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We retrospectively analyzed data and compared the impact of intrauterine manipulators on incidence of LVSI in endometrial cancer patients treated at our department.
Endometrial cancers are among the epithelial malignancies of the lining in the uterine cavity. Standard treatment is surgical, which includes a hysterectomy. The invasion of carcinoma into the lymphovascular space (LVSI - lymphovascular space invasion) is considered a risk factor for the course of the disease Based on the recommended procedures of ESGO-ESTRO-ESP (2020) in the management of endometrial cancer, in the event of significant LVSI positivity, the female patients are included in the upper-medium risk group. A confirmation of LVSI in the preparation is of diagnostic, therapeutic and theoretical importance. During endoscopy approach, we use two types of uterine manipulators, namely the Koh-RUMI manipulator (Cooper Surgical) and the Hegar dilatator along with the McCartney tube (LiNA Medical). We analyzed data and compared the impact of intrauterine manipulators on the incidence of LVSI. In addition, we analyzed tumor grading, invasion and primary histology obtaining methods - curettage or hysteroscopy in correlation to incidence of LVSI.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NonManip | In the group of female patients operated without a uterine manipulator (NonManip), we included the female patients who were operated by abdominal approach without no need to use a manipulator. These female patients did not meet the predominantly anesthesiological requirements for the tolerance of the Trendelenburg position; respectively, the likelihood of adhesions in the abdominal cavity after previous laparotomy operations was there. Therefore, from a safety point of view, due to the risk of damage to the abdominal organs and the need for extensive adhesiolysis, the primary endoscopic surgery was not performed. |
| |
| Manip | The female patients suitable for endoscopic performance to laparoscopic, respectively the robotic hysterectomies, in whom the use of a uterine manipulator (Manip) was planned, were assigned random into two groups. |
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| ManipHe | Subgroup of Manip group patients, in whome we used the Hegar's dilator as intrauterine manipulator. |
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| ManipKoRu | Subgroup of Manip group patients, in whome we used the Koh-Rumi device as intrauterine manipulator. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| hysterectomy | Procedure | Hysterectomy as primary surgical treatment of endometrial cancer. Abdominal laparotomy approach was performed without intrauterine manipulator (NonManip). Endoscopic - total laparoscopic hysterectomy, laparoscopic assisted vaginal hysterectomy or robotic hysterectomy was performed with use of intrauterine manipulator (Manip). It was Hegar dilatator (ManipHe) or Koh-Rumi device (ManipKoRu). |
| Measure | Description | Time Frame |
|---|---|---|
| LVSI and intrauterine manipulator | Finding of the difference in the incidence of LVSI in female patients with and without an intrauterine manipulator | oct. 2015 - jan. 2021 |
| Measure | Description | Time Frame |
|---|---|---|
| LVSI and type of intrauterine manipulator | The effect of a type of an intrauterine manipulator on the incidence of LVSI | oct. 2015 - jan. 2021 |
| Measure | Description | Time Frame |
|---|---|---|
| LVSI and grading of tumor | Connection between grading of tumor and incidence of LVSI | oct. 2015 - jan. 2021 |
| LVSI and myometrial invasion | Connection between myometrial invasion of tumor and incidence of LVSI |
Inclusion Criteria:
Exclusion Criteria:
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Women diagnosed with endometrial cancer, planned to primary surgical treatment - hysterectomy.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| F.D. Roosevelt Teaching Hospital with Policlinic | Banská Bystrica | Slovakia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36542513 | Derived | Hudec B, Dokus K, Urdzik P, Skolka R, Konarcikova T, Smitka M. Influence of uterine manipulator use on the incidence of lymphovascular propagation in the treatment of endometrial cancer. Minim Invasive Ther Allied Technol. 2023 Feb;32(1):12-17. doi: 10.1080/13645706.2022.2153342. Epub 2022 Dec 21. |
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| ID | Term |
|---|---|
| D016889 | Endometrial Neoplasms |
| ID | Term |
|---|---|
| D014594 | Uterine Neoplasms |
| D005833 | Genital Neoplasms, Female |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
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| ID | Term |
|---|---|
| D007044 | Hysterectomy |
| ID | Term |
|---|---|
| D013509 | Gynecologic Surgical Procedures |
| D013519 | Urogenital Surgical Procedures |
| D013514 | Surgical Procedures, Operative |
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|
| oct. 2015 - jan. 2021 |
| LVSI and primary histology procedure | Method of obtaining primary histology, hysteroscopy or curettage in connection to incidence of LVSI. | oct. 2015 - jan. 2021 |
| D009369 |
| Neoplasms |
| D014591 | Uterine Diseases |
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |