Health-related quality of life in patients with newly diagnosed advanced ovarian cancer treated with niraparib vs placebo: Results from the phase 3 randomized PRIMA/ENGOT-OV26/GOG-3012 trial.

Objective: To assess patient-reported health-related quality of life (HRQoL) in patients with ovarian cancer (OC) who received niraparib as first-line maintenance therapy.

Methods: PRIMA/ENGOT-OV26/GOG-3012 (NCT02655016) enrolled patients with newly diagnosed advanced OC who responded to first-line platinum-based chemotherapy. Patients were randomized (2:1) to niraparib or placebo once daily in 28-day cycles until disease progression, intolerable toxicity, or death.

testing in women with high-grade serous ovarian cancer: gynecologic oncologist-initiated testing compared with genetics referral.

Objective: Up to 15% of patients with high-grade serous ovarian, tubal, or peritoneal carcinoma harbor a mutation in genes. Early notion of mutation status may facilitate counseling, predict prognosis, and increase access to Parp-inhibitors. The aim of this study was to examine the rate of germline genetic testing in a retrospective cohort of women with high-grade serous ovarian, tubal, or peritoneal carcinoma to determine if a new pilot project of gynecologic oncologist-initiated genetic testing improved the rate of testing, after 1 year of implementation.

Real-world direct healthcare costs of treating recurrent high-grade serous ovarian cancer with cytotoxic chemotherapy.

To describe the direct healthcare costs associated with repeated cytotoxic chemotherapy treatments for recurrent high-grade serous cancer (HGSC) of the ovaries. Retrospective review of 66 women with recurrent stage III/IV HGSC ovarian cancer treated with repeated lines of cytotoxic chemotherapy in a Canadian University Tertiary Center. Mean cost of treatment of first relapse was CAD$52,227 increasing by 38% for two, and 86% for three or more relapses with median overall survival of 36.

Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer.

Background: Niraparib, an inhibitor of poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP), has been associated with significantly increased progression-free survival among patients with recurrent ovarian cancer after platinum-based chemotherapy, regardless of the presence or absence of mutations. The efficacy of niraparib in patients with newly diagnosed advanced ovarian cancer after a response to first-line platinum-based chemotherapy is unknown.

Methods: In this randomized, double-blind, phase 3 trial, we randomly assigned patients with newly diagnosed advanced ovarian cancer in a 2:1 ratio to receive niraparib or placebo once daily after a response to platinum-based chemotherapy.

Adjuvant therapy in stage III endometrial cancer confined to the pelvis.

Objective: To review outcomes of patients with stage III endometrial cancer confined to the pelvis treated with adjuvant pelvic radiotherapy (RT) or sequential chemoradiotherapy (CRT).

Methods: Between 1990 and 2012, 144 patients diagnosed with stage IIIA, B or C1 endometrial cancer were treated in our institution. All were treated with total hysterectomy, bilateral salpingo-oophorectomy ± lymph node dissection.

Clinical significance of isolated tumor cells and micrometastasis in low-grade, stage I endometrial cancer.

Introduction: Ultrastaging in endometrial cancer (EC) led to increased detection of isolated tumor cells (ITC, ≤0.2 mm) and micrometastases (MM, 0.2-2 mm), with unclear effect on prognosis.

Evaluation of liquid from the Papanicolaou test and other liquid biopsies for the detection of endometrial and ovarian cancers.

We report the detection of endometrial and ovarian cancers based on genetic analyses of DNA recovered from the fluids obtained during a routine Papanicolaou (Pap) test. The new test, called PapSEEK, incorporates assays for mutations in 18 genes as well as an assay for aneuploidy. In Pap brush samples from 382 endometrial cancer patients, 81% [95% confidence interval (CI), 77 to 85%] were positive, including 78% of patients with early-stage disease.

Laparoscopic Ureteroneocystostomy: Be Prepared!

Study Objective: To assess the outcomes and complications of laparoscopic ureteroneocystotomy in gynecologic surgery.

Design: We retrospectively reviewed all medical records of patients who underwent ureteroneocystostomy between April 2008 and May 2012.

Design Classification: Retrospective case series study.

Advancing surgical simulation in gynecologic oncology: robotic dissection of a novel pelvic lymphadenectomy model.

Introduction: Pelvic lymphadenectomy is a key component of the surgical treatment of several gynecologic cancers and involves mastery of complex anatomic relationships. Our aim was to demonstrate that the anatomy relevant to robotic pelvic lymphadenectomy can be modeled using low-cost techniques, thereby enabling simulation focused on surgical dissection, a task that integrates technical skills and anatomic knowledge.

Methods: A model of pelvic lymphadenectomy was constructed through experimentation with several different materials and a number of prototypes.

Surgical management of non-epithelial ovarian malignancies: advantages and limitations of laparoscopy.

Objective: To compare open and laparoscopic surgery in the management of non-epithelial ovarian malignancies.

Study Design: Retrospective study from University Hospital of Clermont-Ferrand, France, of 20 patients undergoing surgery for non-epithelial ovarian malignancies. We compared the outcome of 13 open surgeries and 7 laparoscopic surgeries.

What's the impact of the obesity on the safety of laparoscopic hysterectomy techniques?

Objective: To evaluate the impact of obesity in the safety of laparoscopic hysterectomy.

Study Design: A retrospective study was conducted using a database of 2271 women undergoing laparoscopic hysterectomy for benign diseases between January 1995 and December 2008 at the Centre Hospitalier Universitaire Estaing (Clermont-Ferrand, France). Patients were divided into two groups according to the body mass index: <30 kg/m(2) (n=2088) and ≥ 30 kg/m(2) (n=183).

Ovarian carcinomatosis: how the radiologist can help plan the surgical approach.

