Predictive Score of Nodal Involvement in Endometrial Cancer Patients: A Large, Multicenter Series

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EP1299 Laparoscopic – laterally extended pelvic resection

Introduction/Background Lateral isolated gynecological cancer infiltrating the pelvic side wall (PSW) has been considered as a not operable surgery with poor oncological outcome. The development of the laterally extended endopelvic resection (LEER) and surgical progress for disease overcoming the endopelvic fascia infiltrating muscles and nerves, have achieved the possibility to treat those patients with a curative intent. We describe for the first time the feasibility of laparoscopic laterally extended pelvic resection (L-LEPR), with complete removal of disease. Methodology LEPR was defined as an en bloc lateral resection of a pelvic tumor involving sidewall muscle, and/or bone, and/or maj…

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, r…

Sentinel Lymph Node in Aged Endometrial Cancer Patients “The SAGE Study”: A Multicenter Experience

ObjectiveThe incidence of endometrial cancer is increasing in elderly people. Considering that aging progressively affects lymphatic draining function, we aimed to define its impact on IGC uptake during SLN mapping.MethodsA multicenter retrospective cohort of endometrial cancer patients with apparently early-stage endometrial cancer undergoing complete surgical staging with SLN dissection was identified in four referral cancer centers from May 2015 to March 2021. Patients were classified in Group 1 (<65 years old) and Group 2 (≥65 years old). The primary endpoint was the assessment of the overall, bilateral, and unsuccessful SLN mapping in the two groups. Secondary outcomes were the …

Surgical Neuropelviology: Combined Sacral Plexus Neurolysis and Laparoscopic Laterally Extended Endopelvic Resection in Deep Lateral Pelvic Endometriosis

ABSTRACT Objective Surgical demonstration of combined sacral plexus neurolysis and laparoscopic laterally extended endopelvic resection for deep lateral infiltrating endometriosis. Design Video showing principles of neurolysis and laparoscopic laterally extended endopelvic resection applied to endometriotic surgery. Setting University tertiary referral center. Deep infiltrating endometriosis is an underestimated disease with real medical and clinical issues, recently classified as central pelvic endometriosis and lateral pelvic endometriosis further divided into superficial and deep according to the structures’ involvement [1] . The surgical removal of endometriotic foci remains the standar…

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assess…

Para-aortic lymphadenectomy in abnormal common iliac bifurcation

A 60-year-old-woman was diagnosed with serous endometrial cancer and on pre-operative CT there was evidence of a higher confluence of the common iliac veins in the inferior vena cava ([Figure 1][1]). Due to the presence of ascites (800 mL) and of a neoplastic ileal nodule at laparoscopy, to avoid

EP1201 Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: a cost-benefit comparative analysis

Introduction/Background Obesity represents a major health problem. Several studies reported that morbid obesity is associated with an 81% greater health care expenditure per capita compared with normal weight adults in the US. Although many articles have investigated costs of laparoscopic versus open approach for endometrial cancer, very few data are available in selected population of patients, such as obese women. The aim of this study has been to evaluate pre-, intra- and post-operative costs in obese women affected by endometrial cancer comparing laparoscopic versus open abdominal surgery. Methodology Economic expenditure in pre-operative, intra-operative and post-operative phases of th…

EPV145/#82 Multicentric predictive score validation for nodal assessment in endometrial cancer patients: preliminary data

Laparoscopic aortic lymphadenectomy in left-sided inferior vena cava

Transposition of the inferior vena cava (IVC), also known as left-sided IVC (LS-IVC), is a rare congenital variant which results from regression of the right supracardinal vein and persistence of the left supracardinal vein in embryonic development.[1 2][1] LS-IVC occurs in 0.2–0.5% of the general

The role of surgery in platinum-resistant ovarian cancer: A call to the scientific community.

