BMC Surgery

Uterine carcinosarcoma due to foreign body (migrated intrauterine device): an extremely rare etiology of gynecological neoplasm

Uterine carcinosarcomas are extremely rare gynecological neoplasms. The coexistence of intraabdominal foreign bodies, such as migrated IUDs, and uterine neoplasms, particularly carcinosarcomas, represents a significant clinical challenge and infrequent association. Chronic inflammation associated with foreign bodies can act as a cofactor in carcinogenesis and explain the appearance of these tumors. A 65-year-old woman with a history of cesarean section, presented to the emergency department with a 5-day complaint of abdominal pain, nausea and constipation. An abdominal CT scan was performed, revealing a left parauterine mass containing a migrated intrauterine device (Lippes's loop) with a transition zone in the sigmoid colon. The patient was taken to exploratory laparotomy, where a subtotal hysterectomy and left salpingo-oophorectomy were performed. Pathology report showed uterine carcinosarcoma. This case exemplifies a rare clinical presentation of uterine neoplasm secondary to the presence of a foreign body (Lippes's loop), debuting with bowel obstruction. Uterine neoplasm secondary to foreign bodies are very rare clinical entities, and its pathophysiological mechanisms have not been fully understood. Particularly, uterine carcinosarcomas are a subgroup of these malignancies with a more aggressive behavior and poor oncological prognosis. Early diagnosis and prompt surgical management are the cornerstones of management.

Oncological outcomes of minimally invasive surgery in non-endometrioid endometrial Cancer patients with varying prognostic risks: a retrospective cohort study based on the ESGO/ESTRO/ESP 2020 guidelines

Non-endometrioid endometrial carcinomas (NEEC) are characterized by their rarity and adverse prognoses. This study evaluates the outcomes of open versus minimally invasive surgery (MIS) in NEEC patients stratified by prognostic risks according to the 2020 ESGO-ESTRO-ESP risk classification guidelines. A retrospective analysis was performed on 99 NEEC patients who underwent initial surgery at Fujian University Cancer Hospital. Patients were categorized into two groups: those undergoing MIS and those undergoing open surgery. We compared disease-free survival (DFS) and overall survival (OS) between these groups. Cox regression analysis was employed to identify risk factors for DFS, which were further validated via bootstrap statistical methods. The study included 31 patients in the MIS group and 68 in the open surgery group. The demographics and clinical characteristics such as age, body mass index, comorbidities, histological subtypes, and FIGO stage were similar between groups (P > 0.05). The MIS group experienced ten recurrences (1 vaginal, 2 lymph nodes, 7 distant metastases), whereas the open surgery group had seven recurrences (1 vaginal, 3 lymph nodes, 1 pelvis, 2 distant metastases), yielding recurrence rates of 10.3% versus 25.6% (P = 0.007). Besides lymphovascular space invasion (LVSI), surgical approach was also identified as an independent prognostic factor for DFS in high-risk patients (P = 0.037, 95% CI: 1.062-7.409). The constructed nomogram demonstrated a robust predictive capability with an area under the curve (AUC) of 0.767. Survival analysis for high- and intermediate-risk patients showed no significant differences in OS between the two groups (P This investigation is the inaugural study to assess the impact of surgical approaches on NEEC patients within the framework of the latest ESGO-ESTRO-ESP risk classifications. Although MIS may offer clinical advantages, it should be approached with caution in high-risk NEEC patients due to associated poorer DFS outcomes.

Diagnostic accuracy of artificial intelligence algorithms to predict remove all macroscopic disease and survival rate after complete surgical cytoreduction in patients with ovarian cancer: a systematic review and meta-analysis

Complete Cytoreduction (CC) in ovarian cancer (OC) has been associated with better outcomes. Outcomes after CC have a multifactorial and interrelated cause that may not be predictable by conventional statistical methods. Artificial intelligence (AI) may be more accurate in predicting outcomes. This systematic review aimed to determine the accuracy of AI compared to traditional statistics in predicting outcomes after CC in OC. PubMed, Scopus, Google Scholar, Embase, and Web of Science databases were searched with Mesh terms to find studies that investigated the role of AI in predicting outcomes after CC in EOC from the beginning of 2015 to February 2024. The outcomes included overall survival (OS), removal of all macroscopic disease (R0), length of hospital stay (LOS), and intensive care unit (ICU) admission. This systematic review was conducted based on the PRISMA guidelines. Heterogeneity between studies was evaluated using the I Ten studies (3460 participants) were included. The pooled estimate of 3 studies showed that the accuracy of AI for predicting OS was (Mean: 69.64%, CI 95%:66.50, 72.78%, I AI may accurately predict the outcomes after CC in OC patients. Most studies agree that Artificial Neural Networks (ANN) and Machine Learning (ML) models outperform conventional statistics in predicting postoperative outcomes.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer in an Australian institution: lessons from 20 years’ experience

