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Hwang JH, Kim B. Postoperative Urinary Complications in Minimally Invasive vs. Abdominal Radical Hysterectomy: A Meta-Analysis with a Focus on Ureterovaginal Fistula. J Minim Invasive Gynecol 2024:S1553-4650(24)01557-7. [PMID: 39710105 DOI: 10.1016/j.jmig.2024.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 11/03/2024] [Accepted: 12/18/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE This study aims to perform a systematic review and meta-analysis to compare the incidence of specific postoperative urologic complications, such as vesicovaginal fistula and ureterovaginal fistula, in patients undergoing minimally invasive radical hysterectomy (MIRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. DATA SOURCES A comprehensive literature search was conducted in PubMed, the Cochrane Library, Web of Science, ScienceDirect, and Google Scholar up to April 2024. METHOD Comparative studies evaluating postoperative urologic complications following MIRH and ARH were included. Meta-analyses were conducted using fixed- and random-effects models, with subgroup analyses based on publication year, study quality, BMI, and geographical region. TABULATION, INTEGRATION, AND RESULTS The meta-analysis included 35 studies. Overall, MIRH (N=17,957) was associated with a significantly higher odds ratio (OR) of 3.189 (95% CI: 2.637-3.856, p < 0.001) for postoperative urologic complications compared to ARH (N=31,878). Ureterovaginal fistula was the most frequently reported complication, with an OR of 4.440 (95% CI: 3.398-5.804, p < 0.001). Subgroup analysis showed a higher OR for studies published between 2016-2024 (OR: 3.637, 95% CI: 2.965-4.462, p < 0.001) and in low-quality studies (OR: 3.981, 95% CI: 3.237-4.897, p < 0.001). CONCLUSION MIRH is associated with a higher incidence of postoperative urologic complications compared to ARH, particularly ureterovaginal fistula. These findings underscore the importance of careful patient selection and the potential need for improved surgical techniques or training to reduce these risks. (CRD42024553756).
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, SIMGOKRO 100 GIL 25 SEO-GU INCHEON METROPOLITAN CITY, 22711, Incheon, Republic of Korea.
| | - Bitnarae Kim
- Department of Obstetrics and Gynecology, Dongwon Cancer Specialized Care Hospital, ILSANRO 439 ILSANDONG-GU GOYANG CITY, GYEONGGI-DO, 10359, Republic of Korea
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Wu G, Li H, Luo F, Zheng H, Yuegao Y, Xie L, Luo H, Chen Z, Ye D, Lai C. Total intracorporeal laparoscopic ileal ureter replacement in a single position for ureteral stricture based on membrane anatomy. BMC Surg 2024; 24:88. [PMID: 38481186 PMCID: PMC10935906 DOI: 10.1186/s12893-024-02363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/17/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE The aim of this study was to present our initial experience and prove the feasibility of total intracorporeal laparoscopic ileal ureter replacement (TILIUR) in a single position for ureteral stricture based on membrane anatomy. MATERIALS AND METHODS Between January 2021 and April 2023, six patients underwent TILIUR in a single position for ureteral strictures based on membrane anatomy. All patients with a past medical history underwent radical hysterectomy with bilateral pelvic lymph node dissection as well as extensive ureteral stricture due to radiotherapy. The procedure is performed completely laparoscopically. Dissection of the digestive system as well as ureteral stricture or renal pelvis is based on membrane anatomy. The surgery is performed in a single position. RESULTS TILIUR in a single position for ureteral stricture based on membrane anatomy was successfully performed without open conversion in all patients. Among the 6 patients, 3 patients underwent combined ileal ureter replacement (IUR) and abdominal wall ostomy, 2 underwent unilateral IUR, and 1 underwent bilateral IUR. The mean length of the ileal substitution was 22.83 cm (range: 15-28). The average operative time was 458 ± 72.77 min (range 385-575 min), and the average intraoperative blood loss was 158 mL (range 50-400 mL). The median postoperative hospital stay was 15.1 d (range: 8-32). The median duration of postoperative follow-up was 15 months (range: 3-29 months). The success rate was 100%. CONCLUSIONS TILIUR in a single position may be a promising option for ureteral stricture based on membrane anatomy in selected patients. Moreover, it has a positive effect on patients with renal insufficiency and urinary incontinence. Although IUR is difficult and risky, proficient surgeons can perform the procedure safely and effectively.
