Uterine Manipulation During Minimally Invasive Surgery for Early Stage Endometrial Cancer
- Conditions
- ENDOMETRIAL CANCER
- Interventions
- Device: Surgery with UMDevice: Surgery without UM
- Registration Number
- NCT04586959
- Lead Sponsor
- Anthony Costales, MD
- Brief Summary
This is a prospective, multi-center, randomized non-inferiority phase III study to evaluate if patients undergoing a minimally invasive surgery for early stage uterine cancer have cancer cells in the fluid that is obtained at the time of their surgery when a uterine manipulator is placed versus patients who do not have a uterine manipulator placed.
- Detailed Description
In most cases, patients who have early stage endometrial cancer undergo a surgery to remove the uterus, cervix, tubes, ovaries, and occasionally lymph nodes. This is usually done through a minimally invasive (not a large incision) surgery. To accomplish this, the uterus needs to be manipulated (moved around) to help the surgeon complete your surgery. This is usually done with a device called a uterine manipulator and the majority of surgeons use this device in any patient undergoing a minimally invasive hysterectomy (removal of the uterus and cervix).
Even though the majority of surgeons use a manipulator, there are some surgeons who believe there is a possibility that cancer cells inside the uterus can be spilled into the abdomen through the fallopian tubes. This may cause a higher risk of spreading the cancer and or of the cancer coming back.
Currently, there are very limited research studies directly looking at whether the uterine manipulator may cause these cells to appear in the abdomen.
The purpose of this study is to see if patients undergoing a minimally invasive surgery for early stage uterine cancer have cancer cells in the fluid that is obtained at the time of their surgery when a uterine manipulator is placed versus patients who do not have a uterine manipulator placed.
A computer program will randomly assign the subjects to one of two groups. One group will have minimally invasive surgery with the use of a uterine manipulator and the other group will have minimally invasive surgery without the use of a uterine manipulator.
Researchers will use the information from this study to decide how best to take care of patients undergoing minimally invasive surgery for uterine cancer.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 278
A subject will be considered eligible for inclusion in this study if all the following criteria are met:
-
Patient must be greater than or equal to 18 years old.
-
Suspected clinically early stage endometrial cancer of any histology (endometrioid, mixed, serous, clear-cell, carcinosarcomas, mucinous)
-
Pre-operative imaging not suggestive of extra-uterine disease, if obtained pre-operatively.
-
CA 125 testing is optional but, if obtained, must be within lab normal values. 5. ECOG performance status 0-2 (see appendix 1).
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Signed informed consent and ability to comply with follow-up. 7. Per the opinion of the treating investigator, the patient must be a suitable candidate for the MIS surgical procedure.
A subject must not have any of the following criteria:
- Planned laparotomic hysterectomy
- On progesterone therapy to treat their endometrial cancer
- Any prior pelvic irradiation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Surgery With UM (Arm MAN UA) Surgery with UM Subjects that undergo a MIS approach with a uterine manipulator (experimental arm) Surgery Without UM (Arm Control) Surgery without UM Subjects that undergo a MIS approach without a uterine manipulator (control arm)
- Primary Outcome Measures
Name Time Method Positive peritoneal cytology (PC) Immediately after uterine manipulator placement in the manipulator group or prior to the initiation of the hysterectomy procedure in the non-manipulator group Positive PC is defined as the presence of malignant cells in the peritoneal cytology specimen.
- Secondary Outcome Measures
Name Time Method Percentage of myometrial invasion (MI) During surgery Defined as the % of invasion into the myometrium from the endomyometrial junction
Lymphovascular space invasion (LVSI) During surgery LVSI is defined as the presence of tumor cells within a definite endothelial-lined space (lymphatics or blood vessels) at the advancing edge of the tumor as it invades the myometrium, within an endometrial polyp, or within the endometrial stroma.
Operative time 1 day Defined as time from start of operation to closure of skin in minutes as documented in the electronic medical record
Post-operative positive PC Immediately after closure of the vaginal cuff Positive PC is defined as the presence of malignant cells in the peritoneal cytology specimen.
Extent of lymph node metastases During surgery Defined as presence of isolated tumor cells (ITC - \<0.2 mm), or micrometastasis (mm - 0.2 - 2 mm), or macrometastasis (MM - \> 2 mm), whichever is greater.
Surgical morbidity Intra-operative and up to 30 days post-surgery Surgical morbidity (CTCAE v5.0) grade 3 and higher, or any grade of the following adverse events: colonic fistula, colonic perforation, enterovesical fistula, gastrointestinal fistula, ileus, intra-abdominal hemorrhage, rectal fistula, rectal perforation, small intestinal perforation, abdominal infection, pelvic infection, vaginal infection, intra-operative arterial injury, venous injury, intra-operative gastrointestinal injury, intra-operative hemorrhage, intra-operative neurological injury, intra-operative urinary injury, and post-operative hemorrhage.
Trial Locations
- Locations (5)
Cleveland Clinic
🇺🇸Cleveland, Ohio, United States
Baylor College of Medicine- McNair Campus
🇺🇸Houston, Texas, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
Ben Taub General Hospital
🇺🇸Houston, Texas, United States
Harris Health System - Smith Clinic
🇺🇸Houston, Texas, United States