Whether hysteroscopy contributes to intraperitoneal cell dissemination, progression and recurrence in endometrial...

To assess the oncologic safety of hysteroscopy in patients with endometrial cancer by evaluating its impact on positive peritoneal cytology (PPC), disease-free survival (DFS), and overall survival (OS).

This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024591414). We searched PubMed, the Cochrane Library, ClinicalTrials.gov, Google Scholar, and MEDLINE for studies published through April 2025. Eligible studies enrolled women with confirmed endometrial cancer who underwent hysteroscopy. The primary outcome was PPC; secondary outcomes were DFS and OS. Pooled risk ratios (RRs) were calculated under fixed-effects models, and heterogeneity was assessed using the I² statistic.

The meta-analysis showed no significant difference in PPC between hysteroscopy and control groups in retrospective/prospective studies (p = 0.13) or in randomized controlled trials (p = 0.61). Twelve studies reported DFS data; pooled analysis demonstrated no significant difference between groups (RR = 0.88; 95 % CI, 0.75-1.05; p = 0.16). Heterogeneity was moderate to high (I² = 76 %), likely reflecting variations in follow-up duration, staging criteria, and treatment protocols. Nine studies provided OS data, yielding a pooled RR of 0.99 (95 % CI, 0.83-1.18; p = 0.90), again indicating no significant difference. Despite high heterogeneity (I² = 85 %), results were consistent across studies.

Hysteroscopy does not significantly affect PPC, DFS, or OS in patients with endometrial cancer, supporting its oncologic safety. Future research should stratify outcomes by cancer subtype and implement standardized hysteroscopy protocols (e.g., defined examination duration and fluid pressure).