Mirjana Miladinović

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.

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.

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.