Aleksandar Čelebić

Evaluating the role of robotic surgery in gynecological cancer treatment

Robotic surgery has emerged as a transformative force in the field of gynecologic oncology, offering a minimally invasive yet versatile approach to managing a wide range of gynecologic cancers. Robotic platforms, with their enhanced precision, magnified visualization, and ergonomic advantages, have been translated into tangible benefits for patients, including reduced blood loss, shorter hospital stays, and faster recovery times. In the context of endometrial cancer, robotic-assisted hysterectomy has become an increasingly preferred approach for early-stage disease, demonstrating comparable, if not superior, surgical and oncologic outcomes compared to traditional open or laparoscopic methods across various histopathological subtypes. Similarly, robotic surgery has gained traction in the treatment of early-stage cervical cancer, with robotic-assisted radical hysterectomy offering a minimally invasive alternative with favorable early results. However, recent studies highlighting the importance of long-term survival data underscores the need for ongoing research and careful patient selection. While the role of robotic surgery in advanced ovarian cancer remains less definitive compared to endometrial and cervical cancers, ongoing research is exploring its potential benefits in specific scenarios, such as interval debulking surgery and patients with limited disease burden. Despite its demonstrable advantages, robotic surgery in gynecologic oncology is not without its challenges, including the high initial cost, the need for specialized surgical training, and the inherent limitations of robotic platforms. However, as technology continues to advance and surgical expertise grows, robotic surgery holds immense promise for further refining the surgical management of gynecologic cancers, ultimately striving to provide all women facing these diseases with the most effective, safest, and compassionate care possible.

Ovarian cancer in children and adolescents: A unique clinical challenge

Ovarian cancer in children and adolescents is rare, presenting unique diagnostic and management challenges distinct from adult cases. This paper provides a comprehensive overview of this disease, focusing on the importance of a multidisciplinary approach to care. We discuss the common presentation of ovarian malignant masses in young patients, highlighting the role of imaging and tumor markers in diagnosis. The paper delves into the surgical management of these tumors, emphasizing the importance of fertility-sparing techniques whenever possible. We explore the role of adjuvant chemotherapy, considering histological subtypes and disease stage. Furthermore, we address the good prognosis associated with early diagnosis and treatment, with survival rates exceeding 90 % in many cases. Finally, the need for long-term follow-up to monitor for potential recurrence is underscored and the long-term treatment-related effects are addressed. This review aims to guide clinicians in providing optimal care for this unique patient population, emphasizing the importance of balancing oncological control with the preservation of future fertility and quality of life.

Sentinel lymph node biopsy in gynecological malignancies: A modern approach to surgical staging – A narrative review

Sentinel lymph node biopsy (SLNB) has emerged as a valuable alternative to traditional lymphadenectomy in the surgical management of gynecological cancers. This narrative review delves into the advantages, practical applications, and future research directions of SLNB in this context. Compared to the more extensive lymphadenectomy, SLNB offers a minimally invasive approach to lymph node staging, leading to reduced surgical morbidity, faster recovery times, and improved quality of life for the patients involved. This narrative review highlights the high detection rates and accuracy of SLNB in predicting lymph node metastasis, particularly in early-stage endometrial, cervical and vulvar cancers. By accurately assessing lymph node status, SLNB provides crucial information for treatment planning, potentially guiding decisions regarding adjuvant therapies and assessing the need for further lymph node dissection. From clinical practice guidelines, prospective studies, and relevant research articles, this review provides a thorough understanding the evolving role of SLNB in managing gynecological malignancies. The findings presented underscore the potential of SLNB to improve patient outcomes by providing accurate staging while minimizing surgical complications.

Advancements in uterine sarcoma management: A review

Uterine sarcomas are rare, accounting for 3-7% of uterine malignancies. This review aims to summarize advancements in diagnostics and treatment over the last decade, focusing on innovative imaging techniques, molecular diagnostics, and treatment modalities. Recent diagnostic advancements include enhanced imaging techniques such as MRI and AI-driven algorithms, improving accuracy in differentiating between benign and malignant uterine tumors. Biomarkers like lactate dehydrogenase (LDH) and microRNAs have shown potential in preoperative identification. Treatment strategies continue to evolve, with surgical resection being the cornerstone. The role of lymphadenectomy and adnexectomy varies by histopathological subtype, emphasizing personalized approaches. Adjuvant therapies remain controversial, tailored to patient risk factors and tumor characteristics. Fertility-sparing options are viable for selected patients, though not recommended for high-grade tumors. Significant progress in diagnostic techniques and personalized treatment approaches has improved the management of uterine sarcomas. Future guidelines from major oncology groups are expected to standardize care. Continued research is essential for refining treatment protocols and enhancing patient outcomes.

Neuroendocrine cervical cancer: Have we made any steps forward in its management?

Neuroendocrine tumors (NEC) were first described by Albores-Saavedra in 1972 and these tumors account for only 0.9% to 1.5% of all invasive cervical cancers. We searched for all available interventional studies, reviews, case reports and meta-analyses published from 1995 to 2023. In 2017 Castle et al. Current therapeutic modalities are mainly based on experience in the treatment of SCNEC of the lung. Certainly, a multidisciplinary approach is very important inorder to design a personalized management plan.

