Early-stage Gynecologic Cancer Research Articles

Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review.

Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.

Oncological outcomes in geriatric patients with early stage gynecological cancer who underwent surgery and radiotherapy

ABSTRACT
 Background: 
 Evaluation of oncological results obtained with surgery and adjuvant radiotherapy in geriatric patient group with early stage gynecological cancer.
 Methods: 
 31 patients aged 65 years and older who were operated for early stage gynecological cancer and had adjuvant radiotherapy were included in the study. All patients were evaluated in terms of general characteristics, local and systemic treatments, and oncological outcomes.
 Results:
 Percentages of patients diagnosed with endometrium ca and cervix ca are 80.6% and 19.4%, respectively. The median age of the patients was 69 (range, 65-86). All patients underwent total abdominal hysterectomy and bilateral salpingo oophorectomy, followed by adjuvant pelvic radiotherapy. Intracavitary vaginal brachytherapy was applied to 90.3% of the patients. At a median follow-up of 69 months, 3.2% of patients had local recurrence and 3.2% had distant metastases. The five-year DFS and OS rates were 93% and 80%, respectively
 Conclusions:
 Treatment planning in geriatric patient group should be shaped according to prognostic factors, age group and comorbidity. Remarkable oncological results can be obtained with multimodality treatments in the selected patient group.

Concurrent Surgery for Locoregional Gynecologic Cancers and Pelvic Floor Disorders in a Population of Patients With Medicare Insurance.

To estimate the rate of concurrent surgery for locoregional gynecologic cancer and pelvic organ prolapse-urinary incontinence (POP-UI) and to assess the rate of surgery for POP-UI within 5 years for those who did not undergo concurrent surgery. This is a retrospective cohort study. The SEER-Medicare data set was used to identify cases of local or regional endometrial, cervical, and ovarian cancer diagnosed from 2000 to 2017. Patients were followed up for 5 years from diagnosis. We used χ 2 tests to identify categorical variables associated with having a concurrent POP-UI procedure with hysterectomy or within 5 years of hysterectomy. Logistic regression was used to calculate odds ratios and 95% CIs adjusted for variables statistically significant (α=.05) in the univariate analyses. Of 30,862 patients with locoregional gynecologic cancer, only 5.5% underwent concurrent POP-UI surgery. Of those with a preexisting diagnosis related to POP-UI, however, 21.1% had concurrent surgery. Of the patients who had a diagnosis of POP-UI at the time of initial surgery for cancer and who did not undergo concurrent surgery, an additional 5.5% had a second surgery for POP-UI within 5 years. The rate of concurrent surgery remained constant over the time period (5.7% in 2000 and 2017) despite an increase in the frequency of POP-UI diagnosis in the same time frame. The rate of concurrent surgery for patients with an early-stage gynecologic cancer and POP-UI-associated diagnosis in women older than age 65 years was 21.1%. Of women who did not undergo concurrent surgery but had a diagnosis of POP-UI, 1 in 18 underwent surgery for POP-UI within 5 years of their index cancer surgery. Dedicated efforts must be made to identify patients who would most benefit from concurrent cancer and POP-UI surgery in those with locoregional gynecologic cancers and pelvic floor disorders.

A NEw MOdel of individualized and patient-centered follow-up for women with gynecological cancer (the NEMO study)—protocol and rationale of a randomized clinical trial

