The effect of intrauterine manipulator on oncological outcome in early-stage, low-grade endometrial cancer: A retrospective cohort study

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.