Neuroendocrine tumors of the gynecological tract: A narrative literature review

Neuroendocrine neoplasms (NENs) of the gynecological tract are a rare, heterogenous and aggressive group of neoplasms, with high recurrence rates and poor prognosis. In this review we focus on NENs of the gynecological system emphasizing the classification, epidemiological and clinical characteristics of NENs across the gynecological tract (cervix, endometrium, ovary, vagina, and vulva), risk/prognostic factors, pathology and molecular biology (including actionable genomic mutations), imaging, staging and the most effective treatment modalities in the "standard of care" approach as well as the pipeline products. We also focused on metastatic spreading patterns of gynecological NENs. We searched for all available literature reviews, interventional studies, short series, case reports and meta-analyses published from 1990 to 2024. Deteriorated survival rate is essentially impacted by early development of lymph node, distant organ metastases and vascular propagation toward rapid extra-pelvic metastasis to the brain, liver, lung, bone marrow, lymph nodes and bones. Management of NENs needs to be customized on a case-based manner and comprises a multidisciplinary approach that involves gynecologists, surgeons, medical oncologists, radiologists, radiation oncologists, nuclear medicine specialists, pathologists, molecular biologists, qualified nurses etc. The treatment of extrapulmonary NENs arising in the female genital tract is basically extrapolated from that for small cell lung cancer. This includes, but is not limited to: surgery, chemotherapy, radiotherapy, peptide receptor radionuclide therapy, somatostatin analogs, and immunotherapy as well as investigational drugs in rare prospective clinical trials. Establishing modern therapeutic thesaurus is conditioned by the existence of well-designed clinical trials targeting a tumor's genomic profile and the incorporation of these data into the actual treatment landscape.

Access to molecular classification in endometrial cancer recommended by ESGO–ESTRO–ESP guidelines: multi-national survey in Eastern Europe

Advances in tumor biology have transformed endometrial cancer management. Since 2021, ESGO-ESTRO-ESP (European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology-European Society of Pathology) guidelines have incorporated molecular classification, which is essential in the 2025 update. Its implementation in Eastern Europe remains unclear. This study evaluated the availability, reimbursement, and integration of molecular classification at national and institutional levels. A 2-phase cross-sectional online survey was conducted from December 2024 to September 2025. National coordinators from 17 European Society of Gynaecological Oncology-affiliated countries reported on access, reimbursement, and guidelines. A second survey targeted 67 treatment centers to assess institutional practices. Full molecular profiling (p53-abnormal, POLE-ultra-mutated, mismatch repair-deficient) was available in 29.4% of countries, with partial access in 70.6%. Lack of reimbursement and accredited laboratories were the main barriers. At least 1 test was publicly funded in 58.8% of countries: p53 and mismatch repair-deficient immunohistochemistry in 70.0% and POLE-ultra-mutated next-generation sequencing in 29.4%. National guidelines existed in over half of the countries, but few included molecular classification. At the institutional level, testing was routine in 41.0% of centers, selective in 27.9%, and unavailable in 31.1%. Overall, 55.8% reported access via local or external laboratories. Comprehensive classification was significantly more available in settings with national/public reimbursement (79.2% vs 18.9%, p < .0001). POLE-ultra-mutated testing was more accessible in private than public hospitals (42.9% vs 33.3%, p = .006), while p53 immunohistochemistry was more common in high-volume centers (97.5% vs 76.2%, p = .01). Access to molecular classification in Eastern Europe remains limited because of insufficient reimbursement and laboratory resources. Addressing these disparities is essential to support equitable treatment and improve outcomes.

Analysis of the molecular profile of endometrial cancer depending on microsatelite instability

The absence of precise classification and effective predictive biomarkers in endometrial cancer (EC) leads to suboptimal treatment decisions and outcomes, underscoring the urgent need for improved diagnostic and therapeutic approaches. Endometrial cancer represents 4.8 % of the cases of malignant tumors, being in the sixth place worldwide in terms of incidence of malignant tumors in women. The treatment of endometrial cancer, especially stage I, which affects 70-75 % of patients, remains a subject of debate. According to the current European Society of Medical Oncology (ESMO) recommendations, for the management of patients with endometrial cancer, the treatment strategy is influenced by the results of risk stratification. Regarding endometrial cancer, a large number of prognostic factors are described, which create certain difficulties in their application in clinical practice. Most factors are morphological, and information about them is obtained after surgery on the basis of a standard histological examination. Of particular interest is the study of risk factors in the case of individual endometrial cancer variants. The molecular classification of endometrial tumors has the potential to become an indispensable element of histopathological classification, which would contribute to determining the prognosis and treatment strategies of the disease. In addition, it can lead to the development of a new targeted therapy, as well as to the implementation of molecular diagnostic tests for the detection of endometrial cancer in the early stages, when the prognosis is much more favorable. Despite the large amount of research which focuses on the study of the biological and molecular aspects of endometrial cancer, currently none of the tumor markers is recommended for widespread clinical use in endometrial cancer because there is insufficient information concerning their application into clinical practice.