OBJECTIVE: To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature. DATA SOURCES: PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990–2019 with terms “cervical cancer” and “(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy.” Grey literature and unpublished data were omitted. METHODS OF STUDY SELECTION: After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences. TABULATION, INTEGRATION, AND RESULTS: Variables of interest were manually extracted into an electronic database. A total 47 articles that reported on 2,566 women met inclusion criteria. Most tumors were of squamous histology (68.5%), stage IB1 (74.8%), 2 cm or less (69.2%), and without lymphovascular invasion (68.8%). Of planned trachelectomies, 9% were converted intraoperatively to hysterectomy. Separated by route of trachelectomy, 58.1%, 37.2%, and 4.7% were performed using radical vaginal, abdominal, and laparoscopic approaches, respectively. With median follow-up of 48 months (range 2–202 months) across studies, median recurrence rate was 3.3% (range 0–25%); median time to recurrence was 26 months (range 8–44 months). Median 5-year recurrence-free and overall survival were 94.6% (range 88–97.3%) and 97.4% (range 95–99%), respectively. The posttrachelectomy pregnancy rate was 23.9%, with a live-birth rate of 75.1%. CONCLUSION: Radical trachelectomy for fertility-preserving treatment of cervical cancer is widely reported in the literature, though publications are mainly limited to case reports and case series. Reported follow-up periods infrequently meet standard oncologic parameters but show encouraging recurrence-free and overall survival rates and pregnancy outcomes. Higher-level evidence needed for meta-analysis is lacking. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019132443.

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HighlightsVulvar yolk sac tumor (YST) is an exceptionally rare and aggressive extra-gonadal germ cell tumor, previously only described in 15 cases in the literature.We present a unique case of vulvar YST diagnosed during pregnancy, treated with systemic chemotherapy, who subsequently recurred during a second pregnancy.Despite salvage chemotherapy and autologous stem cell transplantation at recurrence, our patient succumbed to her disease, 31 months post diagnosis.

Highlights Recurrent, non-resectable ovarian granulosa cell tumor has no standard treatment. Estrogen/progesterone receptor signaling regulates granulosa cell tumor growth. Granulosa cell tumor responds well to alternating megestrol and tamoxifen therapy.

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Ovarian cancer is the deadliest gynecologic cancer, in part due to late presentation. Many women have vague early symptoms and present with disseminated disease. Cytoreductive surgery can be extensive, involving multiple organ systems. Novel therapies and recent clinical trials have provided evidence that, compared to primary cytoreduction, neoadjuvant chemotherapy has equivalent survival outcomes with less morbidity. There is increasing need for validated tools and mechanisms for clinicians to determine the optimal management of ovarian cancer patients.

Objectives To compare the overall (OS) and disease free (DFS) in young women with early-stage endometrial cancer undergoing hysterectomy with and without ovarian conservation. Methods We conducted a a retrospective study of a prospective mono-centric database. We identified all premenopausal women under 50 years of age with stage I endometrioid adenocarcinoma of the endometrium who underwent hysterectomy from 2008 to 2018. Patients were stratified based on whether they underwent oophorectomy or had ovarian conservation. Results The cohort of 20 women included 5 (25%) who had ovarian conservation and 15 (75%) who underwent oophorectomy. The rate of ovarian conservation was lower during the last decade. There were no statistical difference between the ovarian conservation group and the oophorectomy group in OS and DFS, in a Kaplan-Meier analysis, (respectively, P=0.073 and P=0.200). Conclusions Ovarian conservation does not adversely affect survival for women with early-stage endometrial cancer.