The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival

Cáncer de cuello de útero; Supervivencia libre de enfermedad; Metástasis linfáticaCàncer de coll de l'úter; Supervivència lliure de malaltia; Metàstasi limfàticaCervical Cancer; Disease-Free Survival; Lymphatic MetastasisObjective The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. Methods Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. Results A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognostic indicator. CALS and LODDS <−2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. Conclusion When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival

Fertility-Sparing Surgery versus Radical Hysterectomy in Early Cervical Cancer: A Propensity Score Matching Analysis and Noninferiority Study

Early cervical cancer; Fertility-sparing surgery; Radical hysterectomyCáncer de cuello uterino temprano; Cirugía conservadora de la fertilidad; Histerectomía radicalCàncer de coll uterí precoç; Cirurgia conservadora de la fertilitat; Histerectomia radicalObjective: Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. Methods: A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. Results: The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of −19.02 percentage points; 95% CI −32.08 to −5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. Conclusion: FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH.This work received financial support from the Medtronic University Chair for Training and Surgical Research, University Jaume I (UJI), Castellon, Spain

The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival

The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognostic indicator. CALS and LODDS <−2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival

Fertility-Sparing Surgery versus Radical Hysterectomy in Early Cervical Cancer: A Propensity Score Matching Analysis and Noninferiority Study

Objective: Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. Methods: A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. Results: The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of −19.02 percentage points; 95% CI −32.08 to −5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. Conclusion: FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH

Fertility-Sparing Surgery versus Radical Hysterectomy in Early Cervical Cancer : A Propensity Score Matching Analysis and Noninferiority Study

Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of −19.02 percentage points; 95% CI −32.08 to −5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH

Nerve-sparing versus non-nerve-sparing radical hysterectomy : surgical and long-term oncological outcomes

There are controversies regarding the long-term oncological safety of preservation of pelvic innervation during radical hysterectomy (RH). This study aimed to analyze the feasibility and safety of nerve-sparing radical hysterectomy (NSRH) for cervical cancer compared with non-NSRH following 17 years of experience in a tertiary cancer referral center. Between May 1999 and June 2016, all patients who underwent RH for cervical cancer were followed-up prospectively. Comparison analyses regarding surgical outcomes, complications, overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were performed between patients treated with NSRH and non-NSRH. A total of 188 patients were included (113 non-NSRH and 75 NSRH). The median follow-up was 112 months. Estimated blood loss and hospital stay were all significantly lower in the NSRH group. Overall intraoperative complication rate (p = 0.02) and need for transfusion (p = 0.016) were lower in the NSRH group. There were no differences in the median operation time, OS, DFS, CSS, or recurrence rates between the NSRH and non-NSRH group. Our study provides a wide perspective on the developments of nerve-sparing procedures for the management of women with early-stage cervical cancer. Our results suggest that NSRH is a feasible and safe procedure, with reduced morbidity outcomes

The impact of surgical practice on oncological outcomes in robot-assisted radical hysterectomy for early-stage cervical cancer, Spanish National Registry

Minimal invasive surgery (MIS) has been associated with lower disease-free survival than open surgery among women who underwent radical hysterectomy for early-stage cervical cancer. However, the mechanisms by which MIS increases mortality in cervical cancer remain uncertain. We aimed to determine if surgical practice among centers using robotic surgery has an impact on oncological outcomes. We evaluated 215 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) who underwent robot-assisted radical hysterectomy in five Spanish tertiary centers between 2009 and 2018. A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed for the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes in all surgical approaches. Abstract: This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of 10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13-1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02-1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04-1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer

Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study

Simple Summary Advanced ovarian cancer (Stages III-IV) continues to be one of the gynecological tumors with the highest mortality. Standard treatment consists of debulking surgery and subsequent adjuvant chemotherapy. Recently, some authors have postulated that the administration of hyperthermic chemotherapy during surgery could increase the survival of patients, especially in cases in which chemotherapy had already been administered before surgery to reduce tumor volume. Our study is important because it collects data from 11 tertiary hospitals in Spain, and the data are subjected to a statistical technique that reproduces the data that we would find in a prospective study but using retrospective data (propensity score matching). It also offers a current view of the status of ovarian cancer treatment in our country.Abstract Introduction: Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). Materials and Methods: A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. Results: A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58-0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64-1.20; p = 0.44). There was no increase in complications in the CRSH group. Conclusion: The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients

Estudio prospectivo para la validación de la técnica del ganglio centinela en cáncer de cervix uterino inicial

