1,722,697 research outputs found
ASO Author Reflections: Minimally Invasive Adjuvant Surgery in Locally Advanced Cervical Cancer: Which Role?
No full textNON
ASO Author Reflections: Conization Before Radical Hysterectomy Improves Disease-Free Survival in Early Stage Cervical Cancer
No full textPast
A well-known randomized study demonstrated that minimally invasive radical hysterectomy was associated with poorer disease-free and overall survival in patients with early stage cervical cancer, when compared with an open approach.1 Despite not yet understanding the technical reasons for this result, different options have been proposed to explain the difference in oncological outcomes. One of these is potential peritoneal ‘contamination’ at time of colpotomy: this possibility is intuitively more likely in cases of bulky tumors.2,3 In this context, conization before radical hysterectomy may reduce the risk of peritoneal exposure to cancer tissue, maintaining the oncological safety of the surgical procedure.
Very few studies have investigated the impact of conization in cervical cancer survival, demonstrating an association between conization and reduced risk of recurrence.3
Present
In this multicenter, retrospective, observational cohort study, we analyzed the survival outcomes of a population of FIGO 2009 stage IB1 cervical cancer, by comparing the group that underwent conization with the group that did not undergo conization before radical hysterectomy. Three hundred and thirty-two patients (166, 50% in each group) were included after balance with a propensity match analysis. On the conization specimens, 14.4% and 85.6% of patients had negative and positive surgical margins, respectively. However, 41.6% of conization patients did not have residual tumor on the hysterectomy specimen, therefore significantly reducing the risk of peritoneal tumor ‘contamination’.
Patients undergoing conization before radical hysterectomy were less likely to receive adjuvant treatment (p < 0.001) and had a better 5-year disease-free survival than patients who did not receive conization (89.8% vs. 80.0%, respectively; p = 0.010). No difference in 5-year overall survival (97.1% vs. 91.4%, respectively; p = 0.114) and in recurrence pattern (p = 0.115) was reported between the two groups. Conization before radical hysterectomy and tumor diameter ≤ 20 mm were independently associated with reduced risk of recurrence.
Future
More and more evidence supports the role of protecting maneuvers performed at the time of radical hysterectomy to avoid peritoneal exposure to tumor cells. Amongst these, the avoidance of using a uterine manipulator, the closure of the vaginal cuff and, now, pre-operative conization, can be listed as actions aimed at reducing or eliminating the risk of peritoneal tumor contamination during minimally invasive surgery.4 Nevertheless, at the moment, most international guidelines and societies’ statements are cautious regarding the use of minimally invasive radical hysterectomy, particularly for tumors > 20 mm, unless within the setting of clinical trials. Prospective randomized trials are ongoing to further confirm or deny the detrimental effect of a minimally invasive approach to radical hysterectomy.5 Importantly, these trials promote or aim to assess the use of protective maneuvers to avoid peritoneal tumor exposure at the time of colpotomy, and conization could be proposed as one of these. Nevertheless, a randomized trial to specifically compare the survival of patients undergoing or not undergoing pre-operative conization, may be necessary in the future to better define and personalize the correct management of early stage cervical cancer.
References
1.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379(20):1895–904.
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2.
Pedone Anchora L, Bizzarri N, Kucukmetin A, et al. Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach. Eur J Surg Oncol. 2020;7983(20):30829–5. https://doi.org/10.1016/j.ejso.2020.09.038.
3.
Casarin J, Buda A, Bogani G, et al. Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: a multi-institutional study. Gynecol Oncol. 2020;159(1):164–70.
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Article
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4.
Bizzarri N, Pedone Anchora L, Kucukmetin A, et al. Protective role of conization before radical hysterectomy in early-stage cervical cancer: a propensity-score matching study. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-09695-4.
5.
Basaran D, Leitao MM Jr. The landmark series: minimally invasive surgery for cervical cancer. Ann SurgOncol. 2021;28(1):204–11
ASO author reflections: secondary cytoreductive surgery in recurrent ovarian cancer
No full textSecondary Cytoreductive Surgery in Recurrent Ovarian Cance
Polycystic ovary syndrome (PCOS) and adolescence: How can we manage it?