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Affiliation(s)
- Guohao Wu
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Haomin Li
- Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road, Guangzhou, 510630, China
| | - Feng Luo
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Handa Zheng
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Yuanzhi Yuegao
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Lishan Xie
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Huilan Luo
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Zhihui Chen
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China
| | - Dongming Ye
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China.
| | - Caiyong Lai
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523560, China.
- Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road, Guangzhou, 510630, China.
- Institute of Kidney Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road, Guangzhou, China.
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Bruno V, Chiofalo B, Logoteta A, Brandolino G, Savone D, Russo M, Sperduti I, Mancini E, Fabrizi L, Anceschi U, Vizza E. Urological Complications in Radical Surgery for Cervical Cancer: A Comparative Meta-Analysis before and after LACC Trial. J Clin Med 2023; 12:5677. [PMID: 37685744 PMCID: PMC10488957 DOI: 10.3390/jcm12175677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND After the LACC trial publication in 2018, the minimally invasive approach (MIS) has severely decreased in favor of open surgery: MIS radical hysterectomy was associated with worse oncological outcomes than open surgery, but urological complications were never extensively explored in pre- versus post-LACC eras, even if they had a great impact on post-operative QoL. The purpose of this meta-analysis is to compare functional and organic urological complication rates before and after LACC trial. METHODS An independent search of the literature was conducted 4 years before and after the LACC trial and 50 studies were included. RESULTS The overall rate of urologic complications was higher in pre-LACC studies while no differences were found for organic urological complications. Conversely, the overall risk of dysfunctional urological complications showed a higher rate in the pre-LACC era. This is probably related to a sudden shift to open surgery, with potential lower thermal damage to the urinary tract autonomic nervous fibers. CONCLUSIONS This meta-analysis showed that the incidence of urological complications in radical cervical cancer surgery was higher before the LACC trial, potentially due to the shift to open surgery. Nevertheless, further studies are needed to shed light on the connection between minimally invasive surgery and urological damage.
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Affiliation(s)
- Valentina Bruno
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Alessandra Logoteta
- Department of Maternal Infantile and Urological Sciences, University of Rome “Sapienza”, Policlinico Umberto I, 00161 Rome, Italy; (A.L.)
| | - Gabriella Brandolino
- Department of Maternal Infantile and Urological Sciences, University of Rome “Sapienza”, Policlinico Umberto I, 00161 Rome, Italy; (A.L.)
| | - Delia Savone
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Mario Russo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Isabella Sperduti
- Unit of Biostatistical, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Emanuela Mancini
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
| | - Luana Fabrizi
- Anesthesia, Resuscitation and Intensive Care Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Enrico Vizza
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (B.C.); (E.M.); (E.V.)
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Di Donato V, Bogani G, Casarin J, Ghezzi F, Malzoni M, Falcone F, Petrillo M, Capobianco G, Calò F, D'Augè TG, Muzii L, Benedetti Panici P, Ervas E, Ditto A, Raspagliesi F, Sopracordevole F, Vizza E, Giannini A. Ten-year outcomes following laparoscopic and open abdominal radical hysterectomy for "low-risk" early-stage cervical cancer: A propensity-score based analysis. Gynecol Oncol 2023; 174:49-54. [PMID: 37149905 DOI: 10.1016/j.ygyno.2023.04.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Accumulating evidence suggested the detrimental effects of adopting minimally invasive surgery in the management of early-stage cervical cancer. However, long-term evidence on the role of minimally invasive radical hysterectomy in "low-risk" patients exists. METHODS This is multi-institutional retrospective study comparing minimally invasive and open radical hysterectomy in low-risk early-stage cervical cancer patients. A propensity-score matching algorithm (1:2) was used to allocate patients into the study groups. Kaplan-Meir model was used to estimate 10-year progression-free and overall survival. RESULTS Charts of 224 "low-risk" patients were retrieved. Overall, 50 patients undergoing radical hysterectomy were matched with 100 patients undergoing open radical hysterectomy. Minimally invasive radical hysterectomy was associated with a longer median operative time (224 (range, 100-310) vs. 184 (range, 150-240) minutes; p < 0.001), lower estimated blood loss (10 (10-100) vs. 200 (100-1000) ml, p < 0.001), and shorter length of hospital stay (3.8 (3-6) vs. 5.1 (4-12); p < 0.001). Surgical approach did not influence the risk of having intra-operative (4% vs. 1%; p = 0.257) and 90-day severe (grade 3+) postoperative complication rates (4% vs. 8%; p = 0.497). Ten-year disease-free survival was similar between groups (94% vs. 95%; p = 0.812; HR:1.195; 95%CI:0.275, 5.18). Ten-year overall survival was similar between groups (98% vs. 96%; p = 0.995; HR:0.994; 95%CI:0.182, 5.424). CONCLUSIONS Our study appears to support emerging evidence suggesting that, for low-risk patients, laparoscopic radical hysterectomy does not result in worse 10-year outcomes compared to the open approach. However, further research is needed and open abdominal radical hysterectomy remains the standard treatment for cervical cancer patients.
