Effect of uterine manipulator on oncologic outcome in early-stage, low-grade endometrial cancer

Objective: To evaluate the influence of intrauterine manipulators on oncological outcomes in early-stage, low-grade endometrioid endometrial cancer. Methods: This retrospective, nationwide population-based study included all women International Federation of Gynecology and Obstetrics stage I, low-grade endometrioid endometrial cancer who underwent total laparoscopic hysterectomy between January 2010 and December 2020 in the Netherlands. Patient data were identified from the Netherlands Cancer Registry. Data regarding hospital manipulator preferences were retrieved through an online survey. Patients were categorized based on hospital manipulator preference. Main outcome measures were recurrence of cancer, disease-free survival, overall survival, site of recurrence, and manipulator preference according to the type of hospital. Survival analyses were performed using univariable and multivariable Cox regression analysis. Results: Of the total study population (N = 5205), 1524 (29.3%) patients underwent surgery in hospitals that preferred no intrauterine manipulators and 3681 (70.7%) in hospitals that demonstrated a preference for intrauterine manipulators. Cancer recurrence was seen in 195 patients, 49 (3.2%) in the non-intrauterine group and 146 (4.0%) in the intrauterine group. (p =.78) After adjusting for potential confounders, the type of uterus manipulator did not affect disease-free survival (HR 0.93, 95% CI 0.78 to 1.11) and overall survival (HR 0.90, 95% CI 0.75 to 1.09). Conclusion: Intrauterine manipulators were not associated with higher recurrence rates in early-stage, low-grade endometrioid endometrial cancer.