Pelvic Para-aortic Lymphadenectomy Research Articles

A novel predictive model of lymphovascular space invasion in early-stage endometrial cancer.

To predict lymphovascular space invasion (LVSI) positivity in early-stage (stage 1-2) endometrial cancer (EC) using a predictive model with prognostic factors of EC. We included 461 patients who underwent total hysterectomy and bilateral salpingo-oophorectomy with pelvic-paraaortic lymphadenectomy as the primary treatment for presumed early-stage EC at our clinic between 2010 and 2020. Moreover, all surgical specimens were examined histopathologically for the positivity or negativity of LVSI, and the patients were divided into two groups based on these pathologic outcomes. Age, menopausal status, histological type (type 1-2), histological grade (grades 1-2-3), depth of myometrial invasion, and peritoneal cytology results were recorded and analyzed as clinicopathological and demographic characteristics of the patients. The Loess algorithm determined the relationship between the observed and predicted outcomes. The distinction between the algorithms was evaluated by calculating the C-index. LVSI positivity was significantly associated with advanced age, menopause, type 2 EC, advanced histological grade, malignant peritoneal cytology, cervical involvement, and a tumor exceeding 50% of the myometrial depth (p<0.001, respectively). Remarkably, LVSI was most strongly associated with three explanatory variables: 1- More than 50% myometrial invasion [odds ratio (OR): 3.78; 95% confidence interval (CI): 1.80-7.60], 2- Advanced histological grade [OR=1.98 (1.20-3.20) 95% CI], 3- Malignant peritoneal cytology [OR= 3.06 (1.40-6.30) 95% CI]. The penalized maximum likelihood estimation model correctly classified 87% of the included patients (C-index: 0.876). Our predictive model may help predict LVSI based on different prognostic factors. The prognostic factors included in the nomogram were significantly associated with LVSI, particularly myometrial invasion depth of more than 50%, advanced histological grade, and malignant peritoneal cytology.

Predicting Factors of Uterine Invasion in Early-Stage (FIGO 2014 Stage IB1–IIA2) Cervical Cancer

Objective: Uterine corpus involvement was demonstrated radiologically or diagnosed by endometrial biopsy in the previous reports. Thus, there are few studies that detect uterine corpus involvement in radical hysterectomy specimens. This study was designed to investigate the factors that influence uterine corpus involvement in surgically treated cervical cancer patients.&#x0D; Materials and Methods: A total of 269 patients with clinical early-stage (stageIB1-IIA2) cervical cancer who underwent radical hysterectomy and pelvic-paraaortic lymphadenectomy at Zekai Tahir Burak Women's Health Training and Research Hospital and Ankara Bilkent City Hospital between January 2008 and August 2021 were recruited, and their clinicopathologic data were extracted from their patient files or the hospital's electronic database.&#x0D; Results: Uterine invasion was positive in 102 (37.9%) patients. Tumor size of patients was ≤20 mm in 66 (24.5%) patients and &gt;40 mm in 82 (30.5%). Parametrial invasion was detected in 44 (16.4%) patients. In the multivariate analysis; tumor type (adenocancer vs. other tumor types) (HR: 8.94; 95% CI: 3.569–22.401; p35 mm vs. ≤35 mm) (HR: 2.34; 95% CI: 1.234–4.440; p=0.009) depth of stromal invasion (&gt;1/2 vs. ≤1/2) (HR: 6.63; 95% CI: 2.205–19.952; p

Factors associated with the involvement of lymph nodes in low‐grade serous ovarian cancer

Evaluating nodal metastases in low-grade serous ovarian cancer (LGSOC) patients. Women with LGSOC who had undergone primary cytoreductive surgery comprising systematic pelvic-paraaortic lymphadenectomy were included. Data were obtained retrospectively from 12 oncology centers. One hundred and forty-eight women with LGSOC who had undergone comprehensive surgical staging were included. Seventy-one (48.0%) patients had metastatic lymph nodes. Preoperative serum CA-125 levels of ≥170 U/ml (odds ratio [OR]: 3.84; 95% confidence interval [CI]: 1.22-12.07; p = 0.021) and presence of lymphovascular space invasion (LVSI) (OR: 13.72; 95% CI: 3.36-55.93; p < 0.001) were independent predictors of nodal metastasis in LGSOC. Sixty (40.5%) patients were classified to have apparently limited disease to the ovary/ovaries. Twenty (33.3%) of them were upstaged after surgical staging. Twelve (20.0%) had metastatic lymph nodes. Presence of LVSI (OR: 12.96; 95% CI: 1.14-146.43; p = 0.038) and preoperative serum CA-125 of ≥180 U/ml (OR: 7.19; 95% CI: 1.35-38.12; p = 0.02) were independent predictors of lymph node metastases in apparent Stage Ⅰ disease. Clinicians may consider to perform a reoperation comprising systematic lymphadenectomy in patients who had apparently limited disease to the ovary/ovaries and had not undergone lymphadenectomy initially. Reoperation may be considered particularly in patients whose preoperative serum CA-125 is ≥180 U/ml and/or whose pathological assessment reported the presence of LVSI.

Primary endometrioid carcinoma of the uterosacral ligament arising from deep infiltrating endometriosis 6\u2009years after bilateral salpingo-oophorectomy due to atypical proliferative endometrioid tumor of the ovary: a rare case report

BackgroundEndometriosis can potentially lead to the development of a malignant tumor. Most malignant tumors arising from the endometriosis originate from the ovarian endometrioma, whereas those arising from extragonadal lesions are rare. We report a rare case of endometrioid carcinoma that developed from deep infiltrating endometriosis in the uterosacral ligament 6 years after treatment for atypical proliferative endometrioid tumor of the ovary in a 48-year-old woman.Case presentationSix years ago, the patient underwent laparoscopic bilateral salpingo-oophorectomy for her right ovarian tumor with atypical proliferative (borderline) endometrioid tumor accompanied by ovarian endometrioma. The solid tumor in the cul-de-sac was detected during follow-up using magnetic resonance imaging. Positron emission tomography/computed tomography revealed an abnormal accumulation of 18F-fluorodeoxyglucose at the tumor site. Thus, tumor recurrence with borderline malignancy was suspected. The patient underwent diagnostic laparoscopy followed by hysterectomy and partial omentectomy. Retroperitoneal pelvic lymphadenectomy and para-aortic lymphadenectomy were also performed. The cul-de-sac tumor at the left uterosacral ligament was microscopically diagnosed as invasive endometrioid carcinoma arising from deep infiltrating endometriosis. The final diagnosis was primary stage IIB peritoneal carcinoma. The patient received six courses of monthly paclitaxel and carboplatin as adjuvant chemotherapy. The patient showed no evidence of recurrence for 2 years after the treatments.ConclusionThis study reports a rare case of metachronous endometriosis-related malignancy that developed 6 years after treatment for borderline ovarian tumor. If endometriosis lesions remain after bilateral salpingo-oophorectomy, the physician should keep the malignant nature of endometriosis in mind.

Does tumor size have prognostic value in patients undergoing lymphadenectomy in endometrioid-type endometrial cancer confined to the uterine corpus?

Background/aimWe aimed to define the effect of tumor size on recurrence and survival rates in patients with stage I–II endometrioid-type endometrial cancer.Materials and methodsA total of 550 patients who had total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic-paraaortic lymphadenectomy were included. Patients with extrauterine spread, sarcomatous components, or synchronized tumor and those who did not undergo lymphadenectomy or did not have data on tumor size were excluded.ResultsThe median tumor size was 35 mm (range: 3–335 mm). According to the 2009 International Federation of Obstetrics and Gynecology (FIGO) criteria, 245 cases were defined as stage IA, 271 as stage IB, and 34 as stage II. The 5-year disease-free survival (DFS) rate was 92% and the 5-year disease-specific survival (DSS) rate was 99%. The effects of prognostic factors on DFS were evaluated. Older age, stage II disease, deep myometrial invasion, and receiving adjuvant radiotherapy were associated with decreased DFS. There was no statistically significant association between tumor size and DFS. The 5-year DFS for patients with a tumor diameter of <35 mm, which was the median tumor size of the entire group, was 94%, while it was 89% for patients having a tumor diameter of >35 mm (P = 0.128).ConclusionTumor size was not a risk factor predicting recurrence in patients with stage I or II endometrioid-type endometrial cancer who had lymphadenectomy.

