Prognostic value of pre-treatment human papilloma virus DNA status in cervical cancer.

OBJECTIVE: Although the relationship between human papilloma virus (HPV) and cervical cancer is well established, the prognostic value of HPV status has not been determined, largely because previous studies have yielded conflicting results. This study aimed to investigate the prognostic value of pre-treatment HPV DNA for predicting tumor recurrence in cervical cancer. METHODS: The study included 248 eligible patients who provided cervical cell specimens for HPV genotyping before surgery or concurrent chemoradiotherapy (CCRT). Of these 248 patients, 108 were treated with radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA cervical cancer, and 140 were treated with CCRT for FIGO stage IB2-IV cervical cancer. RESULTS: HPV 16 and 18 were the two most common HPV types detected, with prevalence rates of 52.4% and 12.5%, respectively. The pre-treatment HPV DNA test showed that 18.5% of cervical cancers were HPV negative. Multivariate analysis showed that HPV negativity was associated with poorer disease-free survival (DFS) than HPV-positive status (hazard ratio [HR], 3.97; 95% confidence interval [CI], 1.84-8.58; p=0.0005), and patients with HPV 16-positive cancers had better DFS (HR, 0.41; 95% CI, 0.23-0.72; p=0.0019). In the surgery group, only HPV 16 positivity was significantly correlated with DFS (HR, 0.34; 95% CI, 0.12-0.96; p=0.0416). In the CCRT group, only HPV negativity was significantly correlated with DFS (HR, 3.75; 95% CI, 1.78-7.90; p=0.0005). CONCLUSIONS: Pre-treatment HPV DNA status may be a useful prognostic biomarker in cervical cancer. The presence of HPV 16 DNA was associated with better DFS, and HPV negativity was associated with worse DFS. However, larger sample sizes and more comprehensive studies are required to verify our findings.

Hyperthermic intrathoracic chemotherapy with cisplatin for ovarian cancer with pleural metastasis.

Intrathoracic metastasis of ovarian cancer has poor prognosis regardless of treatment modality. Recent development of surgical techniques and the new concept of direct infusion of chemotherapeutic agents with hyperthermia could help with the treatment of disseminated diseases in ovarian cancer. Using video-assisted thoracoscopic surgery and intracavitary chemotherapy with hyperthermia, we tried hyperthermic intrathoracic chemotherapy for a case of stage IV high-grade serous ovarian cancer with pleural metastasis. There was no high-grade complication related to the procedure. The patient is alive without disease at 32 months after initial treatment.

Overexpression of microRNA-196b Accelerates Invasiveness of Cancer Cells in Recurrent Epithelial Ovarian Cancer Through Regulation of Homeobox A9.

BACKGROUND/AIM: Although microRNAs (miRNAs) are known to influence messenger RNA post-transcriptional control and contribute to human tumorigenesis, little is known about the differences in miRNA expression between primary and recurrent epithelial ovarian cancer (EOC). The purpose of this study was to assess the differential miRNA expression between primary and recurrent EOC and to investigate whether miR-196b could regulate the expression of the Homeobox A9 (HOXA9) gene, and thus affect the invasiveness of cancer cells in recurrent EOC. MATERIALS AND METHODS: Microarrays were used to generate the expression profiles of 6658 miRNAs from samples of 10 patients with EOC. miRNA expression patterns were compared between primary and recurrent EOC. Aberrantly expressed miRNA, associated genes, and invasion activities were validated by a luciferase assay and an in vitro invasion assay. RESULTS: miRNA microarray analysis identified 33 overexpressed miRNAs (including miR-196b) and 18 under expressed miRNAs in recurrent EOC from 6658 human miRNAs. HOXA9 expression was inversely correlated with miR-196b levels in recurrent EOC. We noted that miR-196b induced ovarian cancer cell invasiveness in recurrent EOC by an in vitro invasion assay. CONCLUSION: Overexpression of miR-196b may contribute to invasion activities in recurrent EOC by regulating the HOXA9 gene. Moreover, miR-196b can be a potential biomarker in recurrent EOC.

