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Survival effect of intra-operative tumor spillage during minimally invasive hysterectomy for early-stage endometrial cancer: a call for research

The term 'intraoperative tumor spillage' refers to the unexpected or unplanned exposure of tumor cells into the sterile surgical field during cases with otherwise no tumor cells outside the affected organ site. As a result, tumor spillage could theoretically lead to tumor seeding and metastasis. The significance of intraoperative tumor spillage on survival has been extensively examined in various malignancies, including gynecologic cancer. In stage I ovarian cancer, intraoperative tumor spillage is recognized as a prognostic factor associated with decreased survival, 2 and this surgical factor has therefore been integrated in the current cancer staging schema as a discrete substage (stage IC1). In cervical cancer, based on the results of the recent randomized controlled trial, which found that minimally invasive radical hysterectomy for earlystage cervical cancer is associated with increased risk of disease recurrence and allcause mortality compared with open radical hysterectomy, multiple investigators speculated that intraoperative tumor spillage during the intracorporeal colpotomy may be one of the possible causes of decreased survival. A recent study suggested that preventative maneuvers to minimize tumor spillage and exposure is associated with improved oncologic outcome. But what about surgery for earlystage endometrial cancer? In a review of current literature there is no study to date which has examined the incidence of intraoperative tumor spillage during minimally invasive hysterectomy for earlystage endometrial cancer. Nor is there a study that has examined the survival