Prospective comparison of loop excision under colposcopic guidance versus vitom guidance

Background: Aim of the study was to compare the quality of loop excision using a colposcope with results using the VITOM system. Results compared included cervical volume removed, intra- and postoperative complications, and positive resection margins. Methods: A total of 200 patients with histologically confirmed high-grade cervical premalignant lesions, persistent atypical cytological results and/or suspicious colposcopic findings, and cytological and histological discrepancies were included in the study. In transformation zone type 1 (T1) only a superficial cone biopsy was done, in zones type 2 and 3 (T2 and T3) a superficial outside cone biopsy or a deeper inside cone biopsy were done respectively, followed by endocervical curettage. Volume of removed tissue, complications, and positive resection margins were compared for the colposcopy and the VITOM groups. Findings: Demographic and reproductive features were similar between groups. In the VITOM group 49% of patients had zone T1, 30% had zone T2, and 21% had zone T3. In the group of patients managed by colposcopy, 48, 45, and 7% of patients had zone T1, T2 and T3 zone, respectively (p0.05). There were no significant differences in the type of procedure or the mean volume of removed tissue. Results were similar for both groups with respect to positive resection margins and complications. Conclusion: VITOM is a safe and reliable system. Results using the VITOM system are comparable to those obtained with conventional colposcopy. The potential advantage of VITOM is the broader availability of endoscopic systems in the operating theatre. © Georg Thieme Verlag KG Stuttgart · New York

Pelvic exenteration for recurrent endometrial adenocarcinoma: a retrospective multi-institutional study about 21 patients.

OBJECTIVE: The aim of our study was to evaluate morbidity, mortality, and long-term survival of patients who underwent pelvic exenteration (PE) with curative intent for recurrence of endometrial adenocarcinoma during a single decade. METHODS: We defined a cohort of 21 patients who met our inclusion criteria, referred to 4 cooperating gynecologic oncology settings in Germany and Italy between 2000 and 2011. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until the last follow-up or death. RESULTS: The median age was 66 years. A total of 42.9% of the patients had major complications, and a complete resection was achieved in 85.7% of the patients. A total of 71.4% of the patients had negative nodes. No patient died intraoperatively. The perioperative mortality, calculated within 30 days from PE, was 4.8%. The overall 5-year survival rate, evaluated using the Kaplan-Meier method, was 40%. For the subgroup with complete resection and negative lymph nodes, overall survival reached 60%. CONCLUSIONS: Despite a high complication rate, PE for solitary pelvic recurrence of endometrial cancer yields a high rate of long-term survival