Abstract In the last decade, a growing attention has been focused on identifying effective therapeutic strategies also in the orphan clinical setting of women with platinum-resistant disease. In this context, secondary cytoreductive surgery (SCS) remains a potential approach only in women with platinum sensitive relapse, but experimental data have been published supporting the role of SCS also in patients with platinum-resistant recurrence. In particular, surgery is emerging as a potential option in specific subgroups of women, such as those patients with low-grade serous histology, or low-volume relapse with disease located in the so-called pharmacological sanctuaries. Furthermore, contras…

Retroperitoneal Squamous Cell Carcinoma Involving the Pelvic Side Wall Arising from Endometriosis: A Case Report

<b><i>Introduction:</i></b> Squamous cell carcinoma (SCC) arising from endometriosis is very rare. Moreover, endometriosis located on the pelvic side wall is uncommon, while its cancerization is quite unusual. We herein report the first case of retroperitoneal SCC arising from endometriosis. <b><i>Case Presentation:</i></b> A case of a 52-year-old woman with retroperitoneal pararectal right mass is presented. The pelvic magnetic resonance imaging showed a retroperitoneal tumor extended to the right pelvic side wall. The neuropelveological examination completed the preoperative assessment, showing a right-sided sciatica and overactive bladder s…

Vena cava resection and bypass for recurrent cervical cancer

A 42-year-old woman was diagnosed with a second para-aortic cervical cancer. The patient had undergone a radical hysterectomy with pelvic lymphadenectomy for FIGO stage IB1 squamous cervical cancer 3 years prior to current presentation. No adjuvant treatment was performed after the primary surgery

EP755 Laparoscopically modified laterally extended endopelvic resection for gynecological malignancies involving pelvic side wall: a feasibility analysis

Introduction/Background Lateral pelvic side wall involvement by gynecological malignancies has been considered for a long time an absolute contraindication to curative resection. Recently the surgical paradigm is challenged with the development of the Laterally Extended Endopelvic Resection, LEER. Although the LEER is perfectly standardized in open surgery, just one small experience has been published about its endoscopic feasibility.The objective of this study is to analyze the feasibility of Laparoscopically Modified Laterally Extended Endopelvic Resection, LM-LEER, in patients with gynecological malignancies involving the lateral pelvic side wall. Methodology We retrospectively evaluated…

Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience.

ObjectiveTo determine the incidence of long term lymphadenectomy complications in primary surgery for endometrial cancer and to elucidate risk factors for these complications.MethodsA retrospective chart review was carried out for all patients with endometrial cancer managed at Parma University Hospital Unit of Gynecology and Obstetrics between 2010 and 2016. Inclusion criteria were surgical procedure including hysterectomy and lymphadenectomy (pelvic or pelvic and aortic). We identified patients with postoperative lymphocele and lower extremity lymphedema. Logistic regression analysis was used to identify predictive factors for postoperative complications.ResultsOf the 249 patients tested,…

Integrated pre-surgical diagnostic algorithm to define extent of disease in cervical cancer

ObjectivesSurvival of patients with cervical cancer is strongly associated with the local extent of the primary disease. The aim of the study was to develop an integrated diagnostic algorithm, including ultrasonography (USG), magnetic resonance imaging (MRI), and examination under anesthesia, to define the local extent of disease in patients with newly diagnosed cervical cancer.MethodsPatients with biopsy proven cervical cancer who underwent primary surgery from January 2013 to December 2018 in four participating centers were recruited. Patients who underwent USG, MRI, and examination under anesthesia prior to surgery were included in the study. Those for whom complete data were not availab…

Impact of Obesity on Sentinel Lymph Node Mapping in Patients with apparent Early-Stage Endometrial Cancer: The ObeLyX study

Conflicting data exists on the impact of Body Mass Index (BMI) on sentinel lymph-node (SLN) detection. The primary study endpoint was to investigate the impact of obesity on overall detection rate, bilateral mapping, and mapping failure rate of SLN. In addition, we evaluated possible differences in terms of surgical management and "empty-packet dissection" rate among obese and non-obese patients.Multicenter, propensity-matched, retrospective study. Patients with apparent early-stage endometrial cancer were included. Study population was divided into women with BMI/≥ 30 (Group-1 and Group-2). To lower the selection bias, a propensity-matched analysis was performed. Matching was based on hist…

Obesity, an independent predictor of pre and postoperative tumor grading disagreement in endometrial cancer

Abstract Introduction Obesity is a known independent risk factor for endometrial cancer (EC), and obese patients have a 4.7-fold increased risk compared to the general population to develop the neoplasm. To date, a general pre and postoperative tumor grading agreement from 53 % to 82 % is reported for endometrial analysis, and a consensus on which factors might influence the tumor grading discordance is still absent. Furthermore, although obesity alters the endometrial microenvironment, no studies investigated the role of obesity in the grading agreement of EC patients. This study aims to analyze the role of obesity in the pre and postoperative tumor grading agreement. Materials and methods…

Obstetrics outcomes after complete and partial molar pregnancy: Review of the literature and meta-analysis.