Abstract Objectives We report the 20-year experience of the largest Australian unit performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer and reflect on learning opportunities. Methods A retrospective review of all cases of CRS for ovarian cancer at St George Peritonectomy Unit from Jan 1998 to Jan 2018 was performed. Prospectively collected data include age, stage, histology, disease extent (PCI), completeness of cytoreduction (CC score), HIPEC regime, 30-day surgical morbidity, disease recurrence, and death. Survival was computed using Kaplan–Meier method and analysed using log-rank tests and Cox-proportional hazards models. Results Forty-one women with advanced ovarian cancer (11 primary stage III/IV, 30 recurrent) underwent CRS, 29 (71%) with HIPEC. Most (68%) had high-volume disease (PCI > 15). In 98%, CC0/CC1 (residual < 2.5 mm) was achieved. Fourteen (34%) had grade 3/4 complications, 1 patient (2%) died within 30 days and 2 patients (5%) died within 90 days. Progression-free and median overall survival was 30.0 and 67.0 months for primary cancer, and 6.7 and 18.1 months for recurrent cancer. Survival was associated with platinum-sensitivity, PCI ≤ 15, and CC score 0, but not HIPEC. Conclusion This study reports outcomes for patients with advanced ovarian cancer patients treated in an Australian centre offering CRS and HIPEC. Whilst survival and morbidity outcomes were good for primary disease, they were poorer than predicted from the literature for cases of recurrent disease. The incorporation of evidence-based predictors of survival and multidisciplinary input are essential to achieve the best survival outcomes.

Giant ovarian tumor with colorectal cancer: suggestion concerning the need for colonoscopy screening in cases with large ovarian tumor—a report of three cases

Abstract Background Patients with giant ovarian tumor often have severe symptoms, such as abdominal distention, and the tumor tends to grow rapidly; therefore, sufficient preoperative assessments are difficult to perform. It is not always easy to differentiate between primary and metastatic ovarian cancer, especially when the ovarian tumor is huge, since a precise diagnosis of ovarian tumor depends on the histopathological findings of the excised specimen. Although metastatic ovarian tumors account for over 20% of all malignant ovarian tumors, preoperative colonoscopy is not considered a routine examination before surgery for giant ovarian tumor. Case presentation We herein report 3 cases of giant (> 25 cm) ovarian tumor with colorectal cancer. All three patients visited the clinic with progressing abdominal distention, and were referred with primary ovarian malignancy. Case 1: Rectal tumor was suspected by a digital examination at the outpatient clinic, and rectal cancer was diagnosed preoperatively by colonoscopy. Computed tomography revealed a single-nodule liver tumor. Ovariectomy, rectal resection, and partial hepatectomy were performed. A histological examination revealed both primary mucinous ovarian carcinoma and rectal carcinoma with liver metastasis. Case 2: Initially, the ovarian tumor was diagnosed as primary carcinoma based on the histological findings of an incision biopsy at the previous hospital. Chemotherapy for ovarian cancer was administered without remission, and subsequently, the patient was referred to our hospital. Since the CEA level was high (142 ng/ml), colonoscopy was performed and cecal cancer was diagnosed. Ovariectomy and right colectomy were performed, and the ovarian tumor was histologically diagnosed as metastatic adenocarcinoma. Case 3: Initial ovariectomy was performed, and rectal cancer was suspected at intra-operative surveillance. Colonoscopy was performed after surgery, and rectal cancer was diagnosed. The ovarian tumor was diagnosed as metastatic adenocarcinoma. After six cycles of FOLFOX, rectal resection was performed. Conclusion Regrettably, two of three cases in the current series were not diagnosed with colorectal cancer at the start of treatment. This experience suggests that screening colonoscopy should be considered before treatment for every case of giant ovarian tumor.

Beyond Pathology: A Procedure-Based Approach to Planning and Predicting Outcomes in Robotic Gynaecological Oncology Surgery

Abstract Background Current surgical planning in robotic gynaecology relies heavily on pathological diagnosis, yet operating theatre utilisation may depend more on procedural requirements. Recent advances in machine learning-based surgical prediction have highlighted the need for more accurate planning models whilst challenging fundamental assumptions about surgical complexity. Objectives To compare the impact of procedural requirements versus traditional complexity markers on operating time and complications in robotic gynaecological surgery, and to develop a practical framework for procedure-based surgical planning that could complement contemporary machine learning approaches. Methods Retrospective analysis of 80 consecutive robotic gynaecological surgeries (2021–2024) at a single tertiary centre. We examined relationships between procedural requirements (lymphadenectomy, adhesiolysis), traditional complexity markers (BMI > 35, pathology type, previous surgery), and outcomes (operating time, complications). A Preoperative Procedural Demand Score (PPDS) was developed and validated against pathology-based predictions. Multivariable regression analysis included β-coefficients, confidence intervals, and comprehensive model diagnostics. Results Procedural requirements explained operating time variation better than pathology type. Standard procedures averaged 135.4 ± 28.6 min. Adding lymphadenectomy increased time by 33.1 min (95% CI: 24.8–41.4), adhesiolysis by 19.8 min (95% CI: 11.5–28.1). Traditional complexity markers showed minimal impact: BMI > 35 added 8.1 min (95% CI: -7.2 to 23.4, p  = 0.42), previous surgery 7.6 min (95% CI: -8.4 to 23.6, p  = 0.48). All complications (6.3%) were minor (Clavien-Dindo Grade I-II). Operating time decreased from 178.0 ± 47.2 to 135.9 ± 36.8 min between study halves ( p  < 0.001), whilst intraoperative complications decreased from 12.5 to 0% ( p  = 0.02), despite similar case complexity. Conclusions This study demonstrates that procedural requirements better predict operating time than traditional markers in robotic gynaecological surgery, representing a novel conceptual framework for surgical planning. However, the single-centre design and modest predictive accuracy compared to contemporary machine learning approaches indicate that comprehensive multi-centre prospective validation is essential before recommending widespread adoption. The excellent safety profile across all complexity levels supports the feasibility of robotic surgery in traditionally “complex” cases, though larger studies are needed to establish definitive safety parameters.

