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ObjectivesThe aim of the present article was to discuss currently available evidence on the impact of frailty assessment on adverse postoperative outcomes and survival in patients undergoing surgery for gynecological cancer.MethodsSystematic search of Medline (PubMed) and Embase databases until September 30, 2020. Key inclusion criteria were: (1) randomized or observational studies; (2) patients undergoing non-emergent surgery for gynecological malignancies; (3) preoperative frailty assessment.ResultsThrough the process of evidence acquisition, twelve studies including 85,672 patients were selected and six tools were evaluable: 30-item frailty index, 40-item frailty index, modified frailty index (mFI), John Hopkins Adjusted Clinical Groups index, Fried frailty criteria, Driver’s tool. The prevalence of frailty varied roughly from 6.1% to 60% across different series included. The mFI was the most adopted and predictive instrument. Pooled results underlined that frail patients were more likely to develop 30-day postoperative complications (OR, 4.16; 95% CI, 1.49–11.65; p=0.007), non-home discharge (OR, 4.41; 95% CI, 4.09–4.76; p<0.001), ICU admission (OR:3.99; 95% CI, 3.76–4.24; p<0.001) than the non-frail counterpart. Additionally, frail patients experienced worse oncologic outcomes (disease-free and overall survivals) than non-frail patients.ConclusionsThe present systematic review demonstrated that preoperative frailty assessment among gynecologic oncology patients is essential to predict adverse outcomes and tailor a personalized treatment. The mFI appeared as the most used and feasible tool in daily practice, suggesting that tailored therapeutic strategies should be considered for patients with 3 or more frailty-defining items.

Background The purpose of this study was to observe the role of secondary cytoreductive surgery in platinum-resistant recurrent ovarian cancer (OC) patients. Methods We collected data of patients affected by recurrent OC treated between 1995 and 2013. Inclusion criteria were: invasive epithelial OC histologically documented, cytoreductive surgery and platinum-based chemotherapy at first-line treat ment with evidence of complete response to treatment, disease-free interval <6 months, and no concomitant neoplasia. Patients considered susceptible of cytoreductive surgery (group A) were compared with a historical series of patients with similar characteristics but not eligible for surgery (group B). Results Of 122 platinum-resistant patients, 18 met the inclusion criteria for the study and were enrolled. They were compared with a historical series of 18 patients not surgically treated with analogous clinical and pathological features. The most frequent sites of relapse included pelvic and aortic lymph nodes (39 %), peritoneum (33 %), bowel (28 %), and pelvis (22 %). A low rate of intraoperative and postoperative complications was reported. No deaths were recorded. Overall survival was significantly longer in cytoreductive group when compared with the control group ( P  = 0.035). Median overall survival was 44 months. Estimated 5-year overall survival rates were 57 versus 23.5 % for groups A and B, respectively. Conclusions Surgery could represent a useful adjunct to chemotherapy in the management of platinum-resistant recurrent OC patients, carefully selected, in highly selected centers. Larger prospective trials are needed to further confirm our experience.

Introduction/BackgroundEndometrial cancer is generally associated with a good prognosis, due to an early diagnosis in stage I and II, 75% and 13% respectively. For advanced-stage disease, the recurrence rate is high and the site of the relapse is heterogeneous with localized or spread peritoneal disease. The treatment strategy is based on site of relapse. For non-localized relapse the chances are limited with a poor prognosis.MethodologyWe reported our experience of three cases with peritoneal spread recurrences, in endometrial cancer patients with advanced stage diagnosis.ResultsThe patients had been underwent to multiple lines of chemotherapy including rechallenging with platinum regimens, pegilated liposomal doxorubicin and taxane, with a progression of disease. These patients came at our Department for abdominal distension and breathing difficulty, CA 125 increased and radiology find (CT scan or US scan) of ascites. In these cases, after paracentesis and a single administration of intraperitoneal chemotherapy based on carboplatin (AUC5) were showed quality of life improvement, reduction of fatigue, improved breathing and reduction of anorexia. No complications occurred.ConclusionAlthough only few cases have been reported, the exceptional results and the absence of side effects observed in these cases, strongly warrant future trials to investigate the role that intraperitoneal chemotherapy can have both as palliative treatment of refractory ascites and as salvage therapy in advanced endometrial cancer.DisclosureAll authors declare that they have no conflict of interest and nothing to disclose.

