Objective: The standard treatment for stage IB-IIA cervical cancer over the past three decades has been the Piver-Rutledge type III radical hysterectomy. This surgery implies a high rate of urologic morbidity. The objective was to determine the role of class I radical hysterectomy compared to class III radical hysterectomy in terms of morbidity, overall survival, DFS and patterns of relapse in patients undergoing primary surgery.Materials and methods: 125 patients with stage IB1 and IIA cervical cancer <= 4 cm were randomized between type I and type III hysterectomy. Clinical, pathologic and follow-up data were prospectively collected. Adjuvant radiotherapy was administered when indicated. Univariate and multivariate analyses were carried out.Results: Sixty-two patients were randomized to class I surgery and 63 to class III. No significant differences were observed regarding pathologic findings and adjuvant treatment. Morbidity rates were higher after class III surgery (84% versus 45%). Pelvic recurrences were equal in both groups (8 cases each one). Fifteen-year overall survival rate was 90 and 74% respectively (p = 0.11) and 76 and 80% when cervical size is <= 3 cm (p = 0.88).Conclusions: There are no significant differences in terms of both recurrence rate and overall survival among patients with stage IB-IIA cervical cancer undergoing simple extrafascial hysterectomy (class I) or radical hysterectomy (class III). Morbidity is proportional to the extent of radicality. These data confirm the need of tailoring the extent of resection to the characteristics of the cervical neoplasia and open new interesting pathways to upcoming protocols for the conservative management of these tumors. (C) 2011 Elsevier Ltd. All rights reserved.

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S218-S218 Invited presentations and presentations by organisations and societies I228 PARAMETRECTOMY IN EARLY STAGE CERVICAL CANCER: NOT NECESSARY A. Maneo, A. ManeoSearch for more papers by this author A. Maneo, A. ManeoSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60258-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S218-S218 RelatedInformation

Objective: The aim of the present study was to assess the oncologic and fertility outcomes of conservative surgery associated with chemotherapy for early-stage cervical cancer in young patients desiring to preserve fertility.

OBJECTIVES:Simple conization represents a plausible treatment scheme for managing stage IA1-2 tumors conservatively. However its curative potential has not been widely exploited as regards stage IB1 lesions. Recent studies suggest that, in selected circumstances, patients with stage IB1 disease undergoing radical hysterectomy could have been safely cured by simple hysterectomy and even by cervical conization. METHODS:Patients with stage IB1 cervical cancer desiring conservative management underwent simple conization and pelvic lymphadenectomy in three Italian institutes. RESULTS:Thirty-six women received the conservative treatment since 1995 to 2010. Median age was 31 (range 24-40) years and median tumor size was 11.7 mm (range 8-25 mm). Adenocarcinoma was present in 12 cases (33%) and grade 3 neoplasia in 5 (14%). Lymph-vascular space involvement was detected in five patients (14%). Eleven had already a child while two had experienced an early abortion and a fetal loss at second trimester. After a median follow-up of 66 months (range 6-168) only one pelvic lymphnodal relapse was observed. Twenty-one pregnancies occurred in 17 patients and 14 live babies have been born (two preterm at 27 and 32 weeks) while one is ongoing. Three first-trimester miscarriages, one second-trimester fetal loss, an ectopic pregnancy and a termination of pregnancy have been recorded. Five patients decided to undergo hysterectomy after 3-12 years after conservative therapy: in one residual microinvasive adenocarcinoma was found. CONCLUSIONS:Cervical conization represents a feasible conservative management of stage IB1 cervical cancer and shows a low risk of relapse, provided that patients are selected carefully. Conization would be suitable to treat stage IB lesions smaller than 15-20mm. with pathologic negative lymphnodes.

