AimThis study aimed to identify the postoperative histological features affecting the prognosis of patients with early‐stage cervical cancer who underwent open radical hysterectomy.MethodsThis retrospective study enrolled 374 patients with pT1a, 1b1 and 2a1 early‐stage cervical cancer who underwent open radical hysterectomy between 2001 and 2018. Survival outcomes were analyzed by Kaplan–Meier method and compared with log‐rank test. Using the Cox proportional hazards regression test, we conducted a multivariate analysis for disease‐free survival and overall survival.ResultsOthers histology, including other epithelial tumors and neuroendocrine tumors, had a significantly worse prognosis in both disease‐free survival and overall survival than those of squamous cell carcinoma and adenocarcinoma (hazard ratio, 4.37 and 11.76; P = 0.006 and P = 0.002, respectively), along with lymph node metastasis (hazard ratio, 2.99 and 7.03; P = 0.009 and P = 0.001, respectively).ConclusionOthers histology including adenosquamous carcinoma had a poor prognosis in early‐stage cervical cancer as with high‐risk factors.

Background/Aim: Tumour biopsy using laparoscopy before neoadjuvant chemotherapy for advanced ovarian cancer has been widely accepted. However, there are few reports about its operative outcome compared to biopsy with laparotomy. We investigated the advantage of laparoscopic biopsy for advanced ovarian cancer. Patients and Methods: We included 23 patients who underwent laparoscopy and 27 who underwent exploratory laparotomy before neoadjuvant chemotherapy between January 2012 and August 2020. We reviewed their medical records and evaluated their operative outcomes. Results: Blood loss was significantly lower in the laparoscopy group (5 ml vs. 320 ml, p<0.05). The period until the initiation of neoadjuvant chemotherapy was significantly shorter in the laparoscopy group (12 days vs. 16 days, p<0.05). Overall survival did not differ significantly between the two groups (25.4 months vs. 24.7 months, p=0.53). Conclusion: Laparoscopic tumour biopsy is useful and safe for histological diagnosis, thereby allowing for early introduction to neoadjuvant chemotherapy.Epithelial ovarian cancer (EOC) is the gynaecological malignancy with the highest mortality rate. At the time of diagnosis, most patients have stage III or IV disease classified according to the International Federation of Gynecology and Obstetrics (FIGO) staging system, indicating that the tumour has disseminated into the peritoneal cavity and/or metastasized to organs outside the pelvis. Adequate surgical cytoreduction is the most important independent prognostic factor, and the standard treatment for advanced EOC is primary debulking surgery (PDS) followed by platinum-based chemotherapy. On the other hand, it is generally supported that massive ascites, poor performance status, malnutrition, and pleural effusion are often associated with extensive disease spread, and in those cases, neoadjuvant chemotherapy (NAC) with interval debulking surgery (IDS) could be a good alternative treatment. Previous randomized clinical trials (EORTC, CHROUS, JCOG0602) reported no difference in survival outcomes in stage IIIC/IV ovarian cancer patients who were treated with NAC plus IDS compared with PDS, and the surgically-related morbidity rate (such as haemorrhagic, infective, and thromboembolic adverse events) was higher in PDS (1-3). However, the problem has been often discussed that these trials resulted in low rate of complete/optimal surgery in both PDS and IDS and median operative time in these trials was shorter than other studies (4-6). The SCORPION trial showed relatively higher rates of complete/optimal surgery in PDS and IDS, 91% and 81% respectively, possibly due to introduction of scoring peritoneal dissemination by laparoscopic surgery (7). There was no difference in prognosis between PDS and IDS groups, in spite of improvement in surgical outcome. The SCORPION trial showed that PDS also resulted in significantly higher incidence of perioperative complication than IDS. Diagnostic laparoscopic surgery for advanced EOC is gaining popularity because it is minimally...

Objective Direct oral anticoagulants (DOACs) are increasingly being used for the treatment of cancer-associated venous thromboembolism (CAT). However, there is limited evidence of the efficacy of DOACs for the treatment of gynecological CAT. Thus, this study aimed to investigate the efficacy and safety of edoxaban for the treatment of gynecological CAT using Japanese real-world data. Methods We reviewed the medical records of patients with 371 gynecological cancer who received edoxaban or vitamin K antagonist (VKA) between January 2011 and December 2018. Results Altogether, 211 and 160 patients were treated with edoxaban and VKA, respectively. Fourteen patients (6.8%) in the edoxaban group and 22 (13.8%) in the VKA group showed recurrence of venous thromboembolism (VTE). Cumulative VTE recurrence was not significantly different between the 2 groups (p=0.340). Adverse events occurred in 15 (7.1%) and 11 (6.9%) patients in the edoxaban and VKA groups, respectively (p=0.697). Subgroup analysis of the edoxaban and VKA groups according to different tumor types, including ovarian, endometrial, and cervical cancer, showed equivalent outcomes in terms of VTE recurrence and adverse events. Patients without pulmonary embolism (PE) were mostly omitted from initial unfractionated heparin (UFH) therapy prior to administration of edoxaban. However, this did not increase the recurrence of VTE. Conclusion This study confirmed that edoxaban is effective and safe for the treatment of gynecological CAT. This finding was consistent for different types of gynecological cancer. Additionally, initial UFH therapy prior to the administration of edoxaban may be unnecessary for patients without PE.

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