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Background. 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. Methods. This is a retrospective, a multi-institutional study evaluating 90-day surgery-related outcomes of patients undergoing treatment for early-stage cervical cancer before (period I: 01/01/2016-06/01/2018) and after (period II: 01/01/2019-06/01/2021) the publication of the results of the LACC trial. Results. Charts of 1295 patients were evaluated: 581 (44.9%) and 714 (55.1%) before and after the publication of the LACC trial, respectively. After the publication of the LACC trial, the number of patients treated with minimally invasive radical hysterectomy decreased from 64.9% to 30.4% (p < 0.001). Overall, 90-day complications occurred in 110 (18.9%) and 119 (16.6%) patients in the period I and period II, respectively (p = 0.795). Similarly, the number of severe (grade 3 or worse) complications did not differ between the two periods (38 (6.5%) vs. 37 (5.1%); p = 0.297). Overall and severe 90-day complications were consistent between periods even evaluating stage IA (p = 0.471), IB1 (p = 0.929), and IB2 (p = 0.074), separately. Conclusions. The present investigation highlighted that in referral centers the shift from minimally invasive to open radical hysterectomy does not influence 90-day surgery-related morbidity. (c) 2022 Elsevier Inc. All rights reserved.

The aim of the present study is to prospectively investigate the efficacy and complications of macroplastique transurethral implantation in cervical cancer patients affected by stress urinary incontinence (SUI) after radical hysterectomy (RH).Patients affected by de novo SUI post type 3 RH were considered for eligibility in this study. Preoperative and postoperative assessment included a standardized urogynecological history, urogynecological and neurological physical examination, evaluation of severity of SUI symptoms, a 3-day voiding diary, urine culture and urodynamic assessment. All patients underwent transurethral implantation using Macroplastique Implantation System (MIS). Patient follow-up was performed 6 and 12 months after surgery.A total of 24 consecutive patients were enrolled. At the 12 month follow up SUI cure rate was 42% (10 of 24 patients), the improvement rate was 42% (10 of 24) and the failure rate was 16% (4 of 24). The overall success rate was 84% (10 patients cured and 10 improved). No intraoperative or postoperative early complications were found. The 4 patients in whom treatment was not a success had preoperative urethral hypermobility. Subjective patient perception of SUI symptom severity showed significant improvement (mean severity of urinary loss perception 6.6+/-1.8 vs 2.3+/-3.3, p0.05). The frequency of incontinence on the 3-day voiding diary was significantly reduced at the follow up (14.5+/-5.8 vs 4.3+/-7.9 episodes per 3 days, p0.05).Bulking agents urethral injection could be a valid option having no surgical complications. This therapeutic strategy is able to treat SUI and improve well being of cervical cancer patients after radical surgery.

Objective To describe the technique, feasibility and early complications of "Rome pouch" urinary diversion. Methods Thirty-five consecutive patients affected by advanced or recurrent gynecological cancers who required anterior or total pelvectomy entered the study. Rome pouch technique starts with the transection of terminal ileum about 12 cm from the ileocecal valve; the large colon is transected 15–20 cm distal to the hepatic flexure. The intestinal wall tension and internal pressure are reduced using 5–8 transverse teniamyotomies of the cecum. The efferent segment of the pouch is created either with the appendix or with the distal ileum. Operative data, intra- and early postoperative complications were recorded. Results Between February 2000 and March 2006, an ileocolonic urinary diversion (Rome pouch) was carried out in 35 patients affected by advanced or recurrent gynecologic malignancies. The average operative time to complete the anterior and total exenteration including reconstruction procedure was 285 (range, 230–350) and 320 (range 280–415) min, respectively. The average time in performing the Rome pouch technique was 60 min (range, 45–90). Overall postoperative complication rate (major and minor complications) was 82% (29 patients). Febrile morbidity occurred in 26 patients (74%). Wound complications and pelvic collection were found in 7 (20%) and 6 (17%) patients, respectively. Conclusion Our experience demonstrated that Rome pouch technique represents a valid alternative in gynecology oncology for continent urinary diversion. This technique showed low rate of medical and early urologic complications. The simplicity of performing the procedure and the reduced operating time are the best goals reached by Rome pouch technique. Future comparative trials will better define the role that the Rome pouch will have in these patients.

Lymphatics are the main pathway of dissemination for gynaecologic malignancies and in particular those with preferential regional spread, so the evaluation of lymph node status has an important role in diagnosis, prognosis and treatment of patients with gynaecologic cancer. Hence, gynecologic oncologist must be familiar with lymphatic anatomy and the ability to perform a systematic retroperitoneal pelvic and aortic lymph node dissection is an important skill in their surgical armamentarium. This review will focus on the performance of systematic aortic lymphadenectomy in cervical cancer.

Background. Post-irradiation breast sarcoma is a rare and highly aggressive tumor, associated with poor prognosis. However, the mean latent periods reported for postradiation sarcomas after treatment of breast cancer ranges from 5 to 10 years. Case. We present a rare case of fibrosarcoma of the axilla, diagnosed 23 months after breast surgery and irradiation for medullary poorly differentiated carcinoma, treated with wide local excision with resection of the serratus anterior muscle until pleural wall. Conclusion. This case confirm a possible early appearance of sarcoma in the irradiation field after radiotherapy. Thus, when a nodule appears in the irradiation field even if within 2 years after radiotherapy, physician should be alert for a possible sarcoma and wide biopsy with histologic confirmation is auspicable.

Objective The aim of this study was to evaluate acute and long-term morbidity, recurrence rate, and overall survival in patients with multiple groin lymph node metastases treated with postoperative chemotherapy. Methods Patients affected by FIGO stages III, IVA, and IVB (pelvic lymph nodes only) submitted to surgery were then treated with four cycles of cisplatin 100 mg/m 2 given 21 days apart. Toxicity, overall, and disease-free survival were evaluated. Results Fourteen patients were evaluated. Median patients age was 58 (range 48–82). Median performance status was 0 (0–2). All patients completed the treatment. No treatment-related deaths occurred. Only two patients suffered from grade 4 neutropenia during chemotherapy. Three patients suffered from long-term severe lymphedema. Four patients suffered a disease recurrence. Three of these patients were subjected to surgery with no severe postoperative complications. Two of the latter patients are still alive. At a median follow-up of 57.5 months (range 23–79 months) actuarial 3-year overall survival and progression-free survival are 86% and 71%, respectively. Conclusions In patients affected by vulvar cancer with multiple lymph node metastases, radical surgery followed by chemotherapy is a feasible strategy, with an acceptable short- and long-term complication rate. Results in terms of overall survival and disease-free survival are promising. Furthermore, due to absence of local long-term tissue toxicity, this strategy allows physicians to surgically treat regional lymph node recurrence safely.