Stefano Uccella1, Matteo Bonzini2, Mario Malzoni3, Francesco Fanfani4, Stefano Palomba5, Giovanni Aletti6, Giacomo Corrado7, Marcello Ceccaroni8, Renato Seracchioli9, Fevzi Shakir10, Annamaria Ferrero11, Roberto Berretta12, Raffaele Tinelli13, Enrico Vizza7, Giovanni Roviglione8, Lucia Casarella3, Eugenio Volpi11, Ettore Cicinelli13, Giovanni Scambia14, Fabio Ghezzi15. 1. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: stefucc@libero.it. 2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 3. Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. 4. Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy; Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Italy. 5. Unit of Obstetrics and Gynecology, IRCCS - ASMN of Reggio Emilia, Italy. 6. Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy. 7. Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy. 8. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy. 9. Minimally-Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 10. Department of Obstetrics and Gynecology, Royal Free Hospital, London, UK. 11. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy. 12. Department of Gynecology and Obstetrics, University of Parma, Parma, Italy. 13. II Department of Obstetrics and Gynecology, Medical School, University "Aldo Moro", Bari, Italy. 14. Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy. 15. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Abstract
BACKGROUND: Although widely adopted, the use of a uterine manipulator during laparoscopic treatment of endometrial cancer represents a debated issue, and some authors hypothesize that it potentially may cause an increased risk of relapse, particularly at specific sites. OBJECTIVE: Our aim was to evaluate the risk and site of disease recurrence, overall survival, and disease-specific survival in women who had laparoscopic surgery with and without the use of a uterine manipulator. STUDY DESIGN: Data were reviewed from consecutive patients who had laparoscopic surgery for endometrial cancer staging in 7 Italian centers. Subjects were stratified according to whether a uterine manipulator was used during surgery; if so, the type of manipulator was identified. Multivariable analysis to correct for possible confounders and propensity score that matched the minimize selection bias were utilized. The primary outcome was the risk of disease recurrence. Secondary outcomes were disease-specific and overall survival and the site of recurrence, according to the use or no use of the uterine manipulator and to the different types of manipulators used. RESULTS: We included 951 patients: 579 patients in the manipulator group and 372 patients in the no manipulator group. After a median follow-up period of 46 months (range,12-163 months), the rate of recurrence was 13.5% and 11.6% in the manipulator and no manipulator groups, respectively (P=.37). Positive lymph nodes and myometrial invasion of >50% were associated independently with the risk of recurrence after adjustment for possible confounders. The use of a uterine manipulator did not affect the risk of recurrence, both at univariate (odds ratio, 1.18; 95% confidence interval, 0.80-1.77) and multivariable analysis (odds ratio, 1.00; 95% confidence interval, 0.60-1.70). Disease-free, disease-specific, and overall survivals were similar between groups. Propensity-matched analysis confirmed these findings. The site of recurrence was comparable between groups. In addition, the type of uterine manipulator and the presence or not of a balloon at the tip of the device were not associated significantly with the risk of recurrence. CONCLUSION: The use of a uterine manipulator during laparoscopic surgery does not affect the risk of recurrence and has no impact on disease-specific or overall survival and on the site of recurrence in women affected by endometrial cancer.
BACKGROUND: Although widely adopted, the use of a uterine manipulator during laparoscopic treatment of endometrial cancer represents a debated issue, and some authors hypothesize that it potentially may cause an increased risk of relapse, particularly at specific sites. OBJECTIVE: Our aim was to evaluate the risk and site of disease recurrence, overall survival, and disease-specific survival in women who had laparoscopic surgery with and without the use of a uterine manipulator. STUDY DESIGN: Data were reviewed from consecutive patients who had laparoscopic surgery for endometrial cancer staging in 7 Italian centers. Subjects were stratified according to whether a uterine manipulator was used during surgery; if so, the type of manipulator was identified. Multivariable analysis to correct for possible confounders and propensity score that matched the minimize selection bias were utilized. The primary outcome was the risk of disease recurrence. Secondary outcomes were disease-specific and overall survival and the site of recurrence, according to the use or no use of the uterine manipulator and to the different types of manipulators used. RESULTS: We included 951 patients: 579 patients in the manipulator group and 372 patients in the no manipulator group. After a median follow-up period of 46 months (range,12-163 months), the rate of recurrence was 13.5% and 11.6% in the manipulator and no manipulator groups, respectively (P=.37). Positive lymph nodes and myometrial invasion of >50% were associated independently with the risk of recurrence after adjustment for possible confounders. The use of a uterine manipulator did not affect the risk of recurrence, both at univariate (odds ratio, 1.18; 95% confidence interval, 0.80-1.77) and multivariable analysis (odds ratio, 1.00; 95% confidence interval, 0.60-1.70). Disease-free, disease-specific, and overall survivals were similar between groups. Propensity-matched analysis confirmed these findings. The site of recurrence was comparable between groups. In addition, the type of uterine manipulator and the presence or not of a balloon at the tip of the device were not associated significantly with the risk of recurrence. CONCLUSION: The use of a uterine manipulator during laparoscopic surgery does not affect the risk of recurrence and has no impact on disease-specific or overall survival and on the site of recurrence in women affected by endometrial cancer.
Authors: Sang Il Kim; Dong Choon Park; Sung Jong Lee; Ji Geun Yoo; Min Jong Song; Chan Joo Kim; Hae Nam Lee; Joo Hee Yoon Journal: Int J Med Sci Date: 2021-01-01 Impact factor: 3.738
Authors: Salvatore Gueli Alletti; Emanuele Perrone; Camilla Fedele; Stefano Cianci; Tina Pasciuto; Vito Chiantera; Stefano Uccella; Alfredo Ercoli; Giuseppe Vizzielli; Anna Fagotti; Valerio Gallotta; Francesco Cosentino; Barbara Costantini; Stefano Restaino; Giorgia Monterossi; Andrea Rosati; Luigi Carlo Turco; Vito Andrea Capozzi; Francesco Fanfani; Giovanni Scambia Journal: Front Oncol Date: 2021-09-10 Impact factor: 6.244
Authors: Vito Andrea Capozzi; Andrea Rosati; Stefano Uccella; Gaetano Riemma; Mattia Tarascio; Marco Torella; Pasquale De Franciscis; Nicola Colacurci; Stefano Cianci Journal: Transl Cancer Res Date: 2020-12 Impact factor: 1.241