Single-port access laparoscopic re-staging with bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection for endometrial cancer

AbstractLaparo-endoscopic single site surgery (LESS) is a relatively new technique that has been described in recent medical literature to be feasible in the management of benign gynaecological conditions. However, the use of this technique in the management of gynaecological cancers is still controversial. In this case report, we describe the first single port laparoscopic pelvic lymphadenectomy performed in Singapore. This involved a patient who was diagnosed with endometrial cancer after a vaginal hysterectomy for uterovaginal prolapse

Risk of newly detected infections and cervical abnormalities in adult women seropositive or seronegative for naturally acquired HPV-16/18 antibodies

Funder: GlaxoSmithKline Biologicals SAPeer reviewedPublisher PD

Minimally invasive surgery for gynecological cancers: Experience of one institution

Objective: Minimally invasive techniques are increasingly used in gynecological cancer surgery. Although many studies worldwide have looked at the safety and outcomes of the laparoscopic approach to gynecological cancers, there is a lack of data on this subject in our local setting. We therefore reviewed the safety and morbidity of laparoscopic techniques for gynecological cancers in Singapore's largest gynecological cancer center. Methods: We carried out a retrospective review of a prospectively maintained database of all patients from Kerdang Kerbau Women's and Children's Hospital who underwent laparoscopic staging surgery for gynecological cancers over a 5-year period from January 2008 to December 2012. We obtained information on patient demographics, the clinical–pathological features, and perioperative and follow-up details, including intraoperative and postoperative complication rates, from clinical notes and electronic records. Results: In total, 142 patients were included in the study. Ninety-eight patients underwent full staging surgery for endometrial cancer and 44 patients underwent full staging surgery for cervical cancer. One hundred and twenty-one operations were laparoscopic hysterectomies and 21 were laparoscopic radical hysterectomies. The overall conversion rate was 0.7%. The median length of the operation, the length of stay in hospital, the intraoperative complications, the lymph node yield, and the postoperative complication rates were comparable with previously published data from other institutions. At a median follow-up time of 29 months, the recurrence rates were 4.1% and 14.2% for laparoscopic hysterectomy and laparoscopic radical hysterectomy, respectively. Conclusion: Laparoscopic surgery for gynecological cancers at our institution is safe, with morbidity statistics comparable with those of other centers

Surgical and oncological outcome of total laparoscopic radical hysterectomy versus radical abdominal hysterectomy in early cervical cancer in Singapore

Introduction: The Wertheim's radical abdominal hysterectomy (RAH) has been the traditional surgical approach for operable Stage IB cervical cancer in Singapore whereas total laparoscopic radical hysterectomy (TLRH) was introduced only in 2009. In this study, we aimed to compare the long-term surgical outcome between the two routes of surgery in our center. Methods: This is a prospective study performed in a single large tertiary institution in Singapore. Inclusion criteria included surgically fit patients with early cervical cancer and no radiological evidence of regional or distant metastases. Results: From November 2009 to December 2014, 51 TLRHs and 85 RAHs were performed. Median blood loss in the TLRH group was significantly lower than in the RAH group (300 vs. 500 mL; P = 0.002) as was median hospital stay (5 vs. 6 days; P = 0.001). Operative time was significantly higher in the TLRH group (262 vs. 228 min; P 2 cm (61.9% vs. 85.4%; P = 0.06). Conclusion: The results of our study suggest that with appropriate patient selection, TLRH can be a safe and effective procedure for the management of early cervical cancer in Singapore, especially in women with small tumors ≤2 cm but should be used with caution in women with larger tumors

Risk of newly detected infections and cervical abnormalities in adult women seropositive or seronegative for naturally acquired HPV-16/18 antibodies

10.1002/cam4.1879CANCER MEDICINE8104938-495

Risk of newly detected infections and cervical abnormalities in adult women seropositive or seronegative for naturally acquired HPV‐16/18 antibodies

Abstract Background Infections with human papillomavirus (HPV) types 16 and 18 account for ~70% of invasive cervical cancers but the degree of protection from naturally acquired anti‐HPV antibodies is uncertain. We examined the risk of HPV infections as defined by HPV DNA detection and cervical abnormalities among women >25 years in the Human Papilloma VIrus Vaccine Immunogenicity ANd Efficacy trial's (VIVIANE, NCT00294047) control arm. Methods Serum anti‐HPV‐16/18 antibodies were determined at baseline and every 12 months in baseline DNA‐negative women (N = 2687 for HPV‐16 and 2705 for HPV‐18) by enzyme‐linked immunosorbent assay (ELISA) from blood samples. HPV infections were identified by polymerase chain reaction (PCR) every 6‐months, and cervical abnormalities were confirmed by cytology every 12 months. Data were collected over a 7‐year period. The association between the risk of type‐specific infection and cervical abnormalities and serostatus was assessed using Cox proportional hazard models. Results Risk of newly detected HPV‐16‐associated 6‐month persistent infections (PI) (hazard ratio [HR] = 0.56 [95%CI:0.32; 0.99]) and atypical squamous cells of undetermined significance (ASC‐US+) (HR = 0.28 [0.12; 0.67]) were significantly lower in baseline seropositive vs baseline seronegative women. HPV‐16‐associated incident infections (HR = 0.81 [0.56; 1.16]) and 12‐month PI (HR = 0.53 [0.24; 1.16]) showed the same trend. A similar trend of lower risk was observed in HPV‐18‐seropositive vs ‐seronegative women (HR = 0.95 [0.59; 1.51] for IIs, HR = 0.43 [0.16; 1.13] for 6‐month PIs, HR = 0.31 [0.07; 1.36] for 12‐month PIs, and HR = 0.61 [0.23; 1.61] for ASC‐US+). Conclusions Naturally acquired anti‐HPV‐16 antibodies were associated with a decreased risk of subsequent infection and cervical abnormalities in women >25 years. This possible protection was lower than that previously reported in 15‐ to 25‐year‐old women

Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years : 7-year follow-up of the phase 3, double-blind, randomised controlled VIVIANE study

Acknowledgments The VIVIANE study was funded and coordinated by GlaxoSmithKline Biologicals SA, which also covered all costs associated with development and publication of this report. We thank all study participants and their families. We gratefully acknowledge the work of the central and local study coordinators, and staff members of the sites who participated in this study. Writing support services were provided by Mary Greenacre (An Sgriobhadair, Isle of Barra, UK), on behalf of GSK Vaccines; editing and publication coordination services were provided by Jérôme Leemans (Keyrus Biopharma, Lasne, Belgium), Stéphanie Delval (XPE Pharma and Science, Wavre, Belgium), and Matthieu Depuydt (Business Decision Life Sciences, Brussels, Belgium), on behalf of GSK VaccinesPeer reviewedPostprin