A. Fotiou

Survival Benefit of Patients with Advanced Primary Fallopian Tube Cancer Undergoing Systematic Lymphadenectomy? Dilemmas and Queries

Fertility-sparing treatment in patients with placental trophoblastic site tumor: a systematic review

Placental site trophoblastic tumor (PSTT) is a rare pathologic entity of gestational trophoblastic neoplasia. The main objective of the present manuscript is to summarize current evidence regarding the possibility of fertility-sparing management. A systematic review of the literature was conducted to evaluate the efficacy, oncological safety, and fertility-preservation outcomes in patients with PSTT undergoing fertility-sparing management. PubMed, Scopus, and Cochrane Library were searched to identify proper articles. Eligibility criteria included all prospective or retrospective cohorts reporting conservative management of PSTT. Primary outcomes were the rate of recurrence and fertility outcome. Secondary outcomes concerned the type of conservative management. Overall, 16 articles were retrieved including a total of 63 patients. The mean age was 28.3 years (range; 21-37) and the mean serum beta-human chorionic gonadotropin was 17,251.9 IU/L (range; <0.1 to 430,290 IU/L). Regarding the antecedent pregnancy, 41.3% (26 cases) were full-term pregnancies, and 30.2% (19 cases) were abortions. Most cases were International Federation of Gynecology and Obstetrics stage I (73%). The overall recurrence rate of disease was 13.8% (8 of 63 patients) with these patients all treated with hysterectomy after recurrence. There were overall 23 full-term pregnancies reported, indicating a 36.5% fertility rate per patient, while 2 pregnancies are still ongoing at the time of publication. Fertility-sparing management of patients with PSTT is feasible and oncologically safe, with 36.5% fertility outcomes.

Upfront or intermediate treatment of advanced ovarian cancer patients with cytoreduction plus HIPEC: Results of a retrospective study

AbstractBackgroundNewly diagnosed advanced‐stage ovarian cancer patients are treated with neoadjuvant chemotherapy, primary or intermediate cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to evaluate the optimal timing of cytoreduction plus HIPEC for advanced ovarian cancer patients.MethodsAdvanced ovarian cancer patients treated with cytoreductive surgery plus HIPEC at three different hospitals between 2005 and 2019 were subgrouped regarding their time of management with cytoreduction plus HIPEC, upfront or intermediate. We retrospectively assessed the overall survival (OS), the progression‐free survival (PFS), and the disease‐free survival (DFS) of these groups.ResultsA total of 112 ovarian cancer patients were contained. Of whom, 47 patients were in the upfront group with 24 (51.1%) to be alive, while 65 patients were included in the intermediate group with 34 (52.3%) to be alive. OS (48 vs. 30 months) and DFS (42 vs. 20 months) indicated no significant difference. Although the same median PFS was observed in both groups (10 months), a higher mean PFS was observed in the upfront group (11.9 vs. 9 months, p = 0.023).ConclusionThe treatment of advanced ovarian cancer patients with upfront cytoreductive surgery plus HIPEC is feasible with the same survival results. Further, larger prospective studies need to verify our results.

Single incision robotic myomectomy: selection criteria, learning curve and cost

The article "Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases" by Kim et al. compares the effectiveness of robotic single-port myomectomy against the traditional multiport approach. The study finds similar operating outcomes, complication rates, and pregnancy rates in expert hands for both methods. Our systematic review supports these findings, revealing no significant differences in operative time, blood loss, or complication rates. Recent meta-analysis further emphasizes the benefits of the single-port approach in reducing morcellation time, overall operative duration, and blood loss. Our letter seeks insights on patient selection criteria to minimize conversion rates between surgical approaches and inquiries on learning curve differences. Additionally, we seek cost analysis details for both techniques. We appreciate the authors' valuable contributions to this field.