Image-guided brachytherapy in cervical cancer: Experience in the Complejo Hospitalario de Navarra.

To evaluate dosimetric and clinical findings of MRI-guided HDR brachytherapy (HDR-B) for cervical carcinoma. All patients had a CT, MRI and pelvic-paraaortic lymphadenectomy. Treatment: pelvic (+/-)para-aortic3D/IMRT radiotherapy (45Gy), weekly cisplatin and HDR-B and pelvic node/parametrial boost 60Gy until interstitial brachytherapy was done. Two implants: 2008-2011: 5 fractions of 6Gy, 2011: 2016, 4 fractions of 7Gy. MRI/TAC were done in each implant. The following were defined: GTV, CTH-HR, CTV-IR; OAR: rectum, bladder and sigmoid. From 2007 to 2016: 57 patients. Patients: T1b2-T2a: 4p, T2b 41p, T3a: 2p; T3B 8p T4a: 2p; N0: 32p, N1 21p, no lymphadenectomy: 4p. Median follow up: 74.6m (16-122m), recurrence: 5p local, 6p node, 9p metastasis and 37p without recurrence.Local control 5 years: 90.1%; Ib2-IIB: 94.8%, III-IVa: 72.2%. (p:0.01). RDFS 5y was 92.5%; IB2-IIB: 93%, III: 85% (p:0.024); for pN0: 100%; pN+ iliac-paraaortic: 71.4% (p: 0.007). MFS 5y was 84.1%. Overall survival (OS) at 5y: 66.6% and the cancer specific survival (CEOS) was 74%. Univariate analysis survival: stage Ib2-II 83% vs. III-IVa 41% (p=0.001); histology: squamous 78%, adenocarcinoma 59.7% (p: ns); lymph node: N0 85% vs. PA+P- 72%, and PA+P+ 35% (p=0.010). In relation with: HR-CTV dose>85Gy, CEOS: 82.5% vs. 77%, and volume CTV-HR<30 cc: 81.8% and >30 cc: 67%; p: ns. Acute grade 2-3 toxicity: rectal 15.7%, intestinal 15.7% and vesical 15.5%. Use of interstitial HDR-BQ guided by RM increased CTV-HR dose and local control, like EMBRACE results. Nodal boost improves RDFS and perhaps OS.

Comparison of pelvic and para-aortic lymphadenectomy versus para-aortic lymphadenectomy alone for locally advanced FIGO stage IB2 to IIB cervical cancer using a propensity score matching analysis: Results from the FRANCOGYN study group

IntroductionPre-treatment evaluation of nodal status is crucial in women presenting with locally advanced cervical cancer (LACC). However, the prognostic impact of surgical staging remains to be proved, as published results comparing surgical versus radiological staging are contradictory. The aim of this study was to compare the prognosis of women with FIGO stage IB2–IIB CC who underwent surgical nodal staging including either exclusive para-aortic lymphadenectomy (PAL) or comprehensive pelvic + para-aortic lymphadenectomy (P-PAL). Materials and methodsData of 314 women with FIGO stage IB2 to IIB CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. The prognosis and outcomes were compared by Propensity score (PS) matching (PSM) analysis. ResultsThe median follow-up was 33 months (2–114). When comparing women who underwent PAL vs P-PAL, the recurrence rates were 26% (37/144) and 28% (41/144), respectively (p = 0.595). The respective 3-year recurrence free survival (RFS) for P-PAL and PAL were 72.9% (95% CI, 65.7–81.0) and 70.7% (95% CI, 62.4–80.2), (p = 0.394). The respective 3-year overall survival (OS) rates for P-PAL and PAL were 86.8% (95% CI, 81.1–92.9) and 78.6% (95% CI, 70.4–87.7) (p = 0.592). In the sub-group of women with lymph node metastases, RFS was improved for women who underwent P-PAL compared to those with exclusive PAL (p = 0.027), with no difference in OS (p = 0.187). ConclusionsComprehensive P-PAL does not seem to be of significant therapeutic benefit compared to exclusive PAL.

Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer

BackgroundCervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner.MethodsA descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis.ResultsIn patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy.ConclusionsThis is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.

Effectiveness of Fibrin Sealant Patch in Reducing Drain Volume after Pelvic Lymph Node Dissection in Women with Gynecologic Malignancy.

Background The goal of this study was to evaluate the effectiveness of fibrin sealant in decreasing postoperative lymphatic drainage in women after pelvic lymphadenectomy and/or para-aortic lymphadenectomy during gynecologic cancer surgery. Methods This study is a retrospective case-control study. Forty-five patients who underwent staging surgery were enrolled. Twenty-seven patients were in the fibrin sealant group (group A) and 18 in the control group (group B). The two groups were compared for the total volume of drain, hospital stay, harvested lymph node, and incidence of asymptomatic lymphocele. Lymphocele formation was evaluated by computed tomography (CT) on 3 months after surgery. Results There were no significant differences in patient demographics between group A and B with respect to age, BMI, and harvested lymph nodes. Patients who received fibrin sealants had reduced total volume of drainage from postoperative days 2 to 5 compared to the control group (group A versus group B: 994.819 ± 745.85 ml versus 1847.89 ± 1241.41 ml; P = 0.015). However no differences were observed in hospital stay (P = 0.282), duration of drain (P = 0.207), and incidence of asymptomatic lymphocele at 3 months (P = 0.126). Conclusion The results of this study indicate that the application of fibrin sealants after pelvic and/or para-aortic lymphadenectomy may reduce lymphatic drainage in gynecologic malignancy.

Embryonal Rhabdomyosarcoma of the Cervix in Young Women.

Cervical rhabdomyosarcoma (RMS) is an extremely rare disease, and there is no precise criteria related to its treatment. Our aim was to describe the clinical and pathological features of cervical RMS. Clinicopathological data of cases with cervical RMS were retrieved from the computerized database of Etlik Zubeyde Hanim Women's Health and Research Hospital. Five patients with the diagnosis of cervical RMS who underwent surgical treatment and had adjuvant chemotherapy between 2003 and 2015 were included in the study. Mean age of patients at the time of diagnosis was 15.8 ± 2 years. Abnormal vaginal bleeding and mass were the most common complaints. All patients had embryonal rhabdomyosarcoma (E-RMS) and Group I disease according to the Intergroup Rhabdomyosarcoma Study Group clinical classification system. Cone biopsy and polypectomy were performed in four patients, and radical abdominal hysterectomy with pelvic-paraaortic lymphadenectomy was performed in one patient. Chemotherapy consisting vincristine, dactinomycin, and cyclophosphamide was given as an adjuvant therapy. Estimated 5-year overall survival and disease-free survival were 40% and 37.5%, respectively. We report a small series of patients with cervical E-RMS who were treated with surgery and adjuvant chemotherapy. Although all patients in the present study had good prognostic factors, survival was not as good as indicated in the literature. Diminished survival of our patient group may be associated with underlying molecular and pathophysiologic differences other than stage and histological subtype that have not been discovered yet.

