Ronghua Liu

Prophylactic salpingectomy as a preventative strategy for ovarian cancer in the general population: a systematic review and meta-analysis

The impact of prophylactic salpingectomy on the prevention of epithelial ovarian cancer (EOC) remains unclear, particularly in Asian populations where data is lacking. In this systematic review and meta-analysis study, we sought to assess whether prophylactic salpingectomy could reduce the incidence of ovarian cancer in the general population of multiple ethnicities. A systematic review and meta-analysis were conducted using PubMed/MEDLINE, EMBASE, the Cochrane Library, and Web of Science to assess the effectiveness of salpingectomy, bilateral salpingectomy (BS), and unilateral salpingectomy (US) in reducing the risk of EOC and evaluating postoperative outcomes. The final analyses included 6 eligible trials (5,747,056 patients), including 1 cohort study and 5 case-control studies. The analyses of these studies demonstrated that women who underwent salpingectomy had a significantly reduced risk of EOC compared to those who did not receive salpingectomy (odds ratio [OR]=0.63; 95% confidence interval [CI]=0.45-0.89; p=0.007). Five studies (5,746,469 patients) indicated a significant reduction in EOC risk among patients who underwent BS (OR=0.48; 95% CI=0.33-0.69; p<0.001). On the other hand, in the analysis of 4 studies (5,745,887 patients) that examined US, the association with EOC risk was not significant despite the protective trend (OR=0.82; 95% CI=0.64-1.06; p=0.12). Our results indicate BS is an effective strategy for reducing the risk of sporadic EOC, but the results did not lead to the same conclusion for patients who underwent US. When a candidate or patient is undergoing a hysterectomy or has other benign diseases, prophylactic BS may be a safe surgical procedure that carries future benefits in terms of EOC risk.

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single‐center retrospective study

AbstractPurposeWe aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease‐free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients.MethodsFour hundred sixty‐five women with EC were included in this retrospective study. Log‐rank tests and Kaplan–Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis.ResultsAmong the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log‐rank p = 0.914 and 0.810 for OS; log‐rank p = 0.707 and 0.771 for DFS, respectively).ConclusionBased on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II‐III EC patients.

Postoperative Adjuvant Treatment in Women with Stage I Endometrial Cancer: A Retrospective Study

Objective. To evaluate whether postoperative adjuvant treatment is beneficial for patient survival after surgery for early stage endometrial cancer (EC). We analyzed the outcomes of patients treated with radiotherapy, chemotherapy, or progestagen combined with other adjuvant treatments. Methods. We analyzed the outcomes of patients treated with radiotherapy alone, chemotherapy alone, or progestagen treatment with other adjuvant treatments. Women without any adjuvant treatment after operation were used as controls. We retrospectively examined disease-free survival (DFS), overall survival (OS), and high-risk factors that affected the survival status of all patients who received different postoperative adjuvant therapies. Results. In all 192 patients, the total relapse and mortality rates were 5.57% and 1.68%, respectively. Fourteen patients (7.29%) developed isolated local recurrence, and 2 patients died (1.04%) of recurrence during the follow-up period. The 5-year DFS and OS rates of all patients were 95.83% and 93.75%, respectively. No significant differences were observed in the 5-year DFS, 5-year OS, OS, or DFS among the four groups of patients with FIGO stage I endometrial cancer ( P = 0.9849 , 0.7430, 0.9754, and 0.4534, respectively). The differences in the log-rank test results of the estimates of the 5-year DFS, 5-year OS, DFS, and OS of patients with different disease stages and different ages were all significant, but no differences were observed in these parameters among patients with varying degrees of differentiation. Histologic grade, CA125 level, ER and PR status, and adjuvant therapy had no significant effect on the DFS and OS of all patients according to univariate and multivariate regression analyses, but a significant effect on DFS and OS was found when the patients were stratified by age. Conclusion. This retrospective study showed that adjuvant therapy after surgery was not significantly associated with improved DFS or OS in patients with early stage endometrial cancer. However, FIGO stage and age affected the survival of patients with stage I endometrial cancer.

An extremely rare disconnection of the external iliac artery and novel collateral remodeling in an endometrial stromal sarcoma woman

Abstract Background Injury to the external iliac artery can have serious consequences and can be extremely challenging for surgeons. Here, we report a patient with bizarre disconnection of the external iliac artery during a laparoscopic operation. Case presentation On May 27, 2020, during a laparoscopic pelvic lymphadenectomy operation to treat endometrial stromal sarcoma, we encountered an unusual anatomy: abnormal disconnection of the left external iliac artery in a 26-year-old female patient. The proximal and distal ends of the left external iliac artery demonstrated old narrowing without active bleeding, and the distance between the two disconnected ends was more than 3 cm. The scenario was surprising to all the staff in the operating theater. After a comprehensive assessment of skin temperature, arterial pulsation and arterial blood flow, a multidisciplinary team determined that collateral circulation of the left lower limb had been established and could meet the blood supply of the lower limbs, which was also confirmed three times by computed tomography angiography and Doppler ultrasound of the blood vessels in the abdomen and lower limbs. Sixteen months after the operation, the patient had no obvious abnormality, and the daily activities of the left lower limb were not affected. Follow-up after treatment for the patient is still in progress. Conclusions We describe the details of the whole case of disconnection of the external iliac artery. We hope to summarize the experience and lessons learned through this case and a relevant literature review to improve the safety and orderliness of our future clinical work.