Airton Stein

Survival after Laparoscopic versus Abdominal Radical Hysterectomy in Early Cervical Cancer: A Randomized Controlled Trial

Previous studies have reported the safety of laparoscopic radical hysterectomy for treatment of early cervical cancer, as option to laparotomy. This study aims to compare overall survival between laparoscopic versus abdominal radical hysterectomy for early cervical cancer. A single-center randomized controlled trial enrolled 30 patients with clinically staged IA2 cervical cancer and lymphovascular invasion, IB and IIA, who underwent laparoscopic radical hysterectomy (16) or abdominal radical hysterectomy (14). The mean overall survival time was 74.74 months (CI 95%: 54.15-95.33) for LRH 91.67 months (CI 95%: 74.97-108.37) for ARH (log-rank test = 0.30). The mean disease-free survival time was 81.07 months (CI 95%: 60.95-101.19) for LRH and 95.82 months (CI 95%: 80.18-111.47) for ARH (log-rank test = 0.371). The overall survival hazard ratio was 2.05 (CI 95%: 0.51-8.24), and the disease-free hazard ratio was 2.13 (CI 95%: 0.39-11.7). Our study suggests a non-significant trend of worse outcomes for LRH. In light of recent controversy and need for prospective studies, further studies in different populations are required for definite conclusions and until then, patients should be aware of risks and benefits, survival data and quality of life outcomes related to both surgical techniques.

Is infracolic omentectomy necessary for presumed early-stage Borderline Ovarian Tumors (BOTs)? A retrospective cohort study and meta-analysis

While omentectomy is included in the guidelines for the surgical management of Borderline Ovarian Tumors (BOTs), it is unclear whether removal of a normal-appearing omentum confers a therapeutic advantage. The retrospective cohort study of patients with BOTs evalua0 ted the role of routine omentectomy and was followed by a meta-analysis to enhance the robustness of the findings. Data were obtained from patients treated at three Brazilian reference centers between January 2009 and October 2023. Progression-Free Survival (PFS), risk of death, and recurrence were compared between patients who underwent omentectomy and those who did not. A total of 218 patients with BOTs were assessed: omentectomy was performed in 161 (73.8 %) and not performed in 57 (26.1 %). OS at 60 months was 95.5 % in the omentectomy group and 94.6 % in the non-omentectomy group (HR = 0.97 [95 % CI 0.20‒4.68]; p = 0.96). PFS was 97.2 % and 89.3 %, respectively (HR = 0.42; 95 % CI 0.10‒1.76; p = 0.23). Twelve studies comprising 2996 women with BOT, were included in the systematic review to evaluate the outcomes with and without omentectomy. Relative Risk (RR) of recurrence was 0.94 (95 % CI 0.67‒1.31; p = 0.7) for the non-omentectomy group compared with the omentectomy group. No statistically significant difference was observed, with an RR of 1.98 (95 % CI 0.24‒16.43; p = 0.53) for risk of death and an HR of 1.02 (95 % CI 0.25‒4.15; p = 0.98) for PFS. The retrospective cohort study and meta-analysis showed a low incidence of metastatic disease in the omentum. No effect of omentectomy on OS, PFS, and recurrence in patients with BOT.