Retroperitoneal vNOTES approach in early-stage endometrial cancer: a feasibility cohort with a contemporaneous laparoscopic comparison

This study aimed to assess the feasibility, safety, and perioperative outcomes of the retroperitoneal vaginal natural orifice transluminal endoscopic surgery (vNOTES) approach for surgical staging in patients with early-stage endometrial cancer. A secondary objective was to compare perioperative and short-term results with those achieved using conventional laparoscopy performed by the same surgical team. Between June 2023 and June 2024, a retrospective study was conducted on 98 patients who underwent surgical staging for early-stage endometrial cancer. Patients were allocated to one of two groups: the vNOTES group (n = 49), who underwent retroperitoneal sentinel lymph node (SLN) biopsy, hysterectomy, and bilateral salpingo-oophorectomy (BSO); and the laparoscopic group (n = 49), who underwent the same procedures via a conventional laparoscopic approach. Demographic, surgical, and pathological parameters, as well as short-term follow-up outcomes, were compared between the two groups. The median operative time was significantly shorter in the vNOTES group than in the laparoscopic group (102 vs. 115 min, p < 0.001). SLN detection rates were identical between the groups (97.9% each). Postoperative pain scores on the Visual Analog Scale (VAS) were significantly lower in the vNOTES group at both 6 h (median 3 vs. 5) and 24 h (median 1 vs. 3) (p < 0.001 for both). Patients in the vNOTES group achieved earlier mobilization (median 5 vs. 6 h, p < 0.001) and had a shorter hospital stay (median 2 vs. 3 days, p < 0.001). The incidence of major complications did not differ significantly between the groups, and no recurrences were observed during a median follow-up period of 12 months. The retroperitoneal vNOTES approach appears to be a feasible and safe technique for the surgical staging of early-stage endometrial cancer, providing perioperative benefits including shorter operative time, reduced postoperative pain, and faster recovery. The comparative findings with conventional laparoscopy should be interpreted as exploratory and require validation in larger prospective studies. Oncologic outcomes remain short-term and should be confirmed through long-term follow-up.

Impact of surgical approach on progress of disease by type of histology in stage IA endometrial cancer: a matched-pair analysis

Abstract Background To compare the impact of surgical approach on progression free survival (PFS) stratified by histologic type in women diagnosed with stage IA endometrial cancer. Methods Myometrial invasion is classified into no myometrial invasion, &lt;50% and ≥50%, with only no myometrial invasion and &lt;50% are included in stage IA patients. A retrospective study is designed by collecting data from women diagnosed as stage IA endometrial cancer from January 2010 to December 2019 in a tertiary hospital. A propensity score is conducted for 1:1 matching in the low-risk histologic patients. Progression free survival and disease-specific survival data are evaluated by the Kaplan–Meier method and compared by the log-rank test in both the whole population and the matched-pair groups. A sub-group analysis is performed to figure out risk factors associated with the effect of surgical approach on PFS and disease-specific survival (DSS). Results 534 (84.49%) low-risk histologic endometrial cancer women, with 389 (72.85%) operated by minimally invasive surgery and 145 (27.15%) by open approach, and 98 (15.51%) high-risk histology, with 71 (72.45%) by laparoscopy and 27 (27.55%) by open surgery, are included. Compared to open surgery, laparoscopy results in lower progression free survival in low-risk patients before and after matching (p = 0.039 and p = 0.033, respectively), but shows no difference in high-risk patients (p = 0.519). Myometrial invasion is associated with lower progression free survival in laparoscopy in low-risk histology (p = 0.027). Conclusion Surgical approaches influence progression free survival in stage IA low-risk histologic diseases, especially in those with myometrial invasion, but not in high-risk histologic endometrial cancer.

Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for treatment of endometrial cancer with peritoneal metastases: a multi-institutional study from PSOGI and BIG RENAPE groups

AbstractObjectiveTo investigate the benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis compared to CRS alone.MethodsWe conducted a retrospective multicentre study of patients from experienced centres in treating peritoneal malignancies from 2002 to 2015. Patients who underwent surgery for peritoneal evolution of endometrial cancer (EC) were included. Two groups of 30 women were matched and compared: “CRS + HIPEC” which used HIPEC after CRS, and “CRS only” which did not use HIPEC. We analysed clinical, pathologic and treatment data for patients with peritoneal metastases from EC. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS).ResultsIn “CRS plus HIPEC” group, 96.7% of women were treated for recurrence, while in “CRS only” 83.3 were treated for primary disease. There was no significant difference between Peritoneal Carcinomatosis Index at laparotomy or Completeness of Cytoreduction score. Grade III and IV complications rates did not significantly differ between “CRS plus HIPEC” group and “CRS only” group (20.7% vs 20.7%, p = 0.739). Survival analysis showed no statistical difference between both groups. Median OS time was 19.2 months in “CRS plus HIPEC” group and 29.7 months in “CRS only” group (p = 0.606). Median PFS survival time was 10.7 months in “CRS plus HIPEC” group and 13.1 months in “CRS only” group (p = 0.511).ConclusionThe use of HIPEC combined to CRS did not have any significance as regard the DFS and OS over CRS alone in patients with primary or recurrent peritoneal metastasis of endometrial cancer.