A cross-sectional study was carried out in a population of North Italy to determine the prevalence of eight oncogenic human papillomavirus (HPV) types most commonly found in cervical carcinoma and to study the relationship between HPV DNA loads and severity of disease. A total of 597 cervical samples obtained from patients with pathological findings (n = 472) and from women with normal cytology (n = 125) were analyzed by means of normalized Real-time PCR assays to quantify HPV-16, -18, -31, -45, and -33 group (including -33, -52, -58, -67); the normalization of oncogenic HPV viral load was carried out by quantitation of a single copy gene. The two most common oncogenic HPV types found were 16 and 31 (24.3% and 22.9% of pathological samples, respectively); multiple infections were demonstrated in 22% of pathological samples. Overall, the HPV total viral load was found to increase with increasing severity of associated lesions, although a stronger association was observed only for HPV-31 and HPV-16 (gamma = 0.49 and 0.41, respectively) as compared to HPV-18 and -33 group (gamma = 0.19 and 0.02, respectively). However, we found that high levels of HPV-31 or 33 group DNA could be prognostic of minor oncogenic risk for high-grade squamous intraepithelial lesions (H-SIL) (age adjusted odds ratio [AORs] = 1.57 and 1.26, respectively) than HPV-16 and HPV-18 (AORs = 30 and 8, respectively). The AORs also increased with HPV total viral load and reached a maximum of AORs = 15.7. Thus, HPV load is a type-dependent risk marker for the development of H-SIL. J. Med. Virol 81:278287, 2009. (c) 2008 Wiley-Liss, Inc.

OBJECTIVE:To compare differences in blood loss, operative time, and intra- and postoperative complications with the harmonic scalpel or conventional electrosurgery in the treatment of vulvar cancer. METHODS:Consecutive patients who underwent radical vulvectomy with inguinal lymphadenectomy using the harmonic scalpel (HS) or conventional electrosurgery (CE) were compared. RESULTS:A total of 42 patients were included, 22 in the HS group and 20 in the CE group. Mean blood loss was significantly less in the HS group compared with the CE group (127 mL vs 210 mL; P<0.05) and mean operative time was significantly shorter with the HS compared with CE (117 minutes vs 142 minutes; P<0.05). There were no significant differences between the 2 groups in postoperative complications. CONCLUSION:Use of the harmonic scalpel for surgical treatment of vulvar cancer is safe and has several advantages, including decreased operative time and blood loss, improved visibility in the operative field, and good postoperative outcome.

Objectives. To assess the effectiveness of chemo-surgical conservative therapy for stage IBI cervical tumors in patients desiring to preserve fertility.Methods. From 1995 to April 2007 51 nulliparous patients with turner <= 3 cm, aged <= 40 years with no uterine and lymphnode neoplastic involvement were evaluated. Three courses with cisplatin 75 mg/m(2), paclitaxel 175 mg/m(2) and ifosfamide 5 g/m(2) (epirubicin 80 mg/m(2) in adenocarcinoma) were followed by cold-knife conization and pelvic lymphadenectomy. When intraoperative frozen section revealed massive neoplastic cervical persistence a radical total hysterectomy was performed.Results. Thirty women (59%) did not accept the conservative approach. fit the remaining 21 patients median age was 30 years and median tumor size was 15 mm (range 10-30 mm). Adenocarcinoma was present in 12 cases (57%) and indifferentiated neoplasia in 10 (48%). Following neoadjuvant treatment. pathological complete response was observed in 5 cases, in situ or microinvasive residue in 12 and stromal invasion >3 mm in 4. Four women deemed ineligible for conservative surgery after chemotherapy and one refusing to preserve her genital apparatus Underwent radical hysterectomy. After a median follow-Lip of 69 months no relapses were observed. Nine women attempted to conceive: ten pregnancies occurred in 6 patients and 9 live babies have been borne while one woman experienced a first-trimester miscarriage.Conclusions. The high rate of pathological response confirms the effectiveness of the preoperative treatment for reducing the tumor volume allowing the removal only of a cervical cone instead of the entire cervix with cardinal ligaments as needed by radical trachelectomy. Successful pregnancies are possible after such integration. (C) 2008 Elsevier Inc. All rights reserved.