UTERİN KARSİNOSARKOMLAR: 18 OLGUDA HİSTOPATOLOJİK GÖZDEN GEÇİRME

Objective: Uterine carcinosarcomas are relatively rare tumors with poor prognosis. These tumors were considered as a subset of uterine sarcomas; however currently they are classified within the carcinoma group. Recent studies have revealed that these tumors behave according to the characteristics of the epithelial component. The aim of the study was to discuss the histopathological characteristics of these quite aggressive tumors, which were diagnosed in our clinic, in the light of the literature. Materials and Methods: We performed a retrospective analysis of 18 patients with uterine sarcoma, who were operated at our oncology department between 2004 and 2014. Cases with a pathology result of either carcinosarcoma or malignant mixed Mullerian tumor were included in the study pathologically. Tumor size, presence of myometrial invasion and pelvic lymph node metastases were reviewed. Demographic data were recorded. Staging was performed according to FIGO (1988) protocol. Results: 18 patients were diagnosed with carcinosarcoma. 95% of the patients were in postmenopausal period. The mean age was 64.6 . 13 patients underwent comprehensive surgical staging (total hysterectomy + bilateral salpingo-oophorectomy + pelvic para-aortic lymphadenectomy + omentectomy + appendectomy). 5 patients with advanced stage disease underwent suboptimal debulking. 7 patients were stage I and 11 patients were stage II-IV. Myometriyal invasion was present in 17 patients and for 9 of these patients the invasion was observed in more than ½ of the myometrium. Lymphovascular invasion was observed in 11 patients. Conclusion: Uterine carcinosarcomas are extremely aggressive neoplasms. Although they used to be categorized under the group of sarcoma, recent studies have shown that uterine carcinosarcomas are high-grade endometrial carcinomas, which include sarcomatous metaplasia. First-line treatment for uterine carcinosarcomas is surgery. Adjuvant chemotherapy and radiation therapy combinations are used as complementary therapies

Analysis of Metastatic Regional Lymph Node Locations and Predictors of Para-aortic Lymph Node Involvement in Endometrial Cancer Patients at Risk for Lymphatic Dissemination

The aim of this study was to provide detailed knowledge of the metastatic lymph node (LN) locations and to determine factors predicting para-aortic LN metastasis in endometrial cancer patients at risk (intermediate/high) for LN involvement. A prospective case series with planned data collection was conducted in a total of 173 patients who treated with systematic pelvic para-aortic lymphadenectomy up to the renal vessels. All the LNs removed from pelvic and para-aortic basins—low or high according to the level of the inferior mesenteric artery—were evaluated separately. Logistic regression analyses were performed to determine the impact of variables on para-aortic metastasis. Lymph node metastasis was observed in 21.9% of the patients, pelvic LN involvement in 17.9%, para-aortic LN involvement in 15.0%, both pelvic and para-aortic LN involvement in 10.9%, and isolated para-aortic LN involvement in 4.0%. The most common metastatic LN locations were the external iliac (50.0%), obturator (50.0%), and low precaval regions (36.8%). The least common location of metastasis was the high precaval region (5.3%). Among patients with para-aortic LN metastasis, 42.3% had metastasis above the inferior mesenteric artery. The number of metastatic pelvic LNs greater than or equal to 2 was the only independent predictor of para-aortic metastasis in multivariate analysis (odds ratio, 23.38; 95% confidence interval, 1.35-403.99; P = 0.030), with 96.94% sensitivity, 95.87% specificity, 98.6% positive predictive value, and 97.0% negative predictive value. The current study supports the idea that in patients at risk of LN involvement, the systematic lymphadenectomy should be performed up to the renal vessels due to the high rate of upper level involvement.

An old patient with growing teratoma syndrome of the ovary

Abstract Growing teratoma syndrome (GTS) is a rare complication of malignant ovarian germ cell tumors. A 52-year old woman was admitted to our Gynecological Oncology Department with metastatic multiple abdominal masses. Her initial gynecological history presented an immature teratoma of the ovary 3 years previously, and she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic-paraaortic lymphadenectomy and omentectomy. She received three cycles of bleomycin, etoposide and cisplatin (BEP) regimen after surgery. Although the tumor markers were within normal limits, multiple metastatic lesions were detected in the 3rd month of follow-up. The patient was referred to our gynecological oncology department, optimal debulking including resection of the tumoral lesions localized on the liver, diaphragm, peritoneum, sigmoid colon, omentum and retroperitoneum was performed. Histopathology of all samples revealed mature teratoma. This syndrome should be remembered when a tumor is refractory to chemotherapy and growth of the tumor still continues after resection of the initial tumor.