Objetivo principal: Estudiar la tasa de detección y analizar el valor predictivo negativo de la técnica del ganglio centinela en las pacientes afectas de cáncer de cérvix en estadio inicial que serán tratadas con cirugía radical utilizando un mapa linfático pre e intraoperatorio, mediante un estudio prospectivo para la validación de dicha técnica. Especificación del objetivo principal:1.- Realizar un análisis descriptivo de las variables epidemiológicas del grupo a estudiar.2.- Estudiar la tasa de detección y localizaciones del ganglio centinela en cáncer inicial cervical utilizando la linfogammagrafía prequirúrgica y la detección intraoperatoria con sonda polar y azul de isosulfán.3.- Estudiar la tasa de detección y localizaciones del ganglio centinela en cáncer inicial cervical utilizando la combinación de tecnecio y azul de isosulfán.4.- Analizar los datos descriptivos de la realización de la técnica del ganglio centinela y estudiar los motivos de fallo de drenaje de los trazadores así como las complicaciones del procedimiento.5.- Analizar el valor predictivo positivo y negativo, la sensibilidad y especificidad y la tasa de de falsos negativos para la detección de las metástasis ganglionares mediante la técnica del ganglio centinela.6.- Estudiar la supervivencia global y el periodo libre de enfermedad medidos tanto en proporción de pacientes vivos a los 5 años como en media de tiempo de vida (en meses) después del tratamiento. 7.- Comparar la supervivencia y el tiempo libre de enfermedad dependiendo del resultado para metástasis del ganglio centinela, medidos tanto en proporción de pacientes vivos a los 5 años como en media de tiempo de vida (en meses) después del tratamiento.8.- Analizar la supervivencia y el tiempo libre de enfermedad estratificada por estadios FIGO de la enfermedad, según prsencia o ausencia de permeación linfovascular y según administración o no de tratamiento adyuvante, medidos tanto en proporción de pacientes vivos a los 5 años como en media de tiempo de vida (en meses) después del tratamiento.9.- Realizar un análisis descriptivo y comparativo de los resultados clínicos del mapa linfático del ganglio centinela y de las variables quirúrgicas del tratamiento realizado vía laparoscópica versus laparotómica.10.- Comparar la supervivencia y el tiempo libre de enfermedad según la vía de abordaje laparoscópica o laparotómica medidos tanto en proporción de pacientes vivos a los 5 años, como en media de tiempo de vida (en meses) después del tratamiento.Objetivo secundario:Agrupar los datos de la literatura mundial para conseguir el número suficiente de pacientes para la validación del método del ganglio centinela determinando una tasa de detección que sea superior al 85% y un valor predictivo negativo superior al 95% con una significación inferior al 5%

Estudio prospectivo para la validación de la técnica del ganglio centinela en cáncer de cervix uterino inicial

Consultable des del TDXTítol obtingut de la portada digitalitzadaObjetivo principal: Estudiar la tasa de detección y analizar el valor predictivo negativo de la técnica del ganglio centinela en las pacientes afectas de cáncer de cérvix en estadio inicial que serán tratadas con cirugía radical utilizando un mapa linfático pre e intraoperatorio, mediante un estudio prospectivo para la validación de dicha técnica. Especificación del objetivo principal: 1.- Realizar un análisis descriptivo de las variables epidemiológicas del grupo a estudiar. 2.- Estudiar la tasa de detección y localizaciones del ganglio centinela en cáncer inicial cervical utilizando la linfogammagrafía prequirúrgica y la detección intraoperatoria con sonda polar y azul de isosulfán. 3.- Estudiar la tasa de detección y localizaciones del ganglio centinela en cáncer inicial cervical utilizando la combinación de tecnecio y azul de isosulfán. 4.- Analizar los datos descriptivos de la realización de la técnica del ganglio centinela y estudiar los motivos de fallo de drenaje de los trazadores así como las complicaciones del procedimiento. 5.- Analizar el valor predictivo positivo y negativo, la sensibilidad y especificidad y la tasa de de falsos negativos para la detección de las metástasis ganglionares mediante la técnica del ganglio centinela. 6.- Estudiar la supervivencia global y el periodo libre de enfermedad medidos tanto en proporción de pacientes vivos a los 5 años como en media de tiempo de vida (en meses) después del tratamiento. 7.- Comparar la supervivencia y el tiempo libre de enfermedad dependiendo del resultado para metástasis del ganglio centinela, medidos tanto en proporción de pacientes vivos a los 5 años como en media de tiempo de vida (en meses) después del tratamiento. 8.- Analizar la supervivencia y el tiempo libre de enfermedad estratificada por estadios FIGO de la enfermedad, según prsencia o ausencia de permeación linfovascular y según administración o no de tratamiento adyuvante, medidos tanto en proporción de pacientes vivos a los 5 años como en media de tiempo de vida (en meses) después del tratamiento. 9.- Realizar un análisis descriptivo y comparativo de los resultados clínicos del mapa linfático del ganglio centinela y de las variables quirúrgicas del tratamiento realizado vía laparoscópica versus laparotómica. 10.- Comparar la supervivencia y el tiempo libre de enfermedad según la vía de abordaje laparoscópica o laparotómica medidos tanto en proporción de pacientes vivos a los 5 años, como en media de tiempo de vida (en meses) después del tratamiento. Objetivo secundario: Agrupar los datos de la literatura mundial para conseguir el número suficiente de pacientes para la validación del método del ganglio centinela determinando una tasa de detección que sea superior al 85% y un valor predictivo negativo superior al 95% con una significación inferior al 5%