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ObjectiveThe prognostic significance of isolated tumor cells (≤0.2 mm) in sentinel lymph nodes (SLNs) of endometrial cancer patients is still unclear. Our aim was to assess the prognostic value of isolated tumor cells in patients with low risk endometrial cancer who underwent SLN biopsy and did not receive adjuvant therapy. Outcomes were compared with node negative patients.MethodsPatients with SLNs–isolated tumor cells between 2013 and 2019 were identified from 15 centers worldwide, while SLN negative patients were identified from Mayo Clinic, Rochester, between 2013 and 2018. Only low risk patients (stage IA, endometrioid histology, grade 1 or 2) who did not receive any adjuvant therapy were included. Primary outcomes were recurrence free, non-vaginal recurrence free, and overall survival, evaluated with Kaplan–Meier methods.Results494 patients (42 isolated tumor cells and 452 node negative) were included. There were 21 (4.3%) recurrences (5 SLNs–isolated tumor cells, 16 node negative); recurrence was vaginal in six patients (1 isolated tumor cells, 5 node negative), and non-vaginal in 15 (4 isolated tumor cells, 11 node negative). Median follow-up among those without recurrence was 2.3 years (interquartile range (IQR) 1.1–3.0) and 2.6 years (IQR 0.6–4.2) in the SLN–isolated tumor cell and node negative patients, respectively. The presence of SLNs-isolated tumor cells, lymphovascular space invasion, and International Federation of Obstetrics and Gynecology (FIGO) grade 2 were significant risk factors for recurrence on univariate analysis. SLN–isolated tumor cell patients had worse recurrence free survival (p<0.01) and non-vaginal recurrence free survival (p<0.01) compared with node negative patients. Similar results were observed in the subgroup of patients without lymphovascular space invasion (n=480). There was no difference in overall survival between the two cohorts in the full sample and the subset excluding patients with lymphovascular space invasion.ConclusionsPatients with SLNs–isolated tumor cells and low risk profile, without adjuvant therapy, had a significantly worse recurrence free survival compared with node negative patients with similar risk factors, after adjusting for grade and excluding patients with lymphovascular space invasion. However, the presence of SLNs–isolated tumor cells was not associated with worse overall survival.

Ten years ago, The Cancer Genome Atlas (TGCA) Research Network classified endometrial cancer into four molecular categories with prognostic significance, suggesting sensitivity to postsurgical treatments [...]

In 2018, 382,069 new cases of uterine cancer were registered worldwide and 89,929 deaths from this cancer were reported [...].In 2018, 382,069 new cases of uterine cancer were registered worldwide and 89,929 deaths from this cancer were reported [...].

Introduction/BackgroundMyometrial invasion (MI) and tumor free distance (TFD) from serosa are associated with an increased risk of relapse in patients with endometrioid endometrial carcinoma (EEC). The extent of the MI has been recognized as an essential prognostic risk factor; instead the TFD doesn’t have the same prognostic role, but may be associated with a higher risk of recurrence.The aim of our study was to investigate the role of the percentage of MI related to TFD as prognostic risk factor.MethodologyIn our retrospective study we enrolled all FIGO Stage IB EEC with at least one year follow up treated in our institution. All patients were stratified in three different subgroups based on tumor invasion in the myometrial layer and TFD, calculating the actual percentage of involved myometrial thickness (Group1: 50–69,9%, Group 2: 70–89,9% and Group 3: 90–100%).We correlated the subgroups with several variables as sentinel lymph node (SLN) status, tumor grading, lymphovascular space invasion (LVSI), and local/distant recurrence.ResultsTwenty-one patients met the inclusion criteria. Four patients were included in the group 1 and one (25%) of them had positive SLN for micrometastasis. In the second group we found 11 patients: 5 (45%) of them had positive SLN and 1 showed local relapse (9%). Moreover one patient had concomitant breast cancer (9%). The group 3 included 6 patients: 2 (33%) were positive for SLN and 1 (16%) of them also had distant relapse.ConclusionPercentage of MI related to TFD represents a promising prognostic risk factor that seems to be associated with an increased risk of relapse such as SLN positivity, especially in those patients with more than 70% of myometrial invasion. Further studies with larger sample size are required to evaluate the relation between MI and TFD as prognostic risk factor in EEC.DisclosuresNone.Abstract 909 Table 1

Introduction/BackgroundThe patient is a 47 years old woman with a history of endometrioid endometrial carcinoma FIGO stage IAG2. During a routine follow-up, abdominal CT-scan demonstrated an enlarged para-aortic lymph node suspected for recurrence. PET-TC scan revealed a bulky lymph node with a diameter about 60 mm with no other site of disease. This video describes step-by-step the complete removal of paraaortic bulky nodes by the extraperitoneal laparoscopic approachMethodologyIn November 2022, the patient underwent lymph node excision by an extraperitoneal laparoscopic approach. After trocar placement, CO2 was insufflated through the pre-peritoneal space. A blunt detachment of adipose tissue was performed, the left psoas and ureter were isolated. After identification of left common iliac artery and para-aortic area, the bulky node was isolated and removed with an endobag.ResultsEstimated intraoperative blood loss were 200cc. Operative time were 4 hours. The patient was discharged on post operative day 2, no minor or major complications were observed, the final pathology revealed lymph node recurrence of endometrioid adenocarcinoma. After tumor board the patient underwent 4 cycles of Platinum-based chemotherapy and radiotherapy in the para-aortic area. At this moment the patient is free of disease.ConclusionLaparoscopic extraperitoneal lymph node debulking performed by expert gynecologic oncologist seems to be feasible with several advantages comparing to the traditional technique in terms of reduced intraoperative blood loss, less post-operative pain, rapid post-surgery recovery and thereby allowing for early introduction to adjuvant treatment.DisclosuresNone.