BackgroundFollow-up programs for gynecological cancer patients are currently under revision. There is limited evidence that traditional follow-up and clinical examinations improve survival in an early-stage gynecological setting. Further, traditional follow-up programs fail to accommodate the patient’s need for psychosocial and sexual supportive care and to actively involve patients and their relatives in the follow-up process. Individualized programs may replace traditional routine follow-up with fixed intervals and length. Focusing on alarm-symptoms and self-reporting may ensure detection of recurrence while allowing a continuous attention to the patient’s well-being and return to daily life.In this study, a nurse-led, individualized, and need-based intervention with a specific focus on patient empowerment is tested against a standard physician-led model primarily focusing on the detection of recurrence.MethodsThe study is designed as a clinical, randomized trial conducted in one of four national onco-gynecological centers in Denmark. Patients with early-stage cervical or endometrial cancer are eligible for inclusion. The intervention group undergoes individualized, nurse-led follow-up supporting patient empowerment including repeated use of electronic patient-reported outcome measures (ePROMs) before each contact as a dialogue support tool. The follow-up contacts are mainly conducted by telephone. All project nurses attended a special training program before project start and are all well-educated and dedicated onco-gynecological nurses. The control group receives standard, physician-led, follow-up without use of ePROMs or specific focus on empowerment.The effect of the intervention is evaluated by questionnaires completed by patients at baseline (3 months after surgery) and 12, 18, and 36 months after surgery. Outcomes include empowerment using the Skill and technique subscale of the HEI-Q questionnaire as the primary outcome while fear of cancer recurrence and health-related quality of life as well as the remaining subscales of the HEI-Q represent secondary outcomes. Data is collected by use of the REDCap technology, which also provides a customized visual support function for the dialogue tool.DiscussionThis study will provide new information about follow-up in early-stage gynecological cancer settings and thereby contribute to improvement of future follow-up programs. Importantly, the study will provide knowledge about the impact of specific focus on patient empowerment in follow-up programs and, further, how to facilitate empowerment among patients.Trial registrationThe study is registered at clinicaltrials.gov: ID no. NCT03838861. Registered on 6 February 2019.Protocol version 2, issue date 21 November 2022.

European Enhanced Recovery After Surgery (ERAS) gynecologic oncology survey: Status of ERAS protocol implementation across Europe.

To acquire a comprehensive assessment of the current status of implementation of Enhanced Recovery After Surgery (ERAS) protocols across Europe. The survey was launched by The European Network of Young Gynecologic Oncologists (ENYGO). A 45-item survey was disseminated online through the European Society of Gynecological Oncology (ESGO) Network database. A total of 116 ESGO centers participated in the survey between December 2020 and June 2021. Overall, 80 (70%) centers reported that ERAS was implemented at their institution: 63% reported a length of stay (LOS) for advanced ovarian cancer surgery between 5 and 7 days; 57 (81%) centers reported a LOS between 2 and 4 days in patients who underwent an early-stage gynecologic cancer surgery. The ERAS items with high reported compliance (>75% "normally-always") included deep vein thrombosis prophylaxis (89%), antibiotic prophylaxis (79%), prevention of hypothermia (55%), and early mobilization (55%). The ERAS items that were poorly adhered to (less than 50%) included early removal of urinary catheter (33%), and avoidance of drains (25%). This survey shows broad implementation of ERAS protocols across Europe; however, a wide variation in adherence to the various ERAS protocol items was reported.

Clinical analysis of 23 cases with simultaneous double primary gynecological malignant tumors

Objective: To investigate the clinicopathological features, diagnosis, treatment and prognosis of simultaneous double primary gynecological malignant tumors. Methods: A total of 23 patients with simultaneous double primary malignant tumors of female reproductive system primarily treated in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 1, 2010 to December 31, 2020 were retrospectively collected. The age, symptoms, tumor stage, tumor type, treatment and prognosis of patients were collected and followed up. Results: (1) The number of patients with gynecological tumors in our hospital increased year by year in the past 11 years. A total of 8 987 patients with gynecological malignant tumors were firstly diagnosed and cured in our hospital, including 3 474 cases of cervical cancer, 3 484 cases of endometrial cancer, 1 329 cases of ovarian malignancies, 171 cases of fallopian tube cancer, 182 cases of uterine sarcoma, 42 cases of vaginal cancer, 192 cases of vulvar cancer, 110 cases of trophoblastic tumor and 3 cases of other gynecological malignancies. The top three cancers were endometrial cancer, cervical cancer and ovarian malignancies. (2) There were 23 patients identified with simultaneous double primary gynecological tumors in the past 11 years, accounting for 0.26% (23/8 987) of female malignant tumors. There were 3 cases of cervical cancer complicated with endometrial cancer, 3 cases of cervical cancer complicated with ovarian cancer, 16 cases of endometrial cancer combined with ovarian cancer, and 1 patient with endometrial cancer combined with fallopian tube cancer. (3) All 23 patients underwent surgical treatment. According to the first diagnosis of the tumor, the surgical methods included cervical cancer radical surgery, endometrial cancer staging surgery and ovarian cancer cytoreductive surgery. After operation, radiotherapy and chemotherapy were supplemented according to the results of pathological examination and tumor staging. (4) The age of 23 patients ranged from 28 to 66 years, with an average age of (49.4±9.7) years. All patients had vaginal bleeding or conscious pelvic mass as their main clinical manifestation. The clinical stage was found in 7 patients (30%, 7/23) with advanced gynecological cancer (stage Ⅲ-Ⅳ), and 16 patients (70%, 16/23) with early stage gynecological cancer (stage Ⅰ-Ⅱ). According to the nonspecific tumor markers, 13 patients (57%, 13/23) had elevated CA125 and CA199. (5) Among the 23 patients, 1 case was uncontrolled and 3 cases recurred during the follow-up period, and the sites of uncontrolled or recurred were all located in the abdominopelvic cavity. Three cases died. Among the 3 patients who died, 1 patient was an uncontrolled patient, whose tumor type was cervical adenosquamous cell carcinoma combined with ovarian clear cell adenocarcinoma. The overall survival time was 19 months with postoperative supplementary radiotherapy and chemotherapy. There were 2 recurrent patients, and the tumor types were endometrioid carcinoma complicated with high-grade serous ovarian carcinoma and ovarian endometrioid carcinoma, respectively. After surgery, all patients received supplementary chemotherapy and recurred 60 and 21 months after surgery, respectively, and the overall survival time was 78 and 28 months, respectively. Another patient recurred 43 months after surgery, and survived with tumor for 14 months after recurrence. The remaining 19 patients were tumor-free and were still being followed up. Conclusions: There are no specific markers for simultaneous double primary gynecological malignant tumors. The most common clinical symptoms are vaginal bleeding or pelvic mass. The treatment principle of simultaneous double primary gynecological malignant tumor is the same as that of single gynecological malignant tumor, but need to be taken into account the characteristics of two tumors. Surgery is the main treatment method, and radiotherapy and chemotherapy play an important auxiliary role. The prognosis of simultaneous double primary gynecological malignancies is related to the late stage of the two malignancies.

Use of methylene blue dye for sentinel lymph node mapping in early-stage gynecological cancers - An option for low resource settings.

Sentinel lymph node (SLN) mapping is a standard of care in gynecological cancers but with limited resources and equipment, intraoperative use of methylene blue for SLN mapping may be more useful. To authenticate the use of methylene blue dye for intraoperative SLN mapping in cases of early-stage gynecological cancers. This pilot study was conducted in a tertiary care teaching hospital. The cases included 14 cervical, 4 endometrial, 1 vulvar, and 1 synchronous cervical-vulvar cancer wherein 21 SLN mappings were done. Four ml of methylene blue was injected submucosally in the cervix in cervical and endometrial cancer. It was injected around the tumor in vulvar cancer. The pelvic lymphatic drainage area was examined in cervical and endometrial cancer while inguinofemoral area was examined in vulvar cancer for any blue LNs. Histopathological examination results were compared for the presence of metastasis in stained and unstained LNs. The observations were presented as numbers and percentages. The SLN mappings showed a detection rate of 76%. The mean number of LNs removed in each case was 10.3 with an average of 2.4 stained and 7.6 unstained LNs. SLN was most commonly found among right external iliac nodes. All stained and unstained nodes among the 16 SLN detections did not show any histological evidence of metastasis suggesting a negative predictive value of 100%. Methylene blue is an efficient, feasible, and safe dye for SLN mapping in early-stage gynecological cancer.

Sexual dysfunction in Thai gynecologic malignancies survivors: A single-institutional cross-sectional observational survey.

To examine the prevalence of female sexual dysfunction (FSD) in gynecologic cancer survivors. A cross-sectional observation survey recruited women aged 18-65 years old who were diagnosed with gynecologic cancers and underwent surgery, radiation, chemotherapy, or combined modalities. Data were collected from September 2019 to March 2020 by the Thai version of the female sexual function index questionnaire to define FSD. The survey contained six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Of the 98 women included in the study, the mean age was 48.7 ± 10.6 years old. Two-third (67.3%) of the participants was premenopausal, had been diagnosed with ovarian cancer, and had early-stage gynecologic cancers. Fifty-eight of 98 (59.2%) participants were sexually active in the past 4 weeks before the survey. Among those, 89.6% had FSD. The median scores in the FSD group were significantly lower than those in the non-FSD group in all six domains, namely, desire, arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05). There was no statistically significant difference observed between participants with and without FSD in terms of age group, cancer-related data, or sexual behavior data, except participants who had good/excellent relationships with their partners, which impacted FSD (p=0.01). This study discovered the high prevalence (89.6%) of hidden issue of "female sexual dysfunction" in Thai gynecologic cancer survivors. The good/excellent relationships with their partners affected the FSD who were sexually active in the past 4 weeks before the survey.