The hydatidiform mole is a rare gynecological disease rising from the trophoblastic. Post-molar pregnancies have an extremely variable course, varying from repeated abortions, stillbirths, preterm births, live births, or recurring in further molar pregnancies. Literature on obstetric outcomes following molar pregnancy is poor, often including monocentric studies, and with data collected from national databases. This review and meta-analysis aim to analyze the obstetric outcomes after conservative management of complete (CHM) and partial (PHM) molar pregnancies. The meta-analysis was performed following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and the preferred repo…

Laparoscopic surgery for isolated inguinal node relapse of high grade serous ovarian cancer using a bipolar combination instrument

Abstract Objective To demonstrate step-by-step minimally invasive surgical technique for dissection of isolated inguinal node relapse of high grade serous ovarian cancer. Methods A 54-year-old woman, BRCA1 +, underwent to open abdominal total hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and aortic lymphadenectomy with zero residual disease, for high grade serous ovarian carcinoma FIGO stage IIB. After surgery, patient underwent platinum-based chemotherapy for six cycles and follow-up examinations every 3 months for the first year and biannual for the second one. Abdominal TC-PET scan after 18 months revealed a right distal iliac external/inguinal nodal relapse (S…

EP273 A new integrated pre-surgical diagnostic algorithm to define the local extent of disease in women with cervical cancer

Introduction/Background Survival of patients with cervical cancer is strongly associated with the local extent of the primary disease. For this reason, the new FIGO staging system has given greater importance to instrumental investigations in the pre-surgical evaluation. The objective of this study is to develop an integrated diagnostic algorithm, including ultrasound (US), magnetic resonance imaging (MRI) and clinical examination under anaesthesia (CEUA), to better define the local extent of disease in patients with newly diagnosed cervical cancer, using histology as the referring gold standard. Methodology Patients with biopsy proven cervical cancer submitted to primary surgery from Janua…

Transperitoneal versus extraperitoneal laparoscopic aortic lymph nodal staging for locally advanced cervical cancer: A systematic review and meta-analysis

Abstract Cervical cancer is the fourth most common neoplasm in women. In locally advanced cervical cancers, the international guidelines recommend nodal aortic assessment. Two techniques have been described to perform laparoscopic aortic lymphadenectomy: transperitoneal laparoscopic lymphadenectomy (TLL) and extraperitoneal laparoscopic lymphadenectomy (ELL). This meta-analysis aims to compare the surgical outcomes of TLL and ELL for staging purposes. The systematic review was carried out in agreement with the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). Two hundred and twenty studies were analyzed, and 19 studies were included in the review (7 for …

Laparoscopic Neuronavigation for Deep Lateral Pelvic Endometriosis: Clinical and Surgical Implications

Abstract Study Objective To evaluate the clinical presentation and surgical outcome in patients with deep lateral pelvic endometriosis (dLPE). Design A retrospective multicentric study (Canadian Task Force classification II-2). Setting University tertiary referral centers. Patients One hundred forty-eight women with deep infiltrating endometriosis (DIE). Interventions Laparoscopic excision of DIE. Disease distribution was classified as follows: central pelvic endometriosis (CPE) when DIE involved 1 of the following anatomic sites: cervix, vagina, uterosacral ligaments, rectum, bladder, or pelvic peritoneum; superficial lateral pelvic endometriosis when parametria, ureters, or hypogastric pl…

Predictive Score of Nodal Involvement in Endometrial Cancer Patients: A Large Multicentre Series

Background: Sentinel lymph node (SLN) biopsy is considered the standard of care in early-stage endometrial cancer (EC). For SLN failure, a side-specific lymphadenectomy is recommended. Nevertheless, most hemipelvises show no nodal involvement. The authors previously published a predictive score of lymphovascular involvement in EC. In case of a negative score (value 3–4), the risk of nodal metastases was extremely low. This multicenter study aimed to analyze a predictive score of nodal involvement in EC patients. Methods: The study enrolled patients with EC who had received comprehensive surgical staging with nodal assessment. A preoperative predictive score of nodal involvement was calculat…

Anatomical distribution of sentinel lymph nodes in patients with endometrial cancer: a multicenter study.