BackgroundPrimary cytoreduction is the mainstay of treatment for advanced ovarian cancer (AOC). We developed and prospectively evaluated an algorithm to investigate the possible role of laparoscopic primary cytoreduction (LPC) in carefully selected patients, with AOC.MethodsFrom June 2007 to July 2015, all patients with stage III–IV ovarian cancer and clinical conditions allowing aggressive surgery were candidate to primary cytoreduction with the aim of achieving residual tumor (RT) = 0. The possibility of attempting laparoscopic cytoreduction was carefully evaluated using strict selection criteria. The other patients were approached by abdominal primary cytoreduction (APC). At the end of LPC, an ultra-low pubic mini-laparotomy was performed to extract surgical specimens and to accomplish a laparoscopic hand-assisted exploration of the abdominal organs, in order to confirm complete excision of the disease.ResultsOf the included 66 patients, 21 were considered eligible for LPC; the remaining 45 underwent APC. Optimal cytoreduction (i.e., RT = 0) was obtained in 95 and 88.4% in the LPC and APC groups, respectively. No intra-operative complication and 4 (19%) early post-operative complications were observed among patients who received LPC. Patients who underwent APC had 17.8 and 46.7% intra- and early post-operative complications, respectively. Median time to initiation of chemotherapy was 15 (range, 10–30) days in the LPC group and 28 (20–35) days in the APC group. After a median follow-up of 51 months, 2-year disease-free survival was 76.2% in the LPC group and 73.4% in the APC group.ConclusionsAfter strict selection, a group of patients with AOC may undergo LPC with extremely high rates of optimal cytoreduction, satisfactory perioperative morbidity, a short interval to chemotherapy, and encouraging survival outcomes.Clinical trial registration NCT02980185

Background/Objectives: This study investigates which demographic, clinical and pathological factors of women with early-stage presurgical EC could be considered risk factors for the presence of different subtypes of metastases in sentinel lymph nodes (SLNs). Methods: This is a retrospective single-center study that collected data between December 2015 and April 2024. EC patients who underwent total hysterectomy with salpingo-oophorectomy and SLN mapping with indocyanine green (ICG) were recorded. Results: Data from 98 women with EC were analyzed. The endometrioid histotype was present in 85 (86%) women, and the non-endometrioid histotype was present in 13 (13%) women. High-grade EC (G3) was present in 21 (21.4%) patients, and low-grade EC (G1-G2) was present in 77 (78.6%) patients. The total number of women with SLN metastasis was 21/98 (21%). Of 21 women, 5 had MAC, 6 had MIC and 10 had ITCs. Conclusions: Preliminary analysis identified three risk factors for nodal involvement: age greater than 67 years, high-grade endometrial carcinomas and myometrial invasion greater than or equal to 50%. Lymphovascular space invasion, histotype 2 and p53 mutation showed a slight, but not statistically significant, tendency to be risk factors for SLN positivity. A deeper analysis with univariate uninominal logistic regression showed that high-grade EC is related to a greater probability of MACs, as shown in other studies, and that low-grade EC (grades 1 and 2) had a strong relationship with low-volume metastasis (LVM); further studies are needed to confirm these results.

Introduction/BackgroundVarious local flaps have been described for vulvar reconstructive surgery. This study aimed to evaluate the long-term follow up (FU), results and satisfaction of those patients who underwent Keystone perforator island flaps (KPIF) technique after radical vulvectomy.MethodologyWe analyzed demographics, complications, pathologic results, clinical and oncological outcomes of all patients undergone KPIF for vulvar cancer in our institution. The benefits, cosmetic results and satisfaction in term of patients’ quality of life were collected at discharge, after one month and during FU. The long-term FU was collected using oral interview and gynecological examination.ResultsFrom 2016 to 2023, we selected eleven patients (mean age 73 years) that underwent vulvectomy: nine for squamous cells vulvar cancer and two for Paget disease. The defects were successfully covered by the KPIF technique in all patients. Nine patients had a quick recovery and were discharged in postoperative day 5. Two patients were discharged after 20 days due to wound infections. Two patients were readmitted respectively on postoperative day 14 and day 21 due to flap dehiscence and surgical revision was required.One month after surgery all the wounds were completely healed and there were no differences in colour compared to the surrounding skin. Six months after surgery, all patients were satisfied, no one developed problems due to scarring even at the donor site and no discomfort in sitting or walking or urinary tract problem had experienced. After a mean time FU of 36 months two recurrences occurred within the first year after surgery, respectively vaginal and cutaneous. Both patients died for the progression of disease.ConclusionKPIF seems to be associated with low complication rates, rapid recovery and good cosmetic outcomes. This technique is well tolerated by patients over time with high satisfaction rates. Therefore, further studies with validated questionaries and larger sample size are needed.DisclosuresNone