Gynecologic Oncology Service Research Articles

Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial: Correction

Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial: Correction

Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial.

To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding. A sample size of 50 per group (N=100) was planned to achieve 80% power to detect a two-day difference in our primary outcome, length of hospital stay; secondary outcomes included: total daily narcotics used, time to postoperative milestones, and complications. A total of 112 women were enrolled between 2013 and 2015. Nine patients did not undergo laparotomy and were excluded, leaving 52 and 51 patients in the control and intervention groups, respectively. There was no difference in length of stay between the two groups (median 3.0 in both groups; P=.36). Enhanced recovery after surgery patients used less narcotics on day 0 (10.0 compared with 5.5 morphine equivalents in the control and intervention arms, respectively, P=.09) and day 2 (10.0 compared with 7.5 morphine equivalents, respectively; P=.05); however, there was no statistically significant difference between groups in any of the secondary outcomes. Post hoc analysis based on actual anesthesia received also failed to demonstrate a difference in time to discharge. When compared with usual care, introducing a formal enhanced recovery after surgery protocol did not significantly reduce length of stay. ClinicalTrials.gov, https://clinicaltrials.gov, NCT01705288.

Características histopatológicas de las tumoraciones anexiales

Se estima que 1 de cada 10 mujeres tendrá un tumor anexial a lo largo de su vida, la mayoría de las cuales requerirá evaluación quirúrgica. Es prioritario descartar la naturaleza maligna, cuyo riesgo aumenta con la edad. Objetivo: Determinar la frecuencia de las tumoraciones anexiales según edad, localización y malignidad. Diseño: Estudio descriptivo, transversal. Institución: Servicios de Ginecología y Oncología Ginecológica, Hospital Nacional Arzobispo Loayza, Lima, Perú. Material: Registros de histopatología. Métodos: Revisión de los resultados histopatológicos de 876 pacientes operadas en los años 2013 y 2014 con diagnóstico postoperatorio de tumoración anexial; incluyeron piezas quirúrgicas de anexectomía, ooforectomía, histerectomía con anexectomía y tumores paratubáricos y paraováricos. Principales medidas de resultados: Frecuencia, localización y malignidad de las tumoraciones. Resultados: El 73% de las tumoraciones correspondió a patología ovárica, 14% a patología tubárica y 13% a patología paratubàrica. El 7% (61) tuvo naturaleza maligna. De las 482 tumoraciones ováricas benignas, 282 fueron cistoadenomas serosos (67,5%). Los teratomas maduros estuvieron presentes en mujeres con edad media de 32 años. De los 61 casos de neoplasias ováricas malignas, presentes a una edad promedio de 63 años, el 26,2% perteneció al tipo adenocarcinoma seroso papilar. Conclusiones: Los cistoadenomas serosos fueron las tumoraciones anexiales más frecuentes, diagnosticadas en una edad promedio de 42,4 años. Hubo un elevado porcentaje de tumoraciones ováricas no neoplásicas (18,8%). El 7% de las tumoraciones fueron malignas y el tipo más frecuente fue el adenocarcinoma seroso papilar, cuyo diagnóstico ocurrió a una edad promedio de 56 años.

Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial.

Nelson, Gregg MD, PhD; Ramirez, Pedro T. MD; Ljungqvist, Olle MD, PhD; Dowdy, Sean C. MD Author Information

Evaluation of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator in Gynecologic Oncology Patients Undergoing Minimally Invasive Surgery