ObjectiveSentinel lymph node (SLN) mapping represents the standard approach in uterine confined endometrial cancer patients. The aim of this study was to evaluate the anatomical distribution of SLNs and the most frequent locations of nodal metastasis.MethodsThis was an observational retrospective multicenter study involving eight high volume gynecologic cancer centers in Italy. We reviewed 1576 patients with a histologically confirmed diagnosis of endometrial cancer from September 2015 to June 2020. All patients underwent total hysterectomy with salpingo-ophorectomy and SLN mapping.ResultsA total of 3105 SLNs were mapped and removed, 2809 (90.5%) of these were bilateral and 296 (9.5%) unila…

EP756 Laterally extended endopelvic resection: a comparative analysis between laparotomic and laparoscopically modified approach

Introduction/Background Laterally Extended Endopelvic Resection (LEER) has been identified as a valid therapeutic option for women with gynecological malignancies involving the pelvic side wall. The historical approach to LEER is laparotomic, recently we have proposed the so called Laparoscopically Modified Laterally Extended Endopelvic Resection (LM-LEER).The objective of this study is to compare surgical and oncological outcomes between LEER and LM-LEER in a consecutive series of patients with gynecological malignancies infiltrating the pelvic side wall. Methodology We retrospectively evaluated women submitted to LEER between October 2012 and January 2019. Inclusion criteria for LM-LEER w…

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 da…

EP1155 Endoscopic near infrared and indocyanine green to verify the viability of the subcutaneous flap for vulvar cancer

Introduction/Background Vulvar cancer often requires radical vulvectomy with subsequent vulvar flap due to tumor aggressiveness and a high percentage of relapses. Approximately in 20–60% of cases, there are post-operative complications ranging from infection to wound dehiscence, lymphocele and flap necrosis that often require reoperation. Several methods have been described to verify the vitality of the flap, especially in plastic surgery, but these are often expensive and require specific machinery that is not generally present in a gynecological clinic. We present a viability verification of V-Y fasciocutaneous advancement flap for vulvar reconstruction by Endoscopic Near-Infrared and Ind…

Confounding factors of transvaginal ultrasound accuracy in endometrial cancer.

Endometrial cancer is the most frequently diagnosed gynecological tumour. Transvaginal ultrasound has a leading role in the preoperative evaluation of endometrial cancer patients. The study aimed to identify factors that can worsen the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients. We retrospectively analysed 290 patients with histological diagnosis of endometrial adenocarcinoma. Two-dimensional (2D) gray-scale ultrasound and power Doppler imaging were performed. Age, menopause status, obesity, parity, Figo stage and benign uterine disorders were evaluated as possible factors worsening the diagnostic accuracy of the ultrasonography. FIGO stage IB was the main…

Primary site disease and recurrence location in ovarian cancer patients undergoing primary debulking surgery vs. interval debulking surgery

Introduction: The natural history and patterns of ovarian cancer (OC) relapse are still unclear. Recurrent disease can be peritoneal, parenchymal, or nodal. This study aims to analyze the location and pattern of OC recurrence according to the primary site of disease and to the type of surgical approach used. Material and methods: All OC patients underwent primary debulking surgery (PDS) or interval debulking surgery (IDS), with 2014 FIGO stage III-IV, and with platinum-sensitive recurrence were included in the study. Primary disease location and site of recurrences were divided into peritoneal, parenchymal, and nodal, according to the presence of peritoneal carcinomatosis, parenchymal metas…

Anterior/Apical single incision mesh (Elevate™): Surgical experience, anatomical and functional results, and long-term complications

Abstract Objective Pelvic organ prolapse is a common condition among post-menopausal women, and surgery is often the standard treatment proposed. Native tissue vaginal surgery is burdened by a high rate of recurrence, and mesh vaginal surgery has become current practice. The purpose of this study was to evaluate the safety and the effectiveness of the vaginal kit Anterior/Apical single incision mesh Elevate™ for the correction of anterior and apical compartment prolapse. Study design Data of patients with symptomatic anterior vaginal prolapse stage ≥ II, receiving mesh repair with the Anterior/Apical Elevate single incision system between January 2010 and January 2015 were retrieved. Prolap…

