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Degano M, Arcieri M, Frigatti P, Scrivere P, Zermano S, Driul L, Cucinella G, Ronsini C, Petrillo M, Capobianco G, Stabile G, Ripepi C, Cianci S, Uccella S, Chiantera V, Scambia G, Vizzielli G, Restaino S. Exploring Vascular Complications in Ovarian Cancer Surgery: A Narrative Literature Review with a New Management Proposal Algorithm. Healthcare (Basel) 2025; 13:270. [PMID: 39942459 PMCID: PMC11817127 DOI: 10.3390/healthcare13030270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 01/25/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND/OBJECTIVES Vascular complications during ovarian cancer surgery are rare but potentially severe. The objective of this review was to underline the need to standardize and optimize the management of these rare complications within an evidence-based framework. METHODS This review included the literature until 29 December 2024 and finally analyzed 17 studies, with 40 vascular complications reported. RESULTS Complications primarily occurred intraoperatively and involved both arterial and venous systems. Management approaches involved interdisciplinary collaboration, including vascular surgeons and interventional radiologists. Nevertheless, the collected data do not accurately reflect the reality of vascular complications in ovarian cancer surgery, as more than half of the included studies were case reports or research letters. This highlights the lack of standardized guidelines and limited training in vascular surgery for gynecologic oncologists, the importance of preoperative planning, including detailed imaging, risk stratification, and a multidisciplinary approach to mitigate complications. The authors propose an algorithm emphasizing prevention, timely identification, and effective management of vascular injuries alongside postoperative monitoring. CONCLUSIONS The findings stress the need for treatment in high-volume tertiary centers and advocate advanced surgical training, incorporating virtual reality simulations to address vascular complications. Future research should focus on large multicenter studies to establish evidence-based guidelines for managing vascular complications in ovarian cancer surgery. Innovations in technology and education may further improve outcomes, ensuring optimal care for patients undergoing these complex procedures.
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Affiliation(s)
- Matilde Degano
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.D.); (M.A.); (S.Z.)
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.D.); (M.A.); (S.Z.)
| | - Paolo Frigatti
- Unit of Vascular and Endovascular Surgery, General Surgery Department, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (P.F.); (P.S.)
| | - Paola Scrivere
- Unit of Vascular and Endovascular Surgery, General Surgery Department, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (P.F.); (P.S.)
| | - Silvia Zermano
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.D.); (M.A.); (S.Z.)
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.D.); (M.A.); (S.Z.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Giuseppe Cucinella
- Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.P.); (G.C.)
| | - Giampiero Capobianco
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.P.); (G.C.)
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (G.S.); (C.R.)
| | - Chiara Ripepi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (G.S.); (C.R.)
| | - Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood G. Barresi, University of Messina, 98122 Messina, Italy;
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy;
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS Civico—Di Cristina—Benfratelli, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giovanni Scambia
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00169 Rome, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.D.); (M.A.); (S.Z.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.D.); (M.A.); (S.Z.)
- PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy
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Duraisamy KY, Ezhilmani M, Balasubramaniam D, Periyasamy K. A Prospective Analysis of Laparoscopic Management of Endometrial Cancer in a Tertiary Care Centre. J Obstet Gynaecol India 2021; 71:621-628. [PMID: 34898901 DOI: 10.1007/s13224-020-01405-6] [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: 07/27/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022] Open
Abstract
Background Laparoscopic management of endometrial cancer is beneficial in view of decreased operative morbidity and post-operative recovery. In the case of early gynaecological malignancies, it is a safe and feasible mode of surgery. Methods A prospective study was conducted in our tertiary centre in the period January 2017-December 2019. The study included 51 patients diagnosed with endometrial carcinoma. Demographic details and operative findings have been recorded. Results The mean age was 55.47 years; 64.7% were post-menopausal. 86.2% had stage IA disease. All patients underwent laparoscopic staging. The mean operative time was 115 min, estimated blood loss was 82.5 ml, pelvic nodal yield was 13.53, and para-aortic nodes were 20.78. There were no conversions to laparotomy or any intra-operative complications, and none of the patients had recurrence. During post-operative follow-up, 2 patients had lymphocyst, 1 had chylous ascites and 1 had port site hernia. Average hospital stay was 3 days. Conclusion In our study, we found that laparoscopic management of endometrial cancer is less morbid and has better post-operative recovery.
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Affiliation(s)
- Kavitha Yogini Duraisamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Malathi Ezhilmani
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Devi Balasubramaniam
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Kodeeswari Periyasamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
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Freytag D, Pape J, Dhanawat J, Günther V, Maass N, Gitas G, Laganà AS, Allahqoli L, Meinhold-Heerlein I, Moawad GN, Biebl M, Mettler L, Alkatout I. Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer. J Clin Med 2020; 9:E4107. [PMID: 33352762 PMCID: PMC7766017 DOI: 10.3390/jcm9124107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient's lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.
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Affiliation(s)
- Damaris Freytag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Julian Pape
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Juhi Dhanawat
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, Center of Excellence in Minimally-Invasive Gynecology (COEMIG), “Filippo Del Ponte” Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy;
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran 1593747811, Iran;
| | - Ivo Meinhold-Heerlein
- Department of Obstetrics and Gynecology, University of Giessen, Klinikstraße 33, 35392 Gießen, Germany;
| | - Gaby N. Moawad
- Department of Obstetrics and Gynecology, Division of Minimally-Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC 20037, USA;
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
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