Study ObjectiveTo evaluate the ability of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator to predict discharge to postacute care and perioperative complications in gynecologic oncology patients undergoing minimally invasive surgery (MIS). DesignA retrospective chart review (Canadian Task Force classification II-1). SettingA university hospital. PatientsAll patients undergoing MIS on the gynecologic oncology service from January 1, 2009, to December 30, 2013. InterventionsSurgical procedures were reviewed, and appropriate Common Procedural Terminology codes were assigned. Twenty-one preoperative risk factors were abstracted from the chart and entered into the ACS NSQIP surgical risk calculator. The predicted risk of discharge to postacute care and 8 additional postoperative complications were calculated and recorded. Actual postoperative complications were abstracted from the medical record. The association between the calculated risk and the actual outcome was determined using logistic regression. The ability of the calculator to accurately predict a particular event was assessed using the c-statistic and Brier score. Measurements and Main ResultsOf the 876 patients reviewed, a majority underwent hysterectomy (71.6%), with almost half of those patients undergoing additional cancer staging procedures (34.8%). Although the calculator was a poor predictor of postoperative complications, it was a strong predictor for discharge to postacute care (c-statistic = 0.91, Brier score = 0.02) with an odds ratio of 2.31 (95% confidence interval, 1.65–3.25; p < .0001). ConclusionThe ACS NSQIP surgical risk calculator does not accurately predict postoperative complications or length of stay in gynecologic oncology patients undergoing MIS. Although it was a strong predictor of need for discharge to postacute care, it vastly overestimated the number of patients requiring this service. Therefore, the calculator's risk score for discharge to postacute care may be considered during preoperative counseling but should not be a predictor of whether or not the patient should proceed with surgery.

Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology

ObjectivesThirty-day readmission is used as a quality measure for patient care and Medicare-based hospital reimbursement. The primary study objective was to describe the 30-day readmission rate to an academic gynecologic oncology service. Secondary objectives were to identify risk factors and costs related to readmission. MethodsThis was a retrospective, concurrent cohort study of all surgical admissions to an academic, high volume gynecologic oncology service during a two-year period (2013–2014). Data were collected on patient demographics, medical comorbidities, psychosocial risk factors, and results from a hospital discharge screening survey. Mixed logistic regression was used to identify factors associated with 30-day readmission and costs of readmission were assessed. ResultsDuring the two-year study period, 1605 women underwent an index surgical admission. Among this population, a total of 177 readmissions (11.0%) in 135 unique patients occurred. In a surgical subpopulation with >1 night stay, a readmission rate of 20.9% was observed. The mean interval to readmission was 11.8days (SD 10.7) and mean length of readmission stay was 5.1days (SD 5.0). Factors associated with readmission included radical surgery for ovarian cancer (OR 2.87) or cervical cancer (OR 4.33), creation of an ostomy (OR 11.44), a Charlson score of ≥5 (OR 2.15), a language barrier (OR 3.36), a median household income in the lowest quartile (OR 6.49), and a positive discharge screen (OR 2.85). The mean cost per readmission was $25,416 (SD $26,736), with the highest costs associated with gastrointestinal complications at $32,432 (SD $32,148). The total readmission-related costs during the study period were $4,523,959. ConclusionsReadmissions to a high volume gynecologic oncology service were costly and related to radical surgery for ovarian and cervical cancer as well as to medical, socioeconomic and psychosocial patient variables. These data may inform interventional studies aimed at decreasing unplanned readmissions in gynecologic oncology surgical populations.

Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service

ObjectiveIn 2014, our hospital implemented an early warning score (EWS) to identify inpatients at risk for clinical deterioration. EWS≥8 is associated with ≥10% mortality in medical admissions. Since postoperative hemodynamic changes may alter EWS, we evaluated EWS in post-laparotomy patients. MethodsGynecologic oncology patients admitted for laparotomy from 9/1/2014 to 7/31/2015 were categorized by highest EWS during admission: <5, 5–7, and ≥8. The primary outcome was a composite including death, ICU transfer, rapid response team activation, pulmonary embolus, sepsis, and reoperation. For patients with the composite, highest EWS prior to that outcome was evaluated. Secondary outcomes were length of stay (LOS), readmission, and transfusion. Groups were compared using chi-square test for trend, analysis of variance, and Kruskal-Wallis tests. A receiver operating characteristic (ROC) curve estimated the association between EWS and the composite outcome. Results411 patients were included: 217 (52.8%) with EWS<5, 151 (36.7%) with EWS 5–7, and 43 (10.5%) with EWS≥8. The composite occurred in 32.6% of patients with EWS≥8, 7.3% with EWS 5–7, and 0% with EWS<5 (p<0.01). EWS≥8 was associated with longer LOS, higher readmission rate, and more transfusions. For the composite, the area under the ROC curve was 0.89 (95% CI 0.84–0.94). EWS≥5 had 100% sensitivity and 56.2% specificity for the primary outcome; EWS≥8 had 56.0% sensitivity and 92.5% specificity for the primary outcome. ConclusionsEWS≥5 after laparotomy is associated with adverse outcomes. Future studies should evaluate the ability of EWS to predict and prevent these outcomes.

