S. Cianci

Secondary Laparoscopic Cytoreduction in Recurrent Ovarian Cancer: A Large, Single-Institution Experience

STUDY OBJECTIVE To analyze the feasibility and safety of laparoscopic secondary cytoreductive surgery in a retrospective series of patients with platinum-sensitive recurrent ovarian cancer. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING Catholic University of the Sacred Heart, Rome, Italy. PATIENTS Between October 2010 and October 2016, 58 patients with recurrent ovarian cancer were selected for a retrospective analysis of data. INTERVENTIONS All patients underwent a laparoscopic secondary cytoreduction with single or multiple procedures. RESULTS The most frequent pattern of recurrence was peritoneal (48.3%); 6 patients (10.3%) experienced parenchymal disease (spleen, n = 5; liver, n = 1), and 24 patients (41.4%) had lymph node recurrence. Complete debulking was achieved in all patients. The median operative time was 204 minutes (range, 55-448 minutes), median estimated blood loss was 70 mL (range, 20-300 mL), and the median length of hospital stay was 4 days (range, 1-21 days). Four patients (6.8%) experienced intraoperative complications. Early postoperative complications were documented in 6 patients (10.3%), but only 1 G3 complication was noted. The median duration of follow-up since secondary cytoreduction was 24 months (range, 9-71 months). Twenty-one patients (36.2%) experienced a second disease relapse. The median progression-free survival (PFS) was 28 months, and the 2-year PFS was 58.7%. Five patients died (8.6%); the 2-year overall survival was 90.7%. CONCLUSIONS For selected patients, laparoscopy is a feasible and safe approach to optimal cytoreduction for patients with recurrent ovarian cancer.

Telelap ALF-X total hysterectomy for early stage endometrial cancer: New frontier of robotic gynecological surgery

• Total Telelap ALF-X Hysterectomy can be performed in early stage endometrial cancer patients.

Near-Infrared Imaging with Indocyanine Green for Detection of Endometriosis Lesions (Gre-Endo Trial): A Pilot Study

STUDY OBJECTIVE To evaluate near-infrared radiation imaging with intravenous indocyanine green (NIR-ICG) during laparoscopic intervention to identify endometriosis lesions. DESIGN A single-center, prospective, single-arm pilot study (Canadian Task Force classification II-2). SETTING An academic tertiary care and research center. PATIENTS Twenty-seven patients with symptomatic endometriosis were enrolled. INTERVENTIONS Patients underwent laparoscopic surgery using a laparoscopic system prototype with NIR-ICG. MEASUREMENTS AND MAIN RESULTS A total of 116 suspected endometriosis lesions were removed from 27 patients. One hundred lesions had already been visualized in white light imaging by an expert surgeon; the remaining 16 were detected and removed using NIR-ICG. A total of 111 specimens were positive for endometriosis pathology. Positive predictive value of 95% and 97.8% and negative predictive value of 86.2% and 82.3% were found by white light imaging and NIR-ICG, respectively, with sensitivity of 85.6% and 82% and specificity of 95.2% and 97.9%, respectively. CONCLUSION NIR-ICG may be a tool for intraoperative diagnosis, confirmation of visible endometriosis lesions, and a marker for identifying occult endometriosis. Further prospective studies with a larger population sample are warranted to validate these encouraging preliminary results.

Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management

PurposePeritoneal mesothelial cysts (PMC) are a clinical dilemma because of their true pathogenic nature. Many definitions have been associated with PMC, including “benign multicystic mesothelioma”, “cystic mesothelioma”, “multilocular peritoneal inclusion cysts”, ‘‘inflammatory cysts of the peritoneum” or “postoperative peritoneal cyst”.MethodsWe herein performed a systematic review of the literature focusing on clinical and histopathological aspects of PMC, diagnosis, and therapies. Moreover, we described our experience with a case of PMC in a young female.ResultsSince there is often a history of prior surgery or inflammatory disease, most authors consider PMC of reactive origin. However, in some cases they occur without any documentable signs of disease or injury. A variety of clinical findings can complicate the preoperative assessment and a multitude of histological pictures may potentially lead to a misdiagnosis. The absence of a uniform treatment strategy and lack of long-term follow-up often hinder the accurate definition leading to unnecessary or unnecessarily aggressive therapy.ConclusionsPMC are more common than had previously been thought. Most authors consider them non-neoplastic; thus the designation of “peritoneal inclusion cyst” is preferable. The term “mesothelioma” should be used only in cases of histological evidences of atypia. The high rates of recurrence suggest that the goal of treatment should not be necessarily complete eradication, but symptomatic relief through individualized treatment. This is a topic of particular importance, especially in young female where recurrence rates could be lower than those reported in adults and where an improperly aggressive treatment could have repercussions on fertility.