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Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes
    1. 1Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
    2. 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
    3. 3Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
    4. 4Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
    5. 5Department of Obstetrics and Gynecology, Kobe University School of Medicine, Hyogo, Japan
    6. 6Department of Obstetrics and Gynecology, Fujita Health University Okazaki Medical Center, Aichi, Japan
    7. 7Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
    8. 8Department of Obstetrics and Gynecology, Nihon University School of Medicine Graduate School of Medicine, Tokyo, Japan
    9. 9Department of Obstetrics and Gynecology, Kagoshima University School of Medicine, Kagoshima, Japan
    10. 10Department of Obstetrics and Gynecology, Yamagata University Graduate School of Medicine School of Nursing, Yamagata, Japan
    1. Correspondence to Dr Koji Matsuo, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA; koji.matsuo{at}med.usc.edu; Hiroshi Yoshida; h-yoshida{at}tsc.u-tokai.ac.jp

    Abstract

    Objective To examine the association between intrauterine manipulator use and pathological factors and oncologic outcomes in patients with endometrial cancer who had laparoscopic hysterectomy in Japan.

    Methods This was a nationwide retrospective cohort study of the tumor registry of the Japan Society of Obstetrics and Gynecology. Study population was 3846 patients who had laparoscopic hysterectomy for endometrial cancer from January 2015 to December 2017. An automated 1-to-1 propensity score matching with preoperative and intraoperative demographics was performed to assess postoperative pathological factors associated with the intrauterine manipulator. Survival outcomes were assessed by accounting for possible pathological mediators related to intrauterine manipulator use.

    Results Most patients had preoperative stage I disease (96.5%) and grade 1–2 endometrioid tumors (81.9%). During the study period, 1607 (41.8%) patients had intrauterine manipulator use and 2239 (58.2%) patients did not. In the matched cohort, the incidences of lymphovascular space invasion in the hysterectomy specimen were 17.8% in the intrauterine manipulator group and 13.3% in the non-manipulator group. Intrauterine manipulator use was associated with a 35% increased odds of lymphovascular space invasion (adjusted odds ratio 1.35, 95% confidence interval (CI) 1.08 to 1.69). The incidences of malignant cells identified in the pelvic peritoneal cytologic sample at hysterectomy were 10.8% for the intrauterine manipulator group and 6.4% for the non-manipulator group. Intrauterine manipulator use was associated with a 77% increased odds of malignant peritoneal cytology (adjusted odds ratio 1.77, 95% Cl 1.29 to 2.31). The 5 year overall survival rates were 94.2% for the intrauterine manipulator group and 96.6% for the non-manipulator group (hazard ratio (HR) 1.64, 95% Cl 1.12 to 2.39). Possible pathological mediators accounted HR was 1.36 (95%Cl 0.93 to 2.00).

    Conclusion This nationwide analysis of predominantly early stage, low-grade endometrial cancer in Japan suggested that intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer may be associated with an increased risk of lymphovascular space invasion and malignant peritoneal cytology. Possible mediator effects of intrauterine manipulator use on survival warrant further investigation, especially with a prospective setting.

    • Endometrial Neoplasms
    • Laparoscopes

    Data availability statement

    No data are available. This study used the Japan Society of Obstetrics and Gynecology database. The Japan Society of Obstetrics and Gynecology Committee forbids the transfer, rent, or sale of the data to any third party without prior approval. For inquiries about access to the data used for this study, Japan Society of Obstetrics and Gynecology can be contacted at +81-03-5206-1982.

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    Data availability statement

    No data are available. This study used the Japan Society of Obstetrics and Gynecology database. The Japan Society of Obstetrics and Gynecology Committee forbids the transfer, rent, or sale of the data to any third party without prior approval. For inquiries about access to the data used for this study, Japan Society of Obstetrics and Gynecology can be contacted at +81-03-5206-1982.

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    Footnotes

    • HY and KM contributed equally.

    • Presented at The 65th Japan Society of Gynecologic Oncology, Matsue, Japan, July 14-16, 2023.

    • Correction notice This article has been corrected since it was first published. A typographical error has been corrected in the Abstract.

    • Contributors CRediT author contributions. Conceptualization: HY and SN. Data curation: HY and HM. Formal analysis: HY and KM. Investigation: all authors. Methodology: HY, KM, and SN. Project administration: HY. Resources: MM and SN. Software: HY. Supervision: YT, TF, MM, KK, HK, and MM. Validation: HY. Visualization: HY and KM. Writing-original draft: HY and KM. Writing-review and editing: all authors. Guarantors: HY and KM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests MH received a research grant from Bristol Meyers Squibb and honorarium from AstraZeneca; SM received a research grant from Merck.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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