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Affiliation(s)
- Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Francesca Falcone
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Filippo Calò
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy; Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | | | - Elisa Ervas
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | | | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy; Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Institute, Rome, Italy
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5
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Pecorino B, D’Agate MG, Scibilia G, Scollo P, Giannini A, Di Donna MC, Chiantera V, Laganà AS. Evaluation of Surgical Outcomes of Abdominal Radical Hysterectomy and Total Laparoscopic Radical Hysterectomy for Cervical Cancer: A Retrospective Analysis of Data Collected before the LACC Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13176. [PMID: 36293758 PMCID: PMC9603513 DOI: 10.3390/ijerph192013176] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 05/03/2023]
Abstract
Although a surgical approach is one of the key treatments for stages IA1-IIA2, results of the Laparoscopic Approach to Cervical Cancer (LACC) published in 2018 radically changed the field, since minimally invasive surgery was associated with a four-fold higher rate of recurrence and a six-fold higher rate of all-cause death compared to an open approach. We aimed to evaluate surgical outcomes of abdominal radical hysterectomy (ARH) and total laparoscopic radical hysterectomy (TLRH) for cervical cancer, including data collected before the LACC trial. In our retrospective analysis, operative time was significantly longer in TLRH compared to ARH (p < 0.0001), although this disadvantage could be considered balanced by lower intra-operative estimated blood loss in TLRH compared with ARH (p < 0.0001). In addition, we did not find significant differences for intra-operative (p = 0.0874) and post-operative complication rates (p = 0.0727) between ARH and TLRH. This was not likely to be influenced by age and Body Mass Index, since they were comparable in the two groups (p = 0.0798 and p = 0.4825, respectively). Finally, mean number of pelvic lymph nodes retrieved (p = 0.153) and nodal metastases (p = 0.774), as well as death rate (p = 0.5514) and recurrence rate (p = 0.1582) were comparable between the two groups. Future studies should be aimed at assessing whether different histology/grades of cervical cancer, as well as particular subpopulations, may have significantly different outcomes using minimally invasive surgery or laparotomy, with or without neoadjuvant chemotherapy.
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Affiliation(s)
- Basilio Pecorino
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 95126 Catania, Italy
| | - Maria Gabriella D’Agate
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 95126 Catania, Italy
| | - Giuseppe Scibilia
- Obstetrics and Gynecology, “Giovanni Paolo II” Hospital, 97100 Ragusa, Italy
| | - Paolo Scollo
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 95126 Catania, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, 00185 Rome, Italy
| | - Mariano Catello Di Donna
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, 90127 Palermo, Italy
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
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Bogani G, DI Donato V, Chiappa V, Lopez S, Monti M, Muzii L, Benedetti Panici P, Ditto A, Raspagliesi F. Minimally invasive surgery in cervical cancer. Minerva Obstet Gynecol 2021; 73:145-148. [PMID: 33306287 DOI: 10.23736/s2724-606x.20.04726-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.
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Affiliation(s)
- Giorgio Bogani
- National Cancer Institute of Milan (INT), Milan, Italy -
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Antonino Ditto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Laparoscopic radical hysterectomy has higher risk of perioperative urologic complication than abdominal radical hysterectomy: a meta-analysis of 38 studies. Surg Endosc 2020; 34:1509-1521. [PMID: 31953731 DOI: 10.1007/s00464-020-07366-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/03/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A meta-analysis was performed to assess risks of intraoperative and postoperative urologic complications in laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). METHODS We searched Pubmed, EMBASE, and Cochrane library for studies published up to December, 2018. Manual searches of related articles and relevant bibliographies of published studies were also performed. Two researchers independently performed data extraction. Inclusion criteria of studies were: (1) had information of perioperative complications, and (2) had at least ten patients per group. RESULTS A total of 38 eligible clinical trials were collected. Intraoperative and postoperative urologic complications were reported by 34 studies and 35 studies, respectively. When all studies were pooled, odd ratios (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.40 [95% confidence interval (CI) 1.05-1.87]. The OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 1.01-1.80]. However, significant adverse effects of intraoperative urologic complications in LRH were not observed among articles published after 2012 (OR 1.12, 95% CI 0.77-1.62) in cumulative meta-analysis or subgroup analysis. The incidence of bladder injury was statistically higher than that of ureter injury (p = 0.001). In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. CONCLUSION LRH is associated with significantly higher risk of intraoperative and postoperative urologic complications than abdominal radical hysterectomy.
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Surgical Efforts Might Mitigate Difference in Response to Neoadjuvant Chemotherapy in Stage IIIC–IV Unresectable Ovarian Cancer: A Case-Control Multi-institutional Study. Int J Gynecol Cancer 2018; 28:1706-1713. [DOI: 10.1097/igc.0000000000001286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
ObjectiveThe aim of the study was to evaluate outcomes of patients with unresectable advanced ovarian cancer experiencing complete response (CR) to neoadjuvant chemotherapy.MethodsData of consecutive patients undergoing neoadjuvant chemotherapy plus interval debulking surgery (IDS) were retrospectively reviewed in 4 Italian centers. Using a propensity-matching algorithm, we compared data of patients achieving CR with neoadjuvant chemotherapy (no macroscopic either microscopic residual disease (RD) at the time of IDS) with patients achieving partial response (PR). This latter group was stratified by the presence of RD (RD = 0 vs RD > 0).ResultsOverall, 193 had IDS after neoadjuvant chemotherapy: 25 (13%), 81 (41.9%), and 74 (38.3%) patients had CR, PR with RD of 0, and PR with RD of more than 0, respectively. In addition, 13 (6.7%) patients had no macroscopic disease detected at DS but just microscopic disease at pathological examination. For the study purpose, 25 patients achieving CR were matched (1:2) with 50 patients having PR and RD of 0 and 50 patients having PR and RD of more than 0. As the result of propensity matching, baseline characteristics were similar between groups. Comparing survival outcomes of patients having CR and PR with RD of 0, we observed that type of response to chemotherapy did not influence disease-free (hazard ratio = 1.53 [95% confidence interval = 0.88–2.66], P = 0.127) and overall (hazard ratio = 1.74 [95% confidence interval = 0.76–4.01], P = 0.189) survivals. Patients achieving CR experienced significantly better disease-free survival (P = 0.004) and a trend toward better overall survival (P = 0.06) than patients achieving PR with RD of more than 0 at IDS.ConclusionsComplete cytoreduction might mitigate the difference in response to neoadjuvant chemotherapy. The presence of RD at IDS is associated with worse survival outcomes.
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9
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Balaya V, Mathevet P, Magaud L, Delomenie M, Bonsang-Kitzis H, Ngô C, Huchon C, Bats AS, Lecuru F. Predictive factors of severe perioperative morbidity of radical hysterectomy with lymphadenectomy in early-stage cervical cancer: A French prospective multicentric cohort of 248 patients. Eur J Surg Oncol 2018; 45:650-658. [PMID: 30910053 DOI: 10.1016/j.ejso.2018.10.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/05/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer and to determine risk factors of severe perioperative morbidity. METHODS Data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II) were analysed. Patients having a radical hysterectomy were included between 2005 and 2012 from 25 French oncologic centers. Postoperative complications were prospectively recorded in a pre-specified analysis. RESULTS 248 patients met the inclusion criteria. The median age was 44.5 years [25-85]. 88.7% of patients had a stage IB1 disease. There were 71.4% epidermoid carcinomas and 25% adenocarcinomas. 125 patients (50.4%) had a laparoscopic-assisted vaginal RH, 88 patients (35.5%) had a total laparoscopic RH, 26 patients (10.5%) had an open RH and 9 patients (3.6%) had a robotic-assisted RH. Sixteen patients (6.4%) had intraoperative complications. On a multivariate analysis, intraoperative complications were significantly associated with BMI >30 kg/m2. The urinary, lymphovascular and neurologic complications rates were respectively 34.3%, 20.6% and 19.8%. 31 patients (12.5%) had severe postoperative complications (Clavien-Dindo ≥ 3 or CTCAE ≥ 3). On multivariate analysis, severe postoperative complications were associated with parametrial involvement, preoperative brachytherapy and inclusion in low surgical skills center. CONCLUSIONS This study based on prospective data showed that RH has low severe postoperative complications. The main complications were urinary infections and lower limb lymphedema. Patients with early-stage cervical cancer should be referred to expert center to ensure best surgical outcomes.
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Affiliation(s)
- V Balaya
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France; URDIA Anatomy EA 4465 UFR Biomédicale des Saints-Pères, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France.
| | - P Mathevet
- Gynecology Department, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - L Magaud
- Hospices Civils de Lyon, Pôle IMER, Lyon, F-69003, France
| | - M Delomenie
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France
| | - H Bonsang-Kitzis
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France
| | - C Ngô
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France
| | - C Huchon
- Obstetrics and Gynecology Department, Poissy UMC, France
| | - A S Bats
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France
| | - F Lecuru
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France
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Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience. Eur J Surg Oncol 2017; 43:2150-2156. [PMID: 28927778 DOI: 10.1016/j.ejso.2017.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/06/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). METHODS Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. RESULTS Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. CONCLUSIONS The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.
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Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy. Obstet Gynecol Int 2017; 2017:2103763. [PMID: 28167964 PMCID: PMC5259609 DOI: 10.1155/2017/2103763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.
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Kyo S, Kato T, Nakayama K. Current concepts and practical techniques of nerve-sparing laparoscopic radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 2016; 207:80-88. [PMID: 27825032 DOI: 10.1016/j.ejogrb.2016.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/29/2016] [Accepted: 10/21/2016] [Indexed: 12/26/2022]
Abstract
Laparoscopic radical hysterectomy has been widely performed for patients with early-stage cervical cancer. The operative techniques for nerve-sparing to avoid bladder dysfunction have been established during the past three decades in abdominal radical hysterectomy, but how these techniques can be applied to laparoscopic surgery has not been fully discussed. Prolonged operation time or decreased radicality due to less accessibility via a limited number of trocars may be a disadvantage of the laparoscopic approach, but the magnified visual field in laparoscopy may enable fine manipulation, especially for preserving autonomic nerve tracts. The present review article introduces the practical techniques for sparing bladder branches of pelvic nerves in laparoscopic radical hysterectomy based on understanding of the pelvic anatomy, clearly focusing on the differences from the techniques in abdominal hysterectomy.
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Affiliation(s)
- Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan.
| | - Tomoyasu Kato
- Department of Gynecologic, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Kentaro Nakayama
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
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Incorporating 3D laparoscopy for the management of locally advanced cervical cancer: a comparison with open surgery. TUMORI JOURNAL 2016; 102:393-7. [PMID: 27373783 DOI: 10.5301/tj.5000527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE To test the effects of the implementation of 3D laparoscopic technology for the execution of nerve-sparing radical hysterectomy. METHODS Thirty patients undergoing nerve-sparing radical hysterectomy via 3D laparoscopic (3D-LNSRH, n = 10) or open surgery (NSRH, n = 20) were studied prospectively. RESULTS No significant differences were observed in baseline patient characteristics. Operative times were similar between groups. We compared the first 10 patients undergoing 3D-LNSRH with the last 20 patients undergoing NSRH. Baseline characteristics were similar between groups (p>0.2). Patients undergoing 3D-LNSRH had longer operative time (264.4 ± 21.5 vs 217.2 ± 41.0 minutes; p = 0.005), lower blood loss (53.4 ± 26.1 vs 177.7 ± 96.0 mL; p<0.001), and shorter length of hospital stay (4.3 ± 1.2 vs 5.4 ± 0.7 days; p = 0.03) in comparison to patients undergoing open abdominal procedures. No intraoperative complication occurred. One (10%) patient had conversion to open surgery due to technical difficulties and the inability to insert the uterine manipulator. A trend towards higher complication (grade 2 or worse) rate was observed for patients undergoing NSRH in comparison to 3D-LNSRH (p = 0.06). Considering only severe complications (grade 3 or worse), no difference was observed (0/10 vs 2/20; p = 0.54). CONCLUSIONS 3D-laparoscopic nerve-sparing radical hysterectomy is a safe and effective procedure. The implementation of 3D laparoscopic technology allows the execution of challenging operations via minimally invasive surgery, thus reducing open abdominal procedure rates. Further large prospective studies are warranted.
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Chen Z, Huang K, Lu Z, Deng S, Xiong J, Huang J, Li X, Tang F, Wang Z, Sun H, Wang L, Zhou S, Wang X, Jia Y, Hu T, Gui J, Wan D, Ma D, Li S, Wang S. Risk model in stage IB1-IIB cervical cancer with positive node after radical hysterectomy. Onco Targets Ther 2016; 9:3171-9. [PMID: 27313462 PMCID: PMC4892859 DOI: 10.2147/ott.s94151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to identify risk factors in patients with surgically treated node-positive IB1-IIB cervical cancer and to establish a risk model for disease-free survival (DFS) and overall survival (OS). A total of 170 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for node-positive International Federation of Gynaecology and Obstetrics (FIGO) stage IB1-IIB cervical cancer from January 2002 to December 2008 were retrospectively analyzed. Five published risk models were evaluated in this population. The variables, including common iliac lymph node metastasis and parametrial invasion, were independent predictors of outcome in a multivariate analysis using a Cox regression model. Three distinct prognostic groups (low, intermediate, and high risk) were defined using these variables. Five-year DFS rates for the low-, intermediate-, and high-risk groups were 73.7%, 60.0%, and 25.0%, respectively (P<0.001), and 5-year OS rates were 81.9%, 42.8%, and 25.0%, respectively (P<0.001). The risk model derived in this study provides a novel means for assessing prognosis of patients with node-positive stage IB1-IIB cervical cancer. Future study will focus on external validation of the model and refinement of the risk scoring systems by adding new biologic markers.
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Affiliation(s)
- Zhilan Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China; Department of Obstetrics and Gynecology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, People's Republic of China
| | - Kecheng Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Zhiyong Lu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China; Hubei Key Laboratory of Embryonic Stem Cell Research, Tai-He Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Song Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China; Department of Obstetrics and Gynecology, University Hospital of Hubei University for Nationalities, Enshi, Hubei, People's Republic of China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Jia Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Xiong Li
- Department of Obstetrics and Gynecology, Wuhan Central Hospital, Wuhan, People's Republic of China
| | - Fangxu Tang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Zhihao Wang
- Department of Pathology and Pathophysiology, Key Laboratory of Ministry of Education of China for Neurological Disorders, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Lin Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Shasha Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Xiaoli Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Yao Jia
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Ting Hu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Juan Gui
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Dongyi Wan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Ding Ma
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Shuang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, People's Republic of China
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Bogani G, Cromi A, Serati M, Di Naro E, Casarin J, Pinelli C, Candeloro I, Sturla D, Ghezzi F. Improving standard of care through introduction of laparoscopy for the surgical management of gynecological malignancies. Int J Gynecol Cancer 2016; 25:741-50. [PMID: 25675038 DOI: 10.1097/igc.0000000000000406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the impact on perioperative and medium-term oncologic outcomes of the implementation of laparoscopy into a preexisting oncologic setting. METHODS Data from consecutive 736 patients undergoing surgery for apparent early stage gynecological malignancies (endometrial, cervical, and adnexal cancers) between 2000 and 2011 were reviewed. Complications were graded per the Accordion classification. Survival outcomes within the first 5 years were analyzed using Kaplan-Meier method. RESULTS Overall, 493 (67%), 162 (22%), and 81 (11%) had surgery for apparent early stage endometrial, cervical, and adnexal cancer. We assisted at an increase of the number of patients undergoing surgery via laparoscopy through the years (from 10% in the years 2000-2003 to 82% in years 2008-2011; P < 0.001 for trend); while the need to perform open surgery decreased dramatically (from 83% to 10%; P < 0.001). Vaginal approach was nearly stable over the years (from 7% to 8%; P = 0.76). A marked reduction in estimated blood loss, length of hospital stay, blood transfusions as well as grade greater than or equal to 3 postoperative complications over the years was observed (P < 0.001). Surgical radicality assessed lymph nodes count was not influenced by the introduction of laparoscopic approach (P > 0.05). The introduction of laparoscopy did not adversely affect medium-term (within 5 years) survival outcomes of patients undergoing surgery for apparent early stage cancers of the endometrium, uterine cervix, and adnexa (P > 0.05 log-rank test). CONCLUSIONS The introduction of laparoscopy into a preexisting oncologic service allows an improvement of standard of care due to a gain in perioperative results, without detriments of medium-term oncologic outcomes.
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Affiliation(s)
- Giorgio Bogani
- *Department of Obstetrics and Gynecology, University of Insubria, Varese; and †Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Papadia A, Bellati F, Bogani G, Ditto A, Martinelli F, Lorusso D, Donfrancesco C, Gasparri ML, Raspagliesi F. When Does Neoadjuvant Chemotherapy Really Avoid Radiotherapy? Clinical Predictors of Adjuvant Radiotherapy in Cervical Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S944-51. [PMID: 26268452 DOI: 10.1245/s10434-015-4799-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to identify clinical variables that may predict the need for adjuvant radiotherapy after neoadjuvant chemotherapy (NACT) and radical surgery in locally advanced cervical cancer patients. METHODS A retrospective series of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB2-IIB treated with NACT followed by radical surgery was analyzed. Clinical predictors of persistence of intermediate- and/or high-risk factors at final pathological analysis were investigated. Statistical analysis was performed using univariate and multivariate analysis and using a model based on artificial intelligence known as artificial neuronal network (ANN) analysis. RESULTS Overall, 101 patients were available for the analyses. Fifty-two (51 %) patients were considered at high risk secondary to parametrial, resection margin and/or lymph node involvement. When disease was confined to the cervix, four (4 %) patients were considered at intermediate risk. At univariate analysis, FIGO grade 3, stage IIB disease at diagnosis and the presence of enlarged nodes before NACT predicted the presence of intermediate- and/or high-risk factors at final pathological analysis. At multivariate analysis, only FIGO grade 3 and tumor diameter maintained statistical significance. The specificity of ANN models in evaluating predictive variables was slightly superior to conventional multivariable models. CONCLUSIONS FIGO grade, stage, tumor diameter, and histology are associated with persistence of pathological intermediate- and/or high-risk factors after NACT and radical surgery. This information is useful in counseling patients at the time of treatment planning with regard to the probability of being subjected to pelvic radiotherapy after completion of the initially planned treatment.
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Affiliation(s)
- Andrea Papadia
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Filippo Bellati
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy. .,Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy.
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Cristina Donfrancesco
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.,Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy
| | - Maria Luisa Gasparri
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.,Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy
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Martinelli F, Bogani G, Ditto A, Carcangiu M, Papadia A, Lecce F, Chiappa V, Lorusso D, Raspagliesi F. How often parametrial involvement leads to post-operative adjuvant treatment in locally advanced cervical cancer after neoadjuvant chemotherapy and type C radical hysterectomy? Eur J Surg Oncol 2015; 41:1089-96. [DOI: 10.1016/j.ejso.2015.03.228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/04/2015] [Accepted: 03/18/2015] [Indexed: 01/22/2023] Open
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Laparoscopic and vaginal approaches to hysterectomy in the obese. Eur J Obstet Gynecol Reprod Biol 2015; 189:85-90. [PMID: 25898369 DOI: 10.1016/j.ejogrb.2015.02.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/14/2015] [Accepted: 02/19/2015] [Indexed: 11/17/2022]
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Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: A systematic review and meta-analysis. Gynecol Oncol 2015; 137:167-72. [DOI: 10.1016/j.ygyno.2014.11.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/08/2014] [Accepted: 11/14/2014] [Indexed: 11/18/2022]
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