Ovarian carcinoma is the most common cause of death due to gynecologic malignancy. Peritoneal involvement is present in approximately 70% of patients at the time of initial diagnosis. The disease spreads abdominally by direct extension, exfoliation of tumor cells into the peritoneal space, and dissemination of tumor cells along lymphatic pathways.

Impact of intraperitoneal pressure of a CO2 pneumoperitoneum on the surgical peritoneal environment.

Background: Animal experiments have suggested that a high intraperitoneal pressure (IPP) might adversely affect the surgical peritoneal environment. The present experimental study investigates the impact of IPP of a CO(2) pneumoperitoneum on human peritoneum.

Methods: Patients undergoing laparoscopic surgery were subjected to either low (8 mmHg) or standard (12 mmHg) IPP.

Educational value of an intensive and structured interval practice laparoscopic training course for residents in obstetrics and gynecology: a four-year prospective, multi-institutional recruitment study.

Objective: To assess the educational value of an ongoing interval practice laparoscopy training program among obstetrics and gynecology residents.

Design: Prospective cohort, multi-institutional recruitment study. We conducted structured laparoscopic training sessions for residents, using both inanimate and porcine models.

[Optical biopsy: the surgical perspective].

Several new intraoperative imaging techniques, often described under the generic term "optical biopsy", have been developed over the last twenty years. The term optical biopsy in fact covers two distinct approaches. The first is endomicroscopy, which provides the surgeon with histologic images comparable to those obtained by the pathologist in the laboratory.

Long-term follow-up after laparoscopic management of endometrial cancer in the obese: a fifteen-year cohort study.

Study Objective: To assess the surgical outcomes and long-term results of laparoscopic treatment of endometrial cancer in obese patients, and compare these results with those of nonobese women.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Two referral cancer centers.

Is laparoscopic hysterectomy feasible for uteri larger than 1000 g?

Objective: To evaluate the feasibility of laparoscopic hysterectomy for uteri weighing more than 1000 g.

Study Design: A retrospective study was conducted in a tertiary center of laparoscopic surgery including 38 women submitted to hysterectomy for uteri weighing more than 1000 g. Patients submitted to open hysterectomy were compared to those submitted to laparoscopic hysterectomy.

Comparison between standard and reverse laparoscopic techniques for rectovaginal endometriosis.

Background: This study was designed to compare the surgical outcomes of standard and reverse laparoscopic techniques for the treatment of rectovaginal endometriosis.

Methods: A retrospective study was conducted in a teaching and research hospital (tertiary center), which included 75 women subjected to laparoscopic treatment of rectovaginal endometriosis that required both vaginal resection and rectal surgery. Standard and reverse laparoscopic techniques were compared in 35 and 40 women, respectively.

Surgical outcomes of laparoscopic hysterectomy for enlarged uteri.

Study Objective: To compare surgical outcomes of laparoscopic hysterectomy for benign diseases according to the uterine weight.

Design: Retrospective study (Canadian Task Force classification II-3).

Setting: Teaching and research hospital, a tertiary center.

Impact of intraperitoneal pressure and duration of surgery on levels of tissue plasminogen activator and plasminogen activator inhibitor-1 mRNA in peritoneal tissues during laparoscopic surgery.

Background: Our objective was to evaluate the impact of intraperitoneal pressure (IPP) and duration of a CO(2) pneumoperitoneum on the peritoneal fibrinolytic system during laparoscopic surgery.

Methods: Human study: Patients undergoing laparoscopic surgery were divided into two groups: low (8 mmHg, n= 32) or standard (12 mmHg, n= 36) IPP. Normal peritoneum was collected from the parietal wall at the beginning of surgery and every 60 min thereafter.

Do patients manage to achieve pregnancy after a major complication of deeply infiltrating endometriosis resection?

Objective: To evaluate the fertility status in women suffering from major postoperative complications following deep endometriosis surgery.

Study Design: A retrospective study in teaching and research hospitals (tertiary centers) including 23 women submitted to the surgical treatment for deep endometriosis and presenting a major postoperative complication. Postoperatively, women desiring pregnancy who conceived were compared to those who did not conceive using Mann-Whitney test and Fisher's exact test.

Incidence of intraabdominal adhesions in a continuous series of 1000 laparoscopic procedures.

Objective: The objective of the study was the laparoscopic evaluation of the incidence of intraabdominal adhesions related to prior abdominal surgery.

Study Design: This was a prospective monocentric study including a continuous series of 1000 gynecologic laparoscopic procedures. Data were collected on history of abdominal surgery.

Carbon dioxide pneumoperitoneum, intraperitoneal pressure, and peritoneal tissue hypoxia: a mouse study with controlled respiratory support.

Background: Animal experiments have suggested that the laparoscopic peritoneal environment is hypoxic. This study aimed to investigate whether peritoneal tissue is hypoxic on a cellular level during a carbon dioxide (CO(2)) pneumoperitoneum at different intraperitoneal pressures (IPPs) and to determine the short-term effects of surgical injury on the hypoxia status of peritoneal tissue in the injured peritoneum and the distant noninjured peritoneum at cellular and molecular levels.

Methods: Experiment 1: Mice were divided into five groups according to the following treatments: anesthesia alone, laparotomy, and CO(2) pneumoperitoneum at IPPs of 2, 8, or 15 mmHg.

Assessment of sentinel nodes for gynecologic malignancies by natural orifices transluminal endoscopic surgery (NOTES): preliminary report.

Objective: To assess the feasibility of sentinel lymph node (SLN) biopsy in gynecologic malignancies using natural orifices transluminal endoscopic surgery (NOTES) in an animal model.

Methods: Ten female pigs were operated. Patent blue dye was injected in the paracervical region.