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Groin wound breakdown, lymphoceles, cellulitis, and chronic leg edema are the most frequent complications of inguinal lymphadenectomy, resulting in severe patient discomfort and significant lengthening of postoperative stay. Despite all innovations, complication rates are still high and inevitable. Our experience suggests that cutaneous flap preparation, identification of the Camper fascia, and preservation of the most lateral lymphatics decrease associated morbidity. The aim of this study is to analyze whether different cutaneous skin flap preparations and their different devascularization (above or below the inguinal ligament), resecting all the lymphofatty tissue, reduce groin wound complications, and whether the same therapeutic approach and number of lymph nodes removed are comparable. This prospective randomized clinical trial of 62 consecutive patients affected by vulvar carcinoma requiring inguinal lymphadenectomy compared skin inguinal incision carried out 3–4 cm above the inguinal ligament (group A) or below it (group B). Inguinal dehiscence was present in 17 of 53 (32.1%) patients in group B and in 9 of 54 (16.7%) in group A (P = 0.10). Lymphocele was observed in 10 of 53 lymphadenectomies (18.9%) in group B and in 3 of 54 dissections (5.6%) in group A (P = 0.07). Upper incision allows more precise identification of the Camper fascia, is less painful, and gives better cosmetic results. Moreover, there may be advantage, albeit not statistically significant, regarding flap length, wound dehiscence rate, and speed of wound healing. There was no difference in chronic leg edema, number of nodes removed, or hospital stay.

The cervix is a possible site of metastasis from any primary malignancy, but no specific indication on follow-up examination is present. We present an asymptomatic patient with isolated breast cancer cervical recurrence diagnosed by colposcopy after 11 years from primary disease. After a PubMed search and a review of current guidelines, no indication to follow-up examination regarding the cervix is present. The adoption of colposcopy in cancer survivors might be an aid to gynecologists in diagnosing cancer recurrence. Cancer survivors might benefit from a more thorough gynecologic examination as compared with the simple Papanicolaou test.

123 Background: Approximately half of women diagnosed with advanced ovarian cancer (AOC) is over 65 years old. According to WHO,65 years is the cut-off age for distinguishing elderly individuals from younger people. Aim of the study was to analyze, in a 10-year retrospective series, the age-related differences in perioperative outcome of cytoreductive surgery for stage IIIC-IV ovarian cancer, identifying in ≥ 65y and < 65y patients(pts)the clinicopathological factors associated with poor prognosis. Methods: 167pts with primary epithelial AOC FIGO stage IIIC-IV underwent cytoreduction and platinum-based chemotherapy from 2005 to 2015 at “Sapienza” University of Rome. Pts ≥ 65 and < 65 years were compared regarding surgical outcome, clinicopathological variables and prognosis. Results: Median age was 56 years(19-87);50 pts (29.9%) were ≥ 65y, whereas 117 pts(70.1%) were younger.42%(21/50) of pts in elderly group and 39%(46/117) in younger group received neoadjuvant chemotherapy followed by interval debulking surgery. No residual tumor was achieved in 82% of elderly pts and in 82.9% of younger pts (p > 0.05).No differences between the two groups were found in terms of mean operative time, mean number of blood units transfused, mean postoperative stay and number of pts requiring intensive care unit stay. The perioperative complications rate was 16% in elderly group and 10.2% in younger pts(p > 0.05).The 60-day postoperative mortality was 2%for elderly and 0.8%for younger pts(p > 0.05).The 10y-PFS was 11.6% vs 15.2%(p = 0.84) and the 10y-OS was 16.9% vs 21.4%(p = 0.60) in elderly and younger pts, respectively. Multivariate analysis showed that age itself was not a prognostic factor for OS but in < 65y pts BMI had an independent prognostic significance (HR:4.97;CI 95%:2.09-11.83),together with residual tumor, which was confirmed to be an independent prognostic factor also in elderly pts(HR = 7.33;CI 95% = 1.30-41.33). Conclusions: Elderly pts with AOC showed a similar perioperative outcome compared to younger pts. In ≥ 65y pts, residual tumor was the only variable impacting significantly survival, while in pts < 65y, BMI was also found to be an independent prognostic factor for OS.

Background Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS) and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22–48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT) findings alone is not enough. Case presentation We describe a patient, affected by ROS concomitant with a asymptomatic lymphocele, initially confused with an aortic lymph nodes relapse, after abdominal radical hysterectomy. The patient was subjected to a surgical approach, included a diagnostic open laparoscopy and laparotomy with sovraombelico-pubic incision, wide opening of the pelvic peritoneum and retroperitoneum. Examination of the mass revealed, macroscopically, a ovary with multiloculated cystic masses filled with clear or yellow serous fluid and the layers were composed by flat or cuboidal mesothelial cells. Conclusion The tribute of this case illustrates the atypical appearance with uncertain aetiology after complex imaging. Gynecologist and radiologist should acquaint with the appearance of fluid collection (urinoma, lymphocele, seroma, hematoma, abscess) in gynecologic oncology follow-up to properly differentiated from tumor recurrence.