Conservative Treatment for Patients with Carcinoma in Situ-Positive Margins After a Loop Electroexcisional Procedure: Is It Safe?

OBJECTIVE: To investigate the clinical significance of and appropriate treatments for carcinoma in situ (CIS)-positive margin after a loop electroexcisional procedure (LEEP) in the management of squamous carcinoma in situ (SCIS), adenocarcinoma in situ (ACIS), and microinvasive carcinoma (MIC). STUDY DESIGN: We analyzed 232 patients who underwent a hysterectomy for CIS-positive margin. We investigated the relationship between residual lesions after hysterectomy and clinical parameters, including age, LEEP method, histologic grade of conized cervix, location of the positive margin after LEEP, results of endocervical curettage (ECC), and size of the conized specimen. RESULTS: Age, LEEP method, proximal endocervical margin positivity, and ECC positivity differed significantly between patients with residual lesions and those with no residual lesions. In a comparison between groups with residual disease of a higher or lower grade than MIC, age, LEEP method, ECC positivity, and histologic grade of conized cervix were significantly different. Age, histologic grade of conized cervix, and ECC positivity were clinical parameters significantly contributing to invasive residual lesion in multivariate regression analysis. There were no residual invasive (MIC or advanced invasive cancer) lesions observed in women <50 years old who had SCIS conized lesions after hysterectomy. CONCLUSION: Conservative treatment with close follow-up or reconization for women <50 years old who have conized SCIS lesions without ECC positivity is acceptable. However, this study does not present sufficient evidence for the conservative treatment of conized ACIS or MIC lesions with CIS-positive margins.

Total vaginal and single-port total laparoscopic hysterectomy for uterine benign diseases.

OBJECTIVE: This study aimed to review the surgical outcomes and health-related quality of life (HRQOL) of total vaginal (TVH) and single-port total laparoscopic hysterectomy (SP-TLH) for uterine benign diseases. STUDY DESIGN: This study included 121 patients who had undergone TVH or SP-TLH for uterine benign diseases between April 2011 and July 2012. Surgical outcomes, complications, and HRQOL were reviewed in the two groups. Preoperative and postoperative HRQOL data from the 36-item Short Form questionnaire (SF-36) were recorded for all patients. RESULTS: TVH was performed more often for the patients who had fewer previous operations (p = 0.32). In the TVH, there were fewer combined surgical procedures (p < 0.01), shorter operation times (p < 0.01), shorter vaginal stump suture times (p = 0.03) and lower complication rates (p < 0.01) than in SP-TLH. Overall, all SF-36 scales improved after surgery, except for the Social Functioning scale. There was no significant difference in any of the scales between the two groups. CONCLUSIONS: TVH has equivalent effects on HRQOL as SP-TLH. SP-TLH is preferred for the cases with complicated and combined procedures.

Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis.

BACKGROUND/AIMS: To determine the long-term efficacy of laparoscopic or robotic adenomyomectomy with or without gonadotropin-releasing hormone (GnRH) for the treatment of severely symptomatic adenomyosis. METHODS: Between August 2008 and May 2011, we prospectively observed 33 patients who underwent laparoscopic or robotic adenomyomectomy with uterine artery ligation for the treatment of symptomatic adenomyosis. Seventeen patients (52%) received 3-course GnRH agonist treatment after the adenomyomectomy. RESULTS: The mean operating time was 147.4 ± 52.0 min, and the mean blood loss was 36.1 ± 37.4 ml. Postoperative complications occurred in 5 patients, including 4 cases of febrile morbidity, 1 case of ileus and 1 case of pelvic abscess. Patients had statistically significant symptom relief during the 3-year follow-up period. Four of the 33 patients (12%) showed symptom relapse; 3 patients showed a relapse with dysmenorrhea and 1 patient showed a relapse with menorrhagia. There were no significant differences in terms of therapeutic outcomes between surgical-only and surgical-medical treatment. CONCLUSION: Laparoscopic or robotic adenomyomectomy was feasible and safe for women with severely symptomatic adenomyosis who requested uterine preservation. Moreover, this procedure provided long-term symptom control, regardless of postoperative GnRH agonist administration.

Robotic hysterectomy or myomectomy without power morcellation: A single-port assisted three-incision technique with manual morcellation.

BACKGROUND: The purpose of this study was to evaluate the feasibility and safety of a single-port assisted three-incision robotic hysterectomy or myomectomy with manual morcellation using a scalpel, and to introduce our novel surgical technique. METHODS: Between October 2010 and July 2014, 16 patients underwent robotic hysterectomy and 50 patients underwent robotic myomectomy using a single-port assisted three-incision technique. Manual morcellation through a single-port site without power morcellation was used to remove the uterus or uterine fibroids. RESULTS: The mean operative times were 130.2 ± 32.6 min in the hysterectomy group and 178.8 ± 77.9 min in the myomectomy group. Intraoperative complications, including a rectal serosa injury and a small bowel injury, occurred in two cases. Three febrile morbidities occurred postoperatively. Finally, no complications were associated with manual morcellation. CONCLUSIONS: Uterine tissues could be removed without any complications by manual morcellation within an endobag, using a scalpel. Copyright © 2015 John Wiley & Sons, Ltd.

Is Laparoscopic Incidental Appendectomy in Gynecological Diseases Related to Postoperative Intraabdominal Infection and Complications?

OBJECTIVE: To establish whether laparoscopic incidental appendectomy in gynecological diseases is related to postoperative intraabdominal infection and complications. STUDY DESIGN: This study was performed prospectively in 443 patients who underwent laparoscopic surgery without appendectomy (n = 222) or with appendectomy (n = 221). On postoperative day 1, drain fluid was cultured in all patients. All data were compared using Student's t test and χ2 test. RESULTS: Bacteria grew in cultures of 93 patients (21.0%): 38 (17.1%) in the nonappendectomy group and 55 (24.9%) in the appendectomy group (p < 0.01). There were statistical differences in the incidence of bacterial growth, postoperative complications, and post-operative laboratory changes for percentage of neutrophils (p < 0.01) and C-reactive protein (p < 0.01). Thirteen genera of bacteria grew in the drain culture. The 9 commensal organisms of the human intestine were identified in all patients, each 8 genera of bacteria in both groups. The surgical type did not affect the postoperative drain culture results. CONCLUSION: Postoperative bacterial growth and complications were increased in the laparoscopic incidental appendectomy group. Infections with bacteria from the intestine in both groups were also related to contamination during surgery and postoperative care.

Comparison of the Prognostic Value of F-18 Pet Metabolic Parameters of Primary Tumors and Regional Lymph Nodes in Patients with Locally Advanced Cervical Cancer Who Are Treated with Concurrent Chemoradiotherapy.

OBJECTIVE: This study investigated the metabolic parameters of primary tumors and regional lymph nodes, as measured by pre-treatment F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) to compare the prognostic value for the prediction of tumor recurrence. This study also identified the most powerful parameter in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy. METHODS: Fifty-six patients who were diagnosed with cervical cancer with pelvic and/or paraaortic lymph node metastasis were enrolled in this study. Metabolic parameters including the maximum standardized uptake value (SUVmax), the metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors and lymph nodes were measured by pre-treatment F-18 FDG PET/CT. Univariate and multivariate analyses for disease-free survival (DFS) were performed using the clinical and metabolic parameters. RESULTS: The metabolic parameters of the primary tumors were not associated with DFS. However, DFS was significantly longer in patients with low values of nodal metabolic parameters than in those with high values of nodal metabolic parameters. A univariate analysis revealed that nodal metabolic parameters (SUVmax, MTV and TLG), paraaortic lymph node metastasis, and post-treatment response correlated significantly with DFS. Among these parameters, nodal SUVmax (hazard ratio [HR], 4.158; 95% confidence interval [CI], 1.1-22.7; p = 0.041) and post-treatment response (HR, 7.162; 95% CI, 1.5-11.3; p = 0.007) were found to be determinants of DFS according to a multivariate analysis. Only nodal SUVmax was an independent pre-treatment prognostic factor for DFS, and the optimal cutoff for nodal SUVmax to predict progression was 4.7. CONCLUSION: Nodal SUVmax according to pre-treatment F-18 FDG PET/CT may be a prognostic biomarker for the prediction of disease recurrence in patients with locally advanced cervical cancer.

