Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study.

BACKGROUND: The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. PATIENTS AND METHODS: We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N = 361) or abandoned (ABAND group, N = 154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. RESULTS: The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P = 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P = 0.56), or death (HR 1.064, 95% CI 0.690-1.641, P = 0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. CONCLUSION: We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. CLINICAL TRIALS IDENTIFIER: NCT04037124.

Anatomical variations of the obturator veins and their surgical implications.

PURPOSE OF INVESTIGATION: The obturator veins and their network contribute to major bleeding complications during gynaecologic surgery. MATERIALS AND METHODS: The anatomical variations of the obturator veins were studied on 106 patients in which a thorough bilateral pelvic lymphadenectomy was performed. RESULTS: Symmetrical drainage on right and left sides was found in 75 cases: only in internal iliac vein in 32 cases, both in external iliac vein and internal in 41 cases, and only in external in two cases (so called "pubic vein"). In 31 procedures, asymmetric drainage was found between the two sides: one side in internal, the other side both in internal and external in 25 patients; in three patients, in external on one side and in both internal and external on the other; and in external on one side and in internal on the other side in one patient. CONCLUSIONS: Anatomical variations of the obturator veins appear quite often.

Abdominal radical trachelectomy (ART) performed during pregnancy: a case report.

PURPOSE OF INVESTIGATION: Cervical cancer is one of the most frequent malignant diseases diagnosed during pregnancy. Abdominal or vaginal radical trachelectomies are fertility-preserving alternatives to radical hysterectomy for young women with early-stage cervical cancer that can be performed during ongoing pregnancy. MATERIAL AND METHODS: The authors report a pregnancy complicated by cervical cancer treated by abdominal radical trachelectomy (ART) at 16-17 gestational weeks with preservation of the concurrent pregnancy. RESULTS: The pregnancy evolved normally and delivery occurred at 38-39 gestational weeks by elective caesarean section. CONCLUSIONS: Radical trachelectomy could be offered as an option for pregnant patients with early invasive cervical cancer. It may help women to avoid the triple losses of a desired pregnancy, fertility, and motherhood.

Multimodal oncosurgery approach to treat peritoneal carcinomatosis in a patient with occlusive ovarian carcinoma.

UNLABELLED: Summary BACKGROUND: This paper aims to present a "pattern" of oncosurgery solution in a case generally considered unrecoverable: intestinal occlusion in case of ovarian carcinoma and carcinomatosis. CASE REPORT: A 62-year-old female patient with ascites, carcinomatosis, unresectable pelvic tumour, and intestinal obstruction suffered a five-step oncosurgery "model": three surgical interventions overlapping chemotherapy administered via the systemic and intraperitoneal route: Step 1: colostomy and partial omentectomy; Step 2: five courses of systemic chemotherapy supported by granulocyte colony-stimulating factor; Step 3: radical surgery--total hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, omentectomy, appendectomy, pelvic peritonectomy, and hyperthermic intraperitoneal chemotherapy; Step 4: consolidation systemic chemotherapy consisting of three more similar cycles; Step 5: closure of the colostomy. Nine months after the beginning of treatment, the patient is with no evidence of disease. CONCLUSIONS: The association of surgical and oncologic treatment and the use of hyperthermic intraperitoneal chemotherapy (HIPEC) technology can solve some of these complex cases.

The mandatory role of groin lymphadenectomy in clinical Stages IB and II vulvar cancer.

PURPOSE OF INVESTIGATION: To analyze the prevalence of inguinofemoral lymph nodes metastases in clinical Stages IB-II vulva cancer. MATERIALS AND METHODS: Twenty-two patients with FIGO Stages IB-II FIGO vulva cancer with no clinically and imagistic evidence of nodes metastases were treated in the present clinic. The surgical procedures consisted in radical vulvectomy plus inguinofemoral lym- phadenectomy. RESULTS: The final pathological result was squamous carcinoma in 20 patients, vulva melanoma in one, and carcinosar- coma in one. The prevalence of positive lymph nodes was 45.4%. The median number of harvested lymph nodes was 14.0 per groin (between four and 27). Twelve patients (54.5%) developed some wound complications, but all were resolved. At the present time, 20 patients are alive, but the follow-up period is short for many of them; two patients died of disease. CONCLUSION: The prevalence of groin metastases in Stages IB-II vulvar cancer is high. A thorough inguino-femoral dissection seems necessary, despite the high incidence of wound complications.

Pelvic exenteration--our initial experience in 15 cases.

OBJECTIVE: To analyse the initial experience of pelvic exenteration for gynaecological malignancies in a tertiary referral center. MATERIALS AND METHODS: Between 2011 and 2013, 15 patients underwent a pelvic exenteration for gynaecological malignancies. RESULTS: Out of the 15 exenterations, six were total, four anterior, and five posterior. The indication was cervical (nine patients), advanced vaginal (one patient), and ovarian cancer (in five patients). A Bricker non-continent ileal urinary conduit was performed in all ten anterior and total exenterations. In-hospital complications occurred in six patients (40%) of whom two perioperative deaths (13%). Among the 15 patients, at this moment, eight are alive and six died because of the disease, and one was lost to follow-up. CONCLUSION: Pelvic exenterantion for recurrent or advanced pelvic malignancies can be associated with long-term survival and even cure without high perioperative mortality in properly selected patients. However, postoperative complications are common and can be lethal.

Three synchronous primary pelvic cancers--a case report.

The occurrence of synchronous primary gynaecologic malignancies is a relatively common event. However, the occurrence of three different pelvic cancers is very rare. In this report, the authors describe the clinical, surgical, and pathological findings of a patient with synchronous primary malignancies of the fallopian tube, endometrium, and sigmoid colon. To the authors' knowledge, it is the first case described in the literature with such an association of primary synchronous cancers.

Spontaneous intrauterine pregnancy following abdominal radical trachelectomy--a case report.

The authors describe a case report of spontaneous pregnancy after an abdominal radical trachelectomy because of cervical cancer Stage IB2.

Three synchronous primary pelvic cancers--a case report.

The occurrence of synchronous primary gynaecologic malignancies is a relatively common event. However, the occurrence of three different pelvic cancers is very rare. In this report, we describe the clinical, surgical and pathological findings of a patient with synchronous primary malignancies of the fallopian tube, endometrium and sigmoid colon. To our knowledge, it is the first case described in the literature with such an association of primary synchronous cancers.