Predictive factors of surgical site infection after hysterectomy for endometrial carcinoma: a retrospective analysis

Abstract Background Surgical site infection (SSI) is a common postoperative complication. We aimed to analyze the potential risk factors of SSI in patients with endometrial carcinoma. Methods Patients with endometrial carcinoma who underwent surgery treatment in our hospital from Sept 1, 2018 to August 31, 2020 were included. We retrospectively compared the characteristics of SSI and no SSI patients, and logistic regression analyses were performed to identify the risk factors of SSI in patients with endometrial carcinoma. Results A total of 318 postoperative patients with endometrial carcinoma were included. The incidence of SSI in patients with endometrial carcinoma was 14.47 %. There were significant differences on the FIGO stage, type of surgery, durations of drainage, postoperative serum albumin and postoperative blood sugar (all p &lt; 0.05), and no significant differences on the age, BMI, hypertension, diabetes, hyperlipidemia, estimated blood loss, length of hospital stay were found (all p &gt; 0.05). FIGO stage IV (HR3.405, 95 %CI 2.132–5.625), open surgery (HR2.692, 95 %CI 1.178–3.454), durations of drainage ≥ 7 d (HR2.414,95 %CI 1.125–2.392), postoperative serum albumin &lt; 30 g/L (HR1.912,95 %CI 1.263–2.903), postoperative blood sugar ≥ 10 mmol/L (HR1.774,95 %CI 1.102–2.534) were the independent risk factors of SSI in patients with endometrial carcinoma (all p &lt;  0.05). Conclusions Measures including reasonable control of serum albumin and blood glucose levels, minimally invasive surgery as much as possible, timely assessment of drainage and early removal of the tube may be beneficial to reduce the postoperative SSI in in patients with endometrial carcinoma.

Clinical comparative study of robot-assisted and traditional laparoscopic surgery in patients with cervical cancer: a retrospective cohort study

A new era in minimally invasive surgery has been ushered in by Leonardo's robot surgical system, but the safety and effectiveness in cervical cancer is lake of evidence. This study aimed to compare the safety, effectiveness, and cost-effectiveness of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in patients with cervical cancer. Patients with cervical cancer who had radical surgery at the first affiliated Hospital of Chongqing Medical University between January 2017 and June 2022 were enrolled. Patients in the LRH and RRH groups were matched 1:1 using propensity score matching (PSM), all patients were followed up to September 2023, cancer recurrence occurred or death, whichever came first. 522 cervical cancer patients were enrolled in this study, 261 of whom were in the LRH group and 261 of whom were in the RRH group. Univariate analysis showed that the RRH group had less intraoperative blood loss, shorter operation time and hospital stay, lower incidence of composite complications and urinary retention, but had higher hospitalization costs. Multivariate Logistic regression analysis showed that LRH was an independent protective factor for composite complications (OR 1.531; 95%CI,1.022 to 2.295; P = .039). Cox regression analysis with cancer recurrence as the endpoint showed that LRH (HR 0.320; 95%CI,0.255 to 0.401; P < .001) and longer operation time (HR 0.995; 95%CI,0.993 to 0.997; P < .001) reduced 68% and 5% risk of cancer recurrence ; results also indicated that the older age (HR 1.017; 95%CI,1.007 to 1.027; P = .001) and postoperative complications (HR 22.410; 95%CI,16.019 to 31.350; P < .001) would increase 224% recurrence risk of cancer recurrence. Both LRH and RRH demonstrated good short-term efficacy, with RRH outperforming LRH in terms of reduced intraoperative bleeding, shorter hospital stays and operation times, and fewer composite complications. However, the RRH group faces a higher risk of early cancer recurrence and incurs greater expenses. In summary, comprehensive long-term prospective studies are needed to thoroughly explore the effectiveness and safety of both LRH and RRH.

A meta-analysis comparing open and minimally invasive cervical tumor surgery wound infection and postoperative complications

AbstractTo evaluate the impact of open surgical care (OSC) compared to minimally invasive surgery (MIS) on the occurrence of wound infection (WI) and overall postoperative aggregate complications (POACs) in female cervical cancer (CC) patients, we conducted this meta-analysis study. A thorough examination of the literature up to March 2024 was conducted, and 1849 related studies were examined. The 44 studies that were selected included 11,631 females who had CC. The odds ratio (ORs) and the estimation using 95% confidence intervals (CIs) were used to calculate the impact of open surgical management and MIS on WI and POACs in females with CC, using dichotomous methodologies and a random or fixed model. When comparing MIS to open surgical care, there was a substantial decrease in WI (OR, 0.19; 95% CI, 0.13–0.29, p &lt; 0.001) and POACs (OR, 0.49; 95% CI, 0.38–0.62, p &lt; 0.001) in females with CC. On the other hand, among female patients with CC, MIS did not differ significantly from open surgical care in pelvic infection and abscess (PI&amp;A) incidence (OR, 0.59; 95% CI, 0.31–1.16, p = 0.13). When compared to OSC, women with CC who underwent MIS experienced considerably fewer WI and POACs; however, there was no discernible difference in PI&amp;A rates. However, given several of the designated examinations for the meta-analysis had relatively small sample sizes, caution must be used while handling its values.