Post-intensive care unit syndrome in gynecologic oncology patients

The purposes of the present study are to describe the demographic and treatment characteristics of women on the gynecologic oncology service who required intensive care and assess prevalence of risk factors for post-intensive care syndrome (PICS). A retrospective chart review was performed encompassing patients requiring admission to the intensive care unit (ICU) on the gynecology oncology service between 1/2008 and 12/2012. Descriptive statistics were computed using SAS version 9.3. One hundred eleven patients met study criteria. Most were Caucasian (85%), were married (50%), and had stage III/IV disease (82%). Risk factors for PICS were as follows: 9% had baseline anxiety, 20% had baseline depression, 21% were taking an SSRI prior to admission, and 18% took other psychiatric medications. Most ICU admissions (47%) were for planned post-operative management. Thirty-seven percent required mechanical ventilation for a median of 1day (range, 1-24). Twenty percent required new scheduled psychiatric medications while in the ICU, and 8.1% of patients were discharged with a newly prescribed antidepressant. Of patients, 15.3% had consultations with psychiatry or social work. Six percent of patients expired, and 18% had a nontraditional discharge disposition. Overall, 60% of the patients had at least one recognized risk factor for PICS. Given the preponderance of psychiatric disorders and mechanical ventilation during post-operative ICU care in patients with gynecologic cancer, prospective evaluation of risk factors and utility of risk-reducing interventions for PICS is warranted. Long-term cognitive or physical disability is known to hasten mortality; thus, preventative strategies may increase the survival and quality of life for this patient population.

Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service

Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service

A Rare Case of Spontaneous Rupture of Endometrial Stromal Sarcoma Resulting in Acute Hemoperitoneum

Abstract Background: The majority of articles in the literature reporting on uterine sarcomas have focused on leiomysosarcomas. This report highlights the rare manifestation of the only reported endometrial stromal sarcoma (ESS) rupture resulting in spontaneous hemoperitoneum in a patient with suspected uterine leiomyomata. Case: A 70-year-old female presented as a referral for management of suspected large uterine leiomyomata. Prior to surgical intervention, the patient experienced spontaneous rupture of an undiagnosed sarcoma. Results: The patient underwent emergent hysterectomy, and, on postoperative day 6, she was discharged to home. Histopathologic examination was remarkable for a ruptured 18.5 × 12.8 × 10.5–cm ESS with vascular invasion. She remained stable postoperatively and is under the care of the gynecology–oncology service. Conclusions: The prognosis of ESS, in comparison with leiomyosarcoma, is better; however, in the setting of tumor rupture, ESS can be equally fatal. When evaluating uterine...

Unplanned 30-day readmission rates as a quality measure: Risk factors and costs of readmission to a gynecologic oncology service

Unplanned 30-day readmission rates as a quality measure: Risk factors and costs of readmission to a gynecologic oncology service

The impact of hyperglycemic intensity on postoperative outcomes for a gynecologic oncology service: A cohort study

The impact of hyperglycemic intensity on postoperative outcomes for a gynecologic oncology service: A cohort study

Incisional hernia formation and associated risk factors on a gynecologic oncology service: an exploratory analysis.