Comparative Study Between Total Laparoscopic and Total Robotic Radical Hysterectomy for Cervical Carcinoma: Clinical Study.

AIM: to compare surgical outcomes and health-related quality of life (HRQOL) between total laparoscopic (TLRH) and total robotic radical hysterectomy (TRRH) for cervical cancer. PATIENTS AND METHODS: Surgical outcomes and HRQOL were compared between the two groups. Pre- and postoperative HRQOL data from 36-item Short Form (SF-36) and European Organization Research and Treatment of Cancer Quality of Life-C30(EORTC QOL-C30) questionnaires were recorded. RESULTS: In the TRRH group, there were more cases of para-aortic lymphadenectomy (p<0.01), longer operative time (p<0.01), less estimated blood loss (p<0.01), and more harvested pelvic lymph nodes (p=0.04). There were no significant differences in the SF-36 and the EORTC QOL-C30 between the two groups. CONCLUSION: TRRH surgical outcomes were associated with less blood loss and more harvested pelvic lymph nodes but longer operative times with statistical significance. The short-term postoperative HRQOL outcomes did not show any significant inter-group differences.

Differential MicroRNA Expression Profiles in Primary and Recurrent Epithelial Ovarian Cancer.

BACKGROUND/AIM: Although it has been shown that microRNAs influence messenger RNA post-transcriptional control and can attribute to human tumorigenesis, little is known regarading the differences in microRNA expression between primary and recurrent epithelial ovarian cancer (EOC). The purpose of the present study was to assess the differential expression of microRNA between primary and recurrent EOC. MATERIALS AND METHODS: Between September 2013 and May 2014, the expression of microRNAs in tumor tissues from 5 primary and 5 recurrent EOC cases were analyzed. The tumor histotype was serous cystadenocarcinoma in all patients. Total RNA was extracted from tumor samples and microRNA expression levels were measured by performing microarray analysis. Expression levels were compared between the two groups and analyzed statistically. RESULTS: Several microRNAs were differentially expressed in recurrent EOC compared to primary EOC, including 18 under-expressed microRNAs and 33 over-expressed microRNAs among 6,658 human microRNAs. Four specific microRNAs were the most significantly over-expressed in recurrent EOC: miR-551b, miR-19b, miR-196b and miR-3198. Moreover, 4 specific microRNAs were the most significantly down-expressed in recurrent EOC: miR-8084, miR-3201, miR-3613 and miR-7515. CONCLUSION: Based on our data, dysregulation of microRNA expression was associated with the recurrence of EOC. Moreover, significantly over- and down-regulated microRNAs can be useful biomarkers for the prediction of recurrence in EOC.

Unabsorbed polylactide adhesion barrier mimicking recurrence of gynecologic malignant diseases with increased ¹8F-FDG uptake on PET/CT.

PURPOSE: To evaluate the incidence and characteristics of the unabsorbed polylactide adhesion barrier with increased (18)F-fluorodeoxyglucose ((18)F-FDG) uptake after surgeries for gynecologic malignancies. METHODS: Between September 2006 and November 2009, we reviewed the charts of 75 patients who were provided a polylactide adhesion barrier after surgery for gynecologic malignant diseases. We surveyed the cases of increased (18)F-FDG uptake on positron emission tomography/computed tomography (PET/CT), and evaluated the effectiveness of polylactide adhesion barrier using an adhesion scoring system. RESULTS: Ten patients (13.3 %) had a solitary pelvic mass with increased (18)F-FDG uptake in the follow up PET/CT. The characteristics of patients and tumors are described below. The median age was 48 years (range 19-66 years). The median tumor size was 1.9 cm (range 1.0-2.3 cm), and the median SUVmax of the pelvic mass was 5.1 (range 3.7-7.9). The median time between initial operations and second operation was 13.5 months (range 8-23 months). We performed laparoscopic excision of the pelvic mass, and the biopsy revealed foreign body reactions with the exception of 1 case, which contained tumor cells under the unabsorbed polylactide adhesion barrier. The median adhesion grade was 1 (range 0-2). CONCLUSIONS: A solitary pelvic mass found in the PET/CT with increased (18)F-FDG uptake after usage of a polylactide adhesion barrier may be an unabsorbed remnant. The adhesion barrier should be used with caution in patients with gynecologic malignant diseases.

Fabrication and Characteristics of High Capacitance Al Thin Films Capacitor Using a Polymer Inhibitor Bath in Electroless Plating Process.

An aluminum (Al) thin film capacitor was fabricated for a high capacitance capacitor using electrochemical etching, barrier-type anodizing, and electroless Ni-P plating. In this study, we focused on the bottom-up filling of Ni-P electrodes on Al2O3/Al with etched tunnels. The Al tunnel pits were irregularly distributed on the Al foil, diameters were in the range of about 0.5~1 µm, the depth of the tunnel pits was approximately 35~40 µm, and the complex structure was made full filled hard metal. To control the plating rate, the experiment was performed by adding polyethyleneimine (PEI, C2H5N), a high molecular substance. PEI forms a cross-link at the etching tunnel inlet, playing the role of delaying the inlet plating. When the PEI solution bath was used after activation, the Ni-P layer was deposited selectively on the bottoms of the tunnels. The characteristics were analyzed by adding the PEI addition quantity rate of 100~600 mg/L into the DI water. The capacitance of the Ni-P/Al2O3 (650~700 nm)/Al film was measured at 1 kHz using an impedance/gain phase analyzer. For the plane film without etch tunnels the capacitance was 12.5 nF/cm2 and for the etch film with Ni-P bottom-up filling the capacitance was 92 nF/cm2. These results illustrate a remarkable maximization of capacitance for thin film metal capacitors.

Role of SUVmax and GLUT-1 Expression in Determining Tumor Aggressiveness in Patients With Clinical Stage I Endometrioid Endometrial Cancer.

OBJECTIVE: The aim of this study was to determine the role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in estimating tumor aggressiveness in patients with clinical stage I endometrial cancer and the correlation between aggressiveness and expression of glucose transporter 1 (GLUT-1). METHODS: F-fluorodeoxyglucose positron emission tomography/computed tomography was performed on 43 patients with clinical stage I endometrioid endometrial cancer. (18)F-fluorodeoxyglucose uptake was quantified by calculating the maximum standardized uptake value (SUV(max)) and GLUT-1 expression status based on immunohistochemistry. RESULTS: The mean (SD) SUV(max) of the primary tumor was 8.55 (5.04). The mean SUV(max) and GLUT-1 expression in stage IB and stage IC were significantly higher than that in stage IA (P = 0.001; P = 0.003). The mean (SD) SUV(max) was 6.81 (4.55) in grade 1, 10.92 (4.61) in grade 2, and 15.35 (1.34) in grade 3 (grade 1 vs grade 2 and 3; P = 0.005). The mean (SD) GLUT-1 expression was 1.17 (0.94) in grade 1, 2.00 (0.94) in grade 2, and 3.00 (0.00) in grade 3 (grade 1 vs grade 2 and 3; P = 0.017). CONCLUSIONS: Tumor aggressiveness, such as myometrial invasion or tumor grade, had a positive correlation with the SUV(max) and GLUT-1 expression in patients with clinical stage I endometrioid endometrial cancer.

Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy.

