Magdalena Bizoń

Minimally invasive surgery is the method of choice in endometrial cancer. Experience in procedures assisted by a robotic system is growing rapidly. One of the new bipolar ones is a Vessel Sealer, with sealing and cutting function. The aim of the study was to compare robotic surgery assisted with the da Vinci X system with use of the Vessel Sealer or without it. The study included 25 patients with high-risk endometrial cancer after completed pelvic and paraaortic lymphadenectomy with mean age 60.07 ± 10.67 (range 34.69–83.23) years divided into two groups: one with use of the Vessel Sealer; the second one only with monopolar scissors and subdivided by one-site versus dual docking. Duration of the operation was significantly associated with previous surgery (p < 0.005). Use of the Vessel Sealer was associated with lower blood loss during surgery (p < 0.05). The number of removal pelvic lymph nodes was higher in case of Vessel Sealer with no relation to BMI. Experience in robotic surgery allowed for shortened operation time and led to better outcomes. The Vessel Sealer used in robotic surgery appears to reduce blood loss during surgery and operation time, especially in the case of previous surgery, however, it increases costs of the procedure.

Ovarian cancer is among the most lethal gynecologic malignancies, often diagnosed at advanced stages due to a lack of effective screening tools. Recent studies suggest that the platelet-to-lymphocyte ratio (PLR), an indicator of systemic inflammation, may serve as a potential biomarker for diagnosing and staging ovarian cancer. We conducted a systematic review and meta-analysis, adhering to PRISMA guidelines. We searched the PubMed/Medline, Scopus, Web of Science, and EMBASE databases. We pooled data using a random-effects model to assess the sensitivity, specificity, and diagnostic performance of PLR in ovarian cancer. The meta-analysis of 22 studies comprising 5740 participants showed significantly elevated platelet-to-lymphocyte ratio (PLR) values in ovarian cancer patients compared to healthy controls, with a mean difference of 46.84 (p < 0.001). Additionally, PLR demonstrated utility in distinguishing benign from malignant lesions and early-stage from advanced-stage ovarian cancer. While PLR shows potential as a cost-effective and accessible biomarker for ovarian cancer diagnosis and staging, its diagnostic accuracy remains moderate. Therefore, combining PLR with other diagnostic tools enhances clinical decision-making.

Purpose of the Report: Endometrial cancer is the most common gynecological cancer. Prostate-specific membrane antigen (PSMA) is expressed in prostate cancer cells but can be found in other cancers, such as endometrial cancer, during angiogenesis. The aim of this prospective pilot study was to evaluate the feasibility of using ⁶⁸Ga-PSMA-11 PET/CT in endometrial cancer patients before surgical treatment. Patients and Methods: Seven women with a mean age of 58 ± 7.9 years were included in the study. All patients underwent standard imaging studies involving transvaginal ultrasound, ceCT scans of the chest and abdomen, and MRI as qualified for surgery. Additionally, PET/CT was performed on a Siemens Biograph scanner 60 minutes after the injection of 2 MBq/kg ⁶⁸Ga-PSMA-11. Results: Six of 7 patients had positive ⁶⁸Ga-PSMA-11 PET/CT images, and histopathology confirmed endometrial cancer. One patient also exhibited uptake in the left ovary, and final histopathology revealed a hemorrhagic cyst. Lymph node involvement was further confirmed after ceCT fusion with ⁶⁸Ga-PSMA-11. The consensus of histopathological staging of endometrial cancer and ceCT was 4/7, that of MR was 6/7, and that of ⁶⁸Ga-PSMA-11 PET/CT was 5/7. All methods were consistent in terms of staging in 3/7 patients. Conclusions: The initial experience showed the possibility of using ⁶⁸Ga-PSMA-11 in endometrial cancer patients. However, prospective large studies are needed to explore the real diagnostic role of radiolabelled PSMA in this field. This study was approved by the Ethical Committee of the Medical University of Warsaw (KB/2/A/2018).

