ABSTRACT
Objective To evaluate the influence of intrauterine (IU) or
non-IU manipulators on oncological outcome in early-stage, low-grade
endometrioid endometrial cancer (EEC).
Design Retrospective cohort study
Setting Nationwide population-based study in the Netherlands
Population Women with FIGO stage I, low-grade EEC who received
total laparoscopic hysterectomy between 2010 and 2020.
Methods 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. Survival analyses were performed using
univariable and multivariable cox regression analysis.
Main outcome measures Recurrence of cancer, disease-free
survival (DFS), overall survival (OS), site of recurrence, and
manipulator preference according to type of hospital.
Results Of the total study population (N = 5,205), 1524
(29.3%) patients underwent surgery in hospitals that used non-IU
manipulators and 3681 (70.7%) in hospitals that used IU manipulators.
Recurrence of cancer was experienced by 195 patients, 49 (3.2%) in the
non-IU group and 146 (4.0%) in the IU group. No significant difference
in site of recurrence was observed (p=0.778). After adjusting for
potential confounders, type of uterus manipulator did not affect DFS
(hazard ratio [HR] 0.93, 95% confidence interval [CI]
0.78–1.11) and OS (HR 0.90, 95% CI 0.75–1.09).
Conclusion IU manipulators are not inferior to non-IU
manipulators with respect to oncological outcome in early-stage,
low-grade EEC.