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Objective: The main objective of this study was to analyze the pattern of recurrence after conization and pelvic lymphadenectomy in early-stage cervical cancer (CC). Methods: We retrospectively identified 60 patients with early-stage CC who referred to the European Institute of Oncology (IEO; Milan, Italy) for fertility-sparing surgery. All of them underwent conization and pelvic lymphadenectomy (one received neoadjuvant chemotherapy followed by simple trachelectomy because of the size of the tumor). Results: In total, 54 patients were considered for final analysis; only 23 patients were entirely treated at IEO. Relapse occurred in 7 (13%) of 54 patients, and in 6 cases (86%) it was local. One patient experienced a pelvic lymph node recurrence (in a woman who conceived 4 months after conservative surgery). However, this was an atypical case for site and timing of recurrence with the consistent doubt that the nodal involvement was already present before conization. Thus, analyzing only IEO population, the recurrence rate was lower (9%), becoming 4% excluding the atypical case with nodal involvement. Conclusions: In our series, the relapse was mainly local (on the cervix). However, the pattern of recurrence and recurrence rates after conization and pelvic lymphadenectomy for early-stage CC are still unclear. Further studies, comparing conization with radical trachelectomy, are necessary to confirm that the adoption of this procedure in clinical practice is safe. Our data highlight that the management of such as a particular condition in dedicated and highly specialized centers is mandatory. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare surgical outcomes using modified (type II) and traditional (type III) abdominal radical trachelectomy (ART) for fertility-sparing surgery in early cervical cancer.A prospectively maintained database of ART procedures was analyzed. Data were collected regarding age, stage, histology, operative outcome, surgical complication, and fertility outcome.We performed 23 fertility-sparing ARTs for patients with International Federation of Gynecology and Obstetrics stages IA to IB1 tumors of less than 2 cm between 2006 and 2010. Type III ART was attempted in 8 patients and modified ART in 15 patients. The median operating time was greater in the type III group compared with that in the type II group (305 vs 247 minutes; P < 0.02). The median surgical blood loss was greater in the type III ART group (580 mL; range, 250-988 mL) compared with that in the modified type II group (366 mL; range, 200-850 mL; P < 0.05). The median time to recovery of bladder dysfunction was less in the type II group (9 days; range, 3-10 days) than that in the type III group (13 days; range, 10-23 days; P < 0.01). There were no recurrences at the time of this report.Type II ART provides surgical and pathological outcomes with better recovery of bladder function similar to those in type III ART. For patients with early cervical cancer who wish to preserve reproductive function, type II ART is a feasible and safe operation. [ABSTRACT FROM AUTHOR]

Preservation of fertility has became a very important issue in gynecologic oncology. It is a result of both the increasing incidence of gynecologic cancer in young patients and the increasing age at first pregnancy. Today, in a young patient with a gynecologic cancer, preservation of fertility is possible and depends primarily on the extent and type of cancer.The clinical importance of an appropriate management of young patients with gynecologic cancer has lead the ESGO Task Force for Fertility Preservation in Gynecologic Cancer to conduct a survey with the aim of exploring the numbers and eligibility of gynecologic cancer patients for fertility-sparing treatment in selected gynecologic oncology centers across Europe. A questionnaire designed to allow adequate insight into the number of patient eligible for fertility-sparing treatment and the resulting treatment was sent to 20 ESGO-accredited centers. The data were collected retrospectively for the year 2007. The reply was received from 14 gynecologic oncology centers, and those surveys were included for analysis.The small numbers of patients eligible for conservative management (14-15 per year/median number in ESGO-accredited centers) and even the smaller number of those who actually receive fertility-sparing treatment (<10) raise the question of quality of care for these patients. These low numbers support the concept of centralization for fertility-sparing management to improve the quality of patients care. Since carrying out the survey on fertility-sparing management in ESGO-accredited gynecologic oncology centers in Europe, the ESGO Task Force for Fertility Preservation in Gynecologic Cancer has proposed a protocol for referrals to centralized units that have developed specific expertise.Optimal management for young patients with gynecologic cancer should include a clear decision-making process, an adequate counseling about the future oncological and obstetrical risks, the appropriate management, and a careful follow-up within a multidisciplinary setting. [ABSTRACT FROM AUTHOR]

Conservative surgical management of ovarian neoplasms can result in favorable oncologic and obstetric outcomes.All reproductive-age women (18-45 years old) with stage IA to stage IIC ovarian neoplasms (N = 161) were retrospectively identified from a single institution's tumor registry between 1990 and 2007. Operative, pathological, outpatient, and delivery records were reviewed to confirm histological findings, stage, extent of surgical resection, adjuvant treatment, oncologic outcomes, and pregnancy outcomes.Women who underwent conservative surgical management for ovarian neoplasms (n = 61 [37.9%]) were identified, including those with low malignant potential (LMP, n = 36), epithelial (n = 12), germ cell (n = 6), and sex cord (n = 7) tumors. Thirteen women conceived 23 pregnancies, producing a pregnancy rate of 25.0% overall and of 68.4% for those attempting conception. Women with LMP tumors conceived most pregnancies and had the highest number of antenatal complications. Of those receiving adjuvant chemotherapy (n = 8), 12.5% were able to conceive after their treatment and with no reported congenital anomalies. Pregnancy after a diagnosis of ovarian neoplasm did not impact disease recurrence (0% vs 7.7%, P = 0.56) or survival (100% vs 100%, P = 1.0).Conservative surgery may be an acceptable option for reproductive-age women with early-stage ovarian neoplasms. We report pregnancy and oncologic outcomes for a cohort of women managed conservatively for LMP, epithelial, germ cell, and sex cord ovarian neoplasms. [ABSTRACT FROM AUTHOR]