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Background: Most patients with ovarian cancer relapse within 2 years. Prospective randomized trials, such as DESKTOP III and SOC-I, have shown the role of secondary cytoreduction in improving oncological outcomes in selected patients, when complete tumor resection is achieved. Recent retrospective series suggest that minimally invasive surgery is a feasible option in oligometastatic recurrences, such as rectal ones. Methods: Five patients with an isolated rectal recurrence infiltrating the bowel wall underwent a robotic rectosigmoid resection with totally intracorporeal colorectal anastomosis. The procedure began with retroperitoneal access to manage the vascular structures, followed by visceral resection with a minimally invasive approach. The standard steps of an en-bloc pelvic resection, including intracorporeal end-to-end anastomosis, were performed. The treatment data were evaluated. Results: The mean age of the patients was 54 years, and their mean body mass index was 30. All patients had at least one previous abdominal surgery and 60% had high-grade serous ovarian cancer at their initial diagnosis. Their mean platinum-free interval was 17.4 months. Complete secondary cytoreduction was achieved in all cases, with histopathology confirming bowel infiltration. The mean procedure duration was 294 min, with an estimated blood loss of 180 mL. No intraoperative complications occurred. The mean hospital stay was 8 days. One patient had a grade 2 postoperative complication. The mean follow-up period was 14 months, with only one patient experiencing a recurrence at the level of the abdominal wall. Conclusions: Robotic rectosigmoid resection is a viable option for complete cytoreduction in isolated recurrent ovarian cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: In assessing the risk factors for the recurrence of EC, the length of the vaginal cuff removed during surgery has shown discrepant results. The aim of this study was to investigate the role of the excised vaginal cuff length as a prognostic factor and its correlation with the expression of L1CAM. To our knowledge, this is the first study evaluating this prognostic factor in such a secluded and tidy cohort. According to our results, vaginal cuff length does not seem to be an independent variable in an EC low-risk group in terms of DFS. Moreover, L1CAM seems to be associated with a higher risk of distant recurrence. A prospective randomized trial in an EC low-risk group is needed to confirm its negative prognostic role, and to determine its potential value in clinical practice to detect that subgroup of low-risk patients which is at a higher risk of recurrence, especially at distant. Objective: The aim of our study was to investigate the role of the excised vaginal cuff length as a prognostic factor in terms of DFS and recurrence rate/site, in low-risk endometrial cancer (EC) patients. Moreover, we correlated the recurrence with the expression of L1CAM. Material and Methods: From March 2001 to November 2016, a retrospective data collection was conducted of women undergoing surgical treatment for low-risk EC according to ESMO-ESGO-ESTRO consensus guidelines. Patients were divided into three groups according to their vaginal cuff length: V0 without vaginal cuff, V1 with a vaginal cuff shorter than 1.5 cm and V2 with a vaginal cuff longer than or equal to 1.5 cm. Results: 344 patients were included in the study: 100 in the V0 group, 179 in the V1 group and 65 in the V2 group. The total recurrence rate was 6.1%: the number of patients with recurrence was 8 (8%), 10 (5.6%) and 3 (4.6%), in the V0, V1 and V2 group, respectively. No statistically significant difference was found in the recurrence rate among the three groups. Although the DFS was higher in the V2 group, the result was not significant. L1CAM was positive in 71.4% of recurrences and in 82% of the distant recurrences. Conclusions: The rate of recurrence in patients with EC at low risk of recurrence does not decrease as the length of the vaginal cuff removed increases. Furthermore, the size of the removed vaginal cuff does not affect either the site of recurrence or the likelihood of survival. [ABSTRACT FROM AUTHOR]

Primary vaginal leiomyosarcomas (LMS) are rare, recurrent tumours with an unknown etiology; the prognosis is poor and there is no consensus guideline on their management (1-2). Surgical resection is generally the gold standard. Due to their rarity there are few studies in the literature including immunohistochemistry and/or ultrastructure (2-4). Herein a primary vaginal LMS is analyzed. Magnetic Resonance Imaging identified a nodular mass in the anterior vaginal wall of a 58-year-old previously hysterectomized woman; it infiltrated the urethra but not the rectovaginal septum. Iliac lymph nodes were negative and a total body CT excluded the presence of distant metastasis. An anterior pelvic exenteration was performed with continent urostomy and creation of a neovagina. The biopsy showed a vaginal LMS that was positive for vimentin, á-smooth muscle actin, caldesmon, desmin, p16 and p53. The sample was fixed and prepared for light microscopy, transmission and scanning electron microscopy. The ultrastructural features showed hypercellularity, moderate mitotic index, nuclear pleomorphism, indented nuclear membrane, prominent nucleoli, absence of intercellular junction complexes, and a dense stroma. No dark, intermediate nor light cells could be recognized as reported (3), may be due to a highly undifferentiated and malignant tumor. After 2 years of surveillance follow-up, the patient is fine and without recurrence. According to the literature, there is still no consensus on the fact that this tumor arises de novo or as a malignant change from a leiomyoma (5-6). The patient had uterine leiomyomas and the vaginal hysterectomy might have seeded atypical cells in the vagina. However, routine uterine histology showed no atypical cells. In conclusion, best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as in this case. As there are different kinds of malignant mesenchymal tumors, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice. The question regarding the origin of vaginal LMS still remains open. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.