Acupoint Massage to Manage Postoperative Ileus in Gynecologic Laparoscopy: A New Potential Player in the Enhanced Recovery After Surgery (ERAS) Pathways?

The introduction of laparoscopic surgery and the development of anesthetic techniques improved postoperative complication rate, minimizing surgical trauma and pain after surgery. Nevertheless, post..

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic

Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer

Recurrence of Early Stage Cervical Cancer after Laparoscopic Versus Open Radical Surgery

Objective The aim of the study was to compare site and time to recurrence in patients affected by early stage cervical cancer (CC) treated with laparoscopy radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH). Methods This retrospective study was conducted in a university teaching, tertiary referral center hospital. We included patients undergoing either LRH or open ARH to treat CC. Results One hundred fifty patients were included, 82 submitted to LRH and 68 submitted to ARH. Baseline characteristics of the 2 groups were comparable, except for body mass index higher in ARH group. Patients undergoing LRH experienced less blood loss (100 vs 400 mL, P < 0.0001), less lymph nodes removed (20 vs 31, P = 0.001), and shorter recovery (4 vs 8 days, P = 0.0005) in comparison with the ARH group. No significant differences were found regarding recurrence rate (9 vs 13, P = 0.17) and time to recurrence (8 vs 17 months, P = 0.066) between LRH and ARH group. Sites of recurrence were also comparable between the 2 groups: 2/9 versus 2/13 (P = 1) local recurrence, 4/9 versus 8/13 (P = 0.66) pelvic recurrence, 4/9 versus 7/13 (P = 1) distant recurrence in LRH and ARH groups, respectively. The most frequent sites of recurrence were pelvic and distant (44.4%) in LRH group and pelvic (61.5%) in ARH group. Conclusions Our data demonstrate that early stage CC can be treated with LRH with similar recurrence rates and patterns in comparison with ARH, reassuring its continuing clinical use

Acupoint Massage to Manage Postoperative Ileus in Gynecologic Laparoscopy: A New Potential Player in the Enhanced Recovery After Surgery (ERAS) Pathways?

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