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: 20 December 2024 | Viewed by 3585

Special Issue Editor


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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

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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 (3 papers)

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Research

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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
Viewed by 1125
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
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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
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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
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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
Viewed by 524
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
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