Role of fallopian tube and cervical canal occlusion in preventing intra-operative tumour spillage in early endometrial cancer- a pilot study
Recent studies have found the presence of post- hysterectomy atypical glandular cells in upper vagina in ~ 30% patients of Endometrial Cancer (EC) with implications of causing isolated vaginal recurrence. The primary objective was to determine the effectiveness of cervical canal and fallopian tube occlusion in preventing intra-operative tumour spillage in EC. A Prospective Interventional Single Institutional pilot study with random allocation to two arms using computer- generated random number sequence was conducted between January 2022 to Feb 2023. Patients with histologically confirmed epithelial endometrial cancer, including endometrioid carcinoma, papillary serous, clear-cell, squamous, mucinous, undifferentiated, and carcino-sarcoma with surgery as primary definitive treatment modality were included. Spillage was detected using vaginal smear and peritoneal wash cytology taken pre- and post- hysterectomy. In interventional arm, cervical os and fallopian tube were occluded using silk sutures as additional steps during surgery. Rate of negative to positive conversion of vaginal smear and peritoneal wash cytology obtained before and after hysterectomy in the interventional arm was compared with control arm who underwent surgery with standard surgical steps. Out of 33 eligibile patients, 3 were excluded due to double primaries and history of radiation pelvis. The two arms of 15 patients each were comparable with respect to clinico-pathological characteristics. The most common histology, grade, degree of myometrial invasion, LVSI, stage, and mean tumour diameter was endometrioid variety (100%), low-grade (83.3%), & >1/2 (50%), negative (83.3%), 1 A (41.7%), and 4 cm in interventional arm and endometrioid (100%), low grade (76.9%), >1/2 (84.6%), negative (92.3%), 1B (84.6%), and 4.5 cm in non- interventional arm respectively. None of the patient in either arm had negative to positive conversion of vaginal and/or peritoneal cytology. We observed no difference of cervical and tubal occlusion on tumour cell spillage in EC. CTRI/2022/05/042348.