Intra-operative tumor spillage in minimally invasive surgery for endometrial cancer and its impact on recurrence risk.

Abstract

OBJECTIVE:

The prognostic impact of intra-operative tumor spillage (ITS) during minimally invasive surgery (MIS) for endometrial cancer (EC) is not well studied. The objective of this study was to determine if there is an association between ITS and EC recurrence.

METHODS:

We performed a case-control study of patients with a laparoscopic or robot-assisted hysterectomy with EC on final pathology between 2017 and 2022 and compared those with (case) and without (control) a subsequent EC recurrence. Electronic medical records were reviewed for demographic, intra-operative and pathologic details, and recurrence status. ITS was defined as uterine perforation with a manipulator, presence of extra-uterine tumor after colpotomy or specimen delivery, exposure of uncontained specimen into peritoneum, and/or pathology/operative reports noting specimen fragmentation. Conditional logistic regression was used to determine odds ratios for the association of cancer recurrence with ITS. We adjusted for >50% myoinvasion, tumor size, and adjuvant treatment.

RESULTS:

1057 patients underwent MIS for EC. Approximately 8% (n = 86) developed recurrent cancer and 172 patients were selected as controls. Twenty percent of recurrent cases (17/86) had ITS compared with 4% of nonrecurrent controls (7/172). When adjusted for tumor size, deep myoinvasion, and adjuvant treatment, patients with ITS had a 5.6 times increased odds (aOR 5.63, 95% CI 1.52-20.86) of recurrence compared to patients without ITS.

CONCLUSIONS:

In patients with EC, we found an association between ITS and cancer recurrence. These findings warrant further investigation to determine if adjuvant therapy or surgical technique should be altered to improve outcomes.

• Authors: Aashna Saini, Lyle Suh, Jenny Gao, Katherine Leung, Gianna Wilkie, Kristen Matteson, Sharmilee Korets
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 175 Pg. 128-132 (08 2023) ISSN: 1095-6859 [Electronic] United States
• PMID: 37356313 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Topics

• Female
• Humans
• Case-Control Studies
• Neoplasm Recurrence, Local (surgery)
• Endometrial Neoplasms (pathology)
• Hysterectomy (methods)
• Laparoscopy (methods)
• Minimally Invasive Surgical Procedures (adverse effects)
• Retrospective Studies