Mariachiara Bosco

Sentinel lymph node biopsy in apparently early-stage ovarian cancer: beyond removal of green nodes and surgical experience

Systematic pelvic and para-aortic lymphadenectomy is the standard procedure for surgical staging in apparently early-stage ovarian cancer. The role of sentinel lymph node biopsy remains unclear. To evaluate the diagnostic accuracy, feasibility, and safety of sentinel lymph node biopsy when performed by a single operator with a standardized technique. Case series of 36 patients with apparently early-stage ovarian cancer who underwent surgery performed by a single operator following the SELLY trial protocol. Sentinel lymph node mapping was performed by injecting the tracer into the infundibulopelvic and utero-ovarian ligaments. Sentinel node biopsy was followed by systematic pelvic and para-aortic lymphadenectomy. Thirty-six consecutive patients with apparently early-stage ovarian cancer were enrolled; 22 patients underwent immediate surgery and 14 delayed procedures after incidental diagnosis. 86.1 % of patients had successful mapping of at least one SLN, and 54.8 % had successful mapping in both pelvic and para-aortic regions. Three patients had isolated tumor cells (ITCs) and one patient had macro-metastasis in SLN. No cases of false negative SLN were observed. The sensitivity and negative predictive value were 100 %. We had five (13.9 %) postoperative complications not related to the SLN procedure itself. SLN is a reliable and safe surgical procedure in apparent early-stage ovarian cancer regardless of immediate and delayed surgery, but strict protocol adherence and expert surgeons are mandatory. SLN mapping in apparent early-stage ovarian cancer is feasible and accurate in detecting lymph node metastasis.

Robotic-Assisted Surgical Staging with Sentinel Node Biopsy for Apparently Early-Stage Endometrial Cancer Using the Modular Multi-Arm Surgical Robot System Versius® (Cambridge Medical Robots): A Case Series

Objectives: The aim of the study was to report the first cases of surgical staging for apparently early-stage endometrial cancer performed using the Versius® next-generation robotic surgical system (Cambridge Medical Robots [CMR] Surgical, Cambridge, UK). Design: The study used a prospective case series. Participants/Materials: Women who underwent surgical staging, including total hysterectomy, bilateral adnexectomy, and sentinel lymph node (SLN) biopsy, for apparently early-stage endometrial cancer using the Versius® next-generation robotic surgical system (CMR Surgical, Cambridge, UK) were included. Setting: The study was conducted at a Gynecologic Oncology Referral Center. Methods: We prospectively recorded data of all consecutive women who underwent the investigated surgical procedure. Results: Fourteen endometrial cancer patients were treated between March and August 2024 at the Azienda Ospedaliera Universitaria Integrata of Verona. The mean age was 69.4 ± 8.7 years, and the average body mass index was 27.2 ± 4.8. SLN biopsy was performed on all patients: 5 patients had unilateral and 9 bilateral successful SLN detection; 6 women underwent systematic pelvic lymphadenectomy in the unmapped areas. The median operative time was 122 (min-max, 77–185) minutes, and the median hysterectomy time was 34 (min-max, 18–68) minutes. None of the surgical procedures required conversion to conventional laparoscopic or open surgery for technical reasons, and no intraoperative complications were recorded. No readmissions, reoperations, or deaths were observed during the follow-up (median 102 days, min-max 39–249). Limitations: The limitations of the study are the first experience in a limited study population and the use of methylene blue for SLN mapping. Conclusions: Our preliminary results with the Versius® platform appear encouraging regarding surgical time, blood loss, rate of completion of the robotic procedures, and complications risk. Further studies will confirm the indications, feasibility, and safety of the Versius® surgical robot system for treating apparently early-stage endometrial cancer.

Hydatidiform Mole with Coexisting Normal Pregnancy: A Systematic Review and Individual Participant Data Meta-Analysis

Background and Objectives: This study aimed to evaluate obstetric, neonatal, and oncologic outcomes of pregnancies complicated by a hydatidiform mole coexisting with a live fetus (HMCF) carried beyond viability, and to assess the impact of delivery mode on outcomes. Materials and Methods: A systematic review and individual participant data meta-analysis included HMCF cases progressing beyond 23 weeks. Obstetric and neonatal outcomes, delivery patterns, and oncologic risks were analyzed. Results: Among 118 pregnancies complicated by HMFC (124 newborns), most were complete moles (87%). Median delivery occurred at 31.6 weeks, with over half before 32 weeks. Common complications included vaginal bleeding (59%), preeclampsia (30%), and hyperthyroidism (18%). Cesarean delivery was performed in 79% of cases, often for mole-related factors, but was not associated with reduced maternal or oncologic risk. Neonatal deaths occurred exclusively in infants delivered ≤32 weeks, highlighting extreme prematurity as the key determinant of survival. Severe preeclampsia was strongly linked to earlier delivery. Conclusions: With close monitoring, continuation of HMCF pregnancies is possible. Neonatal mortality is mainly driven by prematurity, which appears to be an indirect consequence of HMFC through the development of mola-associated complications. Cesarean section does not appear to improve maternal and oncologic outcomes. Vaginal delivery can be considered when no standard contraindications exist.