Advanced robotic surgery in obese patients with gynecological cancers: tips and tricks from literature to clinical practice.

Obesity is closely linked to an increased incidence of several gynecological conditions and poses significant challenges to their surgical management. Among these, endometrial cancer stands out due to its high prevalence in patients with elevated body mass index, with nearly 60% of those requiring primary surgical treatment classified as obese or morbidly obese. The coexistence of multiple comorbidities in this population contributes to a heightened risk of perioperative and postoperative complications.

Which is the best surgical approach for endometrial cancer treatment in elderly women? A systematic review and meta-analysis.

Objective: To compare the surgical outcomes between laparoscopy, laparotomy and robotic surgery in young (<65 years) and elderly (≥65 years) women for treatment of endometrial cancer (EC). In addition, the secondary outcomes included a comparison of these surgical methods for EC management in patients aged <70 years and ≥70 years. Operative time, blood loss, requirement for blood transfusion, intra-operative and postoperative complications, and length of hospital stay were evaluated in the two groups of patients.

Ninety-day surgery-related outcomes of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and sentinel node mapping in apparent early-stage endometrial cancer: a secondary analysis of a prospective single-arm study.

Objective: Limited prospective data are available on the outcomes and performance of sentinel node mapping (SNM) in patients with endometrial cancer (EC). This study aimed to describe the surgical outcomes related to laparoscopic staging and the performance of SNM in patients with apparent early-stage EC.

Methods: This is a secondary analysis of a prospective single-arm study focusing on predictors of nodal disease in apparent early-stage EC.

Fertility-sparing management of low-grade endometrial stromal sarcoma: A systematic review of oncologic and reproductive outcomes.

Objective: Low-grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy and the standard of care, precludes future childbearing. Although fertility-sparing treatment (FST) may be considered in carefully selected patients, high-quality evidence regarding its efficacy and safety is limited. This review aims to systematically evaluate the oncologic and reproductive outcomes associated with conservative treatment for LG-ESS.

Fertility-sparing approach in endometrioid grade II endometrial cancer: the role of molecular classification.

Objective: To investigate whether molecular classification could support individualized selection of patients with grade II endometrioid endometrial cancer for fertility-sparing approaches.

Methods: This is a retrospective multi-institutional study. Data of patients undergoing fertility-sparing treatment with a levonorgestrel intrauterine device (with or without oral hormonal therapy) were retrieved.

Invasive lobular carcinoma: Strategies and perspectives from the lobular breast cancer research group.

Invasive lobular carcinoma (ILC) represents approximately 10-15% of all breast cancers and is defined by a unique discohesive morphology due to loss of E-cadherin. Despite its prevalence, ILC has been historically underrepresented in clinical and translational research, contributing to diagnostic, therapeutic, and prognostic uncertainties. This narrative review, conducted by the Invasive Lobular Carcinoma Research Group, synthesizes current evidence on ILC with expert perspectives to inform future research and clinical strategies.

The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer.

Objectives: Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly recognized as an effective addition to cytoreductive surgery in advanced ovarian cancer, particularly in patients who respond to platinum-based chemotherapy.

Methods: A systematic review of phase III randomized controlled trials testing the role of HIPEC in ovarian cancer was performed, according to the PRISMA guidelines.

Results: Seven randomized controlled trials were included.

Uterine leiomyosarcoma.

Uterine leiomyosarcoma is a rare and heterogeneous gynecological malignancy that poses a significant clinical challenge due to its aggressive nature and limited treatment options. Its multifactorial etiopathogenesis involves complex cytogenetic and molecular aberrations, including TP53, RB1, and chromothripsis-associated gene alterations. The non-specific clinical presentation, resembling other benign conditions, complicates early and accurate diagnosis, alongside intricate radiological and pathological patterns.

Endometrial carcinosarcoma without myoinvasion.

Objective: Uterine carcinosarcoma without myoinvasion, limited to the endometrial lining/polyp or with no residual uterine disease at the time of hysterectomy, is extremely uncommon, with unknown oncologic outcomes. Thus, this study aimed to evaluate the long-term outcomes of patients with carcinosarcoma without myoinvasion.

Methods: Patients with International Federation of Gynecology and Obstetrics 2009 stage IA carcinosarcoma without myoinvasion who underwent surgery from December 1998 to January 2023 were identified from 11 centers worldwide.

Feasibility and safety of robotic single-port surgical staging in epithelial ovarian cancer using the da Vinci SP platform: a preliminary experience.

Minimally invasive surgery has transformed gynecologic procedures by reducing postoperative pain, accelerating recovery, and shortening hospital stays. The da Vinci SP system represents a significant advancement in single-port robotic surgery, offering articulated instruments and enhanced visualization. However, its role in staging epithelial ovarian cancer remains underexplored.

Identifying low-volume metastases through ultrastaging of negative pelvic nodes in recurrent early-stage cervical cancer: a case series and literature review.

Introduction: Ultrastaging has been shown to improve the detection of macrometastases (MACs), micrometastases (MICs) and isolated tumour cells (ITCs). This study evaluated the role of ultrastaging in the management of cervical cancer through a single-centre retrospective analysis, along with a systematic literature review.

Methods: This retrospective study included patients surgically treated for FIGO 2009 stage IA1-IB1 cervical cancer between January 2011 and December 2023 with negative lymph nodes and no adjuvant therapy based on tumour risk factors.

Robotic-assisted single-port and multi-port surgical staging in early-stage endometrial cancer: a propensity matched comparison.