Outcomes of cesarean myomectomy in Singleton compared with twin pregnancies: a 10-year retrospective cohort study

To evaluate and compare the pregnancy outcomes after cesarean myomectomy in singleton and twin pregnancies. We retrospectively reviewed 100 pregnant women diagnosed with myoma who underwent cesarean myomectomy at Chungnam National University Hospital between January 2012 and July 2022. Of them, 77 were singleton pregnancies and 23 were twin pregnancies. Maternal characteristics, largest myoma size, number of myomas, and surgical outcomes were compared between two groups. Myomas were further categorized based on their size; large myomas were defined as lesions measuring ≥ 5 cm in diameter. Maternal characteristics, preoperative and postoperative hemoglobin levels, operative time, and length of hospital stay were compared between the two subgroups. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were assessed using the chi-square test. No significant differences were observed in the maternal characteristics, largest myoma size, number of myomas, or surgical outcomes between singleton and twin pregnancies. However, subgroup analysis based on the largest myoma size (≥ 5 vs.  0.999). No patient required interventions, such as the insertion of an intrauterine Foley balloon, uterine artery embolization, or hysterectomy. Cesarean myomectomy is safe and effective in both singleton and twin pregnancies, even in patients with large myomas.

The potential for de-escalation radical surgery in women with stage IB2 cervical cancer (FIGO 2018): a multi-institutional experience of 63,926 cases over a 14-year period in China

To compare the long-term survival outcomes, recurrence patterns and morbidity of type B and type C radical hysterectomy (RH) for stage IB2 cervical cancer (FIGO 2018). Based on FOUR-C database, patients who underwent type B or C RH in 47 hospitals from 2004 to 2018 were reviewed. Univariate and multivariate analyses were performed to compare 5-year overall survival (OS) and recurrence-free survival (RFS), recurrence patterns and morbidity between the two groups after propensity score matching (PSM). A total of 1308 patients were enrolled in this study, 840 and 468 patients underwent type B and type C. There was no difference in 5-year survival outcomes between groups type B and type C, either before or after matching (OS: unmatched 95.6% vs. 93.3%, matched 95.6 vs. 93.0%, P>0.05; RFS: unmatched: 90.5% vs. 90.1%, matched: 91.2% vs. 89.7%, P>0.05). Type B group had a shorter operative time, less blood loss, earlier recovery of intestinal function, eariler removal of catheter and shorter hospitalization (P0.05), but postoperative complications occurred more frequently in the type C group (8.3% vs. 12.1%, P 0.05). For cervical cancer patients with stage IB2, type B RH demonstrated comparable long-term oncological outcomes and recurrence patterns to type C RH, while being associated with fewer intra-and postoperative complications. Type B RH is a feasible and appropriate surgical option, but the conclusions need to be confirmed by prospective studies.

Significance of cholecystectomy in cytoreductive surgery for advanced ovarian cancer

Abstract Background There have been no studies concerning the complications or benefits of cholecystectomy in ovarian cancer. In this study, we aimed to evaluate the outcomes of cholecystectomy performed during various time periods of the disease course and suggest a management strategy for cholecystectomy in ovarian cancer. Methods We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent cholecystectomy during the cytoreductive surgery from 2009 to 2020. Cholecystectomy was primarily indicated when the gallbladder and surrounding structures were considered to have metastatic tumor invasion. If the final pathologic results showed free of malignant tumor, patients were placed into the no-infiltration group. Clinical outcomes including the recurrence rate and complications were analyzed. Results A total of 62 patients underwent cholecystectomy, 48 of whom (77.4%) underwent cholecystectomy during primary or interval debulking surgery, whereas 14 (22.6%) underwent cholecystectomy during the follow-up period (five with benign disease and 9 with disease recurrence). Among the patients, 32 (51.6%) patients were included in the no-infiltration group in the final pathology. There were no complications observed in the no-infiltration group (n = 32). Seven (78%) of the nine patients who received cholecystectomy for disease recurrence had metastatic disease in the porta-hepatis or lesser sac at the time of primary surgery. However, no recurrent lesions were observed around the porta-hepatis in patients who received cholecystectomy during primary treatment. Conclusion Considering the safety of the procedure, as well as the risk of disease recurrence or cholecystitis, a cholecystectomy can be offered to patients with ovarian cancer who have metastatic lesions around the gallbladder and porta-hepatis at the time of primary surgery.