The moderating role of informal caregiver’s involvement on the relationship between patient activation and adherence to treatment: Implications for self-management intervention in cancer care.

12083 Background: With increasing demands for a more active role on the part of individuals with cancer and their families in cancer care, patient activation (PA) is emerging as a key factor to promote self-management, adherence to treatment, and satisfaction with treatment planning. The present work investigated the relationship between patient activation and treatment decision making. Given the role informal caregivers play on patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. Methods: Survey data collected from 504 cancer survivors recruited through online consumer panels were utilized. The survey contained questions concerning treatment options, quality of life, adherence to treatment, next to presence and involvement of informal caregivers. Additionally, the Patient Activation Measure (PAM), sociodemographic and clinical questions were included. A path analysis Structural Equation Modeling (SEM) controlling for covariates was used to examine the relationship between Patient Activation Measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. Results: Respondents were mostly women (57.1%), non-Hispanic white (72.9%), middle aged or older adults (68% ≥ 55 y.o.) The four largest cancer type groups were prostate (16.3%), early stage breast (9.7%), gynecological (8.9%), and colorectal cancer (8.3%). Most of the respondents were diagnosed more than 4 years earlier (52.0%). Participants were evenly split between those who received care at an academic cancer center (29.4%) and those treated at community hospital (31.7%). Patient activation was significantly associated with treatment planning being reflective of survivors ’goals and values ( p &lt; 0.001); adherence to treatment ( p = 0.011); and satisfaction ( p &lt; 0.001). Caregiver’s involvement significantly moderated the association between activation and adherence to treatment. Conclusions: Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver involvement, patient activation was not associated with treatment adherence. Research is needed to deliver and test patient activation interventions inclusive of informal caregivers to improve self-management.

Indocyanine Green-Loaded PLGA Nanoparticles Conjugated with Hyaluronic Acid Improve Target Specificity in Cervical Cancer Tumors.

PurposeIndocyanine green (ICG) is a promising agent for intraoperative visualization of tumor tissues and sentinel lymph nodes in early-stage gynecological cancer. However, it has some limitations, including a short half-life and poor solubility in aqueous solutions. This study aimed to enhance the efficacy of near-infrared (NIR) fluorescence imaging by overcoming the shortcomings of ICG using a nano-drug delivery system and improve target specificity in cervical cancer.Materials and MethodsICG and poly(lactic-co-glycolic acid) (PLGA) conjugated with polyethylenimine (PEI) were assembled to enhance stability. Hyaluronic acid (HA) was coated on PEI-PLGA-ICG nanoparticles to target CD44-positive cancer cells. The manufactured HA-ICG-PLGA nanoparticles (HINPs) were evaluated in vitro and in vivo on cervical cancer cells (SiHa; CD44+) and human dermal cells (ccd986sk; CD44-), respectively, using NIR imaging to compare intracellular uptake and to quantify the fluorescence intensities of cells and tumors.ResultsHINPs were confirmed to have a mean size of 200 nm and a zeta-potential of 33 mV using dynamic light scattering. The stability of the HINPs was confirmed at pH 5.0–8.0. Cytotoxicity assays, intracellular uptake assays, and cervical cancer xenograft models revealed that, compared to free ICG, the HINPs had significantly higher internalization by cervical cancer cells than normal cells (p<0.001) and significantly higher accumulation in tumors (p<0.001) via CD44 receptor-mediated endocytosis.ConclusionThis study demonstrated the successful application of HINPs as nanocarriers for delivering ICG to CD44-positive cervical cancer, with improved efficacy in NIR fluorescence imaging.

Comparisons of emotional health by diagnosis among women with early stage gynecological cancers

ObjectiveTo assess self-reported emotional health in a cohort of women with early stage gynecologic cancers and to explore differences based on primary cancer type. MethodsWe analyzed survey data from a cohort study of gynecological cancer patients treated at an academic cancer center. Measures of emotional health included cancer-related quality of life, distress, depression, anxiety, posttraumatic stress disorder (PTSD), and posttraumatic growth. Univariate and multivariate linear regression models examined differences in emotional health measures by primary cancer site. Potential confounders considered for inclusion in the final models were age, stage, education, income, partner status, treatment status, and race. Results242 patients with early stage disease completed the survey. Patients with cervical and vaginal/vulvar cancers reported greater cancer-related distress, anxiety and PTSD symptoms. Patients with endometrial cancer reported the lowest posttraumatic growth scores, which remained statistically significant after adjustment for demographic and clinical differences. No significant differences in cancer-related quality of life were observed among individuals with different primary cancer sites ConclusionsThese data suggest patients with early-stage gynecologic cancer face different psychosocial sequelae based on primary cancer site, though underlying clinical and sociodemographic factors may play a significant role in this observed relationship. Further research is needed to assess poorer emotional health among individuals with vaginal/vulvar cancers and the lower posttraumatic growth among patients with endometrial cancer as posttraumatic growth is considered a potentially beneficial psychosocial outcome of cancer.

Exploring Attitudes to Conception in Partners and Young Women with Gynecologic Cancers Treated by Fertility Sparing Surgery

Background:Approximately 20% of women with gynecologic cancers are under age 40 and with delayed childbearing, women may be diagnosed before their first pregnancy. Although fertility preservation is a priority for many women, attitudes to conception have not previously been investigated in these patients or their partners. We explored attitudes to conception in partners and young women, following fertility preserving treatment for gynecologic cancers. Methods:A total of 16 telephone interviews were conducted with a purposive sample of patients who had had an early stage gynecologic cancer or borderline ovarian tumor treated by fertility sparing surgery in Western Australia between January 1st, 2005 to December 31st, 2016. The interviews were audio recorded, transcribed and thematic analysis was conducted. Results:Four main themes were identified: (i) Emotions at diagnosis and perception of information given; (ii) Discussions of fertility and factors affecting childbearing; (iii) Role of partners in decision making and relationship pressures; (iv) Decision for treatment and postoperative regrets. Conclusions:Regret and relationship breakdown were commonly reported. Women need appropriate support including inviting their partners to attend clinic appointments and may need several appointments before treatment. Regret was commonly reported by women who opted for completion surgery.

Sentinel Lymph Nodes and Precision Surgery in Gynecologic Cancer.

Besides histologic features, the presence of nodal metastasis is the most crucial prognostic factor for recurrence and survival for patients with gynecologic cancer. Conventionally, lymphadenectomy has been performed routinely to assess lymphatic metastasis. However, lymphadenectomy may be unnecessary in early-stage gynecologic cancer, because the percentage of patients with lymph node involvement is very low. The recent use of sentinel lymph node mapping has provided high feasibility, safety, and accuracy in the assessment of nodal metastasis. The National Comprehensive Cancer Network Clinical Practice Guidelines have incorporated the sentinel lymph node for nodal evaluation in vulvar, endometrial, and cervical cancers.

Differences in quality of life and emotional health by diagnosis among women with early-stage gynecological cancers.

e23180 Background: Psychosocial outcomes have been described in women with gynecological cancers, but potential differences by diagnosis have received less attention. We sought to compare quality of life (QOL) and emotional health among early stage gynecological cancer survivors by disease location. Methods: We present baseline data from an ongoing cohort study of gynecological cancer patients treated at an academic cancer center. Measures include cancer-related QOL, emotional health and negative (post-traumatic stress disorder-PTSD) and positive (post-traumatic growth-PTG) reactions to cancer. Univariate and multivariate linear regression models (restricted to stage I or II; excluding vaginal/vulvar) explored differences in QOL and emotional health by diagnosis. Potential confounders considered for inclusion in the final models were age, stage, education, income, partner status, treatment status, and race. Results: 222 patients with early stage disease completed the survey: 56 (25.2%) ovarian, 122 (55.5) endometrial, 33 cervical (14.9%), and 11 (5%) vaginal/vulvar cancer. Cervical and vaginal/vulvar cancer patients reported greater cancer-related distress, anxiety and PTSD scores (Table). Endometrial cancer patients reported lowest PTG scores. Conclusions: Our analyses suggest early stage gynecological cancer patients face different psychosocial sequelae based on diagnosis, with worse outcomes generally being associated with younger age. Further research is needed to assess low PTG among endometrial cancer patients, since PTG is considered a potentially beneficial psychosocial outcome of cancer. [Table: see text]

Fertility preservation for patients with gynecologic malignancies: The Korean Society for Fertility Preservation clinical guidelines.

