Impact of obesity in the identification of the sentinel lymph node in endometrial cancer: a retrospective, monocentric study and literature review.

PURPOSE: To evaluate the sentinel lymph node (SLN) protocol for staging endometrial carcinomas, assessing its impact on surgical management, and determining indications for adjuvant therapies. The study also examines factors that may influence SNL mapping, particularly focusing on the failure of the technique due to obesity. METHODS: A retrospective analysis was conducted on the medical records of patients with a histological diagnosis of endometrial carcinoma, who underwent surgical staging with SLN biopsy. The lymph node status was compared between non-obese (group 1) and obese (group 2) patients. RESULTS: 71 women were included in the study, of which 33 were non-obese (46.5%) and 38 were obese (53.5%). The failure detection rate was higher in obese patients (14, 36.8%) compared to non-obese patients (5, 15.2%) (p = 0.039). The risk of mapping failure increased by 1.6 times for every 5-unit increase in body mass index (BMI) (OR 1.672, 95% CI 1.024-2.730, p = 0.040). BMI was confirmed as an independent risk factor for mapping failure in both univariate (OR 3.267, 95% CI 1.027-10.395, p = 0.045) and multivariate analyses (OR 5.779, 95% CI 1.320-25.297, p = 0.020). CONCLUSION: SLN detection in obese patients requires great care, as obesity may alter the sensitivity of the technique.

Cytoreduction surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as treatment choice of metastatic Urachal carcinoma.

INTRODUCTION: Urachal carcinoma accounts for approximately 0.01 % of all adult malignancies and 1 % of bladder cancers. Its prognosis remains poor, with a 5-year overall survival rate of less than 50 %. PRESENTATION OF CASE: A 51-years-old black female, affected by peritoneal malignancies from urachal carcinoma, underwent multiple surgical cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with different chemotherapy regimen, alternating with intravenous chemotherapy. Thirty-two months recurrence-free survival was registered, and overall survival was more than 5 years. DISCUSSION: Our case suggests the importance of rigorous follow-up with both tumor marker testing (CEA) and imaging studies. Optimal debulking surgery plays a pivotal role in controlling primary and recurrent disease. The use of combined intraperitoneal and intravenous chemotherapy may have contributed to her long-term survival. CONCLUSION: CRS and HIPEC combined with intravenous chemotherapy may be potential candidates for treating patients with urachal carcinoma with peritoneal metastases. Our patient is a challenging case in daily surgical practice.

Posterior and Para-Aortic (D2plus) Lymphadenectomy after Neoadjuvant/Conversion Therapy for Locally Advanced/Oligometastatic Gastric Cancer.

Super-extended (D2plus) lymphadenectomy after chemotherapy has been reported in only a few studies. This retrospective study evaluates survival outcomes in a Western cohort of locally advanced or oligometastatic gastric cancer patients who underwent D2plus lymphadenectomy after neoadjuvant chemotherapy. A total of 97 patients treated between 2010 and 2022 were included. Of these, 62 had clinical stage II/III disease, and 35 had stage IV disease. Most patients (65%) received preoperative DOC/FLOT chemotherapy. The mean number of lymph nodes harvested was 39. Pathological positive nodes in the posterior/para-aortic stations occurred in 17 (17.5%) patients. Lymphovascular invasion, ypN stage, clinical stage, and perineural invasion were predictive factors for positive posterior/para-aortic nodes. Postoperative complications occurred in 21 patients, whereas severe complications (grade III or more) occurred in 9 cases (9.3%). Mortality rate was 1%. Median overall survival (OS) was 59 months (95% CI: 13-106), with a five-year survival rate of 49 ± 6%; the five-year OS after R0 surgery was 60 ± 7%. In patients with positive posterior/para-aortic nodes, the median OS was 15 months (95% CI: 13-18). D2plus lymphadenectomy after chemotherapy for locally advanced or oligometastatic gastric cancer is feasible and associated with low morbidity/mortality rates. The incidence of pathological metastases in posterior/para-aortic nodes is not negligible even after systemic chemotherapy, with poor long-term survival.