Introduction/BackgroundEndometrial cancer is the most common gynecological malignancy in developed countries.Transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) are widely accepted as imaging tools in preoperative local staging.In this prospective study, we evaluated the diagnostic accuracy of TVUS and MRI for detecting the depth of myometrial invasion and cervical involvement and for measuring tumor volume. We also correlated tumor volume to negative histological prognostic factors.MethodologyWe enrolled women with a histological diagnosis of endometrial carcinoma. The study was conducted from January 2018 to March 2019. All patients were evaluated by TVUS and pelvic MRI with gadolinium, in the absence of any contraindication. We compared the preoperative imaging results with final histopathology.ResultsThe mean age was 63,65±9.79 years. Fifty-four out of the 60 patients resulted suitable for primary surgery. Six patients underwent neoadjuvant chemotherapy for carcinomatosis. Twenty-eight women underwent both TVUS and MRI. The additional 26 patients underwent only TVUS because they were not able to perform MRI.Both TVUS and MRI showed an accuracy of 85.7% for diagnosing presence or absence of myometrial invasion and an accuracy of 100% and 89.3% respectively, for the assessment of deep myometrial infiltration. The accuracy for the cervical involvement was 92.9% and 96.4% for TVUS and MRI respectively. The coefficient of determination (R2) of tumor volume measurement was 0.99, 0.95 and 0.98 using 3-Dimensional (D) TVUS, 2-D TVUS and MRI respectively.A value of tumor volume ≥2 ml showed a positive correlation with negative histological prognostic factors, such as high tumor grade, lymphovascular space involvement (LVSI) and deep myometrial invasion (p<0.05).ConclusionThe accuracy of TVUS and MRI in evaluating deep myometrial invasion, cervical involvement and tumor volume measurement were comparable. A preoperative evaluation of the tumor volume would allow the identification of the patients with a poor prognosis.DisclosureNothing to disclose.

ObjectivesTo evaluate a correlation between pre-surgical condition as predictor of overall, severe complications and 90 days mortality in patients undergoing cytoreductive surgery for advanced ovarian cancer.MethodsConsecutive patients affected by advanced ovarian cancer who have undergone cytoreduction surgery were considered for the study. Patients’ characteristics’ and surgical data were recorded. Modified Frailty Index (mFI) was evaluated. Higher mFI scores indicated more severe comorbidities. Postoperative complications were evaluated and graded according to Accordion score. Logistic regression was used to evaluate the associations between clinical and surgical variables and severe or overall complications.Results263 patients were included. 86 patients developed at least one complication: 70 (26.6%) of these reported mild complications, 13 (4.9%) developed severe complications, 3(1.1%) died within 90 days from surgery. At multivariate analysis logistic regression mFI>3 (OR: 1.67, CI 95% 1.08–2.81;p=0.05) the complexity of surgical procedures performed (OR: 4.15, CI 95% 2.38–7.23; p<0.001) were independent predictors of overall complications, while BMI>30 (OR: 5.13, CI 95%:1.15–22.92, p=0.03), mFI>3 (OR:2.45,CI95%:1.06–5.67;p=0.04),high complexity surgery executed (OR:12.31,CI95%:3.08–47.74;p<0.001) were independent predictors of severe complications.ConclusionsmFI and high complexity surgery are predictive of Severe and Overall Complications. Patients’ pre-operative care profile evaluation may guide specialists in reducing, preventing and managing complications correctly. mFI seems to be effective in identify high-risk patients and represent a valuable tool to help health professionals in providing risk counseling and discussion of management for women undergoing surgery for gynecologic cancer.