Comprehensive laparoscopic surgical staging of ovarian dysgerminoma in a 10-year-old girl—A case report

Minimal access surgery to stage early ovarian cancer (EOC) is still regarded as an investigation among many gynecologic oncologists. This is a case of comprehensive laparoscopic surgical stage of an ovarian dysgerminoma in a 10-year-old girl described. This patient was referred to the gynecology oncology unit status post left salpingo-oophorectomy through a midline incision when the histopathology showed pure dysgerminoma. We then performed the laparoscopic stage including peritoneal washing; resection of the left infundibulopelvic ligament; systematic pelvic, common iliac, and infrarenal bilateral paraaortic lymphadenectomy; and omentectomy. The uterus and right adnexum were spared to preserve future fertility. The final histopathology showed no metastatic disease (stage ovarian dysgerminoma), and patient has no evidence of recurrence after 52 months follow up. Conclusion: This is the youngest patient reported in the literature with a comprehensive laparoscopic surgical stage for ovarian neoplasm. A full laparoscopic staging for ovarian cancer in a 10-year-old girl is safe and might be considered as an alternative to the stander of care.

Primary malignant mixed müllerian tumor of the fimbriated end of the Fallopian tube causing hematosalpinx and hematometra

Primary malignant mixed müllerian tumor of the fimbriated end of the Fallopian tube causing hematosalpinx and hematometra

Collision of Three Histologically Distinct Endometrial Cancers of the Uterus

A collision tumor is defined by the presence of two separate masses in one organ, which are pathologically distinct. We described a 70-yr-old patient who complained of abnormal vaginal bleeding with a collision tumor of the uterine corpus. The patient received total hysterectomy, bilateral salphingo-oophorectomy, bilateral pelvic-paraaortic lymphadenectomy, omentectomy, and intraperitoneal chemotherapy. The uterine corpus revealed three separate masses, which were located at the fundus, anterior and posterior wall. Each tumor revealed three pathologically different components, which were malignant mixed müllerian tumor, papillary serous carcinoma, and endometrioid adenocarcinoma. Among these components, only the papillary serous carcinoma component invaded the underlying myometrium and metastasized to the regional lymph node. Adjuvant chemotherapy and radiation therapy were performed. The patient is still alive and has been healthy for the last 8 yr. We have reviewed previously reported cases of collision tumors which have occurred in the uterine corpus.

Impact of the Ratio of Metastatic to Examined Lymph Nodes on the Survival of Early-Stage Cervical Cancer Patients

Background: The aim of the study was to determine the impact of the ratio of metastatic to examined lymph nodes (LN) on the survival of early-stage cervical cancer patients. Methods: A retrospective review was performed of all patients undergoing primary radical hysterectomy and pelvicparaaortic lymphadenectomy for stage I–II cervical cancer at the Ankara Oncology Hospital from 1995 to 2000. Survival was determined by Kaplan-Meier method and differences were assessed by log-rank test. Results: A total of 2,085 LN were examined. Nodal metastasis was found in 22.1% of the patients. Patients with zero involved LN had a 5-year survival of 89.19%, while patients with 1 positive LN and > 1 positive LNs had a 5-year survival of 100 and 76.92%, respectively. The difference in survival among these three groups was not statistically significant. The 5-year survival rates according to the metastatic/examined LN ratio (LNR) were 75, 90, and 89.19% in the groups of patients with LNR >10, 1–10, and 0%, respectively. The difference in survival among these three groups was not statistically significant. Conclusions: This factor might be helpful for a better prognostic discrimination of patients with metastatic LN. The stratification of node-positive cervical cancer for prognostic and treatment purposes warrants further investigation.