The purpose of this study was to classify anatomical variations of the internal iliac vein (IIV) in relation to robotic or laparoscopic extended lymphadenectomy. Between March 2011 and July 2012, 60 consecutive patients underwent robotic or laparoscopic extended lymphadenectomy. We retrospectively reviewed surgical video clips and analyzed the pattern of the IIVs in the presacral area. IIV variations were classified into seven types: Type A, normal (n = 39, 65.0%); Type A with a dilated middle sacral vein (n = 5, 8.3%); Type B, left IIV connecting centrally to the left external iliac vein (n = 5, 8.3%); Type C, a separated trunk of the left IIV draining into the left central common iliac vein (CIV; n = 1, 1.7%); Type D, a separated trunk of the right IIV draining into the left central CIV (n = 8, 13.3%); Type E, a separated trunk of the right IIV draining into the right central CIV (n = 0, 0%); and Type F, separated trunks of the bilateral IIV connecting with each other before draining into the left central CIV (n = 2, 3.3%). The prevalence of IIV anomalies was 26.7%; the incidence of separated IIV trunks was 18.3%. To prevent life-threatening IIV injury during extended lymphadenectomy or sacral colpopexy, the anatomical variations of the IIVs should be known exactly.

Effect of Liquid Media on the Formation of Multi-Layer Graphene-Synthesized Metal Particles.

We report a simple approach for the production of copper nanoparticles by a wire explosion process that creates different structures in deionized (DI) water versus isopropyl alcohol (IPA) liquid media. In DI water, copper nanoparticles (CNs) are formed, while multi-layer graphene-synthesized copper nanoparticles (MGCNs) with a high degree of graphitization are formed in the IPA liquid media. The nanoparticles have an average diameter ranging from 10 nm to 300 nm and a quasi-spherical morphology. The morphologies and sizes of nanoparticles formed via this method were characterized by high-resolution transmission electron microscopy (HRTEM), field-emission scattering electron microscopy (FESEM), and analysis of dynamic light scattering (DLS). The microstructures and chemical bonding of the nanoparticles were studied by X-ray diffraction (XRD), Raman spectra measurement, and X-ray photoelectron spectroscopy (XPS). This results show an easily reproducible way to synthesize metal-core nanoparticles with multi-layer graphene shells based onto the liquid media used during synthesis. These materials can be used in the field of energy storage and as additives in the near future.

Safety and effect on quality of life of laparoscopic Douglasectomy with radical excision for deeply infiltrating endometriosis in the cul-de-sac.

OBJECTIVE: To evaluate the safety and effects on health-related quality of life (HRQOL) of radical excision of deeply infiltrating endometriosis (DIE) in the cul-de-sac. PATIENTS AND METHODS: This study included 390 patients with pathologically proven DIE in the cul-de-sac who underwent laparoscopic surgery between January 2000 and December 2011. The preoperative and postoperative visual analog scale (VAS) pain scores and HRQOL data from the 36-item Short Form (SF-36) questionnaire were recorded in 343 patients. Surgical outcomes, complications, and HRQOL were compared between patients who underwent hysterectomy and those who did not. Data were analyzed using the paired t test, Student's t test, and Pearson's correlation analysis. RESULTS: In the group overall, the VAS pain score and all SF-36 scales improved after surgery. In patients who underwent hysterectomy, all SF-36 scales improved except physical functioning, role-physical, general health, and vitality. In patients who did not undergo hysterectomy, all SF-36 scales improved except general health. There were significant associations between gonadotropin-releasing hormone agonist therapy and SF-36 mental health, SF-36 mental component summary, and oral medication use. The VAS pain score and SF-36 body pain score showed the greatest improvement, and the SF-36 general health score showed the least improvement. Patients who underwent hysterectomy had more severe disease and poorer surgical outcomes than those who did not undergo hysterectomy. CONCLUSIONS: Laparoscopic radical excision of DIE in the cul-de-sac is safe and significantly improves HRQOL, especially in terms of pain. The severity of endometriosis may affect the degree of improvement in HRQOL scores.

The magnetic properties and microstructure of Co-Pt thin films using wet etching process.

Perpendicular magnetic recording (PMR) is a promising candidate for high density magnetic recording and has already been applied to hard disk drive (HDD) systems. However, media noise still limits the recording density. To reduce the media noise and achieve a high signal-to-noise ratio (SNR) in hard disk media, the grains of the magnetic layer must be magnetically isolated from each other. This study examined whether sputter-deposited Co-Pt thin films can have adjacent grains that are physically isolated. To accomplish this, the effects of the sputtering conditions and wet etching process on magnetic properties and the microstructure of the films were investigated. The film structure was Co-Pt (30 nm)/Ru (30 nm)/NiFe (10 nm)/Ta (5 nm). The composition of the Co-Pt thin films was Co-30.7 at.% Pt. The Co-Pt thin films were deposited in Ar gas at 5, 10, 12.5, and 15 mTorr. Wet etching process was performed using 7% nitric acid solution at room temperature. These films had high out-of-plane coercivity of up to 7032 Oe, which is twice that of the as-deposited film. These results suggest that wet etched Co-Pt thin films have weaker exchange coupling and enhanced out-of-plane coercivity, which would reduce the medium noise.

Inverted Y incision and trans-sacral approach in retroperitoneal aggressive angiomyxoma: a case report.

INTRODUCTION: Aggressive angiomyxoma is a rare myxedematous mesenchymal tumor that mainly occurs in the female pelvis and perineum. The principle of treatment for aggressive angiomyxoma is surgical excision. The tumor can be removed by local excision alone when it occurs locally on the perineum. However, it cannot be completely excised by a perineal approach alone when it passes through the perineum and pelvic bone to extend into the retroperitoneal space. CASE PRESENTATION: A 34-year-old Asian woman presented with a rapidly growing left perineal mass and swelling in the left gluteal region. The swelling was associated with a mild, dull pain in the left gluteal region. In the present case of bulky aggressive angiomyxoma extending to the perineum and retroperitoneal space, the authors made an inverted Y incision through the buttock, removed the coccyx and lower portion of the sacrum, and excised the retroperitoneal mass and perineal lesion through a perineal approach. CONCLUSION: The inverted Y incision and trans-sacral approach can provide easy access to deep retroperitoneal aggressive angiomyxoma and reduce damage to neighboring organs.

Robot-assisted total preservation of the pelvic autonomic nerve with extended systematic lymphadenectomy as part of nerve-sparing radical hysterectomy for cervical cancer.

OBJECTIVE: To evaluate our short-term clinical outcomes of robot-assisted autonomic nerve-sparing extended systematic lymphadenectomy as part of nerve-sparing radical hysterectomy. METHODS: Between March 2011 and June 2012, we observed prospectively 28 consecutive patients who underwent robot-assisted autonomic nerve-sparing extended systematic lymphadenectomy, including the superior and inferior gluteal, presacral (subaortic), common iliac, and lower para-aortic nodes. RESULTS: The predominant International Federation of Gynecology and Obstetrics stage was IB1 (15 patients), followed by IB2 (5 patients), IA2 (3 patients), IIA1 (3 patients), and IIA2 (2 patients). The mean ± SD total operating time was 308.8 ± 54.9 minutes, and the mean ± SD console time was 280.0 ± 46.0 minutes. The mean ± SD blood loss was 102.7 ± 153.8 mL. The mean ± SD acquired pelvic lymph node was 27.1 ± 9.3, the mean ± SD extended lymph node was 19.2 ± 9.6, and the mean ± SD total lymph node was 46.3 ± 14.5. A total of 10 patients (35.7%) had nodal metastasis; among them, 6 patients (21.4%) had single pelvic nodal metastasis, 3 patients (10.7%) had concurrent pelvic and extended nodal metastasis, and one patient (3.6%) had single extended nodal metastasis. No intraoperative complications that required treatment occurred; however, ureterovaginal fistula was identified in 4 patients (14.3%) and ureter stricture in 4 patients (14.3%) after radiotherapy. After a median follow-up of 10 months (range, 1-16 months), there was no pelvic recurrence; however, one patient had recurrence at transposition site of ovary. CONCLUSIONS: With the advantage of delicate movement of robot instrument, robot-assisted systematic extended lymphadenectomy with total preservation of pelvic autonomic nerves did not compromise the radicality, and its surgical technique was feasible and safe. By using this approach, we could harvest more lymph nodes and have a high rate of metastatic nodes without disturbing voiding function; however, there was increased rate of urological complications. Moreover, long-term survival benefit after an extended systematic lymphadenectomy must be evaluated.