No full textPolycystic Ovary Syndrome is a very complex syndrome, with typical hormonal and metabolic features. In adolescent girls, this condition shows particular characteristics which are in common with adult sign and symptoms, often making the diagnosis difficult. On the other side, treatment strategy aims to manage the different aspects of this syndrome, and is generally based on lifestyle/diet modifications possibly associated with use of estroprogestins, anti-androgens and insulin-sensitizing agents. In this article, we will briefly review both diagnosis and clinical approach to polycystic ovary syndrome in adolescence which still remain a matter of debate in view of the peculiar hormonal milieu of that critical period
Nerve-Sparing Laparoscopic Colposacropexy Using a Percutaneous Surgical System: A Case Report
No full textStudy Objective The primary aim of this study was to evaluate the feasibility, efficacy, and safeness of nerve-sparing laparoscopic colposacropexy performed with a minimally invasive approach by using 2.9-mm Percuvance percutaneous surgical system (PSS; The Percuvance System; Teleflex Inc., Wayne, PA). The secondary aim was to investigate the technical performance of these instruments as needle holder in the placement of the mesh. The final aim was to establish the rate of prolapse recurrence. Design Step-by-step video demonstration of the surgical technique. Setting The Internal Department Committee approved this study. Patient The patient was adequately informed about the possible risks and benefits of this experimental technique, and a written consent agreeing to undergo the described procedure was signed. Intervention Nerve-sparing laparoscopic colposacropexy with positioning of two polypropylene titanized meshes and concomitant subtotal hysterectomy and salpingo-oophorectomy entirely performed with a 2.9-mm PSS. Measurements and Main Results Pelvic organ prolapse is a condition affecting up to 50% of multiparous women. It may be considered a significant public health problem with an important impact on general health-related quality of life. A conservative and/or medical treatment may be considered only for women with a mild degree of prolapse, women with a reproductive desire, or women unable to undergo surgery. In the remaining cases, surgery seems to be the most effective treatment. The surgical approach may be abdominal (colposacropexy by laparotomy, laparoscopy, or robot-assisted) or vaginal (autologous or prosthesic reinforcement). The aims of the surgical procedures include not only the anatomic correction of the prolapse but also the improvement of patient quality of life and prolapse symptom relief, guaranteeing normal bladder, bowel, and sexual functions and avoiding iatrogenic dysfunctional symptoms. At present, the laparoscopic technique of sacral colpopexy offers a number of important advantages, including an excellent visualization of the pelvis, reduction in adhesions formation, and decreased postoperative pain and recovery, with reported success rates of 90% to 96% with a mesh erosion rate of 1% to 8%. Conclusion This case report is the first to report a nerve-sparing laparoscopic colposacropexy performed with a 2.9-mm PSS. The major advance of this technique is the possibility of performing a major gynecologic surgery with a scarless approach, which results in fewer traumas for the patient in the postoperative time. The use of these instruments does not increase the operation time or the rate early or late complications, most of all prolapse recurrence. Considering that this is the first case report in literature, more clinical data are needed to confirm these findings
RE: “Ventral hernia following primary laparotomy for ovarian, fallopian tube, and primary peritoneal cancers”
No full textNovel targets for VEGF-independent anti-angiogenic drugs
No full textIntroduction: In the last decades, the active research in the field of tumor angiogenesis led to the development of a class of agents providing an effective inhibition of neovessels formation through the blockade of VEGF-related pathways. More recently, the identification of several non-VEGF factors such as PDGF, FGF, HGF, angiopoietins, ALK1/endoglin, endothelis and ephrins involved in tumor angiogenesis have emphasized the need to develop agents targeting multiple pro-angiogenic pathways. Areas covered: This review aimed at summarizing the role of non-VEGF molecular pathways in targeting tumor angiogenesis. Preclinical and clinical data for investigational agents against non-VEGF targets have been reviewed emphasizing the role of combined inhibition strategies. Expert opinion: Besides the successful development of drugs providing a specific VEGF blockade, novel agents targeting alternative angiogenesis-related pathways are being tested. Although it seems that the potential clinical usefulness of these novel compounds have been not yet fully investigated, sunitinib, sorafenib, pazopanib and other multikinase inhibitors have certainly displayed encouraging results. A more in-depth clarification of anti-angiogenic agents is still needed, in order to design the best clinical setting and schedule for target-based agents and possibly anticipate potential tools to overcome the emerging issue of anti-angiogenic drug resistance. © 2012 Informa UK, Ltd
Basi scientifiche per la definizione di linee-guida in ambito clinico per le Patologie Oncologiche Ginecologiche
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