Objective:To analyze and summarize the oncological outcomes after laparoscopic radical trachelectomy (LRT) for early stage cervical cancer.Methods:The clinical data and follow-up results of 148 patients with early stage cervical cancer who underwent LRT in Renji Hospital, School of Medicine, Shanghai Jiao Tong University from July 2014 to June 2023 were collected, while tumor outcomes and postoperative pregnancy were analyzed retrospectively.Results:(1) General situation: the median age of 148 patients with LRT was 33 years (range: 19-42 years). Pathological type: 111 cases of squamous cell carcinoma, 36 cases of adenocarcinoma, 1 case of adenosquamous carcinoma. International Federation of Gynecology and Obstetrics (2018) stage: 17 cases of stage Ⅰa1 with lympho-vascular space invasion, 25 cases of stage Ⅰa2, 102 cases of stage Ⅰb1, and 4 cases of stage Ⅰb2. (2) Tumor outcomes: 148 patients were followed up regularly after LRT, and the median follow-up time was 59 months (range: 2-104 months). During the follow-up period, 5 cases of tumor recurred (including 1 death), and the median recurrence time was 10 months (range: 4-33 months). Among them, there were 3 cases of pelvic metastasis, 1 case of distant metastasis, and 1 case of both pelvic and distant metastasis. Both 3-year and 5-year disease-free survival rates of 148 patients were 94.5%, and the 5-year overall survival rate was 98.9%. (3) Postoperative pregnancy: among 148 patients with LRT, 67 patients had pregnancy requirements, followed up for 1 year, and 20 of them were pregnant, with a pregnancy rate of 29.9% (20/67). Among the 20 pregnant patients, 2 cases early abortion, 1 case mid-term abortion, and 17 cases gave birth (including 4 cases of premature birth and 13 cases of full-term birth).Conclusion:Under the condition of strict control of surgical indications, guaranteed surgical scope and tumor-free operation, LRT in patients with early cervical cancer has a good outcome.

Background: The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with clinically normal lymph nodes and was associated with a higher incidence of operative complications. However, there is no consensus on whether lymphadenectomy has survival benefit or not in early epithelial ovarian cancer (EOC). Methods We designed the LOVE study, a multicenter, randomized controlled, phase III trial to compare the efficacy and safety of comprehensive staging surgery with or without lymphadenectomy in stages IA-IIB EOC and fallopian tube carcinomas (FTC). The hypothesis is that the oncological outcomes provided by comprehensive staging surgery without lymphadenectomy are non-inferior to those of conventional completion staging surgery in early-stage EOC and FTC patients who have indications for post-operative adjuvant chemotherapy. Patients assigned to experimental group will undergo comprehensive staging surgery, but lymphadenectomy. Patients assigned to comparative group will undergo completion staging surgery including systematic pelvic and para-aortic lymphadenectomy. All subjects will receive 3–6 cycles of standard adjuvant chemotherapy. Major inclusion criteria are pathologic confirmed stage IA-IIB EOC or FTC, and patients have indications for adjuvant chemotherapy either confirmed by intraoperative fast frozen section or previous pathology after an incomplete staging surgery. Major exclusion criteria are non-epithelial tumors and low-grade serous carcinoma. Patients with severe rectum involvement which lead to partial rectum resection will be excluded. The sample size is 656 subjects. Primary endpoint is disease-free survival.

Humans ; COVID-19 ; Consensus ; SARS-CoV-2 ; China

Energy devices have been widely used in gynecological surgeries. From the overall development trend, energy devices improve the efficiency of surgery. The continuous updating and upgrading of energy devices also reduces surgical complications and improves the safety of surgery. The injury caused by energy devices is not only related to the complexity of the operation or the disease itself, but also closely related to whether the operator can reasonably choose and master the use of energy instruments, as well as the surgical skills and experience of the operator. Surgeons should establish the concept of " prevention is better than remedy" when using energy instruments. We should take the initiative to learn and master the working principle of different energy devices, understand the design characteristics of each product and improve the skills of device use, so as to minimize the complications caused by various energy instruments and bring real benefits to doctors and patients.

