Seongyun Lim

Comparison of ArtiSential and Conventional Laparoscopic Instruments in Hysterectomy for Gynecologic Cancers: A Hybrid Observational Study on Surgical Outcomes, Pain Control, and Oncologic Safety

To evaluate the clinical and oncologic outcomes of gynecologic cancer surgeries performed using multi-joint laparoscopic instruments (ArtiSential) compared to conventional instruments, focusing on hysterectomy. A hybrid observational study combining prospective data for the ArtiSential group (n = 44) and retrospective data for the conventional group (n = 136). International multicenter study conducted in Korea, Taiwan, and Japan. 180 patients who underwent hysterectomy for gynecological cancers. Laparoscopic hysterectomy using either ArtiSential or conventional laparoscopic instruments. No significant differences were observed in operative time (100.1 min vs. 99.7 min, p = .95) or estimated blood loss (111.6 mL vs. 125.0 mL, p = .39) between the ArtiSential and conventional groups. The ArtiSential group showed numerical reduction in moderate-to-severe postoperative pain without statistical significance in total group (6.8% vs. 18.4%, p = .09), but a statistically significant reduction in uterine cancer patients (3.6% vs. 21.4%, p = .04). Complication rates were generally lower in the ArtiSential group across all cancer types, although not statistically significant. In radical hysterectomy, the ArtiSential group demonstrated shorter operative times (109.2 min vs. 135.9 min, p = .14) and reduced estimated blood loss (150.0 mL vs. 162.9 mL, p = .75). Multivariate Cox analysis revealed that FIGO stage, operative time, and estimated blood loss significantly affected progression-free survival in uterine cancer, while ArtiSential use did not (p = .47) CONCLUSIONS: ArtiSential instruments appear to be feasible for gynecological cancer surgeries, offering potential benefits such as reduced postoperative pain and fewer complications but without statistical significance. While these findings highlight the utility of ArtiSential in complex pelvic surgeries, further prospective multicenter studies with larger cohorts and longer follow-up periods are required to confirm oncologic safety and long-term complication.

Pre-diagnostic physical activity and mortality in cervical cancer: a nationwide cohort study

The prognostic significance of pre-diagnostic physical activity in cervical cancer remains unclear. This study examined the association between pre-diagnostic physical activity and all-cause mortality among women with cervical cancer. In a population-based cohort study using nationwide South Korean registry data, 8833 women aged 19 to 79 years with newly diagnosed cervical cancer who completed health screenings within 1 year before diagnosis were analyzed. Physical activity was self-reported and categorized by intensity, duration, and total energy expenditure in metabolic equivalent task-minutes per week. All-cause mortality was assessed using multi-variable Cox proportional hazards models with sub-group analyses by Surveillance, Epidemiology, and End Results stage and age. Among the study population, 64.9% had localized, 23.7% regional, and 5.0% distant disease. Higher total energy expenditure was associated with reduced mortality. Compared with <500 metabolic equivalent task-minutes per week, 500 to 1499 metabolic equivalent task-minutes per week was associated with lower mortality (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.98). Physical activity intensity alone was not independently associated with mortality; however, among patients with localized disease, vigorous-intensity activity (HR 0.64, 95% CI 0.43 to 0.95) and regular exercise (HR 0.62, 95% CI 0.43 to 0.88) were associated with lower mortality. Among patients aged ≥65 years, associations between physical activity and mortality were observed mainly in localized-stage disease, with no significant associations in other stages or younger age groups. Higher levels of pre-diagnostic physical activity were associated with improved survival in women with localized cervical cancer, particularly among those aged ≥65 years. These findings suggest that pre-diagnostic physical activity may have prognostic relevance in specific patient sub-groups.