Introduction: Robotic-assisted surgery has emerged as an effective method for managing endometrial cancer. Recently, the new Da Vinci Single-Port (SP) was developed with the aim of minimizing surgery-related morbidity, using a single-port approach. The present research evaluated outcomes of apparent early-stage endometrial cancer patients undergoing single- and multi-port robotic-assisted surgery.

Exploring isolated tumor cells entity in endometrial cancer.

Background: Endometrial cancer (EC) management includes nodal staging and molecular classification. Despite molecular advancements, the biological significance of isolated tumor cells (ITC) in EC remains unclear. This study aimed to characterize ITC in the context of pathological and molecular features MATERIALS AND METHODS: A multicenter, retrospective analysis included EC patients diagnosed between June 2018 and May 2024 who underwent surgical staging via sentinel lymph node (SLN) biopsy and molecular profiling.

Innovations in laparoscopic management of endometrial cancer.

Introduction: Endometrial cancer is one of the most common gynecologic malignancies, with increasing incidence, in developed countries. Advances in minimally invasive surgery, particularly laparoscopic with or without the use of computer-assisted ('robotic') platforms, have transformed its management, improving surgical outcomes and patient recovery.

Areas Covered: This review explores recent innovations in laparoscopic management of endometrial cancer, including robotic-assisted laparoscopic surgery, sentinel lymph node mapping, and the integration of artificial intelligence in surgical navigation.

Exploring the cost-effectiveness of the OSNA method for patients facing endometrial cancer: Insights from a single-institution experience.

Objective: The one-step nucleic acid amplification (OSNA) method has emerged as a potential alternative to ultrastaging for diagnosing lymph node metastasis. This study aims to assess the cost-effectiveness of the OSNA technique compared to ultrastaging for detecting SLN metastasis in patients with early-stage endometrial cancer (EC).

Methods: This retrospective, observational, single-center study included 30 patients with EC who underwent surgical treatment.

Is there a role for the sentinel lymph node in endometrial atypical hyperplasia? Insights from an ESGO-accredited Institution.

Introduction: This study investigates the outcomes of patients with premalignant endometrial findings on biopsy who underwent hysterectomy with sentinel lymph node (SLN) excision and were subsequently diagnosed with endometrial cancer (EC). It aims to highlight the role of nodal assessment in guiding postoperative treatment strategies. Additionally, the study compares surgery complication rates between patients who underwent SLN mapping and those who did not.

Prognostic value of isolated tumor cells in sentinel lymph nodes in intermediate-risk endometrial cancer: results from an international, multi-institutional study.

Objective: This study assessed oncologic outcomes of patients with intermediate-risk endometrioid endometrial cancer and isolated tumor cells (ITC) (≤0.2 mm or ≤200 cells) in sentinel lymph nodes (SLNs).

Methods: Patients with SLN-ITC diagnosed between 2012 and 2019 were identified from 19 centers worldwide, while SLN-negative patients were identified at Mayo Clinic, Rochester between 2014 and 2018.

Evaluation of survival and mortality in pelvic exenteration for gynecologic malignancies: a systematic review, meta-analyses, and meta-regression study.

Objective: Pelvic exenteration is a radical surgery for advanced or recurrent pelvic tumors, requiring careful patient selection and a multi-disciplinary approach. Despite advancements, it remains high-risk, with limited data on outcomes. The present meta-analysis evaluates survival, mortality, and trends to clarify its role in gynecologic oncology.

Hereditary diffuse gastric and lobular breast cancer syndrome associated with germline CDH1 variants: focus on lobular breast cancer.

Background: Hereditary lobular breast cancer (HLBC) is a distinct subset of hereditary breast cancer primarily associated with germline pathogenic variants in the CDH1 gene, which encodes E-cadherin, a crucial protein in cell adhesion. Loss of E-cadherin disrupts tissue architecture, contributing to the invasive growth pattern characteristic of lobular carcinoma. CDH1 mutations are also implicated in hereditary diffuse gastric cancer, predisposing some patients to both cancers.

Fertility-sparing approach for uterine smooth muscle tumors of uncertain malignant potential.

Objective: Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are a category of tumors that present diagnostic/therapeutic challenges since they cannot be assigned to either a benign or a malignant entity. Hysterectomy is the mainstay of treatment of STUMP. However, in most cases, STUMPs represent an incidental diagnosis following myomectomy.

Integration of sentinel node mapping and molecular classification in endometrial cancer staging.

Sentinel node mapping has gained popularity in surgical staging of endometrial cancer, providing a less invasive alternative to lymphadenectomy for staging purpose. Recent advances in molecular classification have deepened our understanding of endometrial cancer, leading to more personalized approaches in diagnosis and treatment. This review examined the interaction between sentinel node mapping and molecular classification in endometrial cancer, emphasizing the clinical implications.

Enhancing surgical precision in ovarian cancer with FRα-fluorescence-guided surgery.

Introduction: Complete cytoreduction is a key prognostic factor in advanced ovarian cancer. Folate receptor alpha (FRα)-targeted intraoperative fluorescence imaging has emerged as a promising tool to enhance identification of tumor localization. Agents like pafolacianine (OTL38) and EC17 improve real-time visualization of malignant lesions, overcoming limitations of conventional methods relying on visual inspection and palpation.

No Increased Risk of Autoimmune Diseases Following HPV Vaccination: A Systematic Review and Meta-Analysis.

HPV vaccination reduces the risk of anogenital warts, high-grade cervical intraepithelial neoplasia (CIN2+), and cervical cancer. To enhance immunogenicity, HPV vaccines include adjuvants such as toll-like receptor agonists, which may theoretically trigger autoimmune responses. However, existing data on this risk remain conflicting.