This is a retrospective study of patients treated for early-stage cervical cancer to identify pathologic risk factors associated with ovarian metastases and, therefore, to establish when ovarian preservation can be performed without increasing the risk of relapse in order to improve the quality of life in premenopausal patients. Between 1982 and 2004, 1965 patients with FIGO stage IA2–IB–IIA cervical squamous cell carcinoma and nonsquamous histology types were surgically treated; 1695 (86%) patients underwent primary radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic node dissection, the remaining 270 patients (14%) had their ovaries preserved. The clinical records were reviewed for all patients and clinical features at presentation, the histopathology and follow-up data were recorded. Overall, ovarian metastases were diagnosed in 16 of 1695 patients, for an incidence rate of 0.9%. Univariate analysis shows age (≤45 vs >45 years: P= 0.0079), FIGO stage (IB1–IIA ≤4 cm vs IB2–IIA >4 cm: P= 0.0133), histology (squamous vs nonsquamous, P= 0.0014), noninvolved peripheral stromal thickness (<3 vs >3 mm: P= 0.0001), lymphvascular space involvement (present vs absent, P= 0.0007), lymph node status (positive vs negative, P= 0.00009) to be statistically associated with the presence of ovarian metastases. Multivariate analysis shows only age (P= 0.0119), FIGO stage (P= 0.011), histology (P= 0.001), and unaffected peripheral stromal thickness (<3 mm: P= 0.037) to be independent risk factors for ovarian metastases. Based on the present data and on the data available in the literature, ovarian preservation could be safely performed in young patients with early-stage squamous cell carcinoma (histology as the most significant risk factor), with macroscopically normal ovaries, and with preserved peripheral unaffected cervical stroma.

Background. The female genital lymphomas are an extremely rare disease accounting for less than 0.5% of gynecological cancers and for 1.5% of all NHL. Because of their low incidence there is no widely accepted consensus on its treatment. Literature data support a radiotherapy-based treatment in case of primary genital lymphomas stages I-II. The role of chemotherapy as neoadjuvant or exclusive treatment is still to be defined.Methods. From 1984 to 2003, the treatments in our institution of 19 patients with genital lymphoma were reviewed. Nine women presented with cervical, 3 with vaginal, I with cervical-vaginal, 2 with vulvar and 4 with ovarian lymphoma. Seven were staged IE, nine IIE, one IIIE and two IVE. As a whole, chemotherapy was used in 18/19 cases: chemotherapy was proposed as first line treatment in 12 cases, while surgery in 7 (followed by chemotherapy in 6 cases).Results. Primary chemotherapy alone obtained a complete response (CR) in 9/12 patients; pathological complete response (pCR) was confirmed in 3 operated patients out of 9. Partial response (PR) was observed in 3, requiring radiotherapy. Chemotherapy obtained CR after incomplete surgical debulking in 3 out of 4 cases. Two patients relapsed in the group treated with chemotherapy alone. Both have been salvaged by further chemotherapy. Only one patient deceased due to her tumor after surgery and chemotherapy.Conclusion. The use of exclusive chemotherapy obtained promising results not only as regards survival rates but also for reducing the need of radiotherapy. A conservative management based on exclusive chemotherapy in primary genital lymphoma stages I-II may be attempted in selected patients desiring pregnancy. (c) 2006 Elsevier lnc. All rights reserved.

We are very grateful to Plante and colleagues for quoting our experience with chemotherapy and conservative surgery in cervical carcinoma [ [1] Plante M. Laub S. Brydonc L. Swenertond K. LeBlance R. Roy M. Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: Case report. Gynecol. Oncol. 2006; 101: 367-370 Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar ]. Furthermore, we greatly appreciate that one of the most experienced oncologic groups about conservative therapies in IB1 cervical cancer decided to explore a different strategy, so far proposed only by our institution and by Kobayashi et al. [ [2] Kobayashi Y. Akiyama F. Hasumi K. A case of successful pregnancy after treatment of invasive cervical cancer with systemic chemotherapy and conization. Gynecol. Oncol. 2006; 100: 213-215 Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar ]. While hoping that other authors can take into account in the future this novel treatment possibility, we would like to make some considerations about the conclusions of the case report.