5547 Background: PROC describes a heterogeneous group of patients (pts) with a variable but generally poor prognosis and low response to chemotherapy. Predicting OS in PROC would help stratify pts ...

Summary Background Isolated gastric recurrence due to ovarian cancer is a rare event and is usually associated with gastrointestinal symptoms. Case report We report a case of an isolated gastric recurrence of ovarian carcinoma in an otherwise asymptomatic 42-year-old woman in whom diagnosis was made using the FDG-PET/CT scan followed by laparoscopy. Conclusions In rare cases, ovarian cancer can directly recur on the stomach without any symptoms. FDG-PET/CT scan and diagnostic laparoscopy are effective in leading to an early diagnosis of disease recurrence.

Objectives: The aim of this study was to evaluate the feasibility of distinguishing the ventral parametrium (vesico-uterine ligament), the lateral parametrium (paracervix), and the dorsal parametrium (recto-uterine ligament) by 2D and 3D ultrasound (US) scan in patients affected by cervical cancer (CC), using anatomy during surgery as probative evidence. Methods: From November 2009 to February 2011, we prospectively analysed 38 consecutive patients, affected by early and locally advanced CC. All patients underwent pelvic US with both transabdominal and transvaginal approaches. Each exam was performed by 2 different operators with 2D and 3D-US scan. Anatomical observations of parametria revealed during the ultrasound evaluations were confirmed by intraoperative live scan. Results: We identified ultrasonographically the ventral and dorsal parametrium in a longitudinal scan, the lateral parametrium in a transversal scan. At the US, the ventral parametrium appears as a hiperechoic ligament with vessels, that starts from the cervix and ends at the lateral side of the bladder. The lateral parametrium is a hiperechoic ligament that starts from the lateral cervix and ends laterally under the iliac vessel. The dorsal parametrium starts from the sacro-uterine and ends at the rectum. We always identified the uterine artery. Proof of the correct identification of the different parts of the parametria was conducted during surgery. The surgeon applied one clip in every parametrium and it was identified by intraoperative live scan procedures. We could identify ventral and lateral parametria in every patient. We could not recognize the dorsal parametria in 8 patients (23.5%). Conclusions: The evaluation of the different cervical parametria can be considered feasible. The identification of dorsal parametria is more difficult than ventral and lateral parametria. We concluded that this method could be used in most cases as an aid in the assessment of parametrial involvement.

A. Gaurilcikas1, D. Vaitkiene1, A. Cizauskas2, E. Svedas1, A. Bartusevicius1, S. Augustis3, A. Testa4 1Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania; 2Department of Pathology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania; 3Lithuanian University of Health Sciences, Kaunas, Lithuania; 4Gynecologic Oncology Unit, Catholic University of Rome, Rome, Italy

Carmela Pisano, Giovanni S Bruni, Gaetano Facchini, Claudia Marchetti, Sandro PignataOncologia Medica, Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori, Napoli, ItalyAbstract: Epidemiologic analysis reveals that the mortality rate from ovarian cancer is continuously decreasing due to the improvement of surgery and chemotherapy. However, the prognosis of ovarian cancer patients is still unsatisfactory overall considering that only 30% of patients are alive after five years. In fact, although surgery and first-line systemic chemotherapy induces complete and partial response in up to 80% of patients with about a 25% pathological complete remission rate, recurrences occur in the majority of patients. The role of surgery in recurrent disease has been recently studied and many patients can receive an optimal secondary cytoreduction. Most of the recurrent patients are subject to a number of treatment regimens that, although palliative in nature, are also able to prolong survival. Important results have been obtained in particular in platinum-sensitive recurrent disease where a platinum-based chemotherapy is able to prolong progression-free survival and overall survival. Overall, our armamentarium for the treatment of progressive or recurrent ovarian cancer is significantly richer than in the past, and in many patients it is possible to achieve our goal of controlling the chronic behavior of the disease.Keywords: ovarian cancer, chemotherapy

Aim of the study was to evaluate the late-pregnancy and perinatal outcomes of patients with threatened miscarriage in the first trimester.An observational cohort study was performed on 81 pregnant women. Subjects were divided into two groups: 1) no bleeding; 2) threatened miscarriage. Patients were followed up until delivery and each materno-fetal complication was registered.Threatened miscarriage was associated with increased risk of preterm delivery, placenta previa, pregnancy induced hypertension/preeclampsia (PE), low birth weight (LBW) and neonatal intensive care unit (NICU) admission. There were no significantly differences between the 2 groups with regard to preterm prelabour rupture of membranes (PPROM), CESAREAN section, retained placenta, perinatal death and intrauterine growth restriction (IUGR). About immediate neonatal outcomes, mean birth weights were lower (≈ 200 g) in the study group (group 2), while no significant difference in the APGAR score between the two groups was noted.Our study suggests that threatened miscarriage in the first trimester is correlated with an increased incidence of late-pregnancy and perinatal complications and, therefore, these pregnancies should be considered as high risk ones.