Masafumi Nii

Laparoscopic retroperitoneal para‐aortic lymph node biopsy in advanced cervical cancer with pelvic lymph node metastases: A single‐center prospective study

Abstract Aim Extended‐field concurrent chemoradiation therapy (Ex‐CCRT) has been widely used for para‐aortic lymph node (PAN) metastases confirmed by radiographic assessment without surgical exploration. The objective of this prospective study was to evaluate the clinical value of laparoscopic retroperitoneal PAN biopsy in locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastases. Methods From May 2017 to March 2020, stage IIB–IIIB cervical cancer patients who were diagnosed with PLN metastasis using positron emission tomography‐computed tomography (PET‐CT) with maximum standardized uptake value (SUVmax) ≥2.0 underwent laparoscopic retroperitoneal PAN biopsy. The radiation fields were extended to PAN areas with pathological metastases. Results Fourteen patients were diagnosed with cervical squamous cell carcinoma of the International Federation of Gynecology and Obstetrics (FIGO) stage IIB ( n  = 7) and IIIB ( n  = 7). The median operating time was 138 min (range, 104–184 min). The median number of harvested PANs was 19 (range, 6–36). Three patients were positive for PAN metastasis on histological analysis. In this study, the sensitivity and specificity of PET‐CT were 66.7% and 90.9%, respectively. Conclusion Our study is characterized by the use of more appropriate eligibility criteria for LACC with PLN metastases. Our results revealed that laparoscopic retroperitoneal PAN biopsy may be a useful approach to determine the radiation field for PANs during standard radiotherapy planning.

Symptomatic and asymptomatic venous thromboembolism after minimally invasive surgery for gynecological cancers

Abstract Aims To clarify the frequency of postoperative symptomatic and asymptomatic venous thromboembolism (VTE) in patients who underwent minimally invasive surgery (MIS) for gynecological cancers; and to identify the risk factors associated with pulmonary embolism (PE). Methods We analyzed data for patients with endometrial, cervical, or ovarian cancers who underwent MIS or open surgery between February 2012 and December 2021 at Mie University Hospital, Japan. Patients who required conversion to open surgery were excluded. We treated deep vein thrombosis (DVT), including distal DVT, with preoperative anticoagulation. In all cases, intra‐ and postoperative VTE prophylaxis with anticoagulation, intermittent pneumatic compression, and compression stockings were provided. Results Overall, 382 patients with gynecological cancers who underwent MIS were included. Approximately 90% of patients had stage I disease. Symptomatic and asymptomatic PE occurred in 0.2% and 1.5% of patients who underwent MIS, respectively. All patients who developed PE had DVT. In the MIS group, both DVT and PE occurred in seven cases each (1.8%). Conversely, in the open surgery group ( n  = 817), there were 19 (2.3%) and 13 (1.6%) cases of DVT and PE, respectively. DVT and PE incidence rates did not significantly differ between the MIS and open surgery groups (DVT: p  = 0.67, PE: p  = 0.80). Uni‐ and multivariate analyses revealed that an operative time >6 h was associated with PE ( p  = 0.034). Conclusions VTE incidence was low among patients with gynecological cancers who underwent MIS. VTE rates remained low following open surgery or MIS when appropriate anticoagulation was administered. However, caution should be exercised during prolonged surgeries.