Intraoperative Tumor Spill during Minimally Invasive Hysterectomy for Endometrial Cancer: A Survey Study

Abstract

<h3>Study Objective</h3> Tumor spill during surgical treatment is associated with adverse oncologic outcomes in many solid tumors. However, in minimally invasive hysterectomy for endometrial cancer, intraoperative tumor spill has not been well studied. This study examined surgeon experiences and practice patterns related to intraoperative tumor spill during minimally invasive hysterectomy for endometrial cancer. <h3>Design</h3> This was a cross-sectional survey composed of 20 questions regarding surgeon demographics, surgical practice patterns (fallopian tubal ablation / ligation, intra-uterine manipulator use, and colpotomy approach), and tumor spill experience (uterine perforation with intra-uterine manipulator and tumor exposure during colpotomy). <h3>Setting</h3> An online survey sent to the Society of Gynecologic Oncology members on three separate occasions between December 2020 to January 2021 via SurveyMonkey. <h3>Patients or Participants</h3> Gynecologic oncologists practicing minimally invasive hysterectomy for endometrial cancer in the United States. <h3>Interventions</h3> None. <h3>Measurements and Main Results</h3> A total of 220 results were available for analysis. Nearly half of the responding surgeons completed subspeciality training >10 years ago (50.5%), and. 74.1% of surgeons had annual surgical volume of >40 cases. The majority of surgeons use an intra-uterine manipulator during minimally invasive hysterectomies for endometrial cancer (90.1%), and 87.2% of the users have experienced uterine perforation with an intra-uterine manipulator. Almost all surgeons perform the colpotomy laparoscopically (95.9%), and nearly 60% of surgeons have experienced tumor spill during colpotomy (59.8%). Nearly 10-15% of surgeons have changed their postoperative therapy as a result of intraoperative uterine perforation (11.8%) or tumor spill (14.5%). Surgeons were found to infrequently ablate or ligate the fallopian tube prior to performing the hysterectomy (14.1%). <h3>Conclusion</h3> This survey study suggests that many surgeons have experienced intraoperative tumor spillage during minimally invasive hysterectomy for endometrial cancer, warranting further studies examining its incidence and impact on survival effect.