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Mat E, Keles E, Dereli ML, Sucu ST, Kartal Ö, Solmaz U, Yıldız P, Yıldız G. Comparison of laparoscopy and vNOTES in early-stage endometrial cancer. J Obstet Gynaecol Res 2024. [PMID: 39160113 DOI: 10.1111/jog.16054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
AIM To compare the demographic, clinical, surgical, histopathological, and oncological outcomes of vNOTES and conventional laparoscopy (CL)for early-stage endometrial cancer. METHODS A retrospective study was carried out in the Gynecologic Clinic of a tertiary hospital from January 2019 to November 2020. Patient demographic characteristics, surgical outcomes, histopathological characteristics, visual analog scale (VAS) pain scores at postoperative 6th, 12th, and 24th, intra- and postoperative complications, and follow-up results were noted. RESULTS A total of 45 patients enrolled, of which 16 underwent CL and 29 were vNOTES. The operative time and decrease in hemoglobin levels were similar for both groups (p = 0.202, p = 0.699). Postoperative hospital stay did not differ between the vNOTES group and the CL group (p = 0.549). VAS pain scores at postoperative 6th, 12th, and 24th h were significantly lower in vNOTES group than in the CL group (p < 0.001). The requirement for additional opioid/narcotic analgesic was lower in the vNOTES group than in the CL group (p = 0.037). CONCLUSION vNOTES may be a safe and feasible option in early-stage endometrial cancer, having less postoperative pain and less requirement of opioid/narcotic analgesic compared with laparoscopy.
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Affiliation(s)
- Emre Mat
- Department of Gynecologic Oncology, University of Health Sciences, Kartal Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences, Kartal Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Murat Levent Dereli
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey
| | - Serap Topkara Sucu
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey
| | - Özgür Kartal
- Department of Obstetrics and Gynecology, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Ulaş Solmaz
- Department of Obstetrics and Gynecology, Izmir Tınaztepe University Faculty of Medicine, Izmir, Turkey
| | - Pınar Yıldız
- Department of Perinatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Gazi Yıldız
- Kartal Lütfi Kırdar City Hospital, Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul, Turkey
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Dicu-Andreescu IG, Marincaș MA, Simionescu AA, Dicu-Andreescu I, Prunoiu VM, Ionescu SO, Neicu ȘA, Radu GM, Brătucu E, Simion L. Abdominal Parietal Metastasis from Cervical Cancer: A Review of One of the Most Uncommon Sites of Recurrence Including a Report of a New Case. Life (Basel) 2024; 14:667. [PMID: 38929651 PMCID: PMC11204997 DOI: 10.3390/life14060667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.
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Affiliation(s)
- Irinel-Gabriel Dicu-Andreescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Marian-Augustin Marincaș
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Anca-Angela Simionescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Ioana Dicu-Andreescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
| | - Virgiliu-Mihail Prunoiu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Sânziana-Octavia Ionescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Ștefania-Ariana Neicu
- Department of Pathological Anatomy, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Gabriela-Mădălina Radu
- Department of Pathological Anatomy, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Eugen Brătucu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Laurențiu Simion
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
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Bebia V, Díaz-Feijoo B, Tejerizo Á, Torne A, Benito V, Hernández A, Gorostidi M, Domingo S, Bradbury M, Luna-Guibourg R, Gil-Moreno A. Patterns of First Recurrence and Oncological Outcomes in Locally Advanced Cervical Cancer Patients: Does Surgical Staging Play a Role? Cancers (Basel) 2024; 16:1423. [PMID: 38611101 PMCID: PMC11011205 DOI: 10.3390/cancers16071423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). METHODS This study was a multicenter observational retrospective cohort study of patients with LACC treated at tertiary care hospitals throughout Spain. The inclusion criteria were histological diagnosis of squamous carcinoma, adenosquamous carcinoma, and/or adenocarcinoma; FIGO stages IB2, IIA2-IVA (FIGO 2009); and planned treatment with primary chemoradiotherapy between 2000 and 2016. Propensity score matching (PSM) was performed before the analysis. RESULTS After PSM and sample replacement, 1092 patients were included for analysis (noPALND n = 546, PALND n = 546). Twenty-one percent of patients recurred during follow-up, with the PALND group having almost double the recurrences of the noPALND group (noPALND: 15.0%, PALND: 28.0%, p < 0.001). Nodal (regional) recurrences were more frequently observed in PALND patients (noPALND:2.4%, PALND: 11.2%, p < 0.001). Among those who recurred regionally, 57.1% recurred at the pelvic nodes, 37.1% recurred at the aortic nodes, and 5.7% recurred simultaneously at both the pelvic and aortic nodes. Patients who underwent a staging PALND were more frequently diagnosed with a distant recurrence (noPALND: 7.0%, PALND: 15.6%, p < 0.001). PALND patients presented poorer overall, cancer-specific, and disease-free survival when compared to patients in the noPALND group. CONCLUSION After treatment, surgically staged patients with LACC recurred more frequently and showed worse survival rates.