This review presents current knowledge on the surgical treatment of endometrial cancer in young patients. Endometrial cancer is the most common gynecological cancer in Europe. Higher morbidity is correlated with obesity, hypertension and diabetes, which are growing worldwide. However, endometrial cancer at an early age is very rare. The first line of treatment for this cancer is radical hysterectomy, which is controversial in young women. There is an alternative method of fertility-sparing treatment. However, there is a group of young patients for whom surgical treatment is recommended. According to European guidelines, minimally invasive surgery is recommended for endometrial cancer. The aim of the study was to present the advantages of robotic surgery for endometrial cancer detected at a young age. The procedure of radical treatment with robot-assisted laparoscopy is more precise. Better visualization and stabilization of instruments allow a shorter procedure time, a brief hospital stay and fewer complications. Quality of life may be at a similar level. Incisions after trocars are painless and more esthetic than a classical wound. Bilateral adnexectomy in endometrial cancer depends on age, molecular status of the cancer, stage, genetic risk factors and individual decision. Conclusions: Robotic surgery seems to be a better surgical method for endometrial cancer in younger patients.

(1) The surgical method of choice for the treatment of endometrial cancer is minimally invasive surgery. In cases of high-risk endometrial cancer, completed paraaortic and pelvic lymphadenectomy are indicated. The aim of this study was to analyze the types of docking during robotic surgery assisted with the da Vinci X system while performing paraaortic and pelvic lymphadenectomy. (2) Methods: A total of 25 patients with high-risk endometrial cancer, with a mean age of 60.07 ± 10.67 (range 34.69–83.23) years, and with a mean body mass index (BMI) of 28.4 ± 5.62 (range 18–41.5) kg/m², were included in this study. The analyzed population was divided into groups that underwent single or dual docking during surgery. (3) Results: No statistical significance was observed between single and dual docking during paraaortic and pelvic lymphadenectomy and between the type of docking and the duration of the operation. However, there was a statistically significant correlation between the duration of the operation and previous surgery (p < 0.005). The number of removed lymph nodes was statistically associated with BMI (p < 0.005): 15.87 ± 6.83 and 24.5 ± 8.7 for paraaortic and pelvic lymph nodes, respectively, in cases of single docking, and 18.05 ± 7.92 and 24.88 ± 11.75 for paraaortic and pelvic lymph nodes, respectively, in cases of dual docking. (4) Conclusions: The robot-assisted approach is a good surgical method for lymphadenectomy for obese patients, and, despite the type of docking, there are no differences in the quality of surgery.

In Poland, robotic surgery is nowadays perceived as a new method of surgical treatment in endometrial cancer patients. We aim to present the first Polish group of endometrial cancer patients treated using robotic surgery. The analysis was based on 79 patients with mean age of 59.72 ± 11.709 (range 27–83) years and endometrial cancer scheduled for surgical treatment. Mean BMI was 31.38 ± 8.78 (range 19.03–65.97) kg/m². The data were collected based on a questionnaire consisting of 19 questions concerning the patient’s perception of robotic surgery before the procedure. Patients with a family history of neoplastic diseases indicate precision of movements as the most important reason for choosing robotic surgery (p = 0.0035). Patients after surgery procedures in the past named shorter hospitalization as a major benefit (p = 0.0037). Patients who chose robotic surgery for financial reasons stressed the cosmetic effect as a priority (p = 0.0319). Shorter length of hospital stay, less blood loss, enlarged view, and good visualization were statistically significant reasons for choosing robotic surgery (p < 0.05). Women who consider work, good material status, and well-being as the most important aspects of their lives cited the cosmetic effect as a benefit of robotic surgery (p = 0.0029 vs. p = 0.0074 vs. p = 0.01745, respectively). In the follow-up after operations, no patients regretted choosing robotic surgery. Good visualization, precise movements, less blood loss, and cosmetic effects are the most frequent reasons for choosing robotic surgery. Even patients after other types of surgery in the past decided on robot-assisted radical hysterectomy because of the clear benefits of this approach.