Fertility preservation plays a central role in cancer care since an increasingly large number of cancer patients are surviving as a result of improvements in diagnostic and therapeutic strategies. Physicians who take part in the initial diagnosis and management of gynecologic cancer should understand the importance of fertility preservation. Since indications for fertility preservation are limited to early-stage gynecologic cancer, a surgeon must carefully consider each indication. Before performing fertility-sparing surgery, health professionals should compare its oncologic and pregnancy outcomes with those of other standard treatments. Individualized treatment strategies should be delivered depending on the patient's situation, and physicians should provide timely information and appropriate counseling.

悪性腫瘍専門施設における婦人科腹腔鏡下腟式子宮全摘術導入の試み

Purpose: Laparoscopic surgery for endometrial cancer became covered by health insurance in Japan. As laparoscopic surgery for cervical cancer has been included in "advanced medical care", demand for such procedures for patients with early stage gynecological cancer is increasing. At our hospital, which is a public regional cancer center, total laparoscopic hysterectomy (TLH) has been newly introduced. We report on the first five cases treated with this procedure at our hospital.

Morphologic Features Suggestive of Endometriosis in Nondiagnostic Peritoneal Biopsies.

Endometriosis is a common disorder that causes significant morbidity from dysmenorrhea, pelvic pain, and subfertility. Establishment of a definitive diagnosis has important therapeutic implications; however, only approximately 50% of biopsies of laparoscopically suspicious areas provide a diagnosis of endometriosis. Histologic criteria for diagnosis require the presence of endometrial glands or endometrial-type stroma. We hypothesize that other frequently present, but nondiagnostic, histologic features of endometriosis suggest its presence in patients with nondiagnostic peritoneal biopsies. We performed a retrospective clinicopathologic study of morphologic and immunohistochemical features that may improve the histologic diagnosis of endometriosis on laparoscopic peritoneal biopsies. We compared diagnostic (n=88) and nondiagnostic (n=54) peritoneal biopsies from pathologically confirmed endometriosis cases with negative peritoneal biopsies (n=84) from early-stage gynecologic cancer cases. Statistical analysis utilized the Fisher exact test. Multiple morphologic features were significantly increased in nondiagnostic biopsies from patients with endometriosis in comparison with those from negative controls, including foamy macrophages (P=0.0001) and submesothelial stromal clusters (SSCs) (P=0.0008). SSCs ranged from subtle aggregates of spindle cells to nodules of whorled spindle cells with small vessels and extravasated red blood cells resembling stromal endometriosis. Immunohistochemical studies confirmed that ER and CD10-positive SSCs were present in a greater proportion of both nondiagnostic and diagnostic peritoneal biopsies and at a greater number of lesions per biopsy. The overall histologic detection rate of peritoneal biopsies for endometriosis was 62.0%, and inclusion of SSCs with or without foamy macrophages in the diagnostic criteria appreciably increased this rate to between 72.5% and 76.8%. We describe SSCs, which appear to be an early or less developed form of stromal endometriosis, and, when included in the diagnostic criteria, improve the histologic detection rate of endometriosis in peritoneal biopsies.

Clinical outcomes of hysterectomies for benign and malignant etiologies using the NSQIP database

Objectives: To report on the safety, feasibility, and surgicopathologic outcomes of a laparoscopic retroperitoneal approach for aortic (inframesenteric [IM] and infrarenal [IR]) lymphadenectomy in earlystage gynecologic cancers. Methods: We conducted a chart review of 76 patients who underwent comprehensive laparoscopic retroperitoneal lymphadenectomy from the ureter up to the inferior mesenteric artery (IM) and then up to the renal veins (IR). All also underwent pelvic lymphadenectomy from the deep circumflex ileac vein crossing over the external ileac artery to the ureter crossing the common ileac artery (pelvic): 4 by retroperitoneal approach and 72 by transperitoneal approach. Fifty-one patients had clinical stage I or II endometrial carcinoma; 21 had clinically early peritoneal, tubal, or ovarian carcinoma; and 4 had early cervical carcinoma. Results: The mean age was 57 years (range, 31–77 years), and mean body mass index (BMI) was 26 (range, 19–39). Mean duration of entire surgery, including hysterectomy, was 238 min (range, 146– 406 min). Mean estimated blood loss for each entire procedure was 210 mL (range, 25–1500 mL), requiring a mean of 0 transfusions (range, 0–3). Mean hospital stay was 1 day (range, 1–5 days). The mean node yields were: pelvic 14 (range, 1–36), IM 13 (range, 3– 31), IR 14 (range, 1–36), and total from all basins 49 (range, 20–90). Nodal metastases were found in 22% of pelvic, 21% of IM, and 17% of IR node basins. Overall, 31% of patients had positive nodes that affected their postoperative therapeutic decisions. Complications included two conversions to laparotomy for high blood loss and failure to complete and one transection of the left renal artery with saphenous vein interposition by laparotomy. The retroperitoneal approach showed no learning curve, and nodal yields remained high, even in patients with BMIs up to 39. Conclusions: Comprehensive laparoscopic pelvic and retroperitoneal IM and IR aortic lymphadenectomy for early gynecologic carcinoma is safe and readily feasible and may affect staging and treatment decisions in one third of patients. A retroperitoneal approach may be easier to learn and be more effective for larger patients.

