Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study

Zhou, Hui; Lai, Kai-Fa; Xiang, Qian; Xu, Yu; Zhang, Qianwen; Hu, Cui; Mao, Xiguang; Chen, Cheng; Wu, Huayue; Mi, Gong-Sheng; Shen, Juan; Tian, Yifei; Ke, Feng-Mei

doi:10.3389/fonc.2022.918693

Cited by 4 publications

(3 citation statements)

References 36 publications

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“… 1 , 2 Hysteroscopy is one of the most common minimally invasive procedures for the diagnosis and treatment of uterine diseases. 3 , 4 In order to relieve the anxiety and tension of patients and successfully complete hysteroscopy, propofol is widely used for hysteroscopic sedation. 5 , 6 Propofol exerts its sedative effect mainly by activating gamma amino butyric acid (GABA) receptors.…”

Section: Introductionmentioning

confidence: 99%

Remimazolam Tosylate Combined with Low-Dose Propofol Improves Sedation and Safety in Hysteroscopy

Zhang¹,

Chang²,

Wang³

et al. 2022

DDDT

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Background Propofol is widely used for sedation of hysteroscopy. It can cause injection pain, respiratory depression, and hypotension. Remimazolam is a novel ultra-short-acting benzodiazepine. Clinical practice has found that the use of remimazolam alone often leads to body movement during hysteroscopy, which decreases the safety and comfort. Here this study is to investigate whether remimazolam combined with low-dose propofol can improve the sedation effect and safety of hysteroscopy. Patients and Methods In this prospective, randomized, parallel-controlled trial, women (18 to 60 years) undergoing hysteroscopy were randomly assigned to receive propofol (Group P), remimazolam tosylate (Group R), or remimazolam tosylate plus propofol (Group RP). Intraoperative sedation depth was kept at the bispectral index (BIS) value of 40–60. 6 μg/kg alfentanil was used for analgesic before sedation. Intraoperative low pulse oxygen saturation (SpO 2 ), body movement, injection pain, mean arterial pressure (MAP), heart rate (HR), and postoperative recovery time, dizziness, nausea and vomiting were recorded and compared. Results From February to July 2022, 193 patients were recruited and randomly assigned to group P (n=64), group R (n=64), or group RP (n=65). There was no significant inter-group difference of the intraoperative BIS values. The incidence of low SpO 2 , injection pain, hypotension, and postoperative dizziness in group RP were less than that in group P, and had no significant difference from group R. The incidence of body movement in group RP was less than that in group R, and had no significant difference from group P. Postoperative recovery time of group RP was shorter than that of the other two groups. No significant inter-group difference in bradycardia, nausea and vomiting was observed. Conclusion Remimazolam tosylate combined with low dose of propofol improved sedation and safety in hysteroscopy, and may be a more ideal sedative method for hysteroscopy.

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Section: Introductionmentioning

confidence: 99%

Remimazolam Tosylate Combined with Low-Dose Propofol Improves Sedation and Safety in Hysteroscopy

Zhang¹,

Chang²,

Wang³

et al. 2022

DDDT

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“…There were no differences between the 5‐year DFS rates and 5‐year OS rates of the diagnostic hysteroscopy group and that of the D&C group. 22 Moreover, a recent study published by Quintana‐Bertó R et al compared relapse and survival rates in 1731 women who had been evaluated by either pipelle biopsy or hysteroscopy in a retrospective multicentric study and found no impact on oncological outcomes. 23 The present study reports agree with these findings.…”

Section: Discussionmentioning

confidence: 99%

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single‐center retrospective study

Sun

Zhang

et al. 2023

Cancer Medicine

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PurposeWe aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease‐free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients.MethodsFour hundred sixty‐five women with EC were included in this retrospective study. Log‐rank tests and Kaplan–Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis.ResultsAmong the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log‐rank p = 0.914 and 0.810 for OS; log‐rank p = 0.707 and 0.771 for DFS, respectively).ConclusionBased on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II‐III EC patients.

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“…They found that 80% of cytology conversions occurred at the third washing, implying that the presence of the manipulator in the uterine cavity during the whole procedure is the main issue, rather than the insertion of the manipulator itself 16 . Interestingly, hysteroscopy has been associated with higher PPC rates, but without worse oncological outcome [26][27][28][29] . This discrepancy might result from different ways of handling the IU device.…”

Section: Discussionmentioning

confidence: 99%

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

Ye,

Timmermans,

et al. 2023

Preprint

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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.

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Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study

Cited by 4 publications

References 36 publications

Remimazolam Tosylate Combined with Low-Dose Propofol Improves Sedation and Safety in Hysteroscopy

Remimazolam Tosylate Combined with Low-Dose Propofol Improves Sedation and Safety in Hysteroscopy

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single‐center retrospective study

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

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