Nuevo paradigma en la cirugía del mioma: reparación uterina / New paradigm in fibroid surgery: Uterine repair

Los miomas uterinos son una patología frecuente que afecta fundamentalmente a mujeres en su tercera y cuarta década de su vida. La mayoría son asintomáticos. Sin embargo, algunos pueden tener una importante repercusión clínica o en la fertilidad de la paciente. Recientemente se han producido cambios relevantes en el diagnóstico y manejo de esta entidad. En este manuscrito se pretende resumir dichos cambios abordados en el 1er Congreso Nacional de la Sociedad Española para el estudio de las Miomas y Endometriosis.(AU)

Uterine fibroids are a frequent pathology that mainly affects women in their third and fourth decade of life. Most are asymptomatic. However, some may have a significant clinical impact or on the fertility of the patient. Recently there have been relevant changes in the diagnosis and management of this entity. This paper aims to summarize these changes discussed at the 1 st National Congress of the Spanish Society for the Study of Fibroids and Endometriosis.(AU)

The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry.

This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of <10% and >10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13-1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02-1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04-1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer.