Akladios C, Lecointre L, Lefebvre F
… +25 more, Eberst L, Menoux I, Ouldamer L, Lavoue V, Huchon C, Dabi Y, Gertych W, Guyon F, Laas E, Bonneau C, Kerbage Y, Chauleur C, Fauvet R, Brun JL, Raimond E, Gauthier T, Costaz H, Rouzier R, Hotton J, Marchal F, Loaec C, Ramanah R, Chopin N, Querleu D, Jochum F
Int J Gynecol Cancer
· 2026 Feb · PMID 41796475
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BACKGROUND: The therapeutic value of lymphadenectomy in endometrial cancer remains controversial, particularly in high-risk patients as defined by the European Society of Gynaecological Oncology-European Society for Radi...BACKGROUND: The therapeutic value of lymphadenectomy in endometrial cancer remains controversial, particularly in high-risk patients as defined by the European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology 2021 histologic and molecular classification. While pelvic and para-aortic lymphadenectomy is the standard of care for high-risk endometrial cancer, sentinel lymph node (SLN) mapping has emerged as a promising alternative for low-risk patients with reduced post-operative morbidity. Recently, the advent of molecular classification has significantly influenced the diagnosis and management of endometrial cancer. In particular, p53 mutation has been recognized as an important prognostic marker and has been included in the criteria for high-risk classification. PRIMARY OBJECTIVE: To evaluate the impact of SLN mapping versus pelvic and para-aortic lymphadenectomy on disease-free survival at 3 years in high-risk patients with endometrial cancer with p53 mutation and a negative pre-operative positron emission tomography computed tomography scan. STUDY HYPOTHESIS: SLN mapping will provide non-inferior survival outcomes compared with pelvic and para-aortic lymphadenectomy in this population, with reduced post-operative morbidity. TRIAL DESIGN: This is a prospective, multicentre, non-inferiority, open-label, de-escalation, randomized, controlled trial in patients with International Federation of Gynecology and Obstetrics 2023 stage I and II endometrial cancer with p53 mutation and negative pre-operative positron emission tomography computed tomography scans. Patients will be randomized 1:1 to SLN mapping or pelvic and para-aortic lymphadenectomy. MAJOR INCLUSION/EXCLUSION CRITERIA: Eligible participants are aged ≥18 years, with International Federation of Gynecology and Obstetrics 2023 stage I or II endometrial cancer confirmed by magnetic resonance imaging, a p53 mutation verified by biopsy, and planned surgery including total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy if indicated. Exclusion criteria include recurrent endometrial cancer, prior chemotherapy, radiotherapy, endocrine therapy, or contraindications to lymphadenectomy or laparoscopy. PRIMARY ENDPOINT: Disease-free survival at 36 months. SAMPLE SIZE: A total of 374 patients. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Estimated completion of recruitment in September 2028, with 36 months of follow-up completed by September 2031. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06900582.
Bizzarri N, Giuliano MC, Parisi G
… +12 more, Pirrelli F, Giannarelli D, Perrone E, Dinoi G, Capasso I, Querleu D, Zannoni GF, Cucinella G, Zapardiel I, Vizzielli G, Fagotti A, Fanfani F
Int J Gynecol Cancer
· 2026 Feb · PMID 41794557
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BACKGROUND: Sentinel lymph node (SLN) biopsy is the standard of care in apparent early-stage endometrial cancer. However, ultra-staging protocols have not been standardized, which may contribute to variability in the det...BACKGROUND: Sentinel lymph node (SLN) biopsy is the standard of care in apparent early-stage endometrial cancer. However, ultra-staging protocols have not been standardized, which may contribute to variability in the detection of SLN metastases. The one-step nucleic acid amplification (OSNA) method has been proposed as a rapid and standardized technique to diagnose SLN metastasis. PRIMARY OBJECTIVE: To compare the ability to detect SLN metastasis between OSNA and ultra-staging. STUDY HYPOTHESIS: OSNA is non-inferior to ultra-staging in detecting lymph node metastases. TRIAL DESIGN: This is a prospective, multi-center, randomized, non-inferiority trial. MAJOR INCLUSION/EXCLUSION CRITERIA: The trial includes patients with histologically confirmed endometrial cancer and apparent (pre-operative) uterine-confined tumor, who are undergoing an attempt at SLN mapping. Exclusion criteria are uterine sarcoma (except for carcinosarcomas), de-differentiated or un-differentiated histology, fertility-sparing management, neoadjuvant therapy, previous surgery to pelvic lymph nodes, and suspicious lymph nodes on pre-operative imaging. PRIMARY ENDPOINT: Incidence of SLN metastasis in the OSNA group versus the ultra-staging group. SAMPLE SIZE: Assuming a maximum allowable difference of -4% in the proportion of patients with detected lymph node metastases (node-positive proportion) to declare non-inferiority, a power of 80%, and a significance level of 2.5% (one side), a sample size of 1922 (961 per arm) is needed. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Four years of accrual, with estimated results to be presented in 2029. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT06935305).
Suh-Burgmann EJ, Nau C, Finertie H
… +5 more, Zhong H, Bookman M, Tewari D, Dolisca S, Schmittdiel JA
Int J Gynecol Cancer
· 2026 Feb · PMID 41794556
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OBJECTIVE: This study aimed to assess factors contributing to the survival disparity between insured Black and White patients with uterine cancer treated within the same large US health care system. METHODS: This is a re...OBJECTIVE: This study aimed to assess factors contributing to the survival disparity between insured Black and White patients with uterine cancer treated within the same large US health care system. METHODS: This is a retrospective cohort analysis of Black and White patients diagnosed with uterine cancer from 2005 to 2022 while members of a large community-based integrated US health care system. Five domains of factors potentially contributing to survival were characterized: co-morbidities, diagnostic process, treatment, tumor characteristics, and socioeconomic factors. Using logistic regression, propensity scores were calculated and used to sequentially balance Black and White patients for each of these domains, evaluating the effect of balancing each domain on the hazard ratio (HR) for 5-year mortality for Black versus White patients. RESULTS: Comparing 11,878 White with 2196 Black patients, the HR for 5-year mortality for Black patients, adjusted for baseline characteristics and co-morbidities, was 2.05 (95% confidence interval [CI] 1.79 to 2.33). Substantial reductions in excess mortality were observed after balancing tumor factors, which reduced the HR to 1.31 (95% CI 1.11 to 1.53), and socioeconomic factors, which further reduced the HR to 1.08 (95% CI 0.91 to 1.28). No significant reduction was observed after balancing co-morbidity, diagnostic, or treatment factors. CONCLUSIONS: Among insured patients treated within the same US health care system, Black patients had approximately twice the mortality risk of White patients, with 70.8% of the excess relative risk of death among Black patients being attributable to tumor characteristics, 21.4% attributable to socioeconomic status, and 7.8% un-explained. Co-morbidities, diagnostic efficiency, and treatment quality were not significant contributors relative to other factors. These findings suggest that eliminating disparities in survival between Black and White patients will require development of more effective treatments for high-risk tumor types and interventions that mitigate the negative effects of lower socioeconomic status on health.
Trutnovsky G, Muntinga C, Holter M
… +7 more, Pucher D, Bracic T, Huetter C, Ciresa-König A, Polterauer S, Tamussino K, van Esch E
Int J Gynecol Cancer
· 2026 Apr · PMID 41791272
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OBJECTIVE: To assess risk factors for long-term recurrence of vulvar high-grade squamous intra-epithelial lesions (vulvar HSIL) and other high-risk human papillomavirus-related genital dysplasia after primary treatment w...OBJECTIVE: To assess risk factors for long-term recurrence of vulvar high-grade squamous intra-epithelial lesions (vulvar HSIL) and other high-risk human papillomavirus-related genital dysplasia after primary treatment with imiquimod or surgery. METHODS: This was a long-term follow-up of the PITVIN trial (Clinicaltrials.gov identifier: NCT01861535), a multi-center, randomized, phase 3 non-inferiority clinical study of topical imiquimod versus surgery for vulvar HSIL. Number of recurrent vulvar HSIL or other HSIL and related treatment types were assessed. The relationship between initial study treatment, patient characteristics, primary response (quick versus slow) to imiquimod, and pre-treatment immune infiltrates in recurrent and non-recurrent HSIL were analyzed. RESULTS: Long-term clinical data was available for 87 patients (42 imiquimod, 45 surgery) of the 107 patients included in the original intention-to-treat analysis. Mean follow-up time was 70 months (standard deviation ±24). Among the 80 patients with per-protocol treatment in the initial study, recurrent vulvar HSIL was diagnosed in 33% (12/36) after imiquimod and in 20% (9/44) after surgery (p =.20). Baseline recurrence status, age, and smoking were not associated with vulvar HSIL recurrence. Within the imiquimod study group, patients with an initial slow or partial response to imiquimod experienced recurrent HSIL lesions in 54% (7/13), and patients with an initial quick response in 22% (5/23) of cases (p =.05). Recurrent vulvar HSILs showed significantly higher initial intra-epithelial infiltration of cluster of differentiation 33+ immature monocytes compared with non-recurrent lesions (p =.04), suggesting tumor-mediated immunosuppression. In the intention-to-treat population, 21% (18/87) developed cervical HSIL (n = 9), vaginal HSIL (n = 3), anal HSIL (n = 3), cervical cancer (n = 1), anal cancer (n = 1) and vulvar cancer (n = 1) during long-term follow-up. CONCLUSIONS: Topical imiquimod and surgical treatment of vulvar HSIL are effective in long-term follow-up, with recurrences occurring in 20% to 33% of patients within 5 years. Initial slow or partial treatment response to imiquimod and the composition of pre-treatment immune infiltrates may be predictors of an increased long-term recurrence risk.
Int J Gynecol Cancer
· 2026 Mar · PMID 41781135
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The rates of endometrial cancer are increasing for pre-menopausal patients with first pregnancy attempt now surpassing 30 years. This combination has created unique challenges for pre-menopausal patients with endometrial...The rates of endometrial cancer are increasing for pre-menopausal patients with first pregnancy attempt now surpassing 30 years. This combination has created unique challenges for pre-menopausal patients with endometrial cancer, and deciding the best treatment options can be complicated for clinicians and patients. This narrative review will discuss current, broadly accepted patient selection criteria and treatment and surveillance strategies for young patients who wish to retain their fertility. Efforts to expand selection criteria for non-surgical management, including novel treatment options for select tumors, and perspectives on nuanced clinical scenarios will also be discussed.
Schoenen S, Delbecque K, Marbaix E
… +10 more, Noel JC, Delvenne P, Seidel L, Van Rompuy AS, Van Nieuwenhuysen E, Van Gorp T, Vergote I, Kridelka F, Bolze PA, Goffin F
Int J Gynecol Cancer
· 2026 Apr · PMID 41780336
