Objective To examine the association between intrauterine manipulator use and pathological factors and oncologic outcomes in patients with endometrial cancer who had laparoscopic hysterectomy in Japan. Methods This was a nationwide retrospective cohort study of the tumor registry of the Japan Society of Obstetrics and Gynecology. Study population was 3846 patients who had laparoscopic hysterectomy for endometrial cancer from January 2015 to December 2017. An automated 1-to-1 propensity score matching with preoperative and intraoperative demographics was performed to assess postoperative pathological factors associated with the intrauterine manipulator. Survival outcomes were assessed by accounting for possible pathological mediators related to intrauterine manipulator use. Results Most patients had preoperative stage I disease (96.5%) and grade 1–2 endometrioid tumors (81.9%). During the study period, 1607 (41.8%) patients had intrauterine manipulator use and 2239 (58.2%) patients did not. In the matched cohort, the incidences of lymphovascular space invasion in the hysterectomy specimen were 17.8% in the intrauterine manipulator group and 13.3% in the non-manipulator group. Intrauterine manipulator use was associated with a 35% increased odds of lymphovascular space invasion (adjusted odds ratio 1.35, 95% confidence interval (CI) 1.08 to 1.69). The incidences of malignant cells identified in the pelvic peritoneal cytologic sample at hysterectomy were 10.8% for the intrauterine manipulator group and 6.4% for the non-manipulator group. Intrauterine manipulator use was associated with a 77% increased odds of malignant peritoneal cytology (adjusted odds ratio 1.77, 95% Cl 1.29 to 2.31). The 5 year overall survival rates were 94.2% for the intrauterine manipulator group and 96.6% for the non-manipulator group (hazard ratio (HR) 1.64, 95% Cl 1.12 to 2.39). Possible pathological mediators accounted HR was 1.36 (95%Cl 0.93 to 2.00). Conclusion This nationwide analysis of predominantly early stage, low-grade endometrial cancer in Japan suggested that intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer may be associated with an increased risk of lymphovascular space invasion and malignant peritoneal cytology. Possible mediator effects of intrauterine manipulator use on survival warrant further investigation, especially with a prospective setting. No data are available. This study used the Japan Society of Obstetrics and Gynecology database. The Japan Society of Obstetrics and Gynecology Committee forbids the transfer, rent, or sale of the data to any third party without prior approval. For inquiries about access to the data used for this study, Japan Society of Obstetrics and Gynecology can be contacted at +81-03-5206-1982.

中文翻译：

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子宫内膜癌腹腔镜子宫切除术中宫内机械手的使用：病理因素与肿瘤结果的关联

目的 研究在日本接受腹腔镜子宫切除术的子宫内膜癌患者中宫内操纵器的使用与病理因素和肿瘤结果之间的关系。方法这是一项日本妇产科学会肿瘤登记的全国回顾性队列研究。研究人群为 2015 年 1 月至 2017 年 12 月因子宫内膜癌接受腹腔镜子宫切除术的 3846 名患者。采用与术前和术中人口统计数据匹配的自动 1 对 1 倾向评分来评估与宫内操纵器相关的术后病理因素。通过考虑与宫内机械手使用相关的可能病理介质来评估生存结果。结果 大多数患者术前患有 I 期疾病（96.5%）和 1-2 级子宫内膜样肿瘤（81.9%）。在研究期间，1607 名 (41.8%) 患者使用了宫内操纵器，2239 名 (58.2%) 患者没有使用。在匹配队列中，子宫切除标本中淋巴管间隙侵犯的发生率，宫内机械手组为17.8%，非机械手组为13.3%。宫内操纵器的使用与淋巴血管间隙侵犯的几率增加 35% 相关（调整后的比值比为 1.35，95% 置信区间 (CI) 1.08 至 1.69）。子宫切除术时盆腔腹膜细胞学样本中发现的恶性细胞发生率，宫内机械手组为 10.8%，非机械手组为 6.4%。使用宫内操纵器与恶性腹膜细胞学发生率增加 77% 相关（调整后的比值比 1.77，95% Cl 1.29 至 2.31）。宫内机械手组的 5 年总生存率为 94.2%，非机械手组为 96.6%（风险比 (HR) 1.64，95% Cl 1.12 至 2.39）。可能的病理介质占HR为1.36(95%Cl 0.93～2.00)。结论 这项对日本主要是早期低级别子宫内膜癌的全国性分析表明，在腹腔镜子宫切除术治疗子宫内膜癌期间使用宫内操纵器可能与淋巴血管间隙侵犯和恶性腹膜细胞学风险增加有关。宫内机械手的使用对生存可能产生的中介效应值得进一步研究，特别是在前瞻性环境中。无可用数据。本研究使用日本妇产科学会数据库。日本妇产科学会委员会未经事先批准，禁止向任何第三方转让、出租或出售数据。如需查询本研究所用数据的获取方式，请致电 +81-03-5206-1982 联系日本妇产科学会。