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Affiliation(s)
- Vicente Bebia
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
| | - Berta Díaz-Feijoo
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Aureli Torne
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08035 Barcelona, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mikel Gorostidi
- Department of Gynecology and Obstetrics, Hospital Universitario Donostia, 20014 San Sebastián, Spain;
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Melissa Bradbury
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
| | - Rocío Luna-Guibourg
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
- CIBERONC Centro de Investigación Biomédica en Red Cáncer, 08193 Madrid, Spain
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Song YL, Li RZ, Feng BJ, Lu YH, Wang LF, Wang ZY, Pei KG, Sun LF, Li R. Survival after minimally invasive radical hysterectomy with protective colpotomy for early-stage cervical cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108240. [PMID: 38457858 DOI: 10.1016/j.ejso.2024.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/09/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
Minimally invasive surgery on treatment of early-stage cervical cancer is debatable. Traditional approaches of colpotomy are considered responsible for an inferior oncological outcome. Evidence on whether protective colpotomy could optimize minimally invasive technique and improve prognoses of women with early-stage cervical cancer remains limited. We produced a systematic review and meta-analysis to compare oncological outcomes of the patients treated by minimally invasive radical hysterectomy with protective colpotomy to those treated by open surgery according to existing literature. We explored PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to December 2022. Inclusion criteria were: (1) randomized controlled trials or observational studies published in English, (2) studies comparing minimally invasive radical hysterectomy with protective colpotomy to abdominal radical hysterectomy in early-stage cervical cancer, and (3) studies comparing survival outcomes. Two reviewers performed the screening, data extraction, and quality assessment independently. A total of 8 retrospective cohort studies with 2020 women were included in the study, 821 of whom were in the minimally invasive surgery group, and 1199 of whom were in the open surgery group. The recurrence-free survival and overall survival in the minimally invasive surgery group were both similar to that in the open surgery group (pooled hazard ratio, 0.88 and 0.78, respectively; 95% confidence interval, 0.56-1.38 and 0.42-1.44, respectively). Minimally invasive radical hysterectomy with protective colpotomy on treatment of early-stage cervical cancer had similar recurrence-free survival and overall survival compared to abdominal radical hysterectomy. Protective colpotomy could be a guaranteed approach to modifying minimally invasive technique.
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Affiliation(s)
- Yue-Lin Song
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Rui-Zhe Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China; Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Bo-Jie Feng
- West China School of Medicine of Sichuan University, Chengdu, China
| | - Yu-Han Lu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li-Fei Wang
- Department of Obstetrics and Gynecology, Deyang People's Hospital, Deyang, China
| | - Zhao-Yun Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Kai-Ge Pei
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li-Fei Sun
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| | - Rui Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
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Fitzsimmons CK, Stephens AJ, Kennard JA, Manyam M, Pepe JW, Ahmad S, McKenzie ND, Kendrick JE, Holloway RW. Carcinomatosis in Early-Stage Cervical Cancer Treated with Robotic Radical Hysterectomy: Recurrence Patterns, Risk Factors, and Survival. Ann Surg Oncol 2021; 29:2006-2013. [PMID: 34757549 DOI: 10.1245/s10434-021-11052-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Minimally invasive radical hysterectomy has been associated with increased recurrence of disease and worse survival compared with open radical hysterectomy for early-stage cervical cancer. We evaluated patterns of recurrence and histopathologic risk factors in patients who underwent robotic radical hysterectomy (RRH). METHODS Patients who underwent RRH (4/2007-12/2018) were evaluated for specific locations of recurrent disease, disease-free survival, overall survival (OS), and histopathologic risk factors for recurrence. Inclusion criteria were follow-up ≥ 1 year, histology with adenocarcinoma, adenosquamous, or squamous carcinoma and clinical stage IA2 to IB ≤ 4-cm tumor size cervical cancers (FIGO-2018). RESULTS A total of 140 patients underwent RRH and 112 met criteria. Median tumor size was 2.1 cm [interquartile range (IQR): 1.1-3.3]. Median follow-up was 61 months (IQR: 36-102). Fifty (45%) patients underwent adjuvant radiation ± cisplatin with either Sedlis' or Peters' risk factors. There were 11 (9.8%) recurrences with median disease-free survival of 12 (IQR 8.5) months. All patients with recurrence had measured tumor size ≥ 2 cm (median tumor size 3-cm (IQR: 2.6-4.0). Tumor size > 2 cm was associated with Sedlis' intermediate-risk factors (p < 0.05) and Peters' high-risk factors (p < 0.05). Forty patients underwent preoperative conization, and two (5%) with deep positive margins in lesions > 2 cm recurred. Five (4.5%) of patients had carcinomatosis representing 45% of all recurrences. Carcinomatosis was associated with reduced OS compared with other recurrence patterns (22 months vs. 7.8 years, p < 0.05). CONCLUSIONS Carcinomatosis was observed in early-stage cervical cancers treated with RRH and was associated with reduced OS. All recurrences were associated with lesions ≥ 2 cm, and no recurrences were identified with negative conization margins.
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Affiliation(s)
| | - Amanda J Stephens
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Jessica A Kennard
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Madhavi Manyam
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Julie W Pepe
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA.
| | - Nathalie D McKenzie
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - James E Kendrick
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Robert W Holloway
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
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