipulator use.

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