International Journal of Gynecological Cancer最新文献

Objective: Post-operative shoulder and subcostal pain are common after laparoscopic gynecologic surgery, often attributed to residual intraperitoneal carbon dioxide. This study aimed to evaluate whether active gas aspiration via a peritoneal drain reduces post-operative pain compared to standard manual gas evacuation.

Methods: We conducted a single-center, randomized, single-blind, phase III clinical trial at the Oscar Lambret Cancer Center (France) from January 2022 to November 2023. Women aged ≥18 years undergoing laparoscopic or robot-assisted gynecologic surgery were randomized 1:1 to receive either manual gas evacuation (control group) or active carbon dioxide aspiration using a subcostal drain connected to vacuum (experimental group). All patients underwent pulmonary recruitment maneuvers. The primary endpoint was the incidence of clinically significant shoulder/subcostal pain (Numeric Rating Scale [NRS] ≥3) within 24 hours post-operatively. Secondary endpoints included pain intensity over the first post-operative week, analgesic use, and adverse events.

Results: A total of 166 patients scheduled to undergo laparoscopy (82 control, 84 experimental) were enrolled in the trial. At 6 hours and 24 hours post-operatively, the proportion of patients experiencing NRS ≥3 shoulder/subcostal pain did not significantly differ between groups (6 hours: 5/82, 6.1%, vs 2/84, 2.4%; 24 hours: 8/70, 11.4%, in both arms). Maximum overall pain during the first 24 hours was also comparable (NRS ≥3: 42/82, 51.2%, vs 47/84, 56.0%, p = .54). Analgesic consumption, pain at day 30, and adverse event rates were not significantly different. No complications were attributed to the aspiration technique.

Conclusions: In this randomized trial, active gas aspiration via a peritoneal drain did not significantly reduce post-operative shoulder or subcostal pain compared to standard manual gas evacuation in gynecologic laparoscopy. Given the low incidence of significant pain and the lack of added benefit, routine use of active aspiration drains is not supported in this surgical context.

Objective: This study aimed to assess intra-operative, short-term, and long-term morbidity and develop a score predicting post-operative complications after pelvic exenteration for gynecologic cancer.

Methods: This was a retrospective, multi-center, international study conducted in tertiary referral centers for gynecologic oncology. The inclusion criteria included cervical, vaginal, vulvar, or endometrial cancer; anterior/total pelvic exenteration performed between January 2005 and March 2023; curative/palliative intent; with or without laterally extended endopelvic/pelvic resection. Logistic regression adjusted for co-variables and a score predictive of severe post-operative complications based on the multi-variable analysis were developed.

Results: A total of 862 patients were included. Seven patients (0.8%) had severe intra-operative complications, and no patient experienced intra-operative death. A total of 225 patients (26.1%) had severe early post-operative complications and 27 (3.1%) died within 30 days. The most frequent severe early post-operative complications were pelvic abscess/collection (23.4%) and urostomy leak/fistula (13.4%). A total of 87 patients (10.1%) had severe late post-operative complications, and 16 patients (1.8%) died between 31 and 180 days. The most frequent severe late post-operative complications were pelvic abscess/collection (21.6%) and benign ureteric stricture (13.5%). Risk factors independently associated with severe early and late post-operative complications were no previous recurrences, American Society of Anesthesiologists score >1, total pelvic exenteration, infra-levator pelvic exenteration, laterally extended endopelvic/pelvic resection; and infra-levator pelvic exenteration and laterally extended endopelvic/pelvic resection, respectively. The COREPEX predictive score identified 4 groups with significantly different risk of severe post-operative complications (p < .001).

Conclusions: Patients undergoing anterior or total pelvic exenteration have a low risk of intra-operative but a remarkable risk of major post-operative complications. No intra-operative death was recorded, and post-operative mortality was low. The COREPEX score predicting the risk of post-operative complications can be used to counsel patients and for future studies.

Objective: To evaluate the current diagnostic accuracy of ultrasound in evaluating inguinal lymph nodes in patients with vulvar cancer and to determine if there have been advancements since 2020.

Methods: A systematic review of research up to August 26, 2025, that compares the efficacy of ultrasound to histological examination of inguinal lymph nodes in all types and all stages of vulvar cancer. All studies that reported the diagnostic performance of data, including at least one of sensitivity, specificity, predictive values, or overall accuracy, were included. Only studies published in English and with adult participants were considered, with no geographic restrictions applied.

Results: A total of 3840 articles were reviewed, and 12 studies fulfilled the eligibility criteria for this systematic review and meta-analysis. The pooled results were as follows: sensitivity of 0.88 (95% confidence interval [CI] 0.76 to 1.00), specificity of 0.87 (95% CI 0.69 to 0.97), negative predictive value of 0.95 (95% CI 0.87 to 1.00), positive predictive value of 0.63 (95% CI 0.07 to 0.92). Overall diagnostic accuracy was 0.86 (95% CI 0.73 to 0.98).

Conclusions: The available evidence since 2020 supports the continued reliability of ultrasound in the context of inguinal node screening in vulvar cancer patients, reflected through the high negative predictive value. However, the limited number of recent publications restricts any definitive conclusions regarding true advancements in diagnostic accuracy. Integration with fine-needle aspiration cytology and individual patient factors may be beneficial to optimize diagnostic confidence.

Objective: Advances in tumor biology have transformed endometrial cancer management. Since 2021, ESGO-ESTRO-ESP (European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology-European Society of Pathology) guidelines have incorporated molecular classification, which is essential in the 2025 update. Its implementation in Eastern Europe remains unclear. This study evaluated the availability, reimbursement, and integration of molecular classification at national and institutional levels.

