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Evolving Trends in the Surgical Therapy of Patients with Gynecological...
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Evolving Trends in the Surgical Therapy of Patients with Gynecological Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (20 December 2024) | Viewed by 8084

Special Issue Editor

Dr. Jacobus van der Velden

E-Mail Website
Guest Editor
Department of Gynecologic Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Interests: gynecologic oncology; clinical studies on vulvar and cervical cancer

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue of Cancers in honor of Prof. Dr Neville F. Hacker. This Special Issue will focus on the trends in the surgical treatment of gynecological cancers. Over the last four decades, surgery has evolved from a one-size-fits-all treatment towards a more individualized treatment. In cervix and vulvar cancer, this individualized treatment is, in general, characterized by less radical procedures for selected groups of patients and greater focus on chemotherapy and/or radiotherapy for prognostically unfavorable groups of patients. An example of this is the treatment of cervix cancer clinically confined to the cervix (stage I). While in the past all patients with a clinical stage of I (IA2/IB) were treated with a type-C1,2 radical hysterectomy, current patients with a tumor diameter < 2 cm and negative pelvic nodes are treated with a simple hysterectomy. With the introduction of minimally invasive surgery and the sentinel node technique, even more individualized treatment is the result. In advanced ovarian cancer, the timing of debulking surgery has been a subject of debate over the last two decades. What are the selection criteria that can be used to make the decision to recommend either a primary or interval debulking surgery in an individual patient? This Special Issue aims to obtain a better insight into the evidence for the oncological safety and level of evidence for the efficacy of the trend towards the more individualized (surgical) treatment of gynecological cancers. 

In this Special Issue, original research articles and reviews on the topic of surgery in gynecological cancers are welcome. For example, research areas may include (but are definitely not limited to) the following:

  1. Surgery or primary chemo-radiotherapy for early cervix cancer and how to select patients.
  2. Is nerve-sparing radical hysterectomy a safe procedure?
  3. Adjuvant radiotherapy or re-excision in patients with an irradical resection margin after surgical treatment for vulvar cancer.
  4. Primary debulking or interval debulking in stage III/IV ovarian cancer. Pros and cons and how to select patients.
  5. Is the debulking of a stage III ovarian cancer through minimally invasive surgery a safe procedure?

We look forward to receiving your contributions.

Dr. Jacobus van der Velden
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endometrial cancer
  • ovarian cancer
  • vulvar cancer
  • cervix cancer
  • resection margin
  • bulky lymph node
  • parametrectomy
  • debulking
  • preservation ovary
  • minimally invasive surgery

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Published Papers (4 papers)

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Research

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9 pages, 570 KiB  
Article
Impact of the Number of Positive Pelvic Lymph Nodes on Risk of Para-Aortic Recurrence in Patients with Clinically Early Cervical Cancer Treated by a Radical Hysterectomy and Pelvic Lymphadenectomy
by Felix J. M. Schoonhoven, Johanna W. M. Aarts, Guus Fons, Lukas J. A. Stalpers, Luc R. C. W. van Lonkhuijzen, Jacobus van der Velden and Constantijne H. Mom
Cancers 2025, 17(1), 23; https://doi.org/10.3390/cancers17010023 - 25 Dec 2024
Viewed by 1205
Abstract
Background: Guidelines recommend the extension of the pelvic radiotherapy volume to the para-aortic region in locally advanced cervical cancer and ≥3 suspicious pelvic lymph nodes (PLN) on imaging. Whether this recommendation is also valid for clinically early stages is uncertain. The objective of [...] Read more.
Background: Guidelines recommend the extension of the pelvic radiotherapy volume to the para-aortic region in locally advanced cervical cancer and ≥3 suspicious pelvic lymph nodes (PLN) on imaging. Whether this recommendation is also valid for clinically early stages is uncertain. The objective of this study was to investigate the para-aortic (PAO) lymph node recurrence rate in patients with early-stage cervical cancer, ≥3 metastatic PLN, and negative common iliac nodes after a radical hysterectomy followed by pelvic (chemo)radiotherapy without extension to the PAO region. Methods: Consecutive patients, surgically treated between 2000 and 2020, with FIGO 2009 stage IB2-IIA1 and positive PLN, were included in this retrospective cohort study. The frequency of PAO recurrences, disease-free survival, and overall survival were analyzed in patients with <3 versus ≥3 positive PLN. Results: In 127 patients, the isolated PAO recurrence rate was 2/88 (2.3%) versus 1/39 (2.6%) for patients with <3 versus ≥3 positive PLNs, respectively (p = 0.671). The 5-year disease-free survival (87.3% versus 73.7%; p = 0.088) and the overall survival (90.7% versus 76.5%; p = 0.355) between patients with <3 versus ≥3 positive PLN was not significantly different. Conclusions: Isolated PAO nodal recurrence rate in women with early-stage cervical cancer after radical hysterectomy and pelvic lymphadenectomy, with positive PLN but negative common iliac nodes, followed by pelvic (chemo)radiotherapy, is low and did not differ between the groups with <3 versus ≥3 positive PLN. This makes it unlikely that the inclusion of the PAO region in the adjuvant radiotherapy volume would result in a better oncological outcome. Full article
(This article belongs to the Special Issue Evolving Trends in the Surgical Therapy of Patients with Gynecological Cancer)
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9 pages, 1348 KiB  
Article
A Preparatory Virtual Reality Experience Reduces Anxiety before Surgery in Gynecologic Oncology Patients: A Randomized Controlled Trial
by Bernd C. Schmid, Dominic Marsland, Eilish Jacobs and Günther A. Rezniczek
Cancers 2024, 16(10), 1913; https://doi.org/10.3390/cancers16101913 - 17 May 2024
Cited by 4 | Viewed by 2268
Abstract
Perioperative anxiety is common among patients undergoing surgery, potentially leading to negative outcomes. Immersive virtual reality (VR) has shown promise in reducing anxiety in various clinical settings. This study aimed to evaluate the effectiveness of VR in reducing perioperative anxiety in patients undergoing [...] Read more.
Perioperative anxiety is common among patients undergoing surgery, potentially leading to negative outcomes. Immersive virtual reality (VR) has shown promise in reducing anxiety in various clinical settings. This study aimed to evaluate the effectiveness of VR in reducing perioperative anxiety in patients undergoing gynecological oncology surgery and was conducted as a single-center, double-arm, single-blinded randomized controlled trial at the Gold Coast University Hospital, Queensland, Australia. Participants were randomized into the VR intervention + care as usual (CAU) group (n = 39) and the CAU group (n = 41). Anxiety scores were assessed using a six-tier visual facial anxiety scale at baseline, after the intervention/CAU on the same day, and, several days up to weeks later, immediately before surgery. There was no significant difference in baseline anxiety scores, type of operation, or suspected cancer between the two groups. The VR intervention significantly reduced anxiety scores from baseline to preoperative assessment (p < 0.001). The median anxiety score in the VR intervention group decreased from 3 (interquartile range 2 to 5) at baseline to 2 (2 to 3) prior to surgery, while the control group’s scores were 4 (2 to 5) and 4 (3 to 5), respectively. Multivariate analysis showed that group assignment was the sole outcome predictor, not age, type of procedure, or the time elapsed until surgery. Thus, VR exposure was effective in reducing perioperative anxiety in patients undergoing gynecological oncology surgery. The use of VR as a preparation tool may improve patient experience and contribute to better surgical outcomes, warranting further research into exploring the potential benefits of VR in other surgical specialties and its long-term impact on patient recovery. Full article
(This article belongs to the Special Issue Evolving Trends in the Surgical Therapy of Patients with Gynecological Cancer)
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11 pages, 1194 KiB  
Article
Patterns of First Recurrence and Oncological Outcomes in Locally Advanced Cervical Cancer Patients: Does Surgical Staging Play a Role?
by Vicente Bebia, Berta Díaz-Feijoo, Álvaro Tejerizo, Aureli Torne, Virginia Benito, Alicia Hernández, Mikel Gorostidi, Santiago Domingo, Melissa Bradbury, Rocío Luna-Guibourg and Antonio Gil-Moreno
Cancers 2024, 16(7), 1423; https://doi.org/10.3390/cancers16071423 - 6 Apr 2024
Cited by 1 | Viewed by 1985
Abstract
Background: We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). Methods: This study was [...] Read more.
Background: We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). Methods: This study was a multicenter observational retrospective cohort study of patients with LACC treated at tertiary care hospitals throughout Spain. The inclusion criteria were histological diagnosis of squamous carcinoma, adenosquamous carcinoma, and/or adenocarcinoma; FIGO stages IB2, IIA2-IVA (FIGO 2009); and planned treatment with primary chemoradiotherapy between 2000 and 2016. Propensity score matching (PSM) was performed before the analysis. Results: After PSM and sample replacement, 1092 patients were included for analysis (noPALND n = 546, PALND n = 546). Twenty-one percent of patients recurred during follow-up, with the PALND group having almost double the recurrences of the noPALND group (noPALND: 15.0%, PALND: 28.0%, p < 0.001). Nodal (regional) recurrences were more frequently observed in PALND patients (noPALND:2.4%, PALND: 11.2%, p < 0.001). Among those who recurred regionally, 57.1% recurred at the pelvic nodes, 37.1% recurred at the aortic nodes, and 5.7% recurred simultaneously at both the pelvic and aortic nodes. Patients who underwent a staging PALND were more frequently diagnosed with a distant recurrence (noPALND: 7.0%, PALND: 15.6%, p < 0.001). PALND patients presented poorer overall, cancer-specific, and disease-free survival when compared to patients in the noPALND group. Conclusion: After treatment, surgically staged patients with LACC recurred more frequently and showed worse survival rates. Full article
(This article belongs to the Special Issue Evolving Trends in the Surgical Therapy of Patients with Gynecological Cancer)
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Review

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11 pages, 773 KiB  
Review
Conservative Management of Vulvar Cancer—Where Should We Draw the Line?
by Neville F. Hacker and Ellen L. Barlow
Cancers 2024, 16(17), 2991; https://doi.org/10.3390/cancers16172991 - 28 Aug 2024
Cited by 1 | Viewed by 1656
Abstract
Vulvar cancer is a rare disease, and cure rates were low until the mid-20th century. The introduction of an en bloc radical vulvectomy and bilateral groin and pelvic lymph node dissection saw them rise from 15–20% to 60–70%. However, this very radical surgery [...] Read more.
Vulvar cancer is a rare disease, and cure rates were low until the mid-20th century. The introduction of an en bloc radical vulvectomy and bilateral groin and pelvic lymph node dissection saw them rise from 15–20% to 60–70%. However, this very radical surgery was associated with high physical and psychological morbidity. Wounds were usually left open to granulate, and the average post-operative hospital stay was about 90 days. Many attempts have been made to decrease morbidity without compromising survival. Modifications that have proven to be successful are as follows: (i) the elimination of routine pelvic node dissection, (ii) the use of separate incisions for groin dissection, (iii) the use of unilateral groin dissection for lateral, unifocal lesions, (iv) and radical local excision with 1 cm surgical margins for unifocal lesions. Sentinel node biopsy with ultrasonic groin surveillance for patients with node-negative disease has been the most recent modification and is advocated for patients whose primary cancer is <4 cm in diameter. Controversy currently exists around the need for 1 cm surgical margins around all primary lesions and on the appropriate ultrasonic surveillance for patients with negative sentinel nodes. Full article
(This article belongs to the Special Issue Evolving Trends in the Surgical Therapy of Patients with Gynecological Cancer)
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