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Abstract Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pre…

Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience

Purpose: To evaluate the incidence, predictors and clinical outcome of pancreatic fistulas in patients receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer. Methods: Data of women who underwent splenectomy during cytoreduction for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Surgical, post-operative and follow-up data were analysed. Results: Overall, 260 patients were included in the study. Pancreatic resection was performed in 45 (17.6%) women, 23 of whom received capsule resection alone, while 22 required tail resection. Hyperthermic intraperito…

Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost-benefit comparative analysis

The aim of the present study was to demonstrate the cost of obese patients affected by endometrial cancer undergoing open surgery compared with minimally invasive surgery. In the retrospective cohort study (Canadian Task Force classification II-2), the economic expenditure in pre-operative, intra-operative and post-operative phases of the selected patients was evaluated. Costs were analyzed for all blood tests, instrumental examinations, consultations, operating materials, drugs, gynecological examinations, hospital stay, intensive care hospitalization and management of operative complications. The average length of stay was longer for patients who underwent laparotomy, with an almost doubl…

EP626 Lymph vascular space invasion, an independent risk factor of sentinel node mapping failure in endometrial cancer, the sentifail study: a multicentric prospective analysis

Introduction/Background Sentinel lymph node (SLN) mapping has become the gold standard for surgical staging of early stage endometrial cancer. Side-specific systematic lymphadenectomy is suggested if SLN mapping failed. The objective of this study is to identify clinical and pathological factors associated with failed mapping. Methodology We prospectively evaluated a consecutive series of early stage endometrial cancer patients submitted to SLN mapping with indocyanine green (ICG) near-infrared compatible surgical platforms in two oncological referral centers from January 2018 to January 2019. Indocyanine green was injected intracervical. Bilateral mapping and failed bilateral SLN mapping g…

Laparoscopic laterally extended endopelvic resection procedure for gynecological malignancies

ObjectivesPelvic side wall infiltration by gynecological malignancies has been considered for a long time an absolute contraindication to curative resection. The development of the laterally extended endopelvic resection (LEER) has challenged this surgical paradigm. Although the LEER has been standardized in open surgery, only small studies have been published about its endoscopic feasibility. The objective of this study is to analyze the safety of LEER in patients with gynecological malignancies involving the pelvic side wall.MethodsWe retrospectively evaluated a consecutive series of patients who underwent a laparoscopically modified LEER between July 2014 and November 2018. This indicate…

Laparoscopic sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: the SENTIFAIL study – a multicentric analysis of predictors of failed mapping

ObjectivesLaparoscopy is commonly used for endometrial cancer treatment, and sentinel lymph node (SLN) mapping has become the standard procedure for nodal assessment. Despite the standardization of the technique, there is no definitive data regarding its failure rate. The objective of this study is to identify factors associated with unsuccessful SLN mapping in endometrial cancer patients undergoing laparoscopic SLN mapping after intracervical indocyanine green (ICG) injection.MethodsWe retrospectively evaluated a consecutive series of endometrial cancer patients who underwent laparoscopic SLN mapping with intracervical ICG injection, in four oncological referral centers from January 2016 t…

Adnexal Torsion in Pediatric Age: Does Bolli’s Score Work? Report of Two Cases

Adnexal torsion is a surgical emergency requiring early diagnosis in order to avoid demolitive surgery. Adnexal torsion’s diagnosis could be very difficult in pediatric patients because children cannot explain symptoms accurately. Furthermore reproductive organs lie high in abdomen, causing unclear examinations findings. For reducing diagnostic mistakes or delay clinical and hematological criteria could be useful. No radiological criteria (CT or MRI) should be taken in count because of the costs and the required time. By combining clinical presentation in patients with OT three useful diagnostic variables have been identified: age, duration of pain, vomiting. Presence of vomiting, short dur…

Laparoscopic laterally extended pelvic resection for gynecological malignancies

Lateral isolated gynecological cancer infiltrating the pelvic side wall has been considered non-operable with a poor oncological outcome.[1][1] The development of the laterally extended endopelvic resection and surgical progress for disease, overcoming the endopelvic fascia infiltrating muscles and

Tumor Size, an Additional Risk Factor of Local Recurrence in Low-Risk Endometrial Cancer: A Large Multicentric Retrospective Study.