Background: No standard therapy has been established for patients with moderate to high risk Endometrial cancer after radical hysterectomy including lymphadenectomy. This study was designed to evaluate the safety of weekly TXL 1 CBDCA therapy in patients with advanced uterine endometrial cancer after radical surgery. Methods: Eleven patients with moderate to high risk Endometrial cancer have enrolled the study in our hospital. Patients received TXL 80 mg/m (d1,8,15) and CBDCA (AUC5) (d1) by intravenous drip in each one hour. Pre-medications included 10 mg of dexamethasone (iv), 50 mg of cimetidine (iv), and 50 mg of diphenhydramine (po) administered 30 minutes before the TXL treatment. Results: Total chemotherapy courses are 66 courses. Median Followup Period 283 days. These chemotherapy were complete performed. Grade-3 or higher hematologic toxicity was observed for leukocyte (total WBC) and neutrophill/granulocyte in one patients (18.1%), but it could be controlled with GCSF. No grade-3 or higher nonhematologic toxicity was noted. Conclusion: The weekly TXL 1 CBDCA therapy was safety for advanced moderate to high risk endometrial cancer after radical therapy and its toxicity was tolerable.

AIM:The aim of this study is to evaluate the effectiveness of radiation, concomitant chemoradiation and primary chemotherapy in the treatment of FIGO stage IIIB cervical carcinoma.METHODS:Between January 1981 and December 2001 94 women with stage IIIB FIGO cervical carcinoma were observed. Exclusive radiotherapy was administered in 30 cases (32%), radiotherapy and radiosensitizing chemotherapy in 20 cases (21%) and primary chemotherapy in 44 cases (47%); among the latter patients 2 (4%) developed neoplastic progression, 28 (64%) underwent surgery and 14 (32%) underwent radiotherapy.RESULTS:After a median follow-up of 69 months, 5-year overall survival of the 3 groups is respectively 23%, 36% and 26% (p=0.7). Total dose to point A greater than 60 Gy and the use of brachyradiotherapy are suggestive for a better outcome among women treated with radiation therapy (5-year overall survival 31% versus 18%, p=0.8 and 33% versus 23%, p=0.4, respectively). Radiologically assessed nodal status is the only statistically significant risk factor (p=0.001). Although not statistically significant, vaginal involvement is a relevant factor influencing survival (p=0.1). Women treated with concomitant chemoradiation showed a better 5-year disease-free survival (45%) when compared to the other treatment groups (radiation alone 27%, primary chemotherapy 30%, p=0.4).CONCLUSIONS:Primary chemotherapy, although useful to allow subsequent surgery, does not yield a survival advantage with respect to the irradiated patients. Among these, concomitant radiosensitizing chemotherapy is likely to improve the disease-free survival.

OBJECTIVES:To evaluate the risk of the laparoscopic approach to patients with borderline ovarian tumors compared to the laparotomic management. METHODS:We treated or followed in our institution 479 women with borderline ovarian tumor. Sixty-two patients had fertility-sparing surgery followed by restaging or follow-up intervention: 30 operated by laparoscopy, 32 by laparotomy. Restaging surgery was performed in five cases and second-look surgery in 57. RESULTS:The diameter of the cyst is significantly lower in patients treated by laparoscopy, especially in women who underwent cystectomy (4.7 cm) compared to oophorectomy (10 cm, P = 0.008). Rupture of the cyst and stage IC were more frequent in the laparoscopic group. After a median follow-up of 61 months for the laparoscopic group and 77 months for the laparotomic group, we observed 11 patients (37%) with persistent disease after primary laparoscopy (adnexa, five cases; peritoneal implants, three cases; both patterns, three cases). After primary laparotomy, no patients showed early persistence of tumor, and ovarian relapses were diagnosed in seven women (22%) 33-138 months after laparotomy. The univariate analysis for the risk of neoplastic persistence after primary laparoscopy shows that patients with cysts greater than 5 cm have a higher risk (odds ratio 9.7, P = 0.02) compared to smaller cysts. No other factors proved significant, but the odds ratios for patients with serous tumor (5.8), stage IC (2.0), and those undergoing cystectomy (1.9) suggest a relationship to the probability of persistence. CONCLUSION:Laparoscopic treatment in borderline ovarian tumors should be reserved to masses not greater than 5 cm. When conservative therapy is desired, the entire affected ovary should be removed. If the neoplasia is bilateral, cystectomy could be allowed in women who wish to preserve fertility, although they are at high risk of relapse.