Laparoscopy-assisted cystectomy for large adnexal cysts

To evaluate the feasibility and surgical outcome of laparoscopy-assisted surgery for large adnexal cysts. From January 1998 to October 2007, 46 women underwent laparoscopy-assisted surgery for large adnexal cysts whose maximum diameter were between 10 and 20 cm, radiologic and laboratory features suggestive of benign disease. All the patients had a pre-operative ultrasound with or without computed tomography and CA-125 assessment. Patients' demographics, clinical and ultrasound features, CA-125 values, surgical procedures, operative and post-operative complications, estimated amount of blood loss (EBL), operative time, conversion to laparotomy and the pathological findings were recorded. Fourty-six consecutive patients underwent laparoscopy-assisted surgery over 9 years. The mean and range of the patients' age and body mass index were 34.1 +/- 6.3 and (21-45) years and 27.4 +/- 5.9 and (22-40), respectively. In all the patients, except one with borderline ovarian tumor, laparoscopy-assisted surgery was successful. There were no operative or post-operative complications. The mean and range of the operative time, EBL and hospital stay were 48.4 +/- 7.3 and (35-65) min, 55.0 +/- 28.9 and (25-150) mL, 1.49 +/- 0.50 and (1-3) days, respectively. The mean and range of the extracorporeal cystectomy time were 10.2 +/- 2.7 and (8-14) min. The surgical procedures performed were: ovarian and paraovarian cystectomy (n = 45), unilateral salpingo-oophorectomy, pelvic-paraaortic lymphadenectomy and omentectomy (n = 1). Pathologic findings included serous cystadenoma (n = 26), mucinous cystadenoma (n = 7), dermoid (n = 6), endometriosis (n = 6), and borderline ovarian tumor (n = 1). Laparoscopy-assisted surgery is feasible and safe for women with large benign adnexal cysts and result s in a short surgery time.

Comprehensive Laparoscopic Surgical Staging of Ovarian Dysgerminoma in a 13-Year-Old Girl: A Case Report

A case of comprehensive laparoscopic surgical staging for ovarian dysgerminoma in a 13-year-old girl is described. A 20-cm pelvic mass, rising from right adnexum, was incidentally diagnosed, and the patient underwent laparoscopic right salpingo-oophorectemy. Pathologic findings were consistent with diagnosis of pure dysgerminoma. We then performed laparoscopic staging including peritoneal washing; resection of right infundibulopelvic ligament; systematic pelvic, common iliac, and infrarenal paraaortic lymphadenectomy; appendectomy; and infracolic omentectomy. Uterus and left adnexum were spared to preserve future fertility. Currently, the patient is alive and free of disease after 21 months of follow-up. To our knowledge, this is the first reported case of comprehensive laparoscopic surgical staging for ovarian neoplasm in a 13-year-old patient.

The value of preoperative platelet count in the prediction of cervical involvement and poor prognostic variables in patients with endometrial carcinoma

Objective(s). To evaluate the relationship between preoperative platelet counts and prognostic factors extensively, among endometrial cancer patients, especially with respect to cervical involvement. Methods. One-hundred fifty-five patients with endometrial carcinoma, who underwent surgery as the initial treatment consisting peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic-paraaortic lymphadenectomy, and omentectomy were retrospectively analyzed. Results. There were no differences with respect to age, histological type (endometrioid vs. non-endometrioid), depth of myometrial invasion, peritoneal cytology, LVSI, and lymphatic metastasis. However, advanced stage (stages III and IV), poorly differentiated tumor grade (grade 3), the presence of cervical and adnexal involvements were associated with significantly higher median preoperative platelet counts. Accepting 325.000/μl platelet count as a threshold value, multivariate analysis revealed cervical involvement ( P = 0.008; OR = 1.84, 95% CI:1.17–2.89) and presence of high grade histology ( P = 0.014; OR = 2.23, 95% CI:1.18–4.23, for grade 3 disease) to be significantly associated with higher platelet count. At a cut-off value of 326.000/μl, 42.3% sensitivity and 82.8% specificity for the prediction of cervical involvement was observed under receiver operator characteristic curve method. Conclusion(s). Higher preoperative platelet counts, even in conditions with normal range (150.000–400.000/μl), may reflect poor prognostic factors such as cervical involvement and high grade among patients with endometrial carcinoma. Also, the higher platelet count should be taken into consideration for the necessity of radical hysterectomy.