ObjectiveThe identification of patients with endometrial cancer (EC) at higher risk for relapse is critical to individualize and better tailor postoperative treatment. No evidence is available regarding the possible association between tumor size (TS) and the risk of local recurrence. The purpose of this study was to analyze the correlation between TS and risk/type of recurrence in EC patients, stratified according to the new European Society of Medical Oncology-European Society of Gynecological Oncology-European Society for Radiotherapy and Oncology classification.MethodsData of patients with histologically proven EC who received primary surgical treatment between November 1999 and June 20…

Surgery vs. chemotherapy for ovarian cancer recurrence: what is the best treatment option

Nowadays, the best treatment option for ovarian cancer recurrence is often subjective, can vary in the different centers and depend on personal experience. Arbeitsgemeinschaft Gynaekologische Onkologie (AGO)-DESKTOP studies have identified a population of patients who could benefit from secondary surgery. The results of the Gynecologic Oncology Group (GOG)-0213 study were recently published, which showed no advantage in terms of overall survival (OS) in patients with platinum-sensitive recurrent epithelial ovarian undergoing secondary cytoreductive surgery (SCS) compared to chemotherapy alone. Aim of this narrative review is to summarize the best aspects that can make ovarian cancer recurre…

Endoscopic near infrared and indocyanine green to verify the viability of the subcutaneous flap for vulvar cancer.

Abstract Introduction Vulvar cancer often requires radical vulvectomy with subsequent vulvar flap. Approximately in 20–60% of cases, there are post-operative complications ranging from infection to flap necrosis that often require reoperation. Several methods have been described to verify the vitality of the flap, but these are often expensive and require specific machinery that is not generally present in a gynecological clinic. In this case report, we present a viability verification of V Y fasciocutaneous advancement flap for vulvar reconstruction by Endoscopic Near-Infrared and Indocyanine Green. Methodology The patient was a 67-year-old woman with FIGO IB ≤ 4 cm squamous cell vulvar ca…

EP485 Confounding factors of trans-vaginal ultrasonography accuracy in endometrial cancer

Introduction/Background Endometrial cancer is the most frequently diagnosed gynecological tumor with more than 60.000 new cases each year. Following the ESMO-ESGO-ESTRO consensus conference, patients are classified in different classes of risk for lymph node metastases based on the instrumental suspected stage of the disease. In this scenario, a correct pre-operative workup is essential for a proper planning treatment offered to the patient. Although most of the oncological centers have replaced the MRI with trans-vaginal ultrasound, this, in the international guidelines, is considered only in the fertility sparing and in cases of contraindicated MRI. The Aim of our study is to evaluate the…

A large multicenter propensity match study of sentinel lymph node biopsy feasibility in endometrioid variants of endometrial cancer

Introduction: Sentinel lymph node (SLN) biopsy algorithm has been routinely applied in all endometrial endometrioid tumors, however, no studies analyzed the feasibility of SLN mapping in endometrioid variants (EV), which included villoglandular, secretory, ciliated cell, mucinous, and squamous differentiation. This study aimed to demonstrate the feasibility of SLN biopsy in EV of EC. Materials and methods: All patients undergoing minimally invasive surgical treatment for early-stage EC were included in the study. Patients were divided into 2 study groups: Group 1 which included patients with EV, and Group 2 which included patients with typical endometrioid histology. A propensity match anal…

Self-Reported Long-Term Autonomic Function After Laparoscopic Total Mesometrial Resection for Early-Stage Cervical Cancer: A Multicentric Study.

ObjectivesThis multicentric retrospective study investigates the early and long-term self-reported urinary, bowel, and sexual dysfunctions in early-stage cervical cancer patients who submitted to laparoscopic total mesometrial resection (L-TMMR), total laparoscopic radical hysterectomy, vaginal-assisted laparoscopic radical hysterectomy, and laparoscopic-assisted radical vaginal hysterectomy.MethodsCervical cancer patients, FIGO (International Federation of Gynecology and Obstetrics) stage IA2–IB1/IIA1 who submitted to nerve-sparing radical hysterectomy were recruited. Pelvic functions were assessed within 30 days (early outcome) and 12 months after surgery (long-term outcome).ResultsTwo hu…

