Preoperative cardiopulmonary exercise testing (CPET) provides an objective measure of a patient’s functional capacity under stress. However, the association between CPET and long-term outcomes for women with ovarian cancer have not been assessed. The aim was to determine whether cardiorespiratory fitness, as measured by CPET parameters—peak oxygen uptake (VO2 peak), ventilatory efficiency at anaerobic threshold (VE/VCO2 at AT), and anaerobic threshold (AT)—could predict overall survival (OS) and recurrence -free survival (RFS) in patients with all stages of ovarian cancer. Methods: This was a retrospective cohort study of patients who underwent CPET prior to surgery for suspected or confirmed ovarian cancer during 2019–2023 at the Northern Gynaecological Oncology Centre, United Kingdom. CPET outcomes were risk-stratified, with thresholds of AT ≥ 10 mL/min, VO2 peak ≥ 15 mL/kg/min, and VE/VCO2 at AT ≤ 34 indicating lower risk. Primary outcomes included OS and RFS. Results: A total of 303 patients were included, of whom 56 (18.5%) had a staging laparotomy, 130 (42.9%) underwent primary cytoreductive surgery, and 117 (38.6%) underwent interval cytoreductive surgery. Survival analysis showed that VO2 peak ≥ 15 was significantly associated with improved OS of the whole population (p = 0.032). VE/VCO2 at AT ≤ 34 was associated with improved survival in patients with advanced stage disease (p = 0.025) after ovarian cancer surgery. There was no association between CPET parameters and RFS. Conclusions: We found that peak VO2 ≥ 15 was associated with improvement of overall survival in patients with all stages of ovarian cancer. In addition, VE/VCO2 at AT ≤ 34 was associated with overall survival in patients with advanced-stage disease.

Vulval cancer is a rare tumor, accounting for 3-5% of malignancies of the female reproductive system. The surgical management usually involves the radical excision of the tumor and inguinal node assessment for tumors with depth >1mm. Inguinal node dissection is usually performed as an open procedure through a 5-10cm incision in the groin area and carries a high risk of postoperative complications including wound infection, delayed wound healing, lymphocele and lymphedema which may result in prolonged hospitalization and delay in the adjuvant treatments for these patients. The role of minimal invasive surgery (MIS) in inguinal node dissection has been recently explored. Data extrapolated from melanoma and penile cancer patients showed that MIS inguinal node dissection is feasible, but it requires technical expertise and involves a steep learning curve. The aim of our study is to explore the feasibility and the oncological safety of the robotic inguinal node dissection for patients with vulval cancer, with secondary endpoint the intra- and post-operative outcomes for these patients compared to the open approach.

ObjectiveTo compare the oncologic and perioperative outcomes of minimally invasive pelvic exenteration versus the conventional open approach in patients with gynecologic malignancies.MethodsThis was an international, multicenter, retrospective study including patients with cervical, vaginal, vulvar, or endometrial cancer who underwent anterior or total pelvic exenteration between January 2005 and March 2023. A propensity score matching(PSM) analysis was performed to reduce allocation bias. The primary endpoint was recurrence-free survival, while cancer-specific survival(CSS) and perioperative outcomes were evaluated as secondary endpoints.ResultsA total of 862 patients were analyzed, of whom 83 (9.6%) underwent minimally invasive surgery. After PSM, recurrence-free survival was comparable between the two groups (median 19 vs. 11 months, p=0.262), as was cancer-specific survival (CSS) (median 46 vs. 27 months, p=0.770). In multivariate analysis, positive surgical margins were independently associated with both shorter recurrence-free(HR 1.668, p<0.001) and cancer-specific survival (HR 1.591, p=0.004). Total pelvic exenteration was associated with reduced recurrence free survival(HR 1.290, p=0.020), while performing pelvic exenteration in the recurrent setting (HR 1.972, p=0.042) and tumor diameter greater than 5 cm (HR 1.412, p=0.013) were associated with shorter cancer specific survival. The minimally invasive approach resulted in significantly lower blood loss (700 versus 500ml, p<0.001) and shorter hospital stay (17 versus 12 days: p=0.006), although with longer operative time(360 versus 512 minutes, p<0.001).ConclusionIn this large, multicenter, propensity score-matched analysis, minimally invasive pelvic exenteration showed no statistically significant difference in oncologic outcomes compared with the traditional open approach, while providing some perioperative advantage. However, larger scale studies higher power would be necessary to conclude about safety and improvement in quality of life of the minimally invasive approach in this setting.