The safety and feasibility of robotic-assisted lymph node staging in early-stage ovarian cancer.

OBJECTIVES: The purpose of this study was to report on the safety and feasibility of robotic-assisted systematic lymph node staging in the management of early-stage ovarian cancer. METHODS: We retrospectively reviewed the charts of presumed early-stage (International Federation of Gynecology and Obstetrics (FIGO) stages I and II) ovarian cancer patients who underwent robotic-assisted surgery that incorporated a systematic pelvic and para-aortic lymphadenectomy from January 2009 until December 2013. Patient demographics, operative characteristics, pathology, lymph node counts, surgical complications, and hospital stay were evaluated. RESULTS: A total of 26 early-stage ovarian cancer patients were identified. The mean operating time was 2.90 hours, and the estimated blood loss was 63 mL; there were no intraoperative complications although 1 patient's surgery was significantly prolonged due to pelvic adhesions. The mean number of pelvic and para-aortic lymph nodes removed was 14.6 (2.3% incidence of pelvic lymph node metastases) and 5.8 (3.3% incidence of para-aortic lymph node metastases), respectively. The patients' mean duration of hospital stay was 18.4 hours, and 2 patients were readmitted for either a postoperative wound infection or vaginal dehiscence. CONCLUSIONS: The results from this study suggest that robotic-assisted surgical staging in the management of presumed early-stage ovarian cancer is both feasible and associated with a minimal patient complication rate. We encountered a low incidence of lymph node metastases, and the readmission rate was favorable. Nevertheless, because the prevalence of lymph node metastases can approach 20% in select patients, physicians should consider a systematic lymph node resection to confer an optimal clinical assessment.

Paget's disease of the vulva: a clinicopathologic institutional review.

BACKGROUND: The aim of this study was to assess the clinicopathologic characteristics of patients with Paget's disease of the vulva who were treated by our gynecologic oncology service between 1985 and 2010. METHODS: Vulvar Paget's disease patient demographics, pathologic diagnosis, treatment and follow-up data were reviewed over a 25-year period. RESULTS: The vulvar Paget's disease patients were primarily (62.5%) treated with a partial simple vulvectomy. Three patients had a history of malignancy, although none of them was intercurrent. Eleven patients had microscopically positive margins, 5 of whom developed progressive disease. Conversely, 5 patients had negative margins, of whom 4 had recurrent disease. There was a significant relationship between the presence of invasive disease and patient progression-free interval (PFI) (p = 0.007), but margin status and lesion size did not correlate with PFI (p > 0.05). Median patient PFI and follow-up was 30 and 53 months, respectively. CONCLUSIONS: We found a significant relationship between the presence of invasive disease and patient PFI in vulvar Paget's disease although the presence of microscopic positive margins and lesion size were not prognostic indicators. In patients with high risk factors, prolonged surveillance should be considered an essential component of optimal patient management.

Robotic-assisted surgery for the treatment of pelvic masses in pregnant patients: a series of four cases and literature review.

The purpose of this study was to assess the safety and feasibility of robotic-assisted surgery for the treatment of a pelvic mass in gravid patients. We retrospectively reviewed the charts of all pregnant women who were diagnosed with a pelvic mass by individual obstetric physicians and referred to our gynecologic oncology service from January 2009 until March 2012; four patients were identified and treated with robotic-assisted surgery by the same group of gynecologic oncologists. The following patient data were collected: age, disease origin, histology, tumor size, gravid status at surgery, surgical procedure, intra- and postoperative surgical complications, and both maternal and fetal outcomes. The gynecologic lesions comprised an immature teratoma, a mucinous cystadenoma, a hemorrhagic cyst and an ovarian endometrioma; in each case, blood loss was minimal and no maternal or fetal intra-operative complications were encountered. All patients had normal, spontaneous vaginal deliveries at term. Robotic-assisted surgery for the treatment of pelvic masses in pregnant patients is ostensibly feasible and associated with favorable outcomes for both the patient and fetus.

Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer.

OBJECTIVE: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. METHODS: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. RESULTS: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. CONCLUSION: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.