Primarily Outcome of Laparoscopic Hysterectomy for Early-Stage Malignant Gynecological Cancer of Unselected Cases in Five Years

Objective: To investigate the feasibility and safety of laparoscopic hysterectomy (LH) in early-stage malignant gynecological cancer. Methods: Data from patients who underwent surgical management for early-stage gynecological cancer between 2009 and 2014 were retrospectively reviewed. Each woman gave her informed consent to be included into the study, which was previously approved by the local ethics committee and Institutional Review Board. Inclusion Criteria: All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of hysterectomy or radical hysterectomy, with or without bilateral salpingo-oophorectomy, with or without para-aortic lymphadenectomy, with or without omentectomy, and peritoneal cytology. Results: 345 patients who underwent laparoscopic surgery (201 cervical cancer cases, 110 endometrial cancer cases and 34 ovarian cancer cases) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The median patient age for early-stage of gynecological cancer was 48 years (range, 29 - 71 years). 87 (25.22%) of whom were elderly (>60 years); 98 (28.41%) were obese (>30 kg/m2); 164 (62.96%) were postmenopausal; 103 (29.86%) had undergone previous abdominal surgery; 96 (25%) had a history of medical disease. The median operative time and estimated blood loss were 3.5 hours (range, 2.5 - 5.5 hour) and 80 mL (20 - 200 mL), respectively. Intra-operative and postoperative complications occurred in 6 (1.74%) and 34 (9.86%). None of the patients occurred death. The interval to bowel movement and indwelling catheter were 3 days (range, 1 - 5 days) and 7 days (range, 5 - 11 days). The median postoperative hospital stay was 10 days (range, 6 - 18 days). The mean operating time and hospital days for cervical cancer was shorter; the estimated blood loss was lower; and the peri-operative complications were lower in the second stage (July 2012-May 2014) than in the first three years (May 2009-June 2012) in our department (p

Quality of life, lifestyle behavior and employment experience: A comparison between young and midlife survivors of gynecology early stage cancers

GoalsTo evaluate differences and changes in quality of life (QoL), lifestyle behavior and employment experience of young in comparison to midlife adults in response to early stage gynecologic cancer diagnoses. Methods263 patients, divided into two age groups (Group A: ≤45 and Group B: >45years), were interviewed on their QoL, lifestyle behavior (dietary habits, tobacco and alcohol use, physical activity) and employment experience (employment status and working time) at diagnosis and within 4years from the treatment. The QoL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) and its specific modules for each cancer type (in particular endometrium, cervix, ovarian and breast). ResultsGlobal health status was significantly different between the two groups. In the younger age group a more relevant cancer interference on family life and social activities and a greater impact on perception of health status have been observed. Young women were more affected by fatigue, constipation, gastrointestinal symptoms, lymphedema, poor body image and impaired sexuality.Cancer diagnosis had a major negative impact on employment of younger patients.Conversely, younger patients had overall better health behavior. They reported a higher daily intake of fruits and vegetables, along with lower alcohol consumption, furthermore they were a little more physically active than midlife adults. ConclusionsTo enhance quality of life and to promote healthy lifestyle behavior of female cancer patients, particularly in younger age, it is essential to assure multidisciplinary approaches with specific medical intervention and psychosocial supports. Indeed, midlife adults seem to have a more rapid adaptive tendency to return towards levels of well-being, following cancer diagnosis and treatment, than younger patients.