Objective:To investigate the value of positron emission tomography/computed tomography (PET/CT) in diagnosis of retroperitoneal lymph node metastasis for early cervical cancer.Methods:Retrospectively analyze the preoperative PET/CT examination results and postoperative pathological results of patients with early cervical cancer who underwent surgical treatment from May 5, 2019 to August 31, 2020, and analyze the clinical characteristics, so as to explore the high risk factors of PET/CT in the diagnosis of retroperitoneal lymph node metastasis.Results:The accuracy, sensitivity, specificity and area under the curve (AUC) of PET/CT in the diagnosis of retroperitoneal lymph node metastasis were 75.2%, 60.0%, 81.3% and 0.707, respectively. Univariate analysis showed that 2009 International Federation of Gynecology and Obstetrics (FIGO) stage, tumor diameter >4 cm, lymphovascular space involvement (LVSI) positive, depth of invasion, high squamous cell carcinoma antigen (SCC-Ag) level and cytological grade were important factors for PET/CT in the diagnosis of retroperitoneal lymph node metastasis ( P<0.05); Multivariate analysis showed that tumor diameter >4 cm was an independent risk factor for PET/CT diagnosis of retroperitoneal lymph node metastasis ( P=0.015). Conclusions:PET/CT has a certain diagnostic value in the evaluation of retroperitoneal lymph node metastasis, but it can not fully reflect the facticity of lymph node metastasis; tumor diameter > 4cm is an independent risk factor for PET/CT in the diagnosis of retroperitoneal lymph node metastasis.

Since 2018,the controversy between laparotomy and minimally invasive surgery for cervical cancer has been paid attention widespread,In addition,we should analyze the other problems in cervical cancer surgery objectively and comprehensively.Laparoscopic surgery has been rapidly popularized in China due to its advantages over the past 10 years.However,there are still many points in the treatment of cervical cancer in China,such as not paying attention to the concept of tumor-free,not strictly grasping the indications for surgery,inadequate surgical scope,and lack of oncologist training,etc,which needs we pay more attention.In order to obtain the best therapeutic effect,we not only pay attention to the discuss of laparotomy and minimally invasive of the cervical cancer,but should also pay attention to the nature of tumor treatment.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Objective Systematic pelvic lymph node ( SPLN) +abdominal paraaortic lymph node ( APLN) dissection re-mains controversial in the treatment of endometrial carcinoma , especially in the early stage of the tumor .This study aims to investigate the value and safety of APLN dissection in the treatment of early-stage endometrial carcinoma . Methods We retrospectively ana-lyzed the clinical data about 109 cases of early-stage endometrial adenocarcinoma , 56 treated by SPLN dissection ( group A ) and the other 53 by SPLN+APLN dissection ( group B ) .We compared the postoperative complications , recurrence and metastasis , and progno-sis-related factors between the two groups of patients . Results No statistically significant difference was found in the incidence rate of postoperative complications between groups A and B ( 19.64% vs26.41%, P>0.05).Recurrence and metastasis were found in 12 of the 109 patients, 10 in group A and 2 in group B (17.86%vs 3.77%, P=0.019).Multivariate logistic regression analysis showed that the independent factors of recurrence and metastasis includ -ed the differentiation degree (OR=7.385, 95%CI:1.877-29.062), pathologic stage (OR=5.444, 95%CI:1.673-17.720), range of lymph mode dissection (OR=19.171, 95%CI:2.242 -163.946), and range of lesion focus (OR=12.524, 95%CI:1.186-132.280), with the range of lymph mode dissection as the greatest influencing factor on prognosis . Conclusion SPLN+APLN dissection can reduce the recurrence and metastasis and improve the prognosis of early -stage endometrial adenocarcinoma , and therefore is safe and feasible for the treatment of the tumor .

Objective To explore the outcomes of the oncology, the fertility and pregnancy on patients with early-stage cervical cancer after undergoing fertility-sparing treatments, and to investigate its value on clinical treatment. Methods A total of 29 patients with cervical cancer (stage Ⅰa2-Ⅰb1) who had undergone the fertility-sparing treatments in Renji Hospital, School of Medicine, Shanghai Jiaotong University from February 2010 to September 2015 were analyzed retrospectively. Surgical procedures included transvaginal cervical cold knife conization (CKC)+laparoscopic pelvic lymphadenectomy (PLD) or total laparoscopic uterine cervix extensive resection (RT; contains PLD); 48 patients with early cervical cancer under going laparoscopic uterine extensive resection (RH; contains PLD) by the same group of physicians in the same period were chosen as the control group. The perioperative related indicators, postoperative specimen examination, pregnancies after surgery and postoperative tumor follow-up results were retrospectively analyzed and compared between the two groups. Results (1) Among these 29 patients in the study group, 26 cases were underwent the fertility-sparing surgery quick frozen pathological examinations were positive in 3 cases, which underwent total laparoscopic RT eventually. (2) The perioperative related indicators: compared with the study group and the control group, the operation time [(182 ± 21), (147 ± 24) minutes, respectively] has significant difference (t=6.563, P<0.01). There were no significant difference (P>0.05) in intra-operative blood loss [(102±26), (99±34) ml], postoperative aerofluxus time [(1.3±0.4), (1.1±0.9) days], the average length of hospital stay [(11.2 ± 2.1), (10.6 ± 3.5) days], rate of urine retention [10%(3/29), 10%(5/48)] and rate of postoperative infection [3%(1/29), 2%(1/48)]. (3)Postoperative specimen examination:compared with the study group and the control group, there were no significant difference (P>0.05) innumber of removed lymphatic nodes (23.4 ± 4.1, 22.8 ± 3.9), length of cardinal ligament [(2.9 ± 0.5), (3.0 ± 0.6) cm], lengthof uterosacral ligament [(2.6±0.7), (2.8±0.4) cm], length of removed vaginal [(3.4±0.3), (3.5±0.3) cm]. (4) Pregnancies after surgery and postoperative tumor follow-up results:in the study group, only 14 patients had fertility requirement after treatments. Pregnancies occurred in 5 women (5/14), which included1 case of full-term labor, 1 case of preterm labor, and 3 cases of spontaneous abortion. The Average follow-up time in postoperative patients of the study group and control group was 29.4, and 30.2 months respectively. In follow-up period, compare with study group and the control group, there was no significant difference (χ2=0.004, P>0.05) in the recurrence rate [4%(1/26), 4%(2/48)]. Conclusion Fertility-sparing surgery of early-stage cervical cancer is safe but the outcome of the fertility and pregnancy is still need toimprove.

Background and purpose:A variety of measures are taken preoperatively to reduce the tumor size of stageⅠb2 bulky cervical cancer before surgery. Which one is safer and more effective, currently, there is no consensus. This article compared the effect in 3 different treatment methods (neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and operation) on patients with stageⅠb2 bulky cervical cancer, and provided evidence for clinical decision. Methods:Retrospective analysis the clinical date of 133Ⅰb2 bulky cervical cancer patients, who received preoperative neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and direct operation from Apr. 2006 to Oct. 2010 in our hospital. Results: The effective rates of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy group were 91.8% and 92.5%, respectively, there was no statistical difference(P>0.05). The tumor size got smaller after treatment compared with the size before treatment (P<0.05);The pathological efifciency rates were 95.56%and 97.30%, respectively, the difference was not statistically significant (P>0.05). The bleeding volume of neoadjuvant chemo radio therapy group was significantly higher than those in the other 2 groups (158.9±50.7 vs 116.8±45.5, 123.1±30.2;P<0.05), the infection of immediate surgery group was more severe than the other 2 groups (P<0.05). The pairwise comparison of average operation time in neoadjuvant chemotherapy group, neoadjuvant chemoradiotherapy group, and the immediate surgery group, pairwise comparisons of neoadjuvant chemotherapy group and the immediate surgery group in bleeding, comparion of neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group on postoperative infection, and the comparison of the 3 groups on pelvic organ injury and lymphocele, had no statistical difference(P>0.05);Pathological examination showed that vascular invasion in surgery group had statistical differences than other 2 groups (P<0.05), there was no patient with positive margin in the 3 groups, and the lymph node metastasis rates also had no statistical difference (P>0.05);Besides, there were no statistical difference on vascular invasion between the 3 groups (P>0.05);And on 3-year overall survival, disease-free survival there was no statistical difference between the 3 groups (P>0.05). Conclusion:Neoadjuvant chemotherapy can effectively reduce tumor size for patients with stage Ⅰb2 bulky cervical cancer before operation, it is better than direct surgery or preoperative chemoradiotherapy in improving the resection rate, and reducing postoperative pathological positive rate, and infection. Neoadjuvant chemotherapy can improve the pathological complete remission rate. The combination of radiation and chemotherapy might produce synergistic effect on huge cervical tumor, but it can’t improve the survival rate. Therefore, neoadjuvant chemotherapy is the best choice for the stageⅠb2 cervical cancer patients. Therefore, a long-term follow-up or large sample randomized controlled trials is necessary to assess the prognosis of preoperative neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.