The lack of specific symptoms in ovarian cancer delays onset of the diagnostic process. Hence, most cases are recognized in late stages of the disease. The aim of this study was to confirm the role of Il-6 compared to other markers in diagnosis and survival in ovarian cancer. The database was collected from 13 January 2021 to 15 February 2023. In total, 101 patients with pelvic tumors with a mean age of 57.86 ± 16.39 participated in the study. In every case, CA125, HE4, CEA, CA19-9, Il-6, C-reactive protein and procalcitonin measurements were taken. Patients with ovarian borderline tumor and metastatic ovarian tumors were excluded from further analysis. Statistically significant correlations were found between diagnosis of ovarian cancer and levels of CA125, HE4, CRP, PCT and Il-6. Comparison of Il-6 with other markers revealed that longer overall survival correlated with lower values of Il-6. In the case of a higher concentration of Il-6, OS and PFS were shorter. Sensitivity and specificity of Il-6 in diagnosis of ovarian cancer were 46.8% and 77.8%, respectively, while for CA125, CRP and PCT were 76.6% and 63%; 68% and 57.5%; 36% and 77%, respectively. More investigations are needed to identify the most specific and sensitive marker for ovarian cancer.

Purpose of the Report: Ovarian cancer is usually diagnosed in an advanced stage of disease due to the absence of specific symptoms and a lack of sensitive diagnostic methods. Prostate-specific membrane antigen (PSMA) is expressed on prostate cancer cells but can be found in other tumors such as ovarian cancer. The aim of this pilot study was to evaluate the feasibility of using ⁶⁸Ga-PSMA-11 PET/CT in detection of ovarian neoplasm before surgical treatment. Patients and Methods: Eight women with mean age of 56.0 ± 16.2 years were included in the study. All patients underwent transvaginal ultrasound followed by CT scan of the chest and abdomen as qualification for surgery. Within a 1-week interval, PET/CT was performed on a Siemens Biograph scanner, 60 minutes after injection of 2 MBq/kg ⁶⁸Ga-PSMA-11. Results: In 3 cases (37.5%), the ⁶⁸Ga-PSMA-11 PET/CT was positive, whereas histological examination confirmed 2 serous ovarian cancer cases and 1 ovarian borderline tumor. The SUV_max in the serous ovarian cancer was 8.7 and 4.1, and in the borderline ovarian tumor, it was 13.8. No correlation was found between antigen CA-125 level and ⁶⁸Ga-PSMA expression. Range of tumor SUV_max was not correlated with stage of disease. The remaining 62.5% (5/8) were negative in ⁶⁸Ga-PSMA-11 PET/CT, and histopathology confirmed benign pelvic tumor. Conclusions: The initial experience supports the potential to use ⁶⁸Ga-PSMA-11 in ovarian cancer to differentiate malignant and benign tumors before surgery. This study was approved by the Ethical Committee of the Medical University of Warsaw (KB/2/A/2018).

Purpose Ovarian cancer is usually diagnosed in an advanced stage of disease due to the absence of specific symptoms and a lack of sensitive diagnostic methods. Prostate-specific membrane antigen (PSMA) is expressed on prostate cancer cells, but can be found in other tumours such as ovarian cancer. The aim of this pilot study was to evaluate the feasibility of using [⁶⁸Ga]Ga-PSMA-11 PET/CT in detection of ovarian neoplasm before surgical treatment.Material and methods: Eight women with mean age of 56.0±16.2 years were included in the study. All patients underwent transvaginal ultrasound followed by CT scan of the chest and abdomen as qualification for surgery. Within a 1-week interval, PET/CT was performed on a Siemens Biograph scanner, 60 min after injection of 2 MBq/kg [⁶⁸Ga]Ga-PSMA-11.Results: In three cases (37.5%) the [⁶⁸Ga]Ga-PSMA-11 PET/CT was positive, whereas histological examination confirmed two serous ovarian cancer cases and one ovarian borderline tumour. The SUVmax in the serous ovarian cancer was 8.7 and 4.1, and in the borderline ovarian tumour it was 13.8. No correlation was found between antigen CA 125 level and [⁶⁸Ga]Ga-PSMA expression. Range of tumour SUVmax was not correlated with stage of disease. The remaining 62.5% (5/8) were negative in [⁶⁸Ga]Ga-PSMA-11 PET/CT and histopathology confirmed benign pelvic tumour.Conclusion The initial experience supports the potential to use [⁶⁸Ga]Ga-PSMA-11 in ovarian cancer to differentiate malignant and benign tumours before surgery. This study was approved by the Ethical Committee of the Medical University of Warsaw (KB/2/A/2018).