Associated characteristics and impact on recurrence and survival of free-floating tumor fragments in the lumen of fallopian tubes in Type I and Type II endometrial cancer

Abstract

ObjectiveThis study sought to evaluate characteristics of cases of free-floating tumor fragments within the lumen of fallopian tubes (‘floaters’) on final pathology for Type I and Type II endometrial adenocarcinoma, including relationships with disease recurrence and mortality.MethodsA single institution experience of 1022 consecutive cases of uterine cancer presenting between 2005 and 2010 was retrospectively reviewed, with data extraction from electronic medical records. Associations of floaters with baseline characteristics were studied with logistic regression, and relationships with disease recurrence and survival were assessed with Cox proportional hazards models.ResultsAmong 816 included cases of Type I or Type II endometrial adenocarcinoma, floaters were identified on final pathology for 20 patients (2.5%). Patient characteristics of cases with floaters mirrored the overall sample. With adjustment, presence of floaters trended towards association with laparoscopic/robotic approach (OR = 3.84; 95%CI 0.98-15.1), and was significantly associated with lymphovascular invasion (OR = 9.65; 95%CI 2.35-39.6) and higher stage disease. Although floaters were associated with increased risk of recurrence in unadjusted analysis (HR = 3.22; 95%CI 1.41-7.37), after adjustment for disease type, stage, and patient comorbidities, no evidence for impact on disease recurrence or overall survival was found.ConclusionsThe presence of floaters is rare. Floaters were generally associated with more extensive disease, but no evidence was found to show any independent prognostic impact on risk of recurrence or death. In agreement with prior research, this study found a trend towards association of floaters with laparoscopic/robotic approach, indicating the possibility of floaters sometimes being the result of trauma from uterine manipulator insertion.

Does the use of a uterine manipulator in robotic surgery for early‐stage endometrial cancer affect oncological outcomes?

“…Pathological studies indicated that the use of a uterine manipulator increased lymphovascular space invasion, the rate of positive peritoneal cytology, and the presence of free-floating tumour fragments within the lumina of the fallopian tubes. [12][13][14] However, these effects were not recognized in another research. 15,16 According to reports on oncologic outcome, the use of a uterine manipulator in laparoscopic surgery does not affect recurrence and survival.…”

“…There has been extensive debate concerning the use of uterine manipulators in endometrial cancer surgery. Pathological studies indicated that the use of a uterine manipulator increased lympho‐vascular space invasion, the rate of positive peritoneal cytology, and the presence of free‐floating tumour fragments within the lumina of the fallopian tubes 12–14 . However, these effects were not recognized in another research 15,16 .…”

A Multicentric Randomized Trial to Evaluate the ROle of Uterine MANipulator on Laparoscopic/Robotic HYsterectomy for the Treatment of Early-Stage Endometrial Cancer: The ROMANHY Trial

“…Although these observations are logical and far from negligible, their real clinical meaning has been well clarified by several studies that suggested that the use of IUM is safe in EC staging (21,40,41). However, the retrospective nature of these researches did not allow the scientific community to say a definitive word on this issue.…”