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To analyze the impact of radical cytoreductive surgery-as part of primary tumor debulking-on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery.Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected.Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients. Advanced age (hazard ratio [HR] 1.04, 95 % confidence interval [CI] 1.02-1.06, P0.01), FIGO stage IV disease (HR 3.61, 95 % CI 1.48-8.83, P0.01), and grossly visible RD (HR 3.24, 95 % CI 1.90-5.53, P0.01) were identified as significant factors associated with poor prognosis in the entire cohort of 203 patients. Radical surgery (HR 0.56, 95 % CI 0.37-0.87, P = 0.01) was associated with improved survival. In the subgroup of patients with stage IIIC disease with peritoneal carcinomatosis, independent prognostic factors were advanced age (HR 1.04, 95 % CI 1.01-1.06, P = 0.01), radical surgery (HR 0.58, 95 % CI 0.35-0.96, P = 0.03), and grossly visible RD (HR 2.86, 95 % CI 1.55-5.30, P0.01). Patients with no gross RD had the longest overall survival (86 months) compared with RD 0.1-1 cm (46 months) and RD1.0 cm (37 months) (P0.01).No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.

The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy.A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of ≥ 31 U/ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis.Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of31 U/ml and deep myometrial invasion by MRI.

To determine the safe criteria for less radical trachelectomy to treat patients with early-stage cervical cancer.We reviewed medical records and pathologic slides of 65 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IB1 cervical cancer. The safe criteria for less radical trachelectomy were determined by using three factors such as tumor size ≤ 1 cm, stromal invasion ≤ 5 mm, and no lymphovascular space invasion (LVSI) for minimizing parametrial involvement, lymph node metastasis (LNM), and the need of adjuvant radiotherapy. The diagnostic values were investigated by calculating specificity, negative predictive value for no parametrial involvement, no LNM, and no need of adjuvant radiotherapy.The median age was 32 years (range 22-44 years), and the median duration of follow-up was 26 months (range 2-103 months). Among seven single or combined factors for the safe criteria, (1) tumor size ≤ 1 cm, (2) tumor size ≤ 1 cm and stromal invasion ≤ 5 mm, (3) tumor size ≤ 1 cm and no LVSI, (4) tumor size ≤ 1 cm, stromal invasion ≤ 5 mm, and no LVSI did not show parametrial involvement, LNM, and the need of adjuvant radiotherapy. In particular, tumor size ≤ 1 cm showed the highest specificity (28.1-29.5%) and negative predictive value (100%). In spite of no difference in progression-free survival (PFS) between tumor size ≤ 1 cm and1 cm (P = 0.22), tumor size ≤ 1 cm showed better PFS without disease recurrence than tumor size1 cm (2-year PFS, 100% vs. 90%).Less radical trachelectomy may be safe in patients with early-stage cervical cancer who have tumor size ≤ 1 cm.

The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P.001), tumor size (P = .003), depth of myometrial invasion (P.001), cervical invasion (P.001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P.001), serosal/adnexal invasion (P.001), positive cytology (P = .002), peritoneal seeding (P.001), and pelvic LNM (P.001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients.