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Surgical Management of Gynaecological Cancer
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Surgical Management of Gynaecological Cancer

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (15 January 2022) | Viewed by 13419

Special Issue Editor

Dr. Ahmad Sayasneh

E-Mail Website
Guest Editor
1. Department of Gynaecological Oncology, Surgical Oncology Directorate, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
2. Faculty of Life Sciences & Medicine at Guy’s, The School of Life Course Sciences, King’s College London, London WC2R 2LS, UK
Interests: ultrasonography; gynecological cancer; radical and supraradical surgery for gynae cancer; robotics and minimal-access surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Gynaecological surgical oncology as a subspecialty has broadened significantly in the last few decades. The radicality of surgery has increased for some gynaecological cancers such as advanced ovarian cancers and training curriculums now include performing upper abdominal surgeries such as splenectomy and diaphragm peritoneal stripping. The route of surgery for cervical cancer has changed in view of the LACC trial where abdominal access was shown to be safer than robotic and laparoscopic access. However, minimal access surgery is still the recommended route for early stage endometrial cancers. The robotic surgery vs. laparoscopic surgery debate continues and advocates from each side promote their modality of treatment. The use of advanced technology such as the sentinel lymph node identification using the Gamma camera in vulval cancer and the Indocyanine Green (ICG) infrared fluorescence in endometrial and cervical cancer is claimed to reduce postoperative morbidity with no compromise in survivorship. Fertility-preserving surgery has become a safe and efficient option for many young gynaecological cancer patients. The aim of this Special Issue is to look into the different advances in surgical techniques in gynaecological oncology and to assess the novel surgical approaches in the last few years. Research and review articles evaluating different surgical approaches and modalities in all aspects of gynaecological oncology will be welcomed. In summary, the Special Issue is about surgical technicalities in gynaecological cancers in open and minimal access surgery. The Special Issue is about the rational, benefit, risk, and morbidity of the novel surgical approaches.   

Dr. Ahmad Sayasneh
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 short 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. Journal of Clinical Medicine 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 2600 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

  • Ultraradical surgery
  • supraradical surgery
  • minimal access surgery
  • ovarian neoplasm
  • vulval cancer
  • cervical cancer
  • pelvic exenteration
  • robotics
  • fertility preserving surgery
  • nerve preserving radical hysterectomy
  • sentinel lymph nodes

Published Papers (4 papers)

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Research

9 pages, 1149 KiB  
Article
Sentinel Lymph Node Staging with Indocyanine Green for Patients with Cervical Cancer: The Safety and Feasibility of Open Approach Using SPY-PHI Technique
by Mustafa Zelal Muallem, Ahmad Sayasneh, Robert Armbrust, Jalid Sehouli and Andrea Miranda
J. Clin. Med. 2021, 10(21), 4849; https://doi.org/10.3390/jcm10214849 - 21 Oct 2021
Cited by 3 | Viewed by 3851
Abstract
(1) Background: Sentinel lymph node staging (SLN) with indocyanine green (ICG) in cervical cancer is the standard of care in most national and international guidelines. However, the vast majority of relevant studies about the safety and feasibility of this method are conducted on [...] Read more.
(1) Background: Sentinel lymph node staging (SLN) with indocyanine green (ICG) in cervical cancer is the standard of care in most national and international guidelines. However, the vast majority of relevant studies about the safety and feasibility of this method are conducted on minimally invasive surgery; (2) Methods: This study is a retrospective analysis of a retrospective collected database of 76 consecutive patients with cervical cancers, who were operated laparoscopically (50%), or laparotomy (50%). Sentinel nodes were defined as the ICG-positive pelvic nodes in the first and second echelons. False negative cases were defined as positive non-sentinel lymph nodes despite successful sentinel mapping or failed mapping bilaterally by per-patient assessment or unilaterally by pelvic sidewall assessment; (3) Results: Regardless of the approach (open or laparoscopic), the SLN technique achieved a total sensitivity, specificity, and negative predictive value (NPV) of 94.7%, 98.6%, and 94.7%, respectively in the entire sample. The bilateral detection rate was as high as 93.4% with identical results in both approaches. The sensitivity and NPV for SNL in open surgery was found to be similar to minimal access surgery; (4) Conclusions: ICG and SPY-PHI technique is a reliable tool to detect sentinel lymph nodes in cervical cancer during laparotomy. Full article
(This article belongs to the Special Issue Surgical Management of Gynaecological Cancer)
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10 pages, 1285 KiB  
Article
Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study
by Su-Jeong Lee, Jun-Pyo Myong, Yun-Hee Lee, Eui-Jin Cho, Sung-Jong Lee, Chan-Joo Kim and Jin-Hwi Kim
J. Clin. Med. 2021, 10(20), 4647; https://doi.org/10.3390/jcm10204647 - 11 Oct 2021
Cited by 1 | Viewed by 2144
Abstract
Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in [...] Read more.
Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer. Methods: We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes. Results: A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40–59 years, aOR = 1.413; 95% confidence interval (CI) 1.203–1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239–1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27–2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer (p < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years. Conclusions: Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed. Full article
(This article belongs to the Special Issue Surgical Management of Gynaecological Cancer)
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10 pages, 429 KiB  
Article
Feasibility and Outcomes of “No-Look No-Touch” Laparoscopic Radical Trachelectomy for Early-Stage Cervical Cancer
by Hiroyuki Kanao, Yoichi Aoki, Atsushi Fusegi, Makiko Omi, Hidetaka Nomura, Terumi Tanigawa, Sanshiro Okamoto, Tomoko Kurita, Sachiho Netsu, Kohei Omatsu and Mayu Yunokawa
J. Clin. Med. 2021, 10(18), 4154; https://doi.org/10.3390/jcm10184154 - 15 Sep 2021
Cited by 6 | Viewed by 3583
Abstract
Intraoperative tumor manipulation and dissemination may compromise the survival of women with early-stage cervical cancer who undergo laparoscopic surgery. This study aimed to examine survival and obstetrical outcomes related to laparoscopic radical trachelectomy (LRT) with a “no-look no-touch” technique in 40 women. This [...] Read more.
Intraoperative tumor manipulation and dissemination may compromise the survival of women with early-stage cervical cancer who undergo laparoscopic surgery. This study aimed to examine survival and obstetrical outcomes related to laparoscopic radical trachelectomy (LRT) with a “no-look no-touch” technique in 40 women. This technique incorporates five measures to prevent tumor spillage and damage to the uterine artery perfusion. Five LRTs were aborted because of positive nodes or positive surgical margins. Compared with those of type III laparoscopic radical hysterectomy, the surgical outcomes of LRT in 35 patients were acceptable: operative time (380 min), estimated blood loss (140 mL), length of hospital stay (15 days), and lengths of excised parametrium and vagina. During follow-up (median, 41.3 months), the 5-year disease-free survival and overall survival were 95.0% (95% CI: 69.5–99.3%) and 100%, respectively. Of the nine patients (26%) who attempted pregnancy, seven conceived (nine pregnancies, 76%). Eight were delivered by term cesarean section, while one was miscarried in the first trimester. Our study suggests that the no-look no-touch technique may be effective in reducing the risk of recurrence and improving obstetrical outcomes during LRT for early-stage cervical cancer. Full article
(This article belongs to the Special Issue Surgical Management of Gynaecological Cancer)
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18 pages, 595 KiB  
Article
Challenges and Controversies in the Surgical Treatment of Cervical Cancer: Open Radical Hysterectomy versus Minimally Invasive Radical Hysterectomy
by Jona Röseler, Robert Wolff, Dirk O. Bauerschlag, Nicolai Maass, Peter Hillemanns, Helder Ferreira, Marie Debrouwere, Fülöp Scheibler, Friedemann Geiger and Mohamed Elessawy
J. Clin. Med. 2021, 10(17), 3761; https://doi.org/10.3390/jcm10173761 - 24 Aug 2021
Cited by 6 | Viewed by 2089
Abstract
Objective: The aim of the study was to perform a systematic assessment of disease-free survival (DFS), overall survival, and morbidity rates after open radical hysterectomy (ORH) and minimally invasive surgery (MIS) for early-stage cervical cancer and discuss with experts the consequences of the [...] Read more.
Objective: The aim of the study was to perform a systematic assessment of disease-free survival (DFS), overall survival, and morbidity rates after open radical hysterectomy (ORH) and minimally invasive surgery (MIS) for early-stage cervical cancer and discuss with experts the consequences of the LACC trial (published by Ramirez et al. in 2018) on clinical routine. Methods: A total of 5428 records were retrieved. After exclusion based on text screening, four records were identified for inclusion. Five experts from three independent large-volume medical centers in Europe were interviewed for their interpretation of the LACC trial. Results: The LACC trial showed a significantly higher risk of disease progression with MIS compared to ORH (HR 3.74, 95% CI 1.63 to 8.58). This was not seen in one epidemiological study and was contradicted by one prospective cohort study reported by Greggi et al. A systematic review by Zhang et al. mentioned a similar DFS for robot-assisted radical hysterectomy (RRH) and LRH. Recurrence rates were significantly higher with MIS compared to ORH in the LACC trial (HR 4.26, 95% CI 1.44 to 12.60). In contrast, four studies presented by Greggi reported no significant difference in recurrence rates between LRH/RRH and ORH, which concurred with the systematic reviews of Zhang and Zhao. The experts mentioned various limitations of the LACC trial and stated that clinicians were obliged to provide patients with detailed information and ensure a shared decision-making process. Conclusions: The surgical treatment of early-stage cervical cancer remains a debated issue. More randomized controlled trials (RCT) will be needed to establish the most suitable treatment for this condition. Full article
(This article belongs to the Special Issue Surgical Management of Gynaecological Cancer)
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