Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study.
OBJECTIVE
Concerns exist about the risk of endometrial cancer cells spreading into the peritoneal cavity after fluid minihysteroscopy. The aim of our study was to evaluate the 5-year incidence of pelvic recurrences in women affected by early-stage endometrial carcinoma (stage IA or IB) who did or did not undergo preoperative hysteroscopy with low pressure (<70 mm Hg) saline uterine distention.


METHODS
A total of 140 women were randomized into two groups of 70 women who underwent or did not undergo diagnostic fluid minihysteroscopy before surgical staging. Women were followed up every 6 months for at least 5 years. Diagnosis of pelvic recurrence was based on a positive result at clinical examination and/or at vaginal cytology and/or at magnetic resonance imaging/positron emission tomography scan. Univariate analysis of disease-free survival was performed with the Kaplan-Meier method and survival curves were compared using the long-rank test.


RESULTS
No difference in peritoneal cytology was observed between the two groups (5.7% and 8.5% of cases in the hysteroscopy and control group, respectively). After a mean duration of follow-up of 62 months, 2 (2.85%) pelvic recurrences in the hysteroscopy group and 3 (4.28%) in the control group were found. No significant difference was found between the two groups when the recurrence rate was compared. Overall survival rates and disease-free survival projected by Kaplan-Meier curves were not significantly different for the two groups.


CONCLUSIONS
Preoperative low-pressure fluid minihysteroscopy does not increase the risk of intraperitoneal transport of endometrial carcinoma cells during the examination or the risk of pelvic recurrence at the 5-year follow-up. It does not seem to modify the recurrence rate, disease-free survival, and overall survival, although multicenter randomized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.
Cicinelli
Ettore
E
Department of Obstetrics and Gynecology, University Medical School of Bari, 70124 Bari, Italy. cicinelli@gynecology1.uniba.it
Tinelli
Raffaele
R
Colafiglio
Giuseppe
G
Fortunato
Francesca
F
Fusco
Annarita
A
Mastrolia
Salvatore
S
Fucci
Anna Rosa
AR
Lepera
Achiropita
A
D000328:Adult; D016022:Case-Control Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D010808:Physical Examination; D011300:Preoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis