Para-aortic Lymphadenectomy Research Articles

Localized endometrioid cancer in the abdominal wall with synchronous early-stage endometrial cancer

Presented herein is the only case in literature with the synchronous development of endometrioid-type endometrium cancer and endometrioid carcinoma originating from the endometriosis foci in a scar tissue. A 44-year-old female patient presented with complaints of abnormal uterine bleeding, swelling at the rectus muscle level in the abdominal wall, and cyclic pain close to the old cesarean section incision scar. Pathological findings of the rectus muscle and endometrial biopsies revealed endometrioid adenocarcinoma (grades 2 and 1, respectively). Positron emission tomography, performed for primary focus investigation, revealed pathologic fluorodeoxyglucose uptake in the uterine cavity and biopsy site, consistent with residual tumor without any pathologic uptake elsewhere. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic and para-aortic lymphadenectomy, and the residual tumor in the left rectus muscle was excised. The patient was followed up for 3 years. At a postoperative follow-up in the 4th year, no relapsed tumor or metastasis was seen on imaging.

Left Retroaortic Renal Vein and Superior Mesenteric Artery Vascular Lesion Risk

To highlight the importance of preoperative assessment of imaging studies to rule out vascular abnormalities involving high bleeding risk in para-aortic lymphadenectomy for gynecological cancer.

Place du ganglion sentinelle dans la prise en charge du cancer de l’ovaire de stade précoce : revue de la littérature

The initial management of early-stage ovarian cancer consists of staging surgery including pelvic and para-aortic lymphadenectomy. The use of the sentinel lymph node (SLN) procedure in this setting may decrease the morbidity associated with this surgery. The objective of this review was to evaluate the feasibility of the SLN procedure in ovarian cancer diagnosed at an early stage by comparing the different techniques used and their accuracy.A systematic literature search was performed on PubMed and ClinicalTrials.gov for articles in English or French about the SLN technique in ovarian cancer.Ten studies were included in the analysis, with a total of 179 patients. The main tracers used were Technetium-99m, indocyanine green, and patent blue, and the most common site of injection was the proper ovarian and unfundibulopelvic ligaments. The overall detection rate was 87.7%. Of the small number of cases of lymph node metastasis reported, the SLN procedure had a sensitivity of 90.9% and a negative predictive value of 98.8%.The sentinel node procedure appears to be feasible and safe and could be reliable in determining the lymph node status of patients with early-stage ovarian cancer.

Uterine Carcinosarcoma after Prolonged Antiestrogenic Therapy-Pathohistological Characteristics, Immunohistichemical Analysis, Prognosis and Complex Treatment: A case report with literature review

Uterine carcinosarcoma (UCS) is a rare aggressive neoplasm.We present a clinical case with UCS, developed during along-term five years adjuvant tamoxifen treatment and ovarian suppression with LHRH agonist on the occasion of invasive ductal breast carcinoma. Crucial for obtaining diagnosis of this rare aggressive neoplasm is the strict pathohistological and immunohistochemical analysis, carried out by an experienced pathologist. Every patient with a history of breast carcinoma is a subject for periodic monitoring. Genital bleeding is required to perform a separated endometrial abrasion with a precise histological study. For UCS / III C2 FIGO stage without distant metastases is necessary to conduct a maximal surgical tumor reduction, involving ever total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy, followed by a combined simultaneous chemo-radiotherapy of tumor bed and pelvic lymph nodes, definitive radiotherapy of para-aortical lymph nodes, as well as adjuvant chemotherapy.

Para-aortic lymphadenectomy: step by step surgical education video

Para-aortic lymph nodes are exclusively important for the staging of gynecologic malignancies. This surgical education video describes the step-by-step technique for para-aortic lymphadenectomy with anatomic landmarks in a cadaver.

Para-aortic lymph nodes and ductal adenocarcinoma of the pancreas: Distant neighbors?

BackgroundPara-aortic lymph nodes in the ductal adenocarcinoma of the pancreatic head are regarded as distant metastases. Chemotherapy is considered the only treatment option if para-aortic lymph nodes metastases are detected preoperatively or intraoperatively. The role of standardized para-aortic lymph node lymphadenectomy during pancreaticoduodenectomy remains controversial. The aim of this study was to evaluate complication profiles and survival. MethodsAll cases of ductal adenocarcinoma of the pancreatic head were evaluated from a prospectively maintained database (n = 289). Para-aortic lymph node lymphadenectomy was routinely performed in all patients with suspected ductal adenocarcinoma of the pancreatic head. Subgroup analysis was performed between patients with histologically positive (+) and negative (-) para-aortic lymph nodes. Patients receiving pancreaticoduodenectomy without para-aortic lymph node lymphadenectomy for other causes served as a control group. ResultsA total of 192 patients received para-aortic lymph node lymphadenectomy, of which 41 were positive for para-aortic lymph node metastases. In 97 patients with ductal adenocarcinoma of the pancreatic head, no para-aortic lymph node lymphadenectomy was performed owing to postoperative pancreatic ductal adenocarcinoma diagnosis. Clinicopathologic data were homogenously distributed. Hospital stay and postoperative morbidity demonstrated no significant difference between the 3 subgroups. The median overall survival of 19.63 months (95% confidence interval: 14.57–24.79 months) in para-aortic lymph node– patients was not statistically different when compared with the median overall survival of 18.22 months (95% confidence interval: 12.68–23.75 months) in para-aortic lymph node + patients (log-rank test P = .223). Preoperative computed tomography was a poor predictor for para-aortic lymph node status (sensitivity = 10.3%, specificity = 97.8%). ConclusionThis study represents the largest cohort receiving routine para-aortic lymph node lymphadenectomy. Extended lymphadenectomy can be performed safely and, although disease-free survival of para-aortic lymph node+ patients was significantly shorter, overall survival and postrelapse survival were on par with that of para-aortic lymph node– patients. Preoperative computed tomography indicating para-aortic lymph node metastasis should not preclude curative resection.

What is the impact of corpus uterine invasion on oncologic outcomes in surgically treated cervical cancer?

To investigate the clinical significance of uterine corpus involvement in patients with surgically treated cervical cancer. Patients (n=354) with clinical early-stage (stage IB1-IIA2) cervical cancer who underwent radical hysterectomy and pelvic ± paraaortic lymphadenectomy were evaluated. Uterine invasion was detected in 60 (16.9%) patients. Patients with uterine invasion had a higher rate of pelvic lymph node metastasis than those without uterine invasion (35% vs 22.8%, p=0.046). In multivariate analysis, no statistically significant difference was identified between patients with and without uterine invasion for pelvic lymph node metastasis (p=0.953). Uterine invasion was identified as an independent risk factor for paraaortic lymph node metastasis in multivariate analysis (p=0.012). The presence of pelvic lymph node metastasis was found to be another significant predictor of paraaortic lymph node involvement (p=0.022). In addition, uterine invasion and lymph node metastasis were identified as an independent risk factors regarding poor prognosis in cancer-specific survival (hazard ratio [HR]: 4.537; 95% confidence interval [CI], 1.304-15.782; p=0.017 and HR: 5.598; 95% CI, 1.581-19.823; p=0.008, respectively). Uterine invasion is an independent predictor of decreased survival and the presence of paraaortic lymph node metastasis in cervical cancer. The presence of the uterine invasion in cervical cancer should be considered as a poor prognostic factor in the decision of treatment.

Sentinel Lymph Node Mapping in Early Stage Endometrial Cancer Patients in Low-Resource Settings

Background: Lymph node status has a prognostic role in endometrial cancer patients and it determines the adjuvant therapy to be administered postoperatively. Complete lymphadenectomy carries the risk of serious complications. Sentinel Lymph Node mapping (SLN) may be a good option to reduce these complications. Cervical injection of methylene blue may be a suitable technique for SLN mapping, which can be applied in low-resource institutes. Objective: Assessment of the detection rate, sensitivity and false negative rate of SLN mapping using cervical injection of methylene blue. Methods: A total of 76 patients with early stage endometrial cancer were included. Methylene blue was injected into the cervix prior to surgery and open surgical approach was used. SLNs were detected by direct visualization of stained lymph nodes after opening of pelvic spaces. SLNs were excised and pelvic lymphadenectomy was performed. Para-aortic lymphadenectomy was performed when indicated and surgically feasible. Specimens were examined by H&E staining. Results: The SLN detection rate was 47.4% and all detected SLNs were pelvic nodes. All patients with lymph node metastasis had metastatic disease in their SLNs. The technique had 100% sensitivity, 100% negative predictive value and a 0% false-negative rate. An inverse relationship between SLN detection and BMI was detected. Conclusion: Cervical injection of methylene blue dye with an open approach to detect SLNs in patients with early stage endometrial cancer has a low detection rate. The most important factor associated with failed mapping is increased BMI. Further trials are needed to investigate the usefulness of this technique.

Impact of lymphadenectomy and intraoperative tumor rupture on survival in early-stage mucinous ovarian cancers

<h3>Objectives:</h3> Mucinous ovarian carcinoma (MOC) is a rare subtype of epithelial ovarian cancer and often presents a management conundrum. The aim of the study was to investigate the prognostic significance of lymphadenectomy and intraoperative rupture on patient survival. <h3>Methods:</h3> We conducted a retrospective cohort study of all MOCs diagnosed between 1999 and 2019 at two tertiary care cancer centers. Pathology was reviewed to rule out cases with metastasis from gastrointestinal tract primary. Baseline demographics, surgical management details, and outcomes were collected. Five-year overall survival (OS) and recurrence free survival (RFS) were calculated from Kaplan-Meier curves and comparisons made using log-rank test. Cox proportional hazard models were used to determine the association of lymphadenectomy and intraoperative rupture on survival. <h3>Results:</h3> A total of 170 women with MOC were identified, of which 149 (88%) had apparent stage I disease upon presentation. Median age was 49, (IQR 33-58) and the majority presented with low-grade unilateral ovarian masses (grade 1; 71%) with median size of 20.5cm (IQR 16-28) and had a five-year OS of 88.9% (82.9-95.3%) and RFS of 82.7% (75.7-90.3%). Forty-eight (32%; N=149) patients had a pelvic and/or para-aortic lymphadenectomy, but only 1 patient with grade 2 disease was upstaged due to positive pelvic lymph nodes. Omentectomy was carried out in 128 (86%) patients, and 2 patients with grade 2 disease were upstaged due to microscopic omental disease (1.6%). Intraoperative rupture was documented in 52 cases (35%); these were more likely to have initial surgery performed by a non-gynecologic oncologist (48% vs 11%; p<0.001). At final pathology, 137 had stage I (92%), 5 stage II (3%), 6 stage III (4%) and 1 stage IV (1%) disease. Fifteen patients (10%) received adjuvant chemotherapy; there was no significant difference in the rate of adjuvant therapy between those with or without intraoperative rupture (p=0.39). There were 20 recurrences in the cohort (13%; 9 grade 1, 6 grade 2, 4 grade 3), with the vast majority peritoneal (95%). On multivariable analysis, after adjusting for age, final stage, and use of adjuvant chemotherapy, there was no significant association between intraoperative rupture with OS (HR 2.2 (0.6-8.0), p=0.25) or RFS (HR 1.3 (0.5-3.3), p=0.63) or lymphadenectomy with OS (HR 0.9 (0.3-2.8), p=0.90) or RFS (HR 1.2 (0.5-3.0), p=0.73). Advanced stage was the only factor that was significantly associated with survival. <h3>Conclusions:</h3> For women with apparent stage I MOC, a second operative procedure for systematic lymphadenectomy has low utility, as very few patients are upstaged and recurrence typically occurs in the peritoneum. Furthermore, intraoperative rupture does not independently confer a worse survival, and therefore these women do not benefit from adjuvant treatment based on rupture alone.

Diagnostic accuracy of frozen section and patterns of nodal spread in high grade endometrial cancer: a secondary analysis of the SENTOR prospective cohort study

<h3>Objectives:</h3> Recent studies have shown that sentinel lymph node (SLN) biopsy accurately detects nodal metastases in patients with high-grade endometrial cancer (EC). SLN biopsy has the potential to replace complete lymphadenectomy for surgical staging in patients with high-grade EC, provided that an SLN algorithm is followed (side-specific pelvic and para-aortic lymphadenectomy for non-mapped hemipelves). The aim of this study was to define the accuracy of intraoperative frozen section for the detection of metastases in SLN biopsy and describe the pattern of lymph node (LN) spread in patients with high-grade EC. <h3>Methods:</h3> We performed a secondary analysis of clinicopathologic data from the SENTOR prospective cohort study evaluating SLN node biopsy at 3 designated cancer centres in Toronto, Canada (ClinicalTrials.gov ID: NCT01886066). Patients with clinical stage I high-grade EC (grade 3 endometrioid, serous, clear cell, carcinosarcoma, undifferentiated, or mixed tumors) undergoing laparoscopic or robotic primary hysterectomy were enrolled. The primary outcome was sensitivity of frozen section of the SLN specimen, compared to a standardized ultrastaging protocol. Secondary outcomes included the pattern and characteristics of LN spread. <h3>Results:</h3> There were 126 patients with high-grade EC with median age 66 years (range: 44-86) and median BMI 26.9 kg/m² (range: 17.6-49.3). Frozen section was performed on surgical specimens from 212 hemipelves; SLNs were identified in 202 specimens (95.7%) and fatty tissue alone was identified in 10 specimens (4.7%). Of the 202 hemipelves in which SLNs were identified, 24 were positive for metastatic disease. Frozen section correctly identified only 12, yielding a sensitivity of 50% (12/24, 95% CI 29.6-70.4) and negative predictive value of 94% (178/202, 95% CI 89-96.5). A total of 24 patients had LN metastases: 16 (13%) had isolated pelvic metastases, 7 (6%) had both pelvic and para-aortic metastases and 1 (0.8%) had an isolated para-aortic metastasis. All para-aortic metastases (n=8) occurred in non-sentinel LNs, among patients with serous (n=5), carcinosarcoma (n=2), and dedifferentiated (n=1) histology. One patient with isolated para-aortic metastases (carcinosarcoma, p53 abnormal) did not have a mapped SLN, but was identified by the SLN algorithm. Nodal metastases occurred in 10% of patients (3/30) with grade 3 endometrioid histology (all pelvic), compared to 33% of patients (15/46) with serous histology (10 pelvic alone, 5 pelvic and para-aortic). <h3>Conclusions:</h3> Intraoperative frozen section of SLNs in high-grade EC patients has poor sensitivity. However, frozen section may still be beneficial to confirm the presence of nodal tissue and ensure adherence to an SLN algorithm, including complete pelvic and para-aortic lymphadenectomy for non-mapped hemipelves. Because isolated para-aortic metastases are rare, para-aortic lymphadenectomy may be omitted in patients in which SLNs were successfully mapped to the pelvis.

Not all high-intermediate risk endometrial cancers are created equal: recurrence-free survival and cause-specific survival after observation or vaginal brachytherapy in all possible subgroups of early-stage high-intermediate risk endometrial cancer

<h3>Objectives:</h3> Historically, patients with early-stage high-intermediate risk (HIR) endometrioid endometrial cancer (EC) have been known to benefit from improved recurrence-free survival (RFS) with the use of adjuvant therapy. However, specific subgroups of HIR patients may benefit from observation ± vaginal brachytherapy (VB) only. We sought to evaluate RFS and cause-specific survival (CSS) after observation ± VB in the subgroups of early-stage HIR endometrioid EC. <h3>Methods:</h3> We identified patients with early-stage HIR endometrioid EC, who underwent a total hysterectomy, bilateral salpingo-oopho-rectomy, and sentinel lymph node biopsy or pelvic ± paraaortic lymphadenectomy at Mayo Clinic and Cleveland Clinic between 1999 and 2016. HIR group was defined based on revised GOG99 criteria used in the GOG249 trial: age ≥70 with 1 risk factor, age ≥50 with 2 risk factors, or all the 3 risk factors (grade 2-3, ≥50% myometrial invasion, or positive lymphovascular space invasion [LVSI]). HIR subgroups were determined by all possible combinations of risk factors, and 3-year RFS, site-specific RFS, and CSS were estimated. <h3>Results:</h3> Among 1,507 women with stage I or II EC, 447 stage I endometrioid EC patients were identified who fulfilled HIR criteria, and 349 (78.1%) were managed with observation ± VB. Eleven subgroups were defined and evaluated (Table). Among stage IA patients (1-5 subgroups), subgroup 5 (G3 ≥50y LVSI+) had the lowest RFS and CSS of 68.9% (46.6-100.0%) and 86.7% (71.1-100.0%), respectively, whereas the remaining 4 subgroups had 3-year RFS and CSS >90%. In all stage IA subgroups, 3-year lymphatic RFS was >90%; 3-year distant RFS was lowest in subgroup 5 (79.6% [56.9-100.0%] and 97.1% [91.8-100.0%] in subgroup 3 [G2 ≥50y LVSI+]). Additionally, 3-year CSS was <100% in these two subgroups (vs. 100% in subgroups 1, 2, and 4). Among the 6 stage IB subgroups (6-11), 3-year RFS ranged from 68.2% (48.6-95.7%) to 93.6% (87.7-99.9%) and 3-year CSS from 80.0% (58.7-100.0%) to 100.0% (100.0-100.0%). Lymphatic recurrence was observed in subgroup 8 (IB G2 ≥50y LVSI -), but site-specific RFS was >90%. Conversely, all stage IB subgroups experienced distant recurrence; 3-year distant RFS ranged from 73.1% (53.5-99.7%) to 96.5% (91.8-100.0%). 3-year distant RFS lower than 90% was observed in those subgroups with grade 3 or positive LVSI (7, 9, 10, and 11). <h3>Conclusions:</h3> Our results suggest that observation ± VB can be sufficient in some subgroups of stage I endometrioid HIR patients, specifically stage IA endometrioid HIR EC without the concomitant presence of grade 3 and LVSI. Among stage IB endometrioid HIR EC subgroups, particularly those with grade 3 or LVSI, observation ± VB is associated with lower RFS and CSS. Stratifying HIR patients into risk subgroups would alleviate the risk of overtreatment and undertreatment among patients with early-stage endometrioid EC; in this regard, the molecular characterization will provide a further instrument to achieve this objective.

Para-aortic lymphadenectomy in abnormal common iliac bifurcation

A 60-year-old-woman was diagnosed with serous endometrial cancer and on pre-operative CT there was evidence of a higher confluence of the common iliac veins in the inferior vena cava ([Figure...

Nerve-sparing surgery in current gynecologic oncology

Nerve-sparing surgery is currently a very important topic in gynecologic oncology. In this review, it is shown that radical hysterectomy is not the only operation where the nerve-sparing technique can be used. Most surgical procedures in modern gynecologic oncology should spare the autonomic nerve structures. The review includes recently published articles precisely describing the nerve-sparing techniques in paraaortic and pelvic lymphadenectomy, and the modern approach to radical nerve-sparing hysterectomy. It has been shown in the literature that the quality of life of patients is directly dependent on the operation technique and its extension. As mentioned above, the nerve-sparing technique needs to be used not only in surgical procedures for cervical cancer, but more extensively also for endometrial and ovarian cancers. Modern techniques demonstrate that such an operation can be suitable both for the radicality and improved quality of life. Results of such operations are comparable to the old – not nerve-sparing techniques – both in terms of progression-free survival and overall survival. Nerve-sparing surgery in gynecologic oncology is our future. Better quality of life and greater patient satisfaction should be our goals. Studies are needed for better examination and comparison of the presented systematic nerve-sparing operations of lymphadenectomy in ovarian and endometrial cancers, and also combined with nerve-sparing radical hysterectomy.

Radiomic models for lymph node metastasis prediction in cervical cancer: can we think beyond sentinel lymph node?

Liu and colleagues performed a retrospective study to validate a computed tomography (CT) scan-based radiomic model to detect lymph node metastasis in cervical cancer. The proposed model incorporating the arterial and venous phase CT-scan features represented a non-invasive method exhibiting high sensitivity in the prediction of lymph node metastasis. It is well established that lymph node metastasis is one of the most significant prognostic factors in cervical cancer. For this reason, management of cervical cancer is strictly related to lymph node status, with international guidelines recommending definitive chemo-radiation in case of metastatic lymph node. More and more evidence supports the use of sentinel lymph node in early-stage cervical cancer but its frozen section analysis may result in false negative results; in locally-advanced stages staging para-aortic lymphadenectomy is proposed by many Authors to tailor chemoradiotherapy treatment, with potential intra-and post-operative related complications. The use of a validated radiomic model able to predict lymph node metastases in radiologically normal lymph nodes may represent an essential tool to possibly spare lympadenectomy related morbidity.

Effectiveness of Laparoscopic Combined Retroperitoneal and Transperitoneal Approach in Para-aortic Lymphadenectomy for Endometrial Cancer.

This study aimed to compare laparoscopy with laparotomy and evaluate the effectiveness of a laparoscopic combined retroperitoneal and transperitoneal approach for para-aortic lymphadenectomy in patients with endometrial cancer. In this single-center retrospective study, patients with endometrial cancer who underwent para-aortic lymphadenectomy between December 2016 and November 2019 were analyzed. The patient's clinical and pathologic data were procured from medical records. Statistical analyses were performed using Fisher's exact and the Mann-Whitney U-tests. A total of 37 and 28 patients were included in the laparoscopic and laparotomy groups, respectively. The laparoscopic group had similar operative time, similar number of resected para-aortic and pelvic lymph nodes, less intraoperative blood loss and complications, lower rate of blood transfusion, and shorter postoperative stay than the laparotomy group. Laparoscopic combined retroperitoneal and transperitoneal approach for endometrial cancer is safe and effective compared to laparotomy.

English

BACKGROUND Endometrial carcinoma is a leading malignancy among females. Pre-operative imaging and biopsy are necessary to identify the disease. Clinicopathological analysis determines the extent of the disease. Complete surgical staging is advised for high-risk patients. The purpose of this study was to analyze the different clinical endpoints, prognostic factors and demographic details that will influence the survival patterns of the cases of carcinoma of endometrium who underwent surgery during the period from 2014 to 2017 at a tertiary care centre, Chennai, India. METHODS Patients diagnosed with operable endometrial carcinoma were surgically staged based on the surgical procedures performed namely, total abdominal hysterectomy (TAH) with bilateral salphingo-oophorectomy (BSO), bilateral pelvic lymph node dissection, and para-aortic lymphadenectomy (patients with high-risk features). Post-surgical staging specimens were histopathologically examined in the Department of Pathology. Adjuvant radiation was given to patients with stage IA grade II and above. Patients with stage III disease received adjuvant chemotherapy. Descriptive analysis was done to show the distributions of patients accordingly. Kaplan-Meier survival analysis was performed for the overall median survival of the patients. RESULTS The study consisted of a total of 35 patients with a mean age of 56 ± 8.64. Parameters such as age, clinicopathological features, stage (FIGO staging), tumor size, grade, lymphovascular invasion (LVI), myometrial invasion, cervical involvement, involvement of margins, lymph node ratio (LNR) and survival were studied. Tumor size and grade were found to be significant factors affecting the survival. Overall median survival period of patients who underwent surgery was found to be 31 months. CONCLUSIONS Tumor size and grade of the tumor are significant prognostic factors affecting the survival of the patients with carcinoma of endometrium. Lymph node ratio is a new concept in carcinoma endometrium to be pondered upon as a factor predicting survival in future studies thereby defining the role of lymph node dissection in surgical staging. KEYWORDS Endometrial Cancer, FIGO Staging, Lymph Node Ratio, Prognosis, Survival Analysis

Intratumoral budding: A novel prognostic biomarker for tumor recurrence and a potential predictor of nodal metastasis in uterine cervical cancer

ObjectiveTo evaluate the prognostic and predictive significance of lymphovascular invasion (LVI) and lymph node metastasis of intratumoral budding (ITB) and its correlation with clinicopathological parameters in patients with cervical cancer. MethodsTotal 151 patients with cervical cancer who underwent radical hysterectomy with pelvic and/or paraaortic lymphadenectomy were included. We assessed the status of ITB and peritumoral budding (PTB) in all available hematoxylin and eosin-stained specimens. Univariate and multivariate analyses were performed for ITB, PTB, and other clincopathological parameters as predictors of recurrence. ResultsITBhigh (≥3TB/HPF) was significantly associated with large tumor size, deep stromal invasion, LVI, parametrial invasion, and lymph node metastasis. The numbers of ITBs and PTBs were positively correlated (r2 = 0.754, p < 0.0001). ITBhigh was more frequently observed in squamous cell carcinoma compared with adenocarcinoma and adenosquamous cell carcinoma (p = 0.010). ITBhigh was found to be an independent prognostic factor for tumor recurrence by multivariate analysis (hazard ratio, 1.92; 95% confidence interval [CI], 1.37–9.90; p = 0.026). Multiple logistic regression showed association of LVI (odds ratio [OR], 1.85; 95% CI, 1.11–3.06; p = 0.017) and lymph node metastasis (OR, 1.96; 95% CI, 1.26–4.66; p = 0.019). ConclusionITBhigh is an independent prognostic factor for tumor recurrence. ITB is a surrogate marker for predicting LVI in cervical cancers. The evaluation of ITB may be readily applied in the clinical setting for improved prognosis and to guide the clinical management of patients with cervical cancer.

Endometrial Cancer Lymphadenectomy Trial (ECLAT) (pelvic and para-aortic lymphadenectomy in patients with stage I or II endometrial cancer with high risk of recurrence; AGO-OP.6)

BackgroundThe impact of comprehensive pelvic and para-aortic lymphadenectomy on survival in patients with stage I or II endometrial cancer with a high risk of recurrence is not reliably documented. The...

Laparoscopic Debulking of Enlarged Pelvic Nodes during Surgical Para-aortic Staging in Locally Advanced Cervical Cancer: A Retrospective Comparative Cohort Study

To evaluate laparoscopic pelvic lymph node debulking during extraperitoneal aortic lymphadenectomy in diagnosis, therapeutic planning, and prognosis of patients with locally advanced cervical cancer and enlarged lymph nodes on imaging before chemoradiotherapy. Retrospective, multicenter, comparative cohort study. The study was carried out at 11 hospitals with specialized gynecologic oncology units in Spain. Total of 381 women with locally advanced cervical cancer and International Federation of Gynecology and Obstetrics 2018 stage IIIC 1r (radiologic) and higher who received primary treatment with chemoradiotherapy. Patients underwent pelvic lymph node debulking and para-aortic lymphadenectomy (group 1), only para-aortic lymphadenectomy (group 2), or no lymph node surgical staging (group 3). On the basis of pelvic node histology, group 1 was subdivided as negative (group 1A) or positive (group 1B). False positives and negatives of imaging tests, disease-free survival, overall survival, and postoperative complications were evaluated. In group 1, pelvic lymph node involvement was 43.3% (71 of 164), and aortic involvement was 24.4% (40 of 164). In group 2, aortic nodes were positive in 29.7% (33 of 111). Disease-free survival and overall survival were similar in the 3 groups (p = .95) and in groups 1A and 1B (p = .25). No differences were found between groups 1 and 2 in intraoperative (3.7% vs 2.7%, p = .744), early postoperative (8.0% vs 6.3%, p = .776), or late postoperative complications (6.1% vs 2.7%, p = .252). Fewer early and late complications were attributed to radiotherapy in group 1A than in the others (p = .022). Laparoscopic pelvic lymph node debulking during para-aortic staging surgery in patients with locally advanced cervical cancer with suspicious nodes allows for the confirmation of metastatic lymph nodes without affecting survival or increasing surgical complications. This information improves the selection of patients requiring boost irradiation, thus avoiding overtreatment of patients with negative nodes.

Abstract 91: IGCS Fellowship Program in Mozambique: the Results

Abstract Purpose: Mozambique is a country with a very high prevalence of gynecological cancer and, until 2018 had no training program in gynecologic oncology and no gynecologic oncology specialists. Through the International Gynecologic Cancer Society (IGCS) global fellowship program, three gynecologists in Mozambique were trained to become gynecologic oncologists and completed training in October 2020. Methods: The training program pairs specialists in gynecologic oncology with gynecologists in countries without a formal training program in gynecologic oncology. In Mozambique, fellows were paired with specialists from Brazil and the United States, due to a common language with Brazilians and pre-existing partnerships. Over a 2.5 year period, fellows performed self-study using an on-line curriculum, received training in clinical practice and surgery with specialist mentors who traveled to Mozambique 3-4 times/year, attended monthly tumor boards and other regular virtual meetings, and visited the mentors' hospitals in Brazil for a 3 month observership. All surgical cases were logged in REDCap. after completing all requirements, the fellows successfully completed a final exam and received a certificate of successful completion of training. Results: During the training, each fellow participated on average of 251 surgical procedures where they performed: 69 radical hysterectomies, 80 simple hysterectomies, 92 salpingo-oophorectomies, 73 pelvic lymphadenectomies, 2 para-aortic lymphadenectomies, 14 radical vulvectomies, 19 inguinal lymphadenectomies, 34 cold knife conizations and 38 loop electrosurgical excision procedures (LEEPs). At the conclusion of the fellowship, the fellows were performing these procedures independently. Conclusion: The IGCS program and international mentors supported the training of physicians in Mozambique, a country without formal gynecologic oncology training, facilitating the acquisition of the knowledge and skills to effectively care for women with gynecologic cancers. Citation Format: Ricardina Rangeiro, Dercia Changule, Siro Daud, Magda Ribeiro, Elvira Luis, Flora Mabota, Georgia Cintra, Renato Moretti-Marques, Andre Lopes, Marcelo Vieira, Mila Salcedo, Ellen Baker, Cesaltina Lorenzoni, Kathleen Schemeler. IGCS Fellowship Program in Mozambique: the Results [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 91.