The aim of this study is to identify the rate of incisional hernias and associated risk factors following a vertical midline laparotomy on a gynecologic oncology service. This is a retrospective cohort study of patients that underwent a laparotomy through a vertical midline abdominal incision between September 1998 and November 2012. Hernias and various factors were identified including demographics, disease comorbidities, intraoperative variables, and suture technique. Assessment of association with hernia formation was performed using Cox regression and log-rank test. Two hundred and fifty-two patients with follow-up of at least 30days were identified. Mean age was 59years (range 21-88years) and mean BMI was 35.9kg/m(2)(range 17.2-84.4kg/m(2)). Sixteen (6.3%) developed incisional hernias with a median follow-up of 1.7years (range 1month to 13years). The estimate of the 5-year probability of being hernia-free is 86% (95% CI 76.5-91.9). Average age of patients who developed a hernia was 66.2years while average age of those without hernia was 58years (p<0.05). There was a significant association of hypertension with incisional hernia occurrence (p=0.0035, log-rank test). Cancer was present in 100% of patients that developed hernias and 73% (172/236) of those that were hernia-free (p=0.0041, log-rank test). By univariate analysis the risk of developing an incisional hernia was higher, if the abdominal fascia was closed with loop sutures (HR 4.6, 95% CI 1.49-13.94; p=0.008). By multivariable analysis incisions closed with loop suture had more than a fivefold increased risk of developing a hernia (HR 5.2, 95% CI 1.65-16.39; p=0.005). Presence of both hypertension and utilization of loop sutures had the highest risk of incisional hernia development (HR 7.1, 95% CI 2.28-22.4; p=0.001). Wound complications including incisional hernias contribute to morbidity in gynecologic oncology patients. Older age, hypertension, utilization of loop sutures, and cancer were found to be associated with hernia formation after laparotomy through a vertical midline abdominal incision. The use of loop sutures to close the abdominal fascia should be investigated further.

Laparoscopic fertility-sparing surgery for early ovarian epithelial cancer: A multi-institutional experience

ObjectiveThere is as yet limited evidence about fertility-sparing surgery for early ovarian cancer (EOC) carried out laparoscopically. We sought to investigate the safety, adequacy and fertility outcome of ovarian cancer patients who underwent fertility-saving laparoscopic surgical staging using a multi-institutional sample. MethodsProspectively collected data in five gynecologic oncology service databases were searched for epithelial EOC patients undergoing laparoscopic fertility-preserving surgery. Surgical, pathologic, oncologic and reproductive outcome data were analysed. ResultsThe study cohort consisted of 65 women. Median age of the patients was 33 (range: 21–42) years. In this cohort 36 (55.4%) and 29 (44.6%) patients were at low risk (FIGO stage IA G1–2) and high-risk (FIGO stage IA G3 or more), respectively. The disease was reclassified to a higher stage in 4 (6.1%) women. After a median follow up period of 38months (range: 2–144), the overall survival was 95.4% and recurrence-free survival 84.6%. Overall, there were 23 pregnancies in 22 women. After ovarian cancer treatment, 64.8% women reported pregnancy intent and 60% of these conceived spontaneously. ConclusionsLaparoscopic staging may represent a viable option for premenopausal women seeking fertility preservation in the setting of early ovarian cancer. More research is needed to determine whether laparoscopy may offer reproductive benefits to this particular population.

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients.

Background: Laboratory blood testing incurs financial costs and the blood draws can increase discomfort, yet minimal data exists regarding routine testing in gynecologic oncology surgical patients. Additionally, an increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. An increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. Objective: The aims of this study were (1) to evaluate the frequency and etiology of perioperative laboratory test abnormalities in patients undergoing laparoscopic and laparotomy surgery in a gynecologic oncology service, and (2) to establish an evidence-based algorithm to reduce unnecessary laboratory testing. Materials and Methods: A single-institution retrospective study was completed, investigating laparoscopic and laparotomic surgeries over 4 years. Information on preoperative and postoperative laboratory data, surgical parameters, perioperative interventions, and patient demographics was collected. Quality-assurance data were reviewed. Data were tabulated and analyzed using Statistical Product and Service Solutions (SPSS) version 22. A Student's t-test was used to test for group differences for continuous variables with equal variance, the Mann-Whitney–U test for continuous variables when unequal variance was detected, and Pearson's χ2 was used to investigate categorical variables of interest. p-Values <0.05 were considered to be statistically significant. Logistic regression was performed to investigate the relationships among multiple predictors and each identified outcome. Results: The study included 481 subjects (168 laparoscopies, 313 laparotomies). Patients undergoing laparoscopy were, on average, younger (53.5 versus 57.4), with lower body mass indexes (29.7 versus 33.0) and lower rates of diabetes (10.7% versus 19.5%), compared to patients undergoing laparotomy. Overall, >98% of patients underwent at least one preoperative and postoperative laboratory test, totaling 8060 preoperative and 5784 postoperative results. The laparoscopy group was significantly less likely to have postoperative metabolic abnormalities or to undergo perioperative blood transfusion. Patients taking an angiotensin-converting-enzyme inhibitor, angiotensin-II–receptor blocker, or diuretic were significantly more likely to have elevated creatinine preoperatively (odds ratio [OR]: 5.0; p < 0.001) and postoperatively (OR: 7.1; p < 0.001), and this remained true for each group when divided by surgical approach. Perioperative complications meeting institutional quality assurance criteria occurred in 1.7% of laparoscopy patients compared to 11.8% of laparotomy patients (p < 0.001); perioperative laboratory testing was not a factor in the diagnosis of these complications. Conclusions: Clinically significant laboratory abnormalities are uncommon and are less likely to be found on routine perioperative testing in gynecologic oncology patients undergoing laparoscopy, compared to patients undergoing laparotomy. This suggests a role for limiting perioperative laboratory blood testing. (J GYNECOL SURG 32:111)

HrHPV positivity in ASC-US Papanicolaou tests from women with treated HPV- and non-HPV-related gynecologic malignancies

Although the utility of high-risk human papillomavirus (hrHPV) testing is established in the triage of ASC-US Papanicolaou tests from the general population, its role in women who have been treated for cervical cancer and other HPV-related cancers is less clear. Records of patients with ASC-US Papanicolaou tests and HPV testing results submitted by our gynecologic oncology service with a history of malignancy between 2006 and 2012 were reviewed. Thirty-nine women with a history of treatment for HPV-related cancer and ASC-US Papanicolaou tests who had undergone hrHPV testing were identified. hrHPV was detected in the in specimens from 12 of the 39 patients. Among the 12 patients with ASC-US/hrHPV+ Papanicolaou tests, 2 had a subsequent Papanicolaou test with high-grade squamous intraepithelial lesion (HSIL) and 1 had a cervical biopsy that showed invasive squamous cell carcinoma. Among the 27 patients with ASC-US/hrHPV- Papanicolaou tests with pathologic follow-up, none had HSIL or worse. In patients with treated non-HPV-related cancers, hrHPV was detected in cervical/vaginal cytology specimens from 11 of 47 patients. Of 11 patients with ASCUS/hrHPV+ Papanicolaou tests, 1 had an HSIL Papanicolaou test and a negative vaginal biopsy within 18 months. None of the 36 patients with ASC-US/hrHPV- Papanicolaou tests had HSIL or worse on follow-up. The rates of hrHPV positivity in ASC-US Papanicolaou tests from women treated for both HPV-related (31%) and non-HPV-related (23%) gynecologic malignancies were similar to those reported in women older than 45 years. hrHPV testing identified all women with ASC-US Papanicolaou tests who subsequently developed HSIL or worse.

18: Unplanned thirty-day readmission rates as a quality measure: Risk factors and costs of readmission on a gynecologic oncology service

18: Unplanned thirty-day readmission rates as a quality measure: Risk factors and costs of readmission on a gynecologic oncology service

Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy

ObjectiveThe objective of this study was to evaluate the ability of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator to predict complications in gynecologic oncology patients undergoing laparotomy. MethodsA chart review of patients who underwent laparotomy on the gynecologic oncology service at a single academic hospital from January 2009 to December 2013 was performed. Preoperative variables were abstracted and NSQIP surgical risk scores were calculated. The risk of any complication, serious complication, death, urinary tract infection, venous thromboembolism, cardiac event, renal complication, pneumonia and surgical site infection were correlated with actual patient outcomes using logistic regression. The c-statistic and Brier score were used to calculate the prediction capability of the risk calculator. ResultsOf the 1094 patients reviewed, the majority were <65years old (70.9%), independent (95.2%), ASA class 1–2 (67.3%), and overweight or obese (76.1%). Higher calculated risk scores were associated with an increased risk of the actual complication occurring for all events (p<0.05). The calculator performed best for predicting death (c-statistic=0.851, Brier=0.008), renal failure (c-statistic=0.752, Brier=0.015) and cardiac complications (c-statistic=0.708, Brier=0.011). The calculator did not accurately predict most complications. ConclusionsThe NSQIP surgical risk calculator adequately predicts specific serious complications, such as postoperative death and cardiac complications. However, the overall performance of the calculator was worse for gynecologic oncology patients than reported in general surgery patients. A tailored prediction model may be needed for this patient population.

Management of Incidental Adenoma Malignum of the Cervix: A Case Report

Background: Minimal deviation adenocarcinoma (MDA, also reported as Adenoma Malignum) of the cervix is a rare variant of cervical carcinoma. It is thought to represent about 1% to 3% of all cervical adenocarcinomas. The symptoms can be multifarious and aspecific, however the most peculiar and recurrent is a persistent watery-mucoid vaginal discharge. Because of the symptoms, patients are often referred to a general gynecologist and invariably further examinations are carried out, but not always a precise diagnosis is obtained. Thus, the patients are usually candidated for a surgical non-conservative treatment, mainly to relief the symptoms. Albeit its rareity this cancer is highly aggressive, hence the need for oncologically appropriate approach. Since extremely low incidence of this cancer the majority of general gynecologist will fail in recognise “hints symptoms” and therefore cannot offer a correct treatment. Case presentation: We present a case of a caucasian patient, aged 45 years old, multipara and with profused watery vaginal discharge since half an year. According to anamnestic fitting, gynecological examinations were negative and a recent pap smear was reported as negative. Ultrasound scans described few cysts compatible with Nabothian cysts within an otherwise normal uterus and cervix. MRI of the pelvis confirmed the presence of the cystic morphology of the cervix. In view of the persistent symptomatology without a raised suspect of malignancy, the patient underwent an extrafascial hysterectomy and consensual bilateral salpingooophorectomy because of her age. Histopathology reported differential diagnosis among lobular endocervical glandular hyperplasia versus adenoma Malignum of the cervix. Patient has been therefore referred to the Gynecological Oncology service at our hospital. Histopathology review confirmed MDA of the cervix with a maximum size of 23 mm, negative margins and without lymph-vascular invasion. Multidisciplinary Tumor Board suggested two equivalent options for appropriate treatment: adjuvant external beam radiotherapy of the pelvis with vaginal brachytherapy versus robotic bilateral parametrectomy and lymphnodal pelvic dissection for a proper staging. Further surgical approach has been performed and histopathology confirmed a stage FIGO Ib1. Patient has been therefore sent for routine follow-up and after 10 months she is cancer free. Conclusion: Referring to tertiary hospitals a rare malignancy as MDA for primary treatment is the best practise. However even in case of incidental finding or misdiagnosis, an early and timely referring can hopefully reduce errors and morbidity in the primary treatment.

Promising Tumor Remission After Immunotherapy for Late Relapse of Locally Advanced Cervical Adenocarcinoma Revealed by [18F] Fluoro-2-Deoxy-DGlucose Positron Emission Tomography

The prognosis of patients with metastatic cervical cancer is poor, with a median survival of 8-13 months. Treatment with chemotherapeutic drugs alone is rarely curative. In the past few years, the development of immunotherapy, targeted therapy, angiogenesis inhibitors, and tyrosine kinase inhibitors has provided better treatment choices for patients with metastatic cervical cancer. A 52-year-old woman was diagnosed on July 2001, with locally advanced adenocarcinoma of cervix, stage IIb. She underwent concurrent chemoradiotherapy resulting in complete remission for over 10 years. Unfortunately, she was found to have a late relapse of cervical adenocarcinoma with liver metastases (segments 7 and 8) on June 2013. She underwent segmental hepatectomy and cholecystectomy and was transferred to our gynecologic oncology service for standard chemotherapy with immunotherapy based on her immune risk profile (IRP). Immunomodulatory agents, including picibanil (OK-432), interferon-alpha, celecoxib (cyclooxygenase-2 inhibitor), thymalfasin, and aldesleukin (IL-2) were given. Approximately 20 months later, spleen metastasis was suspected by [18F] fluoro-2-deoxy-D-glucose positron emission tomography. The patient underwent gasless laparoscopic intraperitoneal treatment with immunomodulatory agent celecoxib (cyclooxygenase-2 inhibitor) and intraperitoneal immunoviral therapy to create host immunosurveillance for consolidation therapy. Three months later, there was complete remission of the metastatic splenic nodule on repeat imaging. Our case demonstrates the dramatic promise of immunomodulatory therapy to induce complete remission of a metastatic cancer nodule. This case suggests the potential value of immunotherapy to augment host immunosurveillance to improve survival of metastatic cervical cancer.