Analysis of the Safety and Pregnant Outcomes of Fertility-Sparing Surgery in Ovarian Malignant Sex Cord-Stromal Tumors: A Multicenter Retrospective Study

Background: To assess the difference in survival between fertility-sparing surgery (FSS) and radical surgery (RS) and explore pregnant outcomes after FSS in stage I malignant sex cord-stromal tumors (MSCSTs).Methods: We performed a multicenter retrospective cohort study on patients who were diagnosed with stage IA or IC MSCSTs. Inverse Probability of Treatment Weighting was performed between the FSS and RS groups. The Chi-square test and Kaplan-Meier method were used to compare the categorical variables and disease-free survival (DFS). The binary logistic regression analysis and Cox proportional hazards regression analysis were used to identify high-risk factors related to DFS and pregnancy.Results: A total of 107 patients were included, of whom 54 (50.5%) women underwent FSS, and 53 (49.5%) women underwent RS. After IPTW, 208 patients were obtained, and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7-156 months), there was no significant difference of DFS between the two groups in both unweighted cohort (P=0.969) or weighted cohort (P=0.792). In the weighted cohort, stage IC (P=0.014), tumor diameter >8 cm (P=0.003), incomplete staging surgery (P=0.003) and no adjuvant chemotherapy (P <0.001) were 4 high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully, and the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P=0.009) was associated with infertility.Conclusions: On the premise of complete staging surgery, FSS is safe and feasible in stage IA and IC MSCSTs with satisfactory reproductive outcomes.

The Feasibility and Effects in Full Staging Surgery of Endometrial Cancer by Combination of Transumbilical Single-port Laparoscopy and ERAS

BackgroundsTo study the safety, feasibility and aesthetics of transumbilical single port laparoscopic technology combined with accelerated rehabilitation surgery in stage I endometrial cancer staging surgery, and whether the laparoscopic surgery is a factor affecting the prognosis of endometrial cancer. MethodsA total of 93 patients with type I endometrial cancer stage I were enrolled in this study, including 31 cases and 62 cases in the single port and multi-port laparoscopic groups, respectively. Both groups received ERAS technology to compare the intraoperative and postoperative conditions. Subsequently, the medical records of 62 patients who had undergone open surgery were collected, and the survival, recurrence and death of the single port laparoscopic group, the multi-port laparoscopic group and the open surgery group were compared through survival analysis. ResultsThe time of surgery, intraoperative blood loss and fluid infusion volume in the single port group and the multi-port group were significantly less than those of the multi-port group (P<0.05). The single-hole group was better than the open group in terms of rapid postoperative recovery, hospitalization days, incision abdominal incision cometic effect, physical function, physical pain, vitality, and mental health (P<0.05). And there is no significant differences of mortality and recurrence among single port, multi-port and open surgery (P>0.05). Laparoscopic surgery is not a risk factor affecting OS and DFS in patients with endometrial cancer. ConclusionsTransumbilical single port laparoscopy combined with ERAS was safe and feasible for the treatment of stage I endometrial cancer with good cosmetic results and more advantages than multi-port laparoscopy.

Comparison of Left Lower Entrance and Traditional Laparoscopic Greater Omentum Resection for Stage I Ovarian Cancer

Objective : To describe the surgical method, safety and convenience of " lower left entrance laparoscopic greater omentum resection" and evaluate its clinical application value for stage I ovarian cancer. Methods: 31 patients with early stage I ovarian cancer underwent with laparoscopic staging surgery adopted " lower left entrance laparoscopic omentum resection " as the observation group, and 29 cases underwent by conventional laparoscopy as control group. The intraoperative and postoperative indexes were compared. Results: During the greater omentum resection, there was no significant difference between two groups in the blood loss, but the operation time in observation group was significantly shorter than the control group. There was no difference in postoperative hospital stay、gastrointestinal exhaust time and postoperative severe complications.Conclusion: " lower left entrance laparoscopic greater omentum resection " may be a safe and effective technique in stage I ovarian cancer.

Comparison of Penile Appearance and Outcomes Between Prefabricated Urethra and Pre-implanted Urethral Plate for Treatment of Children With Severe Hypospadias: A Retrospective Study

Objective: To compare the effect of prefabricated urethra and pre-implanted urethral plate in the treatment of severe hypospadias in children.Methods: We retrospectively analyzed the clinical data of 53 patients who diagnosed as severe hypospadias underwent staging urethroplasty from January 2015 to January 2018 in the Department of Pediatric Surgery, First People's Hospital, Zunyi City. The patients were divided into two groups: group A (n = 25) were treated with prefabricated urethra and group B (n = 28) were treated with pre-implanted urethral plate. After the second stage surgery, the ratios of complications such as urethral fistula, urethral stenosis, urethrocele, and recurrence chordee were compared. The penis was scored from meatus, glans, shaft skin, general appearance by the parents, blinded urologists according to The Pediatric Penile Perception Score, and the scores were compared too.Results: All patients were followed up after two stage operations for an average of 28 months. Glans dehiscence occurred in two patients (8%), urethral orifice stenosis occurred in one (4%) and urethral fistula occurred in three (12%) in group A. No urethral stenosis, urethrocele and recurrence chordee was observed. One patient presented urethral plate inactivation (3.6%), two patients presented urethral fistula (7.1%) and one patient presented urethral stenosis (3.6%) in group B. No urethrocele, glans dehiscence and recurrence chordee was observed. The total complication rate in group A was 24 and 14.3% in group B, respectively, and the difference was not statistically significant (P = 0.582). The differences between two groups scored by parents in glans (P = 0.030) was statistically significant. The differences between two groups scored by operators in meatus (P = 0.041), shaft skin (P = 0.000), glans (P = 0.001), and general appearance (P = 0.007) were statistically significant. The differences between two groups scored by counterparts in meatus (P = 0.006), shaft skin (P = 0.003), glans (P = 0.010), and general appearance (P = 0.014) were statistically significant.Conclusion: Both prefabricated urethra and pre-implanted urethral plate methods are suitable for correction of severe hypospadias as staging surgery in children. In general, pre-implanted urethral plate is more worthy of spread because it is much more applied in patients with small glans and achieve good appearance of penis.

Advanced ovarian malignancy in pregnancy mimicking ovarian hyperstimulation syndrome: a case report

Advanced ovarian malignancy is a rare occurrence in pregnancy. Here we report a case of primary infertility presenting in early pregnancy following invitro fertilization with features of Ovarian hyperstimulation syndrome unresponsive to treatment. Further evaluation revealed advanced ovarian malignancy. She was treated with chemotherapy followed by staging surgery at the time of elective cesarean at 35 weeks gestation. This case outlines the difficulties in diagnosis of ovarian cancer during pregnancy.

Association between Postoperative Adjuvant Chemotherapy and Disease-Specific Survival in Women with Ovarian Sex Cord-Stromal Tumors: A SEER-based Study

Background Ovarian sex cord-stromal tumors (SCSTs) are relatively rare tumor. The standard treatment is surgery, while adjuvant chemotherapy remains controversial. This study evaluated the effect of adjuvant chemotherapy and disease-specific survival (DSS) in patients with SCSTs.Methods 323 Patients with SCSTs were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic and clinicopathological characteristics were compared using Mann–Whitney U-test, Fisher’s exact test, and chi-square test. DSS were estimated by Kaplan–Meier and compared with the log-rank test. Cox proportional hazards model was used to control for confounders.Results A total of 323 patients were included in this study, and the mean age was 44 years (range, 10-89 years). The most common histologic subtype was granulosa cell tumor (GCT) (n=197, 61%). 60.7% were diagnosed with stage IA or IB disease and 18% with stage IC disease. Among them, 62.2% of patients (n=201) received chemotherapy. The Median follow-up time was 71 months (range,1-224 months). 12.7% (41/323) of patients experienced death. Patients who did not received chemotherapy (n=122) had better DSS compared to those who received chemotherapy, 5-year DSS rates were 93.5% VS 80.3% (P = 0.0005), 10-year DSS rates were 93.0% and 78.69% (P = 0.0002). Multiple Cox regression analysis showed that higher stage (p＜0.001), poor differentiation（P=0.24）, larger tumor size(size＞10cm) （P=0.018） were independently associated with an increased hazard of death，while histological subtype（P=0.082）,adjuvant chemotherapy(p=0.762), complete staging surgery（p=0.554）was not associated with prognosis.ConclusionChemotherapy could not improve the prognosis and may be associated with poorer DSS. Age, histopathologic subtype, complete staging surgery, lymphadenectomy are not associated with prognosis.

A large-scale multi-institutional study evaluating prognostic aspects of positive ascites cytology and effects of therapeutic interventions in epithelial ovarian cancer

Positive ascites cytology is a strong prognostic factor in patients with early-stage ovarian cancer (OvCa). However, limited information is currently available on the impact of positive ascites cytology on patient prognoses under each clinical background. We herein investigated the comprehensive impact of positive ascites cytology on patients with epithelial OvCa and the effectiveness of additional therapeutic interventions, including complete staging surgery and chemotherapy. Among 4730 patients with malignant ovarian neoplasms, retrospectively identified in multiple institutions, 1906 with epithelial OvCa were included. In the investigation of its effects on clinical factors using a multivariate analysis, positive ascites cytology correlated with a poor prognosis. Positive ascites cytology had a significantly worse prognosis than those with negative cytology in all subgroups except for patients with stage IV tumors and a mucinous histology. Chemotherapy may be effective in reducing the negative impact of positive ascites cytology on the prognosis of patients in terms of progression-free and overall survivals, while complete staging surgery did not improve the prognosis of patients with positive ascites cytology. Collectively, our findings suggested that positive ascites cytology had a negative impact on the prognosis of patients with epithelial OvCa, but not those with stage IV tumors or a mucinous histology.