Methods: A 2-phase cross-sectional online survey was conducted from December 2024 to September 2025. National coordinators from 17 European Society of Gynaecological Oncology-affiliated countries reported on access, reimbursement, and guidelines. A second survey targeted 67 treatment centers to assess institutional practices.

Results: Full molecular profiling (p53-abnormal, POLE-ultra-mutated, mismatch repair-deficient) was available in 29.4% of countries, with partial access in 70.6%. Lack of reimbursement and accredited laboratories were the main barriers. At least 1 test was publicly funded in 58.8% of countries: p53 and mismatch repair-deficient immunohistochemistry in 70.0% and POLE-ultra-mutated next-generation sequencing in 29.4%. National guidelines existed in over half of the countries, but few included molecular classification. At the institutional level, testing was routine in 41.0% of centers, selective in 27.9%, and unavailable in 31.1%. Overall, 55.8% reported access via local or external laboratories. Comprehensive classification was significantly more available in settings with national/public reimbursement (79.2% vs 18.9%, p < .0001). POLE-ultra-mutated testing was more accessible in private than public hospitals (42.9% vs 33.3%, p = .006), while p53 immunohistochemistry was more common in high-volume centers (97.5% vs 76.2%, p = .01).

Conclusions: Access to molecular classification in Eastern Europe remains limited because of insufficient reimbursement and laboratory resources. Addressing these disparities is essential to support equitable treatment and improve outcomes.

Enhanced recovery after surgery (ERAS) protocols are evidence-based peri-operative care pathways that aim to reduce surgical stress, enhance patient recovery, and improve clinical outcomes. Despite well-documented benefits, real-world implementation remains inconsistent, with adherence rates varying widely across institutions and regions. This review offers practical insights, addressing core challenges in ERAS protocol compliance evaluation, including patient adherence, provider engagement, workflow integration, and documentation. We aim to provide a practical framework for other institutions seeking to adopt ERAS, offering actionable strategies to overcome common barriers and achieve long-term success with data-driven quality improvement. Peri-operative measures are outlined, highlighting implementation challenges and potential solutions. Successful ERAS implementation extends beyond protocol design. It requires sustained institutional support, clear and consistent communication, ongoing education, and pragmatic adaptation to the local infrastructure.

Objective: Malignant ovarian germ cell tumors are chemosensitive but also characterized by a rapid tumor growth. This study aimed to evaluate the impact of delay on adjuvant chemotherapy administration on the survival of patients with advanced-stage malignant ovarian germ cell tumors who underwent primary surgery.

Methods: The National Cancer Database was accessed, and patients diagnosed between 2004 and 2015 with stage III to IV malignant ovarian germ cell tumors who underwent primary surgery and received adjuvant chemotherapy were identified. Clinico-pathologic characteristics and overall survival were compared between patients who received adjuvant chemotherapy 1 to 4 weeks (early administration group) and 4.1 to 12 weeks (delayed administration group). Overall survival was compared with the log-rank test after generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders.

Results: A total of 622 patients were identified; the median time interval between primary surgery and adjuvant chemotherapy was 25 days (interquartile range 18). Delay in adjuvant chemotherapy administration occurred for 229 patients (36.8%). Patients in the early administration group were younger (median age 22 vs 24 years, p < .001). There were no differences between the two groups in terms of patient race, insurance status, presence of medical co-morbidities, tumor histology, and disease stage. Delay in adjuvant chemotherapy administration was associated with worse overall survival (p = .004; 5-year overall survival rates were 77.6% and 87.5%, respectively). After controlling for confounders, delay in adjuvant chemotherapy administration was associated with worse overall survival (hazard ratio 1.99, 95% confidence interval 1.34 to 3.01).

Conclusions: For patients with advanced-stage malignant ovarian germ cell tumors, especially those with non-dysgerminoma histology, early administration of adjuvant should be strongly considered because delay may be associated with a detrimental impact on overall survival.

Objective: Vulvar cancer represents 5% of all gynecological malignancies, but its incidence has increased. Management of early stages requires radical local excision, with simultaneous reconstruction when direct suturing is not indicated. The genito-crural island perforator flap is a reliable option that can be considered in most vulvar reconstruction cases, combining limited morbidity and preservation of aesthetic and functional vulvar concerns.

Methods: This monocentric, retrospective single-arm study includes patients treated between 2021 and 2025, who underwent vulvar cancer surgical resection with genito-crural island perforator flap reconstruction. The study aims to highlight the feasibility and surgical results of this flap in terms of wound healing, hospitalization duration, and post-operative outcomes.

Results: Of the 27 patients included, 19 had bilateral genito-crural island perforator flap reconstruction, resulting in a total of 46 flaps. A total of 59.3% of patients had no risk factors for impaired healing, despite an occasionally advanced age (median 61 years, range; 35-81) and patients often being overweight (median 27.7kg/m², range; 18.7-43.6) and smokers (44.4%). A complete vulvar healing was obtained in less than 4 weeks in 78.3% and in more than 8 weeks in 4.3%. Adjuvant vulvar radiotherapy was administered with no delay in treatment initiation. Donor sites healed in less than 4 weeks in 69.6% and in more than 8 weeks in 2.2%. The median hospitalization duration was 4 days (range; 1-15). Post-operative complications occurred in 33.3% of patients, primarily, wound dehiscence (17.4%) or local infection (21.7%). No cases of total flap necrosis were observed. No life-threatening complications related to vulvar reconstruction were observed.

Conclusions: Genito-crural island perforator flap is a simple and reliable procedure, enabling rapid healing with short post-operative recovery, low morbidity, and satisfactory functional and morphological outcome. In our practice as a tertiary cancer center, we routinely use this flap.