Does a uterine manipulator affect cervical cancer pathology or identification of lymphovascular space involvement?

Rakowski, J.A.; Tran, Tien Anh; Ahmad, Sarfraz; James, Jeffrey A.; Brudie, Lorna A.; Pernicone, Peter J.; Radi, Michael J.; Holloway, Robert W.

doi:10.1016/j.ygyno.2012.07.094

Cited by 35 publications

(19 citation statements)

References 16 publications

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“…We think that this can prevent spread of broken tumor fragments into the pelvic or abdominal cavity and peritoneal seeding. Although several studies have addressed the use of uterine manipulators in cervical cancer, no data are available on the survival outcomes. One study has warned that the use of a uterine manipulator poses a theoretical possibility of peritoneal dissemination of tissue from the cervix .…”

Section: Discussionmentioning

confidence: 99%

Long‐term oncological outcomes of minimally invasive radical hysterectomy for early‐stage cervical cancer: A retrospective, single‐institutional study in the wake of the LACC trial

Kawakami

Andou

Yanai

et al. 2019

J of Obstet and Gynaecol

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Aim: The objective of this study was to investigate the long-term oncological outcomes of minimally invasive radical hysterectomy (MIRH) for the treatment of early-stage cervical cancer retrospectively in the wake of the laparoscopic approach to cervical cancer (LACC) trial. Methods: A total of 109 patients with stage IA1 with lymphovascular space involvement, IA2, and IB1 cervical cancers were included in this study. The surgical and oncological outcomes were retrospectively evaluated. All patients underwent type C MIRH with a no-touch isolation technique for cervical tumor. Results: The median number of resected pelvic lymph nodes was 36 (range, 14-94), and 10 patients (9.2%) had positive nodes. One patient (0.9%) had positive surgical margins. Forty-six patients (42%) underwent adjuvant therapy. The median follow-up time was 73 months (range, 30-146 months). Five patients (4.6%) developed recurrent disease, and 3 patients (2.8%) died of cervical cancer. The 5-year disease-free survival and overall survival rates were 96.3% and 97.2%, respectively. A comparison between patients with tumor diameter ≤ 2 cm (n = 59) and those with tumor diameter > 2 cm (n = 50) did not identify any significant differences, with 5-year disease-free survival 96.6% versus 94.0% and 5-year overall survival 98.3% versus 96.0%, respectively. Conclusion: In this retrospective study, MIRH with a no-touch isolation technique for stage IA to IB1 cervical cancer was a safe approach in terms of oncological outcomes. However, every surgeon who treats early-stage cervical cancer should inform each patient of the results of the LACC trial because it has an exceedingly high impact.

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Section: Discussionmentioning

confidence: 99%

Long‐term oncological outcomes of minimally invasive radical hysterectomy for early‐stage cervical cancer: A retrospective, single‐institutional study in the wake of the LACC trial

Kawakami

Andou

Yanai

et al. 2019

J of Obstet and Gynaecol

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“…In addition, the database does not include information regarding the use of intrauterine manipulators as well as vaginal colpotomy type, both of which are potential factors affecting tumor spread following MIS. 36,37 Some surgeons also advocate for the use of neoadjuvant chemotherapy before trachelectomy or a vaginal trachelectomy approach, both of which were not assessed in this study either due to small cases (n ¼ 2 for neoadjuvant therapy) or nonspecific coding (vaginal trachelectomy). [38][39][40][41] Although radical vaginal trachelectomy is performed infrequently in the United States, we recognize the inability to subclassify these patients as an important limitation of the study.…”

Section: Commentsmentioning

confidence: 99%

Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy

Matsuo

Chen

Mandelbaum

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: A recent trial demonstrated decreased survival in women with early-stage cervical cancer who underwent radical hysterectomy via minimally invasive surgery compared with laparotomy; however, outcomes following trachelectomy have yet to be studied. OBJECTIVE: To examine trends, characteristics, and survival of reproductive-aged women with early-stage cervical cancer who underwent minimally invasive trachelectomy. STUDY DESIGN: This is a retrospective study examining the National Cancer Database between 2010 and 2015. Women aged <50 years who underwent trachelectomy for stage IA2-IB cervical cancer were grouped by mode of surgery. Clinicopathologic characteristics and outcomes were compared between minimally invasive surgery and laparotomy groups. RESULTS: A total of 246 women were included, 144 (58.5%, 95% confidence interval, 52.4%e64.7%) of whom had trachelectomy with a minimally invasive surgery approach. Median age was similar between the minimally invasive surgery and laparotomy groups (median, 31 vs 29 years, P ¼ .20). There was a significant increase in the use of minimally invasive surgery from 29.3% in 2010 to 75.0% in 2015 (P < .001). Specifically, minimally invasive surgery became the dominant approach for trachelectomy by year 2011 (54.8%). Hospitals registered in the West (75.0% vs 25.0%) were more likely, whereas those registered in the Midwest (46.9% vs 53.1%) were less likely, to perform minimally invasive surgery (P ¼ .02). Median follow-up was 37 months (interquartile range, 23e51) for the minimally invasive surgery group and 40 months (interquartile range, 26e67) for the laparotomy group. During follow-up, there were 11 (5.3%) deaths, 4 (3.5%) in the minimally invasive surgery group and 7 (7.6%) in the laparotomy group (P ¼ .25). CONCLUSION: Minimally invasive surgery has become the dominant modality for trachelectomy in reproductive-aged women with stage IA2-IB cervical cancer after year 2011. Survival of women with stage IA2-IB cervical cancer who underwent trachelectomy is generally good regardless of surgical modality. Although our study showed no difference in survival between the minimally invasive surgery and laparotomy approaches, effects of MIS on survival remain unknown and further study is warranted.

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“…This finding indicates the possibility that floaters could sometimes be a result of tissue dislodged by intra-operative use of a uterine manipulator, a theory that was also proposed by Delair et al [11 ] Uterine manipulators have been previously postulated to cause higher rates of positive peritoneal cytology and “psuedo” lymphovascular space invasion by disruption of tissue ( Sonoda et al, 2001 , Logani et al, 2008 ). However, both of these associations, as well as any impact on outcomes from uterine manipulator use have been discounted in a number of more recent studies ( Hopkins et al, 2014 , Lee et al, 2013 , Momeni et al, 2013 , Rakowski et al, 2012 , Zhang et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

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

Albright

Black

Passarelli

et al. 2018

Gynecologic Oncology Reports

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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.

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Does a uterine manipulator affect cervical cancer pathology or identification of lymphovascular space involvement?

Cited by 35 publications

References 16 publications

Long‐term oncological outcomes of minimally invasive radical hysterectomy for early‐stage cervical cancer: A retrospective, single‐institutional study in the wake of the LACC trial

Long‐term oncological outcomes of minimally invasive radical hysterectomy for early‐stage cervical cancer: A retrospective, single‐institutional study in the wake of the LACC trial

Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy

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

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