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OBJECTIVE: Approximately 15% to 20% of complete hydatidiform moles progress to post-molar gestational trophoblastic neoplasia. The presence of atypical extra-villous trophoblast foci, described in complete hydatidiform m...OBJECTIVE: Approximately 15% to 20% of complete hydatidiform moles progress to post-molar gestational trophoblastic neoplasia. The presence of atypical extra-villous trophoblast foci, described in complete hydatidiform moles, has been associated with an increased risk of developing post-molar gestational trophoblastic neoplasia. The primary objective of this study was to evaluate the predictive value of atypical extra-villous trophoblast foci for treatment response in post-molar gestational trophoblastic neoplasia. Secondary objectives were to assess the clinical impact of these foci on disease characteristics, the International Federation of Gynecology and Obstetrics (FIGO) score, disease stage, and human chorionic gonadotropin (hCG) kinetics. METHODS: A retrospective multi-center study was conducted by the Belgian Gestational Trophoblastic Diseases Registry (French-speaking center) between January 2017 and December 2022. All cases of complete hydatidiform mole were centrally reviewed by expert pathologists specialized in placental pathology from 3 university hospitals. Post-molar gestational trophoblastic neoplasia was diagnosed according to FIGO 2000 criteria. Clinical features were compared according to the presence or absence of atypical trophoblast foci. RESULTS: Among 216 patients diagnosed with complete hydatidiform mole, 56 (26%) developed post-molar gestational trophoblastic neoplasia. Atypical extra-villous trophoblast foci were identified in 38 of 56 (68%) cases. Baseline demographic characteristics, including age, were comparable between the 2 groups. Patients with atypical foci more frequently had FIGO scores ≥6 (p =.044) and pulmonary metastases (18.4% vs 5.6%). All patients requiring multi-agent chemotherapy belonged to the atypical foci group (p =.073). Pre-treatment hCG nadir levels were higher, and hCG slopes steeper in the atypical group (p =.0027 and p =.0052). CONCLUSIONS: Post-molar gestational trophoblastic neoplasia arising from complete hydatidiform moles with atypical extra-villous trophoblast foci is more frequently associated with an unfavorable prognosis and the need for multi-agent chemotherapy than disease arising from moles without atypical foci.
Obermair HM, Mathew A, Zand B
… +1 more, Obermair A
Int J Gynecol Cancer
· 2026 Mar · PMID 41775571
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Lymph node dissection has been a component of surgical staging for endometrial cancer, with more recent change to sentinel lymph node biopsy as standard of care. However, comparisons of any lymph node assessment with no...Lymph node dissection has been a component of surgical staging for endometrial cancer, with more recent change to sentinel lymph node biopsy as standard of care. However, comparisons of any lymph node assessment with no nodal assessment is limited. We conducted a systematic review of literature published between June 2015 and July 5, 2025, searching Medline and Embase. Eligible studies compared sentinel lymph node biopsy to no nodal assessment and reported on: (1) peri-operative outcomes (2) oncologic outcomes (3) adjuvant treatment (4) patient-reported outcomes (5) lymphoedema outcomes, or (6) cost. Peer-reviewed publications in English, reporting on adult women who underwent sentinel lymph node biopsy or no nodal assessment for endometrial cancer were included. Studies reporting fewer than 10 patients, and reviews, commentaries, editorials, letters, protocol papers, conference proceedings, guidelines, and clinical trial registrations were excluded. Screening was performed in Covidence by 2 independent reviewers. Eight observational studies were eligible for inclusion. Considerable heterogeneity existed in study design and reporting. Evidence was too inconsistent to detect meaningful differences in peri-operative outcomes (blood loss, length of stay, intra-operative complications, conversion to laparotomy) or oncologic outcomes (recurrence, overall survival). Adjuvant treatment findings varied-1 study found no difference in adjuvant treatment between sentinel lymph node biopsy compared to no nodal assessment; another study found that patients who did not have nodal assessment were less likely to receive adjuvant treatment. Lymphoedema outcomes were inconsistent-2 studies suggested lower rates with sentinel lymph node biopsy, while another found no difference. Cost data were limited; 1 study reported no nodal assessment as attracting the lowest charges. There were no studies comparing patient-reported outcomes between sentinel lymph node biopsy and no nodal assessment. Comparative evidence between sentinel lymph node and no nodal assessment in endometrial cancer remains limited. Gaps are greatest in patient-reported outcomes, lymphoedema, and cost outcomes.
Trent PB, Blaker Y, Nakken E
… +3 more, Bruheim K, Wang Y, Eriksson AGZ
Int J Gynecol Cancer
· 2026 Mar · PMID 41775570
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Endometrial carcinoma is one of the most common gynecological malignancies, classified into various risk categories based on histopathological parameters. Despite not demonstrating an overall survival benefit, the standa...Endometrial carcinoma is one of the most common gynecological malignancies, classified into various risk categories based on histopathological parameters. Despite not demonstrating an overall survival benefit, the standard treatment approach in patients with intermediate-risk endometrial carcinoma has historically included adjuvant radiotherapy. However, this intervention may not be requisite for all patients within this classification. A Cochrane meta-analysis, including the PORTEC-2 and GOG-99 studies, indicate that the addition of radiotherapy may not yield substantial survival benefits, while potentially compromising quality-of-life due to treatment-related morbidities. International guidelines generally recommend adjuvant radiotherapy, but list observation as a possible post-surgical strategy. This review aims to assess the current literature on adjuvant radiotherapy in intermediate-risk endometrial carcinoma. A multidisciplinary approach that incorporates shared decision-making, quality-of-life assessments, and ongoing research into the molecular classification of tumors can lead to more personalized treatment paradigms. Ultimately, this article advocates for a more selective use of adjuvant radiotherapy based on individual patient assessments and evolving evidence in women diagnosed with intermediate-risk endometrial carcinoma.
Santía MC, Morante-Caicedo C, Piñeros Castillo WA
… +5 more, Taylor A, Mburu A, Bhandoria G, Alvarenga-Bezerra V, Noll F
Int J Gynecol Cancer
· 2026 Mar · PMID 41775569
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Cervical cancer remains a major public health concern in low- and middle-income countries, where more than 80% of new cases and deaths occur each year. For decades, the gold standard for early-stage disease has been radi...Cervical cancer remains a major public health concern in low- and middle-income countries, where more than 80% of new cases and deaths occur each year. For decades, the gold standard for early-stage disease has been radical hysterectomy or radical trachelectomy with lymph node assessment, procedures associated with significant morbidity. Recent evidence from retrospective and prospective studies demonstrates that less radical surgical approaches, such as conization or simple hysterectomy, can achieve oncologic outcomes comparable to radical procedures in carefully selected patients with early-stage disease while reducing morbidity. In this narrative review, we summarize the available evidence on conservative surgical management of cervical cancer in low- and middle-income countries, highlight its feasibility and oncologic safety, and discuss the unique barriers that hinder the widespread implementation of surgical de-escalation in resource-limited environments.
Viveros-Carreño D, Agustí N, Mora-Soto N
… +2 more, Wilke RN, Pareja R
Int J Gynecol Cancer
· 2025 Oct · PMID 41775568
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The surgical management of early-stage cervical cancer has evolved from routine radical hysterectomy to more tailored, less invasive approaches. Historical innovations established radical hysterectomy as a cornerstone of...The surgical management of early-stage cervical cancer has evolved from routine radical hysterectomy to more tailored, less invasive approaches. Historical innovations established radical hysterectomy as a cornerstone of cervical cancer treatment, but recent evidence has challenged its necessity in selected low-risk patients. Prospective and randomized controlled trials, including the ConCerv and Simple Hysterectomy and Pelvic Node Assessment (SHAPE) studies, support the safety of simple hysterectomy in tumors ≤2 cm with favorable pathological features, demonstrating similar oncologic outcomes and reduced morbidity. Sentinel lymph node biopsy has emerged as a reliable alternative to full lymphadenectomy, with high diagnostic accuracy and lower complication rates. The intra-operative abandonment of radical surgery upon detection of nodal metastasis appears to avoid overtreatment without affecting survival. Finally, preoperative brachytherapy, though associated with higher local control and reduced need for adjuvant external beam radiotherapy, remains investigational pending results from high-quality randomized controlled trials. Current guidelines reflect some of these evolving strategies, recommending fewer radical procedures and sentinel node mapping for selected patients. This paradigm shift emphasizes individualized surgical planning, balancing oncologic efficacy with quality of life, and underscores the ongoing refinement of cervical cancer care in the modern era.