Subcutaneous Vulvar Flap Viability Evaluation With Near-Infrared Probe and Indocyanine Green for Vulvar Cancer Reconstructive Surgery: A Feasible Technique

Introduction: Vulvar cancer is a rare condition affecting older women and accounts for 3–5% of all gynecological cancers. Primary surgical treatment involves the removal of a large amount of tissue for which reconstructive surgery is often necessary with a high rate of postoperative complications. Despite several techniques for the evaluation of vulvar flap viability have been proposed, many methods cannot be performed during surgery and require expensive devices often missing in a gynecological clinic. This study aims to verify the feasibility and the safety of the vulvar flap viability evaluation through a near-infrared endoscopic probe and Indocyanine green (ICG) tracer in a small group …

EP1224 Predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience

Introduction/Background The aim of the surgical treatment of advanced ovarian cancer is to completely remove all macroscopic disease.To achieve optimal cytoreduction, the use of extensive upper abdominal surgery has become widely accepted.Although the disease doesn’t usually invade the splenic parenchyma, the capsule may commonly be infiltrated. These metastases may be difficult to be dissected from the pancreatic tail and a partial pancreatic resection en bloc with spleen may be required. The objective of this study is to evaluate predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer. Methodology Data of women recei…

Novel preoperative predictive score to evaluate lymphovascular space involvement in endometrial cancer: an aid to the sentinel lymph node algorithm.

IntroductionSentinel lymph node (SLN) dissection has been recognized as a valid tool for staging in patients with endometrial cancer. Several factors are predictors of recurrence and survival in endometrial cancer, including positive lymphovascular space invasion. The aim of this study is to formulate a pre-operative score that, in the event of no-SLN identification, may give an estimate of the true probability of lymphovascular space invasion and guide management.MethodologyThis was a multi-institutional retrospective study conducted from January 2007 to December 2017. We included all patients with any grade endometrial tumor with a complete pathological description of the surgical specime…

Concordance of Radiological, Laparoscopic and Laparotomic Scoring to Predict Complete Cytoreduction in Women with Advanced Ovarian Cancer

Objective: To identify the best method among the radiologic, laparoscopic and laparotomic scoring assessment to predict the outcomes of cytoreductive surgery in patients with advanced ovarian cancer (AOC). Methods: Patients with AOC who underwent pre-operative computed tomography (CT) scan, laparoscopic evaluation, and cytoreductive surgery between August 2016 and February 2021 were retrospectively reviewed. Predictive Index (PI) score and Peritoneal Cancer Index (PCI) scores were used to estimate the tumor load and predict the residual disease in the primary debulking surgery (PDS) and interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT) groups. Concordance percentages we…

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Objective Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results M…

Surgical Neuropelveology: Lateral Femoral Cutaneous Nerve Endometriosis. Laparoscopic Resection and Nerve Transplantation

ABSTRACT Study Objective To demonstrate the application of surgical neuroanatomic principles for the diagnosis and treatment of deep infiltrating endometriosis involving the lateral femoral cutaneous nerve. Design Video demonstration of laparoscopic lateral femoral cutaneous endometriosis resection with nerve transplant. Setting Endometriosis infiltrating somatic nerves is a poorly known condition, which can cause severe neuropathic symptoms [1] and is often unrecognized with a subsequent treatment delay [1] . Intimate knowledge of pelvic neuroanatomy and expertise in minimally invasive surgery are essential to manage this challenging surgical scenario 2 , 3 , 4 . Interventions Thirty-six y…

Semiquantitative evaluation of lymph-vascular space invasion in patients affected by endometrial cancer: Prognostic and clinical implications.

Objectives: The interpretation of lymph-vascular space invasion (LVSI) is usually qualitative, as presence or absence. The aim of this study is to investigate the prognostic role of LVSI in patients affected by endometrial cancer, when evaluated with a semiquantitative analysis. Methods: This retrospective multicentre study enrolled patients who received a histologically confirmed diagnosis of endometrial cancer. The assessment of LVSI was semiquantitative in accordance with the three-tiered scoring system (absent, focal and diffuse). Results: Among 1258 patients with surgical-stage endometrial cancer, LVSI has been found in 32.8% of cases (n = 412), whose 12.7% (n = 160) were focal, and 20…