A survey-based study reports that intraoperative tumor spill during minimally invasive hysterectomy for endometrial cancer usually occurs, although it did not result in any change in the postoperative management of the patients in most cases. Intraoperative tumor spillage is the unplanned or unexpected exposure of the sterile surgical field to tumor cells during surgery with the associated risk of tumor seeding and metastasis

A cross-sectional questionnaire-based online survey of members of the Society of Gynecologic Oncology was conducted between December 2020 to January 2021 to find out the experiences of surgeons with regard to intraoperative tumor spillage (uterine perforation with intra-uterine manipulator and tumor exposure during colpotomy) during minimally invasive hysterectomy for endometrial cancer and the surgical practices adopted by them (fallopian tubal ablation or ligation, use of intrauterine manipulator and approach to colpotomy). The final analysis included 220 members. About 50% of participants had more than 10 years of experience and 74% reported performing more than 40 surgeries annually.

About 90% of surgeons said that they used an intra-uterine manipulator during the laparoscopic surgery. Majority of these (87.2%) reported experiencing uterine perforation with the intra-uterine manipulator. Around 96% performed colpotomy laparoscopically; ~60% experienced tumor spill while making colpotomy. Only 10-15% of surgeons reported that tumor spillage affected the postoperative line of management of their patients. Ligation of fallopian tubes before hysterectomy was done occasionally (14%), while 60% of surgeons obtained peritoneal washings. These findings were presented at the American Association of Gynecologic Laparoscopists (AAGL) 2021 annual meeting, which concluded on Wednesday this week.

Intraoperative tumor spillage associated with laparoscopic surgery is an issue of concern. Studies of patients with early-stage ovarian cancer, cervical cancers, gallbladder adenocarcinoma and rectal carcinoma have observed decrease in progression-free and overall survival with tumor spill. However, the present study did not examine the outcomes due to tumor spillage. Techniques suggested by the authors to minimize the spill include ligating or ablating fallopian tubes before inserting the manipulator or avoiding use of manipulator whenever possible and cleaning exposed tumor contents in the upper vaginal canal before the laparoscopic colpotomy.

Reference

1. Chang EJ, et al. Intraoperative tumor spill during minimally invasive hysterectomy for endometrial cancer: A survey study. Journal of Minimally Invasive Gynecology. November-December 2021;28(11 Suppl): S114-Abstract 5497.