Radiation therapy for the gynecologic oncologist.

Updates to post-treatment surveillance after curative intent treatment for patients with gynecologic cancers: A Society of Gynecologic Oncology clinical practice statement.

We aimed to compare the oncological outcomes of patients with bilateral sentinel lymph nodes (SLNs) detection and removed with those who underwent pelvic lymphadenectomy (PLA) in addition to bilateral SLNs removal. This multicenter, retrospective study included cases of endometrioid type, grade I-II endometrial cancer, in which bilateral SLNs were detected and removed. Patients who had only bilateral SLNs detected and removed (group I) and patients who had bilateral SLNs detected and removed and subsequent additional bilateral PLA (group II) were included in the evaluation. In group I (n=216), SLN metastasis rate was 5.5% and in group II (n=251), it was 10.3%. The low-volume disease detection rate was 4.6% in group I and 4.8% in group II. In group II, in patients with SLN macrometastasis had also 28.6% non-SLN macrometastasis. No false-negative results occurred in group II. Recurrence was detected 1.8% in group I and 5% in group II; however, there was no significant difference (p=0.083). Disease-free survival and overall survival, were almost same between the groups (hazard ratio [HR]=2.11; 95% confidence interval [CI]=0.681-6.588; p=0.187) and (HR=1.531; 95% CI=0.392-5.975; p=0.537), respectively. SLN mapping, ultrastaging, and immunohistochemical staining can identify low-volume metastases that may not be identified with classic lymphadenectomy and hematoxylin & eosin staining. It has been observed that adding PLA beyond SLN mapping did not provide an additional positive contribution to survival. For endometriod type grade I-II patients, detection of bilateral SLNs in both hemipelvis only, if detectable, is an adequate approach.

To assess the necessity of restaging surgery for patients with suspected International Federation of Gynecology and Obstetrics (FIGO) stage I-II epithelial ovarian cancer (EOC) following incomplete surgical staging. This multicenter retrospective study evaluated patients with early-stage EOC referred for restaging. These patients were diagnosed with suspected FIGO stage I-II EOC between January 2007 and November 2022 after incomplete surgical staging, and no residual region was confirmed by radiological evaluation. Progression-free survival (PFS) and overall survival (OS) were examined. Among the 173 patients included in the study, 56 were assigned to the no restaging surgery group, and 117 to the restaging surgery group. After restaging, 23 were upstaged to other main stage. However, PFS and OS were not significantly different between the groups, also, dividing the groups into 4 groups who underwent chemotherapy and those who did not also did not show significant differences. In multivariate analysis, histologic grade independently influenced PFS outcomes. While restaging surgery resulted in upstaging in some patients, it was not associated with significant differences in PFS or OS in this retrospective analysis. However, the omission of any additional treatment warrants careful consideration and further discussion. Nevertheless, the observation that patients who did not undergo restaging surgery but received adjuvant chemotherapy did not show significantly different prognoses highlights the need for further research to establish appropriate treatment strategies tailored to diverse patient contexts.

To evaluate the feasibility, safety, and surgical outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy in patients with enlarged uteri due to benign, premalignant, and malignant conditions. Patients who underwent vNOTES hysterectomy at a tertiary gynecologic oncology center were included. Patients with large uteri (>280 g or equivalent to >12-week size) were included regardless of prior cesarean delivery, obesity, nulliparity, or the presence of premalignant or malignant pathology. Demographic data, surgical outcomes, and complication details were analyzed. Complications were classified as minor or major. The cohort consisted of 46 women with a median age of 54 (40-74) years, and median body mass index 31 (21-51) kg/m². A history of previous abdominal surgery was present in 58.7%, and 21.7% (10/46) had previously undergone cesarean section. The median operative time was 56 (35-95) minutes, and the median uterine weight was 410 (280-1036) grams. The overall conversion and complication rates were both 4.3% (n=2). No major complications were observed. Minor complications included intraoperative bleeding controlled without transfusion and postoperative vaginal bleeding managed conservatively. The median hospital stay was 30 (16-72) hours. All patients were discharged without requiring reoperation during the postoperative period. vNOTES hysterectomy was a feasible and safe, minimally invasive approach for patients with enlarged uteri, including those with obesity, prior abdominal surgery, and premalignant or malignant indications. It provides favorable surgical outcomes with low complication and conversion rates. This study supports the use of the vNOTES technique with a broader adoption in patients with large uteri.

BackgroundRecurrent endometrial cancer is still associated with poor survival rates. Daily life factors and comorbidities influence adherence to oncologic treatment. This study provides multicenter real-world data on patients life conditions and tumor’s characteristics, which might contribute to treatment decision-making.Materials and methodsThe study was performed retrospectively in five centers for gynecologic oncology. All patients treated for recurrent endometrial cancer between 2005 and 2022 were included, regardless of whether they received curative or palliative, surgical or medical treatment. Data collection was performed using the RedCap® software (Research Electronic Data Capture).Results In total, 277 patients with recurrent endometrial cancer were included in the study. The median age at time of recurrence was 70 years. 68.3 % of the patients had distant metastases, most of them (41 %) had pulmonary metastases. 63.9% of the patients had pelvic recurrences. 30.7 % of the patients had a second recurrence and 49.6 % of all patients died during the follow-up. 86.3 % of patients died due to endometrial cancer. Polypharmacy as an indicator of frailty was analyzed revealing that 34.2 % of the patients took more than five different drugs per day.ConclusionThe findings of this study indicate that the majority of patients with recurrent endometrial cancer undergo tumor-specific treatment rather than best supportive care. However, in cases of recurrence, the carcinoma itself remains a very frequent cause of death. Considering that a significant number of patients are living independently at the time of diagnosis, this study may contribute to treatment plans that prioritize strategies that enable patients to stay at home and maintain their autonomy.Key messageThe present study suggests that most patients with recurrent endometrial cancer are in relatively good overall health, allowing them to undergo anti-tumor treatment. In general, they live independently and prefer active treatment over best supportive care.

PurposeTo explore the categories of flourishing in patients undergoing postoperative chemotherapy for ovarian cancer and analyse the influencing factors for each category.Patients and MethodsA cross-sectional survey was conducted with 260 patients who underwent postoperative chemotherapy at the gynaecological oncology ward of a tertiary hospital in Shanxi Province between May 2024 and May 2025. Participants completed the General Information Questionnaire, Flourishing Scale, Learned Helplessness Scale, Index of Autonomous Functioning Scale, and Perceived Social Support Scale. Latent profile analysis (LPA) was used to identify the flourishing profiles. Subsequently, univariate and multivariate logistic regression analyses were conducted to examine the factors associated with profile membership.ResultsAmong the 237 patients who completed valid questionnaires (recovery rate: 91.2%), the mean age was 59.48 ± 9.70 years. The LPA revealed three distinct latent categories of flourishing: low flourishing group (38.1%, n = 90), moderate flourishing group (34.2%, n = 80), and high flourishing group (27.7%, n = 67). Illness duration, comorbidity burden, learned helplessness, autonomous functioning, and perceived social support were significant factors influencing latent flourishing profiles (P<0.05).ConclusionSignificant heterogeneity exists in flourishing levels among patients with ovarian cancer undergoing postoperative chemotherapy. Healthcare professionals can tailor interventions based on these distinct flourishing profiles and their key characteristics. This approach aims to promote patient flourishing, thereby improving their quality of life.

Enhanced recovery after surgery (ERAS) represents a global, multidisciplinary surgical quality improvement initiative to improve preoperative, intraoperative, and postoperative patient care with demonstrable economic benefit. In this narrative review, we outline 5 innovative ERAS initiatives, including an improved surgical safety checklist, ongoing advocacy for same-day discharge postoperatively, the role of application-based telehealth in supporting patients after hospital discharge, patient engagement in ERAS protocols and appropriate postoperative opioid prescribing. These innovative strategies are applicable to a broad array of disciplines; however, our focus in this paper is within the fields of gynecology and gynecologic oncology.

Ovarian Cancer is often diagnosed at an advanced stage. Central to treatment is a correct initial assessment and the probability of complete resection of visible cancer. The predictive index value (PIV) is a validated tool for laparoscopic procedures, assessing the chance of complete resection by evaluating 7 intra-abdominal areas. The final PIV determines the type of treatment to which women with ovarian cancer are referred. Gynecologic oncologists perform the procedure and assessment, and agreement and correct staging are essential. This study examines the agreement among gynecologists when assessing videos using the PIV. Laparoscopic videos were collected from October 2021 to January 2024, comprising 20 videos, of which 5 were duplicated. Each video was edited by a gynecologic oncologist, representing the seven intra-abdominal areas according to the PIV model. Eight gynecologic oncologists, eight gynecologists specialized in benign conditions, and eight residents in gynecology were invited to assess the videos using the PIV. The ratings from the participants were examined according to laparoscopic real-time scores. Inter-rater and intra-rater agreement were quantified using kappa statistics. Twenty-one individuals participated in the study. Correct assessment of intra-abdominal areas, that is, agreement with laparoscopic real-time scores, ranged from 58.4% to 81.7%. The probability of correct scores among groups of gynecologists ranged from 34% (95% CI 14.9 to 60.2) to 98.9% (95% CI 95.9 to 99.7), with the highest scores among gynecologic oncologists. The inter-rater agreement of all participants ranged from moderate to substantial agreement (Light κ = 0.436-0.624). For specific intra-abdominal sites, it ranged from fair to perfect agreement (Light κ = 0.181-0.829). Assessing ovarian cancer based on videoclips was challenging, even for specialists in gynecologic oncology, indicating that edited videos reduce accuracy in evaluating disease burden. Gynecologic oncologists achieved the highest scores among all groups, suggesting that specialized training and knowledge improve consistency and that the assessment should remain an expert task.

Reconsidering follow-up care in gynaecologic oncology: A scoping review exploring alternative approaches.

In this review article, we aim to provide a comprehensive update on enhanced recovery after surgery (ERAS) in gynecologic oncology. Specifically, we focus on topics including pelvic exenterations, hyperthermic intraperitoneal chemotherapy, vulvar surgery, optimal intraoperative fluid management, postoperative pain control, and disparities in ERAS care. In addition, we discuss contemporary practice patterns including prehabilitation in the ERAS pathway and smartphone applications for postoperative care in gynecologic oncology patients.

Transperitoneal laparoscopic paraaortic lymphadenectomy in 10 steps.

Health Care Disparities in Gynecologic Oncology.

Updates in Gynecologic Oncology

The effect of a multimodal prehabilitation programme on preoperative physical fitness and nutritional status of women with gynaecological cancer.

Comparison of oncologic outcomes between completion hysterectomy and no completion hysterectomy in patients who achieved complete response and completed childbearing after fertility-sparing treatment for early-stage endometrial cancer: Gynecologic Oncology Research Investigators coLLaborAtion study (GORILLA-3001).

Robotic single-port (da Vinci SP) versus multiport (da Vinci Xi) for the treatment of atypical endometrial hyperplasia and endometrial cancer: A multi-institutional comparison of surgical outcomes.

The diagnosis of endometrial cancer is made by surgical staging. Lymph node dissection (LND) in early-stage endometrial cancer is a controversial issue. Detection of pelvic lymph node metastasis in surgical staging is clinically very important. Metastases are associated with a higher risk of recurrence and highlight the importance of postoperative adjuvant treatments. We aimed to investigate the relationship between pelvic lymph node involvement and endometrial cancer prognostic factors and the predictive value of pelvic lymph node metastasis. The relationship and predictive value of pelvic lymph node metastasis (PLNM) in 275 patients, who underwent hysterectomy, bilateral salpingo-oophorectomy and at least pelvic LND for endometrial cancer in our Gynaecological Oncology Clinic between 2008 and 2021 were investigated. PLNM was present in 31 (11.2%) patients. In univariate analyses, adnexal involvement, perineural involvement, perinodal involvement, cervical stromal involvement, peritoneal and omentum metastasis, cytology positivity, disease stage, Cerb, and CEA positivity were found to be significant with PLNM. PLNM was statistically found to affect 5-year survival (P < 0.01). PLNM was also interpreted as a predictive criterion for paraaortic lymph node metastasis (PALNM). The most significant predictors in multivariate analysis are LVSI, depth of myometrial invasion and PALNM (LVSI P < 0.01, depth of myometrial invasion P < 0.001, PALNM P < 0.001). In this retrospective study, multivariate analyses showed that LVSI and depth of myometrial invasion were independent risk factors for pelvic lymph node involvement. Pelvic lymph node positivity was also a predictive factor for paraaortic lymph node involvement. There is no consensus on the surgical staging of endometrial cancer. Surgical staging therefore serves to identify patients for whom treatment for extrauterine disease is indicated and to avoid overtreatment of the majority of patients with localised disease. Routine paraaortic lymphadenectomy may not be necessary in patients without pelvic LN metastasis.

The Landscape of Personalized Medicine in Gynecologic Cancer.

Distant disease-free survival as a surrogate endpoint for overall survival in randomised trials of neoadjuvant therapy for early breast cancer: a pooled analysis of GBG and AGO-B Study Group trials.