PURPOSE OF INVESTIGATION:The objective of this retrospective multicenter study was to assess the clinical outcome of patients with microinvasive squamous cell carcinoma of the uterine cervix.METHODS:The hospital records of 166 patients with microinvasive squamous cell carcinoma of the uterine cervix were reviewed. All cases were retrospectively staged according the 1994 International Federation of Gynecology and Obstetrics (FIGO) nomenclature. One hundred and forty-three cases were in Stage Ia1 and 23 in Stage Ia2 disease. Surgery consisted of conization alone in 30 (18.1%) patients, total hysterectomy in 82 (49.4%), and radical hysterectomy in 54 (32.5%). All patients in whom conization was the definite treatment had Stage Ia1 disease and had cone margins negative for intraepithelial or invasive lesions.RESULTS:None of the 67 patients submitted to pelvic lymphadenectomy had histologically proven metastatic lymph nodes. Of the 166 patients, eight (4.8%) had an intraepithelial recurrence and four (2.4%) had an invasive recurrence. With regard to FIGO substage, disease recurred in nine (6.3%) out of 143 patients with Stage Ia1 and three (13.0%) out of 23 with Stage Ia2 cervical cancer. With regard to type of surgery, disease recurred in three (10.0%) out of the patients treated with conization alone, four (4.9%) out those who underwent total hysterectomy, and five (9.3%) out of those who underwent radical hysterectomy. It is worth noting that none of the 30 patients treated with conization alone had recurrent invasive cancer after a median follow-up of 45 months. However three (10%) of these patients developed a cervical intraepithelial neoplasia (CIN) III after 16, 33, and 94 months, respectively, from conization.CONCLUSIONS:Conization can represent the definite treatment for patients with Stage Ia1 squamous cell cervical cancer, if cone margins and apex are disease-free. For patients with Stage Ia2 cervical cancer extrafascial hysterectomy with pelvic lymphadenectomy might be an adequate standard therapy, although the need for lymph node dissection is questionable.

Purpose: The purpose of this study is to report the results of a systematic laparoscopic staging procedure in locally advanced cervical carcinomas Patients and methods: Between 1/97 and 11/02, 133 patients with IB2(41); IIA(7); IIB(29); IIIA(6); IIIB(44); IVA(2) or a recurrent (4) cervical carcinoma, underwent a pretherapeutic laparoscopic staging involving a diagnostic transperitoneal laparoscopy, followed, if normal, by an ilio-infrarenal extraperitoneal laparoscopic para-aortic lymphadenectomy Results: Age averaged 46 ( (cid:3) 9) years. BMI was 24 ( (cid:3) 5) kg/m2. Node count was 20 ( (cid:3) 11) with 29 (22 % ) pN1 patients. Operative time averaged 154 ( (cid:3) 46) min and postop stay was 2 days. Symptomatic lymphoceles (14 % ) were the main complication. 2 patients had to be re-operated (1 abcess, 1 bowel obstruction). If radiation therapy is usually limited to the pelvis in stage IB2, our staging revealed that 9pN1 patients (22 % ) would have been under-treated. In the other hand, in the subgroup of 89 stage IIB, III and IV, usually managed by extended field therapy, our 69 pN0 patients (77,5 % ) would have been over-treated. At a distance, pN1 patients tolerated well the extended chemoradiation treatment but prognosis was poor (median survival 27 months), the median survival of pN0 patients after pelvic radiation was not reached after 16.6-month follow up. Conclusions: Laparoscopic staging of locally advanced cervical carcinoma is a feasible and useful technique that combines the