The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients

Abstract Background To review the utilization of bowel resection in ovarian cancer surgery in our institution. Methods All ovarian cancer patients who received bowel resection between 2006/01 and 2018/12 were identified. Postoperative morbidities were assessed according to the Clavien–Dindo classification (CDC). Results There were 182 patients in the anastomosis group and 100 patients in the ostomy group, yielding a total of 282 patients. The median age was 57 years, and most patients had high-grade serous histology (88.7%). Forty-nine (17.3%) patients received neoadjuvant chemotherapy. During the operation, 78.7% of patients had ascites, and the median volume was 800 mL. Extensive bowel resection (at least two-segment) and upper abdominal operation were performed in 29 (10.2%) and 69 (24.4%) patients, respectively. The rectosigmoid colon was the most commonly resected (83.8%) followed by right hemicolectomy (5.9%) and small bowel resection (2.8%). No macroscopic residual disease was observed in 42.9% of the patients, whereas 87.9% had residual disease ≤ 1 cm. Among the entire cohort, 23.0% (65/282) experienced different complications. Severe complications (CDC 3–5) accounted for 9.2% of complications and were mostly categorized as pleural effusion requiring drainage (3.5%) followed by wound dehiscence requiring delayed repair in the operating room (1.8%). Nine patients experienced anastomotic leakage (AL): one in the ostomy group with extensive bowel resection and eight in the anastomosis group. The overall AL rate was 4.2% (9/212) per anastomosis. Conclusions The execution of bowel resection as part of debulking surgery in patients with newly diagnosed ovarian cancer resulted in a severe morbidity rate of 9.2%.

Survival benefit of surgery with postoperative radiotherapy in locally advanced cervical adenocarcinoma: a population-based analysis

Abstract Background The incidence of cervical adenocarcinoma (AC) has experienced a considerable increase in recent decades. Despite this, our understanding of the optimal management of locally advanced cervical AC remains limited. The present study sought to compare the clinical outcomes of radical hysterectomy with postoperative radiotherapy (PORT) and primary radiotherapy (RT) in patients with locally advanced cervical AC using the Surveillance, Epidemiology, and End Results (SEER) database. Methods The data were extracted from the SEER database utilizing the SEER ∗ STAT software (version 8.4.0.1). The study included patients diagnosed with locally advanced cervical AC between 2004 and 2017 with adequate information available for analysis. Patients were assigned to either the Surgery + PORT or Primary RT group based on treatment modality, and their clinical characteristics were compared. Propensity score matching (PSM) was utilized to adjust for differences in baseline characteristics between groups. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). Results Of the 1363 patients who met the inclusion criteria, 302 (22.16%) underwent Surgery + PORT, while 1061 patients received Primary RT. The two groups differed significantly in terms of age, year of diagnosis, tumor size, grade, stage, T/N stage, and chemotherapy. PSM was performed to balance the baseline characteristics between the two groups, resulting in 594 patients being analyzed. After PSM, the Surgery + PORT group exhibited significantly improved survival rates. The 5-year OS rates were 69.7% (95% CI: 63.3%-76.9%) for the Surgery + PORT group and 60.9% (95% CI: 56.0%-66.3%) for the group receiving Primary RT (p = 0.002). The 5-year CSS rates for the two groups were 70.7% (95% CI: 64.3%-77.8%) and 66.2% (95% CI: 61.3%-71.5%), respectively (p = 0.049). Multivariate analysis revealed that Surgery + PORT was an independent favorable prognostic factor for OS (HR = 0.60, p = 0.001) and CSS (HR = 0.69, p = 0.022). Although the combined approach of surgery and PORT resulted in a favorable impact on OS in patients aged 65 years or older (HR = 0.57, p = 0.048), it did not result in a statistically significant improvement in CSS in the same age group (HR = 0.56, p = 0.087). Similarly, the combined treatment did not yield a statistically significant increase in either OS (HR = 0.78, p = 0.344) or CSS (HR = 0.89, p = 0.668) in patients with tumors larger than 60 mm. Conclusion The present study demonstrated that Surgery + PORT was associated with improved OS and CSS in patients with locally advanced cervical AC when compared to Primary RT. As such, Surgery + PORT may be a preferable therapeutic option for carefully selected patients with cervical AC. These findings offer valuable insight into the management of locally advanced cervical AC and may assist in personalized treatment decisions.

The effectiveness of cold-knife conization (CKC) for post-menopausal women with cervical high-grade squamous intraepithelial lesion: a retrospective study

AbstractBackgroundThe effectiveness of surgery of high-grade squamous intraepithelial lesion in post-menopausal women needs to be investigated. This study evaluated the clinical significance of cold-knife conization in the diagnosis and surgery of cervical high-grade squamous intraepithelial lesions in post-menopausal women.MethodsWe conducted a retrospective analysis of post- and pre-menopausal patients with high-grade squamous intraepithelial lesion. All patients received cold-knife conization as the primary therapy.ResultsThe satisfactory rate of colposcopy was significantly lower in the post-menopausal group than in the pre-menopausal group (38.33 vs. 71.25%;χ2 = 36.202,P &lt; 0.001). The overall positive margin rate of cold-knife conization (25.83 vs 12.50%;χ2 = 10.106,P = 0.001) and rate of positive endocervical cone margins (16.67 vs. 4.58%;χ2 = 14.843,P &lt; 0.001) were significantly higher in the post-menopausal group. Moreover, 49 post- and 60 pre-menopausal women underwent subsequent surgical treatment (40.83 vs. 25.00%). Residual rate of positive and negative margins in patients before and after menopause was significantly different (χ2 = 5.711,P = 0.017;χ2 = 12.726,P &lt; 0.001, respectively). The recurrence rate in post-menopausal women remained 3.85%.ConclusionsCold-knife conization can be performed as a primary procedure for diagnosis and surgery of post-menopausal patients with high-grade squamous intraepithelial lesions. Sufficient deep excisions are necessary to avoid positive endocervical margins, which can reduce the residual and recurrence of postoperative lesions.

Successful use of ovarian vein as a ureteral substitute for long-segment ureteral stricture post-pelvic radiotherapy: a case report

Long-segment ureteral stricture secondary to radiotherapy for female pelvic malignancies represents a severe complication, significantly impairing patients' renal function and quality of life. Despite the availability of multiple treatment modalities, this condition remains challenging to manage, with high recurrence rates and perioperative complication rates. We report a 57-year-old female patient who underwent surgical treatment for cervical malignancy. After postoperative pelvic radiotherapy, the patient developed long-term left ureteral stricture. Both transurethral ureteral stenting and ureterocystostomy failed to achieve satisfactory results. Finally, the left ureter was successfully reconstructed using the ovarian vein. The patient's postoperative course was uneventful, and no ureteral fistula or restenosis occurred during the 3-year follow-up. Although current evidence suggests that ovarian vein substitution for the ureter in treating radiation-induced long-segment ureteral stricture yields favorable prognosis at 3 years postoperatively, its long-term efficacy still requires further in-depth research.

Comparison of identification of sentinel lymph nodes between ICG vs methylene blue in v notes staging surgery for endometrial cancer

Abstract Objective This study aimed to assess the comparative effectiveness of indocyanine green and methylene blue in the marking and identification of sentinel lymph nodes during sentinel lymph node biopsy procedures in patients diagnosed with endometrial cancer undergoing staging surgery through vaginal natural-orifice transluminal endoscopic surgery. Methods In this retrospective cohort study conducted at a tertiary center, we analyzed 80 patients with endometrial cancer who underwent vaginal natural orifice transluminal endoscopic staging surgery. Patients were classified into two cohorts based on the tracer used for sentinel lymph node sentinel lymph node mapping: indocyanine green ( n  = 40) or methylene blue ( n  = 40). The primary endpoints, including sentinel lymph node detection rates (overall and bilateral) and number of nodes retrieved, along with surgical outcomes, were compared between the groups. Findings : Eighty patients (indocyanine green group, n  = 40; methylene blue group, n  = 40) were included in the study. The vaginal natural orifice transluminal endoscopic surgery identification rate was significantly higher in the indocyanine green group (95%) than in the methylene blue group (82.5%) ( p  = 0.045). The mean number of sentinel lymph nodes identified in the indocyanine green group (3.2 ± 1.1) was significantly higher than that in the methylene blue group (2.5 ± 0.9) ( p  = 0.021). The rate of bilateral vaginal natural orifice transluminal endoscopic surgery identification was higher in the indocyanine green group (80%) than in the methylene blue group (65%); however, the difference was not statistically significant ( p  = 0.112). Surgical time, blood loss, and complication rates were similar between the two groups. Histopathological examination revealed a similar number of positive sentinel lymph nodes in both the groups. Conclusion In the context of sentinel lymph node biopsy for staging surgery and natural orifice transluminal endoscopic surgery for endometrial cancer, indocyanine green has demonstrated a superior sentinel lymph node identification rate and a higher yield of sentinel lymph nodes compared to methylene blue. Given the advantage of real-time imaging, indocyanine green has emerged as a promising agent for sentinel lymph node biopsy in minimally invasive approaches, such as vaginal natural orifice transluminal endoscopic surgery.

Laparoscopic splenectomy both for primary cytoreductive surgery for advanced ovarian cancer and for secondary surgery for isolated spleen recurrence: feasibility and technique

Abstract Background This study investigated the feasibility and safety of laparoscopic splenectomy conducted in the contexts of both laparoscopic secondary surgery for isolated recurrence in the spleen and primary laparoscopic cytoreductive surgery for advanced ovarian cancer. Methods We performed a perspective observational study including all consecutive patients with ovarian cancer who underwent laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer or secondary surgery for isolated splenic recurrence between January 2016 and May 2020. Results We enrolled 13 consecutive patients, candidate to laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer (6 patients) or secondary surgery for isolated splenic recurrence of platinum-sensitive ovarian cancer (7 patients). Median operative time (509 min [range, 200–845]) for primary cytoreductive surgery varied according to surgical complexity depending on the extensiveness of the disease. Median operative time for secondary surgery for isolated splenic metastasis was 253 min (90–380). Only 1 patient with isolated splenic recurrence required conversion to an open approach. No intraoperative complication occurred, and no intraoperative blood transfusions were required. Median hospital stay was 3 days (range, 2–5) for isolated recurrence and 9 days (7–18) for primary cytoreductive surgery. Complete tumor resection was achieved in all patients. Median time from surgery to adjuvant chemotherapy was 16 days (7–24). All six patients who underwent laparoscopic splenectomy during primary cytoreductive surgery remain alive, four of whom exhibit no evidence of disease (median follow-up 25 months [4–36]). Among patients who underwent laparoscopic splenectomy during secondary surgery for isolated splenic relapse, all patients are alive and only one had a central diaphragmatic relapse 2 years after surgery (median follow-up 17 months ([5–48 months]). Conclusions The laparoscopic approach to splenectomy is feasible and safe both in patients undergoing primary cytoreductive surgery for advanced stage disease and those with isolated recurrence of ovarian cancer, without compromising survival and allowing early initiation of postoperative systemic chemotherapy.

The effects of obesity on surgical complications and postoperative prognosis of epithelial ovarian cancer: a meta-analysis

To comprehensively evaluate and compare surgical outcomes of obese patients versus non-obese patients for surgical complications and postoperative prognosis due to epithelial ovarian cancer (EOC). Studies were obtained from database search systems of Medline (PubMed) and Embase. Data were analyzed by the meta-analysis method and the random-effect or fixed-effect model. The heterogeneity between the studies was evaluated by I2 index and the data were analyzed using STATA version 15.1 and Review Manager version 5.4. 14 studies with 4858 cases of proven epithelial ovarian cancer who underwent extensive surgery were included. Obesity may be a risk factor of the low surgical complex score (RR1.08, 95% CI 1.01-1.15, p = 0.05), but had no manifesting difference in the surgical complications score compared non-obesity group (RR 0.50, 95% CI 0.07-3.79, p = 0.501 and RR 0.60, 95% CI 0.22-1.63, p = 0.316). Obesity EOC patients who undergone surgery tended to be correlated with surgical complications, such as wound infection (RR 2.71, 95% CI 1.59-4.61, p = 0.000), intestinal complications (RR 2.09, 95% CI 1.00-4.35, p = 0.000), and 30-readmission rate (RR 1.84, 95% CI 1.16-2.93, p = 0.000). Obese patients were more likely to have shorter prognosis free survival (PFS) (SMD 0.62-year, 95% CI-0.13 to 0.15), but the results did not discover a significant difference in overall survival (OS)between obesity and non-obesity. (SMD 0.01-year, 95% CI-0.13 to 0.15) CONCLUSIONS: Obesity affects the difficulty of ovarian cancer surgery, and a negative relationship between obesity and surgical complications is observed. Obesity is a potential risk factor for prognosis of EOC patients. Attention is played on determining what kind of case should be benefit most from this surgery to minimize the rates of operative complications and postoperative mortality. CRD 42,023,434,781.

Use of human fibrin glue (Tisseel) versus suture during transvaginal natural orifice ovarian cystectomy of benign and non-endometriotic ovarian tumor: a retrospective comparative study

Abstract Background To evaluate the use of a human fibrin glue (Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors. Methods A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined. Results Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210). Conclusion The use of Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible.

Internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer: a case report and literature review

Abstract Background The common complications of radical hysterectomy and pelvic lymphadenectomy usually include wound infection, hemorrhage or hematomas, lymphocele, uretheral injury, ileus and incisional hernias. However, internal hernia secondary to the orifice associated with the uncovered vessels after pelvic lymphadenectomy is very rare. Case presentation We report a case of internal hernia with intestinal perforation beneath the superior vesical artery that occurred one month after laparoscopic pelvic lymphadenectomy for cervical cancer. A partial ileum resection was performed and the right superior vesical artery was transected to prevent recurrence of the internal hernia. Conclusions Retroperitonealization after the pelvic lymphadenectomy should be considered in patients with tortuous, elongated arteries which could be causal lesions of an internal hernia.

Comparative analysis of hysterectomy types and approaches on oncological survival in 2023 FIGO stage II endometrial carcinoma

The objective is to investigate the relationship between the type and approaches of hysterectomy and the oncological survival outcomes in women diagnosed with stage II endometrial carcinoma (EC), as classified by the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system. A retrospective analysis was conducted on patients with 2009 FIGO early-stage (stages I and II) EC who underwent surgical treatment between 2018 and 2019. These patients were reclassified in accordance with the 2023 FIGO staging system, and those diagnosed with stage II EC under this system were selected as the study population. A non-inferiority test was employed for the analysis, with disease-free survival (DFS) serving as the primary outcome measure. DFS was evaluated using Kaplan-Meier curves, and comparisons were conducted through the log-rank test. A cohort of 288 patients diagnosed with early-stage EC according to the 2009 FIGO staging system were re-evaluated and reclassified. Ultimately, the study encompassed a cohort of 80 patients diagnosed with stage II EC, as classified according to the 2023 FIGO staging system. 52 individuals underwent radical hysterectomy or modified radical hysterectomy (RH/mRH), while 28 patients received a simple hysterectomy (SH). The 5-year DFS was 84.62% for the RH/mRH group vs. 92.86% for the SH group (difference, 8.24% [95% CI, -5.44-21.92%]), which met the noninferiority criterion. Between the groups, the difference in 5-year DFS (p = 0.255) was not statistically significant. The laparoscope group comprised 62 cases, whereas the laparotomy group consisted of 18 cases. Between the groups, the difference in 5-year DFS (88.55% versus 83.33%, p = 0.538) was not statistically significant. This finding aligns with our observations of patients diagnosed with 2009 FIGO Stage II EC. In comparison to SH, RH/mRH did not confer a survival advantage for patients diagnosed with 2023 FIGO stage II EC.