Int J Gynecol Cancer
· 2026 Mar · PMID 41775567
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Among the 4 molecular subtypes of endometrial carcinoma, POLE mutated carcinomas are notable for excellent clinical outcomes. Pathogenic POLE mutations cause DNA proofreading loss, resulting in the "ultramutated" phenoty...Among the 4 molecular subtypes of endometrial carcinoma, POLE mutated carcinomas are notable for excellent clinical outcomes. Pathogenic POLE mutations cause DNA proofreading loss, resulting in the "ultramutated" phenotype, making POLE mutated tumors highly visible to the immune system leading to antitumor immunity. Abundant retrospective studies, meta-analyses, and clinical trials data all confirm the relative indolent course for patients with these tumors; however, until recently, no prospective clinical trials have evaluated the safety of de-escalation of therapy. The recently published PORTEC-4a randomized phase III clinical trial provided prospective data demonstrating that de-escalating therapy by omitting adjuvant treatment is safe for patients with a "favorable" molecular profile, including most stage I and II POLE mutated endometrial carcinomas. POLE mutated tumors often display features considered high risk of recurrence in other molecular subtypes, such as high grade, deep myometrial invasion, and lymphovascular invasion, yet studies consistently find that these features are inconsequential for POLE mutated cancer outcomes. For implementing therapy de-escalation in clinical practice, key factors must be considered to maintain patient safety. Chief among these is to restrict diagnosis of POLE mutated endometrial carcinomas to cancers that contain 1 of 11 validated pathogenic mutations. Further considerations include how best to manage POLE mutated tumors with additional p53 abnormalities and/or mismatch repair deficiencies (so called multiple classifiers) and how to manage rare advanced stage POLE mutated carcinomas. This review evaluates the evidence supporting de-escalated therapy in carefully selected patients with POLE mutated endometrial carcinoma. We highlight the critical considerations to make effective and safe treatment decisions for patients with these tumors.
Caicedo-Martínez M, Arbeláez-Mariño AF, Arbeláez L
… +2 more, Farach A, Martinez-Perez DA
Int J Gynecol Cancer
· 2026 Mar · PMID 41775566
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Locally advanced cervical cancer remains a major global health challenge, with outcomes and access disparities greatest in low-middle income countries. Since the 1999 National Cancer Institute clinical alert endorsing co...Locally advanced cervical cancer remains a major global health challenge, with outcomes and access disparities greatest in low-middle income countries. Since the 1999 National Cancer Institute clinical alert endorsing concurrent chemoradiation as standard of care, advances in external beam radiotherapy and brachytherapy have improved disease control and toxicity profiles. Whether these advances constitute true treatment de-escalation remains uncertain. This narrative review synthesizes historical milestones and contemporary evidence in definitive radiotherapy for locally advanced cervical cancer, focusing on strategies that may enable de-escalation: refined external beam radiation therapy techniques and volumes, optimized treatment time, systemic therapy, and modernization of brachytherapy. Landmark trials eliminated routine surgery after radiation therapy and established concurrent chemoradiation as the backbone of care. Technologic evolution from 2- to 3-dimensional conformal radiotherapy to intensity-modulated radiotherapy/volumetric arc therapy and image-guided adaptive brachytherapy has reduced toxicity while maintaining and even improving control. EMBRACE I/II benchmarked magnetic resonance imaging-guided adaptive brachytherapy and modern external beam radiotherapy, demonstrating high local control with lower severe morbidity and wider adoption of combined intracavitary/interstitial techniques. De-escalation by precision includes selective use of extended-field radiation, abandonment of pelvic sidewall boosts, and simultaneous integrated boost to nodal disease to avoid prolonging overall treatment time. True dose, volume, and time-reducing strategies remain investigational. Current progress reflects optimization and refinement rather than definitive de-escalation of locally advanced cervical cancer radiotherapy. Realizing de-escalation will require improving universal access to state-of-the-art external beam radiation and brachytherapy, rigorously designed trials, and in the future, biologically guided patient selection to deliver less intensive, yet equally curative treatment.
Agusti N, Iniesta MD, Fagotti A
… +1 more, Rauh-Hain A
Int J Gynecol Cancer
· 2026 Mar · PMID 41775564
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Minimally invasive surgery has emerged as a promising approach to the management of advanced-stage epithelial ovarian cancer, particularly in the setting of interval debulking surgery following neoadjuvant chemotherapy....Minimally invasive surgery has emerged as a promising approach to the management of advanced-stage epithelial ovarian cancer, particularly in the setting of interval debulking surgery following neoadjuvant chemotherapy. Although primary cytoreduction has traditionally been performed via laparotomy, growing evidence supports the use of neoadjuvant chemotherapy to reduce surgical morbidity without compromising survival, creating new opportunities for minimally invasive surgery. Retrospective and prospective studies consistently report perioperative advantages with minimally invasive surgery, including less blood loss, shorter hospital stay, faster recovery, and earlier resumption of chemotherapy, when applied in carefully selected patients. Importantly, these benefits have yet to be supported by definitive data on long-term oncologic outcomes, underscoring the need for high-quality randomized trials of minimally invasive surgery, which are ongoing. Patient selection remains central to the safe application of minimally invasive surgery. Candidates are typically characterized by favorable response to chemotherapy, limited residual disease, and absence of extensive upper abdominal involvement, with pre-operative assessment supported by imaging, measurement biomarkers such as CA-125, and diagnostic laparoscopy. Despite encouraging feasibility data, adherence to oncologic principles and readiness to convert to laparotomy remain essential safeguards. Parallel technologic advances are expanding the scope of minimally invasive surgery. For example, robotic platforms improve dexterity and ergonomics, whereas intra-operative fluorescence imaging, ultrasound, and augmented-reality navigation offer new ways to identify residual disease and guide cytoreduction. Computational tools, including predictive models, artificial intelligence, and radiomic/pathomic integration, are emerging to refine triage and surgical planning. These innovations, although largely investigational, illustrate the potential of multi-modal integration to enhance both the precision and safety of minimally invasive surgery. Looking forward, the future of minimally invasive surgery will depend on maturation of evidence from randomized trials, broader incorporation of patient-centered outcomes, and integration with precision oncology and adjunct therapies. Minimally invasive surgery holds significant promise to reduce the morbidity of and improve recovery from advanced epithelial ovarian cancer, but its widespread adoption must await confirmation of oncologic equivalence to the open approach.
Agusti N, Lago V, Nero C
… +10 more, Uccella S, Buda A, Chi D, Gardner G, Laven P, Rey I, Torné A, Fagotti A, Diaz-Feijoo B, Bizzarri N
Int J Gynecol Cancer
· 2026 Mar · PMID 41775563
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Sentinel lymph node (SLN) mapping is being explored as a less invasive alternative to systematic lymphadenectomy in early-stage epithelial ovarian cancer. Existing evidence, mainly from feasibility and diagnostic accurac...Sentinel lymph node (SLN) mapping is being explored as a less invasive alternative to systematic lymphadenectomy in early-stage epithelial ovarian cancer. Existing evidence, mainly from feasibility and diagnostic accuracy studies, shows that SLN detection by mapping is achievable, but results remain inconsistent due to heterogeneity in methodology. Detection rates of SLN vary widely across studies, influenced by tracer type, injection technique, timing, and the extent of pathological assessment. Dual-tracer protocols combining radiotracers and indocyanine green generally yield higher detection rates than single tracers do, while injection into both infundibulopelvic and utero-ovarian ligaments yields adequate coverage of para-aortic and pelvic regions. However, detection of pelvic SLNs remains limited. In this context, cervical injection has been proposed as an alternative, with preliminary data showing enhanced pelvic lymph node detection. As for injection timing, pre-adnexectomy injection preserves native lymphatics but is technically demanding; post-adnexectomy injection is technically easier and more widely used. While ultra-staging enhances diagnostic sensitivity, its clinical implications for detecting micro-metastases and isolated tumor cells in epithelial ovarian cancer are still undefined and require further investigation. To support safe and standardized research-based implementation, we propose a unified framework that integrates levels of evidence with grades of recommendation across each procedural domain. This structured approach provides a foundation for protocol development, prospective data collection, and future clinical trials, aiming to bridge the gap between experimental mapping and potential clinical integration in early-stage epithelial ovarian cancer.