Introduction/BackgroundThis study aimed to define the role of combination of preoperative PET/CT scan and SLN biopsy for detection of nodal metastasis in Endometrial Cancer (EC) patients.MethodologyAll patients affected by EC prospectively collected from January 2014 to August 2016 underwent PET/CT scan and SLN mapping using indocyanine green (ICG) as tracer. Patients with suspicious lymph nodes at FDG-PET/CT underwent selective pelvic lymphadenectomy. In case of undetectable SNL, no further lymphadenectomy was performed if PET/CT scan was negative. Basic descriptive statistics were used to describe outcomes.ResultsA total of 83 patients were enrolled in the study. PET/CT scan was suggestive of nodal involvement in 15 patients. SLN were detected bilaterally in 78% of patients. Detection rate was influenced by patient’ BMI and learning curve. Five patients were node positive: of these all had hyper metabolic nodes at PET/CT scan, in 1 patient SLN was not detected. Ten out of 15 patients, with suspicious nodal at PET/CT scan, was node negative. After a median follow up of 24 months (range 14–45) all patients are alive. Four patients experienced recurrent disease. No nodal relapse was recorded.ConclusionLymphatic mapping with sentinel node biopsy is able to reduce morbidity associated with pelvic lymphadenectomy. Detection rate is strongly improved with learning curve and reduced in morbidly obese patients. PET/CT scan shows high sensitivity for nodal metastasis but moderate specificity and may help to avoid nodal dissection in patients with sentinel node failure.DisclosureNothing to disclose.

The aim of this study was to evaluate the role of systematic lymphadenectomy, feasibility, complications rate, and outcome in epithelial ovarian cancer (EOC) patients with recurrent bulky lymph node disease. A prospective observational study of EOC patients with pelvic/aortic lymph node relapse was conducted between January 1995 and June 2005. After a clinical and laparoscopic staging, secondary cytoreduction, including systematic lymphadenectomy, were performed. The eligibility criteria were as follows: disease-free interval ≥6 months, radiographic finding suggestive of bulky lymph node recurrence, and patients' consent to be treated with chemotherapy. Forty-eight EOC patients with lymph node relapse were recruited. Twenty-nine patients were amenable to cytoreductive surgery. Postoperatively, all patients received adjuvant treatment. The median numbers of resected aortic and pelvic nodes were 15 (2–32) and 17 (8–47), respectively. The median numbers of resected aortic and pelvic positive lymph nodes were 4 (1–18) and 3 (1–17), respectively. The mean size of bulky nodes was 3.3 cm. Four patients (14%) experienced one severe complication. No treatment-related deaths were observed. After a median follow-up of 26 months, among cytoreduced patients, 18 women were alive with no evidence of disease, nine were alive with disease. Among the 11 patients not amenable to surgery, five women were alive with persistent disease, six patients died of disease, at a median follow-up of 18 months. Estimated 5-year overall survival and disease-free interval for operated women were 87% and 31%, respectively. In conclusion, patients with bulky lymph node relapse can benefit from systematic lymphadenectomy in terms of survival. The procedure is feasible with an acceptable morbidity rate

Objective: To assess the efficacy and toxicity profile of dose-dense cisplatin-based neoadjuvant chemotherapy (NACT) followed by radical surgery in patients affected by locally advanced cervical cancer. Methods: Patients affected by carcinoma of the uterine cervix FIGO (International Federation of Obstetrics and Gynecology) stage IB2-IIIB were enrolled into the study. The treatment schedule consisted of 5 cycles of intravenous paclitaxel 60 mg/m 2 plus cisplatin 60 mg/m 2 every 10 days; patients were then submitted to radical hysterectomy and pelvic lymphadenectomy. Results: From January 2011 to March 2013, 22 patients were enrolled. Median age was 47 (26-83) years. FIGO stages included 1 IIA, 15 IIB, 1 IIIA, and 5 IIIB. Ninety-one percent of patients completed all the 5 planned cycles of NACT. Three patients experienced allergic reactions to paclitaxel. Grade 3-4 hematological toxicity was observed in 18% of cases. In 3 cases, grade 3-4 extra-hematological adverse and life-threatening events were reported (1 ototoxicity, 1 transient ischemic attack, and 1 myocardial infarction). No treatment-related death occurred. The operability rate was 86.4%. The overall response rate was 52.6%: 5 patients (26.3%) experienced clinical complete response, and 5 (26.3%) showed a clinical partial response. Stable disease was observed in 47.4% of patients, with no progressive disease recorded. Pathological response was observed in 57.9% of cases. Six out of 19 (31.6%) patients were submitted to adjuvant treatment. Conclusion: Dose-dense cisplatin-based NACT showed a response rate in approximately half of patients. However, in consideration of the reported extra-hematological toxicity, further studies on and new strategies with dose-dense platinum-based NACT are required to improve outcome in cervical cancer patients.