Vanna Zanagnolo

Robotic single-port (da Vinci SP) versus multiport (da Vinci Xi) for the treatment of atypical endometrial hyperplasia and endometrial cancer: A multi-institutional comparison of surgical outcomes

The da Vinci SP robotic platform offers a novel single-port approach for minimally invasive surgery. Despite its potential, data on its safety and performance in gynecologic oncology remain limited. We aimed to compare surgical outcomes of da Vinci SP versus da Vinci Xi systems in the staging of endometrial cancer (EC). This is a multi-institutional study. Data of consecutive patients with apparent early-stage EC or atypical endometrial hyperplasia who underwent robotic surgery between January 2023-March 2025 were collected. The primary outcome was to compare the surgical outcomes between da Vinci SP and da Vinci Xi. A total of 189 patients were included: 97 (51.3 %) underwent SP surgery and 92 (48.7 %) Xi. The median (range) of operative time, estimated blood loss, and postoperative hospital stay were comparable for SP and Xi groups (140 [70-296] vs. 143 [60-297] min, p = 0.66, 40 [0-250] vs. 64 [0-1300] mL, p = 0.12, 3 [1-11] vs. 3[1-10] days, p = 1). Docking time was significantly shorter in the SP group (10 [4-31] vs. 12 [7-30] min for SP and Xi, respectively, p = 0.004). Intraoperative or post-operative complications rates were comparable (p = 0.30 and p = 0.14,respectively). The patient-reported pain score was significantly lower at 12h and 24h in the Xi group (p = 0.001), while was comparable at 48h after surgery (p = 1). The da Vinci SP system appears to be non-inferior to the multiport da Vinci Xi for surgical staging of early-stage EC. Comparable perioperative outcomes support its clinical use, although patient selection criteria and long-term results require further investigation.

Detection rate of sentinel lymph nodes in early-stage endometrial cancer according to age

Sentinel lymph node (SNL) mapping plays a crucial role in staging patients with an apparent early-stage endometrial cancer. Older age may be associated with lower detection rates due to factors such as decreased lymphatic flow; but consensus is lacking. This study aims to evaluate the impact of age on the SNL detection rate in patients undergoing minimally invasive surgical staging for endometrial cancer. This multicenter retrospective study included apparent early-stage endometrial cancer patients undergoing minimally invasive surgical staging, including SLN mapping across four ESGO-accredited centers (2020-2023). Patients were categorized into two age groups: <65 years, defined as younger adults and ≥65 years, defined as older adults. Univariate and multivariate logistic regression models were used to identify predictors of bilateral mapping. Overall, 642 patients were identified: 342 (53.3%) patients were classified as younger adults and 300 (46.7%) as older adults. The overall bilateral SLN detection rate was 89.3%, with no or unilateral detection in 10.7% of patients. Older adults had a significantly lower bilateral detection rate than younger adults (85.0% vs. 93.0%, p = 0.005). Multivariate analysis identified age ≥65 years as the only independent predictor of failed bilateral mapping (OR 2.2, 95 % CI 1.3-3.8, p = 0.003). Other clinical, surgical, and pathological factors were not associated with mapping failure. Age ≥65 is independently associated with decreased bilateral SLN detection in early-stage endometrial cancer. Nevertheless, SLN biopsy remains a feasible and reliable staging method in older adults when performed using standardized techniques by experienced surgeons.

Predictors of recurrence in early-stage cervical cancer without adjuvant treatment after radical surgery

The role of adjuvant radiotherapy after radical surgery for early-stage cervical cancer is controversial in the absence of high-risk factors. This study aimed to evaluate predictors of recurrence in patients with early-stage cervical cancer undergoing observation after radical surgery. Patients with FIGO 2018 stage I cervical cancer who underwent radical surgery without adjuvant therapy at the European Institute of Oncology, IEO (Milan, Italy) between 2010 and 2023 were retrospectively identified. Patients with high-risk factors for recurrence (positive margins, parametria, or lymph nodes) were excluded. Recurrence-free survival following surgery was estimated using the Kaplan-Meier method. Log-rank test and Cox regression analyses were performed to assess predictors of recurrence. A total of 340 patients were identified: 7 (2.0 %) stage IA1, 31 (9.1 %) IA2, 191 (56.2 %) IB1, 108 (31.8 %) IB2, and 3 (0.9 %) IB3. Twenty-two (6.5 %) patients had a recurrence. The estimated 5-year recurrence-free survival for the overall cohort was 93.5 % (95 % CI, 89.9-95.8). On multivariate analysis, factors associated with a higher risk of recurrence included tumor size ≥2 cm (HR 3.04, 95 % CI 1.26-7.35; p = 0.01) and grade 3 (HR 2.76, 95 % CI 1.1-6.9; p = 0.03). In the absence of high-risk factors, the risk of recurrence in patients with early-stage cervical cancer who did not receive adjuvant treatment after radical surgery was low overall. Patients with individual risk factors such as tumor size ≥2 cm or tumor grade 3 may be at higher risk of recurrence. Further research is warranted to redefine risk groups and tailor adjuvant treatment based on timely clinicopathological risk factors.