AAGO Top Ten #022017


[1]     G. Nelson, A. D. Altman, A. Nick, L. A. Meyer, P. T. Ramirez, C. Achtari, J. Antrobus, J. Huang, M. Scott, L. Wijk, N. Acheson, O. Ljungqvist, and S. C. Dowdy, “Guidelines for postoperative care in gynecologic / oncology surgery : Enhanced Recovery After Surgery ( ERAS ® ) Society recommendations — Part II,” Gynecol. Oncol., vol. 140, no. 2, pp. 323–332, 2016.

 We provide evidence supporting postoperative management of patients undergoing gynecologic/oncology surgery. • This guideline will help integrate knowledge into practice, align perioperative care, and encourage future investigations.

 Guias ERAS parte 2: para el cuidado del pre y intraoperatorio en cirugias de ginecologia oncooógica

[2]     M. Report, “The American Society of Clinical Oncology 2016 annual meeting : A review and summary of selected abstracts,” Gynecol. Oncol., vol. 142, pp. 388–394, 2016.

 Reporte del SGO 2016: revisión y articulos seleccionados

[3]     A. A. Roma, T. Mistretta, A. Diaz, D. Vivar, K. J. Park, I. Alvarado-cabrero, G. Rasty, J. G. Chanona-vilchis, Y. Mikami, S. R. Hong, N. Teramoto, R. Ali-fehmi, D. Barbuto, J. K. L. Rutgers, and E. G. Silva, “Gynecologic Oncology New pattern-based personalized risk strati fi cation system for endocervical adenocarcinoma with important clinical implications and surgical outcome  , ☆☆,” Gynecol. Oncol., vol. 141, no. 1, pp. 36–42, 2016.

 We present a recently introduced three tier pattern-based histopathologic systemto stratify endocervical adeno- carcinoma (EAC) that better correlates with lymph node (LN)metastases than FIGO staging alone, and has the advantage of safely predicting node-negative disease in a large proportion of EAC patients. The systemconsists of stratifying EAC into one of three patterns: pattern A tumors characterized by well-demarcated glands fre- quently forming clusters or groups with relative lobular architecture and lacking destructive stromal invasion or lymphovascular invasion (LVI), pattern B tumors demonstrating localized destructive invasion (small clusters or individual tumor cellswithin desmoplastic stroma often arising frompattern A glands), and pattern C tumors with diffusely infiltrative glands and associated desmoplastic response. Three hundred and fifty-two caseswere included;mean follow-up 52.8months. Seventy-three patients (21%) had pattern A tumors; all were stage I and therewere no LNmetastases or recurrences. Pattern Bwas seen in 90 tumors (26%); allwere stage I and LVIwas seen in 24 cases (26.6%).Nodal diseasewas found in only 4 (4.4%) pattern B tumors (one IA2, two IB1, one IB not further specified (NOS)), each ofwhich showed LVI. Pattern Cwas found in 189 cases (54%), 117 had LVI (61.9%) and 17% were stage II or greater. Forty-five (23.8%) patients showed LNmetastases (one IA1, 14 IB1, 5 IB2, 5 IB NOS, 11 II, 5 III and4 IV) and recurrenceswere recorded in 41 (21.7%) patients. Thisnewrisk stratification system identifies a subset of stage I patientswith essentially no risk of nodal disease, suggesting that patientswith pat- tern A tumors can be spared lymphadenectomy. Patients with pattern B tumors rarely present with LN metastases, and sentinel LN examination could potentially identify these patients. Surgical treatmentwith nodal resection is justified in patients with pattern C tumors.

 Nuevo sistema de estratificación de adenocarcinoma del cuello de utero según el patrón morfológico de invasión para mejor predicción del status ganglionar.

[4]     G. F. Sawaya, “Cervical cancer screening in women over 65 . CON : Reasons for uncertainty,” Gynecol. Oncol., vol. 142, no. 3, pp. 383–384, 2016.

Editorial: screening en cancer cervical en mayores de 65 años. CONTRA


[5]     K. K. Shih, C. Hajj, M. Kollmeier, M. K. Frey, Y. Sonoda, N. R. Abu-rustum, and K. M. Alektiar, “Impact of postoperative intensity-modulated radiation therapy ( IMRT ) on the rate of bowel obstruction in gynecologic malignancy,” Gynecol. Oncol., vol. 143, no. 1, pp. 18–21, 2016.

Objective. The purposewas to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologicmalignancies undergoing postoperative pelvic RT. Methods. We performed a retrospective review of all patients with endometrial or cervical cancer who re- ceived postoperative pelvic RT at our institution from2000 to 2012. Patientswho received definitive or palliative RT, or those with BOdue to disease progression,were excluded. Standard two-sided statistical testswere used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis testswere performed for actuarial analysis. Results. A total of 224 patientswere identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT.Medianfollow-up timewas 67months.BOwas grade 1 (asymptomatic) in2/228 (0.9%), grade 2 (conservativemanagement) in 4 (1.8%), and grade 3≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p=0.006). Patients with BMI ≥ 30 kg/m2 were less likely to develop BO (2.6% vs. 8.3; p=0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p=0.022). Conclusions. The use of postoperative IMRT for cervical and endometrial cancer was associatedwith signifi- cant reduction in the rate of bowel obstruction. This differencemaintained its statistical significance onmultivar- iate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers.

 Estudio retrospectivo que evalua el impacto de la IMRT sobre la obstruccion intestinal en pacientes con cáncer ginecológico que requirieron RT pelviana en el postoperatorio.

[6]     V. Thomas, P. Maher, A. Ternamian, G. Vilos, A. Loddo, H. Reich, E. Downes, I. A. Rachman, L. Clevin, M. S. Abrao, G. Keckstein, M. Stark, and B. Van Herendael, “Principles of safe laparoscopic entry,” Eur. J. Obstet. Gynecol. Reprod. Biol., 2016.

