Effects of uterine manipulation on surgical outcomes in laparoscopic management of endometrial cancer: A prospective randomized clinical trial

Maria Lee, Young Tae Kim, Sang Wun Kim, Sunghoon Kim, Jae Hoon Kim, Eun Ji Nam

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Abstract

This study aimed to evaluate the influence of intrauterine manipulation on the surgical outcome in patients with early-stage endometrial cancer treated with 2 different laparoscopic approaches. Methods: In a randomized parallel trial, 110 patients with clinical stage I endometrial cancer were randomly assigned for laparoscopic staging surgery with (group A, 55) or without (groupB, 55) the use of a uterine manipulator (RUMI), between June 2009 and June 2011. Two sets of peritoneal washings were obtained, 1 before and 1 after the insertion of the uterine manipulator. Primary end points were the rates of positive cytology and lymphovascular space invasion. Results: No difference was detected in patient characteristics between the groups. Mean operative time, estimated blood loss, and postoperative complications were similar between the groups. Group A had a similar incidence of lymphovascular space invasion compared with group B (12.7% vs 9.1%, respectively; P = 0.761). Four patients (7.3%) in group A had positive peritoneal cytology in the initial washing. One of these patients was classified as stage IIIA. One patient in group B was positive in the second washing. The agreement rate between the 2 sets of washings for both groupswas 98.2%. During the median follow-up of 19 months, 6 patients had tumor recurrence without significant difference between the groups. Conclusions: Despite concerns that the use of uterine manipulators may predispose the spread of early-stage disease, insertion of such uterine-manipulating systems did not increase rate of positive peritoneal cytology or lymphovascular space invasion in this study.

Original languageEnglish
Pages (from-to)372-379
Number of pages8
JournalInternational Journal of Gynecological Cancer
Volume23
Issue number2
DOIs
Publication statusPublished - 2013 Feb 1

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Endometrial Neoplasms
Randomized Controlled Trials
Cell Biology
Operative Time
Laparoscopy
Recurrence
Incidence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{d81bac6b55c842c7b9dbbc9a4e5d0733,
title = "Effects of uterine manipulation on surgical outcomes in laparoscopic management of endometrial cancer: A prospective randomized clinical trial",
abstract = "This study aimed to evaluate the influence of intrauterine manipulation on the surgical outcome in patients with early-stage endometrial cancer treated with 2 different laparoscopic approaches. Methods: In a randomized parallel trial, 110 patients with clinical stage I endometrial cancer were randomly assigned for laparoscopic staging surgery with (group A, 55) or without (groupB, 55) the use of a uterine manipulator (RUMI), between June 2009 and June 2011. Two sets of peritoneal washings were obtained, 1 before and 1 after the insertion of the uterine manipulator. Primary end points were the rates of positive cytology and lymphovascular space invasion. Results: No difference was detected in patient characteristics between the groups. Mean operative time, estimated blood loss, and postoperative complications were similar between the groups. Group A had a similar incidence of lymphovascular space invasion compared with group B (12.7{\%} vs 9.1{\%}, respectively; P = 0.761). Four patients (7.3{\%}) in group A had positive peritoneal cytology in the initial washing. One of these patients was classified as stage IIIA. One patient in group B was positive in the second washing. The agreement rate between the 2 sets of washings for both groupswas 98.2{\%}. During the median follow-up of 19 months, 6 patients had tumor recurrence without significant difference between the groups. Conclusions: Despite concerns that the use of uterine manipulators may predispose the spread of early-stage disease, insertion of such uterine-manipulating systems did not increase rate of positive peritoneal cytology or lymphovascular space invasion in this study.",
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Effects of uterine manipulation on surgical outcomes in laparoscopic management of endometrial cancer : A prospective randomized clinical trial. / Lee, Maria; Kim, Young Tae; Kim, Sang Wun; Kim, Sunghoon; Kim, Jae Hoon; Nam, Eun Ji.

In: International Journal of Gynecological Cancer, Vol. 23, No. 2, 01.02.2013, p. 372-379.

Research output: Contribution to journalArticle

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T1 - Effects of uterine manipulation on surgical outcomes in laparoscopic management of endometrial cancer

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AU - Kim, Young Tae

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N2 - This study aimed to evaluate the influence of intrauterine manipulation on the surgical outcome in patients with early-stage endometrial cancer treated with 2 different laparoscopic approaches. Methods: In a randomized parallel trial, 110 patients with clinical stage I endometrial cancer were randomly assigned for laparoscopic staging surgery with (group A, 55) or without (groupB, 55) the use of a uterine manipulator (RUMI), between June 2009 and June 2011. Two sets of peritoneal washings were obtained, 1 before and 1 after the insertion of the uterine manipulator. Primary end points were the rates of positive cytology and lymphovascular space invasion. Results: No difference was detected in patient characteristics between the groups. Mean operative time, estimated blood loss, and postoperative complications were similar between the groups. Group A had a similar incidence of lymphovascular space invasion compared with group B (12.7% vs 9.1%, respectively; P = 0.761). Four patients (7.3%) in group A had positive peritoneal cytology in the initial washing. One of these patients was classified as stage IIIA. One patient in group B was positive in the second washing. The agreement rate between the 2 sets of washings for both groupswas 98.2%. During the median follow-up of 19 months, 6 patients had tumor recurrence without significant difference between the groups. Conclusions: Despite concerns that the use of uterine manipulators may predispose the spread of early-stage disease, insertion of such uterine-manipulating systems did not increase rate of positive peritoneal cytology or lymphovascular space invasion in this study.

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