 Revisión de la literatura, consideraciones y recomendaciones sobre las técnicas de entrada en laparoscopía.


[7]     S. Uccella, M. Bonzini, S. Palomba, F. Fanfani, M. Malzoni, M. Ceccaroni, R. Seracchioli, A. Ferrero, R. Berretta, E. Vizza, D. Sturla, G. Roviglione, G. Monterossi, P. Casadio, E. Volpi, D. Mautone, G. Corrado, F. Bruni, G. Scambia, and F. Ghezzi, “Gynecologic Oncology Laparoscopic vs . open treatment of endometrial cancer in the elderly and very elderly : An age-strati fi ed multicenter study on 1606 women  ,☆☆,” Gynecol. Oncol., vol. 141, no. 2, pp. 211–217, 2016.

 Objective To investigate in depth the effect of increasing age on the peri-operative outcomes of laparoscopic treatment for endometrial cancer, compared to open surgery, with stratification of patients according to the different defini- tions of elderly age used in the literature. Methods. Data of consecutive patientswho underwent surgery for endometrial cancer staging at six centers were reviewed and analyzed accordingto surgical approach (laparoscopic or open),differentdefinitions of elder- ly and very elderly age (≥65 years, ≥75 years, ≥80 years), and class of age (b65; ≥65– b 75; ≥75–80; ≥80 years). Multivariable analysis to correct for possible confounders and propensity-scorematching tominimize selection biaswere used. Results. A total of 1606 patientswere included: 938 and 668 patients received laparoscopic and open surgery, respectively.With increasing age, fewer patients received laparoscopy (P b 0.001with ANOVA). The percentage of patients who received lymphadenectomy declined significantly in both groups for age ≥80 years. Blood trans- fusions, incidence andseverity of post-operative complications, and hospital staywere significantly lower among patients who had laparoscopy both in younger (b65 years) and elderly (whether defined as ≥65 or ≥75 years) patients, with no effect of age on any of the characteristics analyzed (ANOVA: P N 0.05). The same tendency was observed among very-elderly patients (≥80 years). Multivariable and propensity score-matched analysis confirmed these findings. Conclusions. Laparoscopy for staging endometrial cancer retains its advantages over open surgery even in elderly and very-elderly patients. Our data strongly suggest that minimally-invasive surgery is advantageous even among subjects ≥80 years.

 Ventajas de la cirugia laparoscopica sobre la pobalcion anciana y muy anciana

[8]     C. S. Walsh, “Two decades beyond BRCA1 / 2 : Homologous recombination , hereditary cancer risk and a target for ovarian cancer therapy ,” Gynecol. Oncol., vol. 137, no. 2, pp. 343–350, 2015.

 Almost exactly 20 years after their discovery, the BRCA1 and BRCA2 genes have become the target of the first “personalized” therapy available for patients with ovarian cancer. In December 2014, a poly(ADP-ribose) polymerase (PARP) inhibitorwas grantedexpeditedapprovedby theUnitedStates Food andDrugAdministration for use in advanced ovarian cancer patientswith germline BRCA1/2 mutationswho have received three ormore prior lines of chemotherapy. This review article will discuss (1) the BRCA1 and BRCA2 genes within the larger context of homologous recombination deficiency; (2) the advances in our understanding of hereditary cancer risk and the dramatic shifts that have occurred in the genetic testing landscape since the landmark 2013 Supreme Court ruling invalidating patents on BRCA1 and BRCA2 genetic testing; and (3) the clinical trials leading to the approval of olaparib, the first in human PARP inhibitor.

 Una revision del estudio sobre BRCA 1/ BRCA2 y su uso en la terapeutica actual.


[9]     A. A. Wright, K. Bohlke, D. K. Armstrong, M. A. Bookman, W. A. Cliby, R. L. Coleman, D. S. Dizon, J. J. Kash, L. A. Meyer, K. N. Moore, A. B. Olawaiye, J. Oldham, R. Salani, D. Sparacio, W. P. Tew, I. Vergote, and M. I. Edelson, “Neoadjuvant Chemotherapy for Newly Diagnosed , Advanced Ovarian Cancer : Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline,” J. Clin. Oncol., vol. 34, 2016.

 Panel de expertos y revisión sistemática: Guia para el uso de la quimioterapia neoadyuvante y cirugia de intervalo en mujeres con estadio IIIC o IV de cancer de ovario.


 [10]     A. A. Wright, K. Bohlke, D. K. Armstrong, M. A. Bookman, W. A. Cliby, R. L. Coleman, D. S. Dizon, J. J. Kash, L. A. Meyer, K. N. Moore, A. B. Olawaiye, J. Oldham, R. Salani, D. Sparacio, W. P. Tew, I. Vergote, and M. I. Edelson, “Neoadjuvant chemotherapy for newly diagnosed , advanced ovarian cancer : Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline ,” Gynecol. Oncol., vol. 143, no. 1, pp. 3–15, 2016.

 Purpose. To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Methods. The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. Results. Four phase III clinical trials form the primary evidence base for the recommendations. The pub- lished studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioper- ative morbidity and mortality. Recommendations. All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred).Women with a high peri- operative risk profile or a low likelihood of achieving cytoreduction to b1 cmof residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fitfor primary cytoreductive surgery, andwith potentially resectable disease,may receive either neoadjuvant chemother- apy or primary cytoreductive surgery.However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to b1 cm(ideally to no visible disease)with acceptablemorbidity. Be- fore neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer.

 Panel de expertos y revisión sistemática de la literatura: Guía práctica sobre la quimioterapia neoadyuvante para el cancer de ovario avanzado.