Search

To evaluate whether intraoperative rupture affects oncological outcomes in patients with early-stage epithelial ovarian cancer (EOC). A multicenter retrospective study was conducted on patients with early-stage EOC based on surgical and final pathological reports between 2007 and 2021. Oncologic outcomes were compared between the unruptured group (International Federation of Gynaecology and Obstetrics [FIGO] stage IA/IB) and ruptured group (FIGO stage IC1). The primary endpoint was progression-free survival (PFS). Propensity score matching (PSM) was performed to adjust for the imbalance in prognostic factors between the groups. Overall, 197 (58.3 %) patients comprised the unruptured group (FIGO stage IA/IB), and 141 (41.7 %) were in the intraoperatively ruptured group (FIGO stage IC1). No significant difference in the 5-year PFS was observed between the two groups before PSM (92.65 % vs. 92.80 %, P = 0.93). After PSM, the 5-year PFS showed a noticeable decrease in the ruptured group compared to the unruptured group, although this difference showed borderline statistical significance (96.90 % vs. 89.82 %, P = 0.061). This trend was particularly discernible in cases with aggressive tumor characteristics; intraoperative rupture remained an independent prognostic factor for shorter PFS in patients with high-grade histology (adjusted hazard ratio = 14.4, 95 % confidence interval = 2.8–74.1). Although not statistically significant, intraoperative rupture may negatively affect PFS in these patients after PSM. Therefore, rupture during surgery should be avoided as it can cause upstaging and unnecessary chemotherapy. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to assess the relative incidences of cervical adenocarcinoma in situ (AIS) and squamous cell carcinoma in situ (sCIS) and to determine the effect of coexisting squamous cell lesions on prognosis in patients with cervical AIS. Study design We performed a retrospective review of patients diagnosed with AIS or sCIS who underwent cervical conization at a University hospital between 2000 and 2011. Results A total of 1184 patients with cervical carcinoma in situ were included. The ratio of sCIS to AIS was 16:1. Among 71 patients with AIS, AIS with coexisting squamous cell lesions and AIS alone were detected in 41 patients (58%) and 30 patients (42%), respectively. During the median follow-up of 57.1 months, 5 episodes of AIS recurrences and one episode of invasive recurrence occurred. The recurrence rate was significantly higher in patients with AIS alone than in patients with AIS and coexisting squamous cell lesions (17% versus 2%; P = 0.043). Conclusion These results suggest that patients with cervical AIS and coexisting squamous cell lesions have a more favorable prognosis than patients with AIS alone. [ABSTRACT FROM AUTHOR]

Objective Borderline ovarian tumor (BOT) is uncommon in women with advanced age. The authors investigated the characteristics and treatment outcomes of women with BOT ≥65 years of age. Study Design A hospital-based tumor registry was used to identify retrospectively patients with BOT who were treated between 1996 and 2011. Patients were divided into two cohorts: women aged <65 years and women aged ≥65 years. Recurrence and survival was examined using the Kaplan–Meier method. Multivariate Cox proportional hazards model was used to estimate hazard ratios with 95% confidence intervals (95% CI). Results In total, 364 patients were identified, including 326 patients aged <65 years and 38 patients aged ≥65 years. The elderly patients had more comorbidities ( P < 0.001), larger tumor size at diagnosis ( P = 0.001), more perioperative complications ( P = 0.001), and longer postoperative hospital stay ( P < 0.001). In a multivariate model, the hazard ratios for recurrence and disease-related death in patients aged ≥65 years were 2.53 (95% CI, 1.03–6.23) and 7.66 (95% CI, 1.09–53.95), respectively. Conclusions Characteristics and survival of patients with BOTs aged ≥65 years differ distinctly from those of patients aged <65 years. Old age was an independent poor prognostic factor of recurrence and disease-related death. [ABSTRACT FROM AUTHOR]

Annexin A4 study in ovarian cancer has been primarily focused on clear cell carcinoma, which exhibits strong resistance to chemotherapy. The aim of this study was to examine the expression and cellular localization of annexin A4 in serous ovarian carcinomas. We evaluated the expression of annexin A4 with real-time polymerase chain reaction in 40 ovarian serous carcinoma tissues. Furthermore, the distribution of the protein within the tumor was studied by immunohistochemistry in 70 epithelial ovarian carcinoma tissues. The levels of annexin A4 transcripts were higher in 14 chemoresistant tumors than those in 26 chemosensitive tumors (P = .013). Immunohistochemical expressions showed that nuclear expression was detected in 14 (20.0%) of 70 samples, and cytoplasmic expression was detected in 17 (24.3%) of 70 samples. The results showed that 35.7% of women with nuclear expression were resistant to platinum-based chemotherapy, whereas only 14.3% of women without expression were chemoresistant (P = .065). In addition, patients with nuclear staining had significantly shorter disease-free survival than did patients who showed negative staining. Multivariate proportional hazards model revealed that the stage and nuclear annexin A4 expression were independent prognostic factors (hazard ratios, 6.34 [P = .001] and 2.85 [P = .011], respectively). This study showed that overexpression and nuclear localization of annexin A4 are related to chemoresistance and poor survival in patients with serous papillary ovarian carcinomas. Future studies are required to develop new therapies targeting annexin A4 in patients with ovarian epithelial adenocarcinoma. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery. Design: A retrospective study with review of outcomes (Canadian Task Force classification II-3). Setting: A tertiary care/research/university hospital. Patients: Patients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012. Intervention: Use of absorbable suture or staples in primary repair of injured colon. Measurements and Main Results: From January 2000 to April 2012, 12 354 patients underwent laparoscopic surgery. Rectal injury occurred in 15 women (0.12%). Their median age was 42.5 years (30–49), and the median length of injury was 3 cm (0.7–7). Among 13 patients with rectal injuries recognized during surgery, 10 patient injuries were repaired primarily with interrupted absorbable sutures without converting laparotomy, 1 patient underwent laparoscopic low anterior resection with Endo-GIA, 1 underwent open primary repair, and 1 underwent open low anterior resection. Two rectal injuries were detected after surgery. One of these patients underwent primary repair under laparotomy at day 4 after surgery. The other patient had development of a rectovaginal fistula requiring open segmental resection 30 days after primary laparoscopy despite conservative management, including percutaneous drainage and prophylactic antibiotics. Conclusion: Rectal injury during laparoscopy in the gynecologic field can be repaired successfully without the need for a colostomy regardless of mechanism of injury and the size of injury if adequate rectal tissue is available and recognized during surgery. [Copyright &y& Elsevier]

Abstract: Study Objective: The aim of this study was to compare operative outcomes from 300 patients who underwent laparoendoscopic single-site surgery (LESS) with hysterectomy (H) according to previous cesarean section and to describe the bladder dissection technique in detail. Design: Retrospective cohort study (Canadian task classification II-2). Setting: A university hospital, research hospital, and a tertiary care center. Patients: In total, 300 LESS-H procedures were performed for benign gynecologic disease, cervical disease, and endometrial disease at Samsung Medical Center in Seoul, Korea, between May 2008 and February 2012. Patients were categorized into 2 groups according to previous cesarean history: the previous cesarean section group (n = 98) and the no history of previous cesarean section group (n = 202). Intervention: LESS-H with vaginal or lateral approach for bladder dissection. Measurements and Main Results: Baseline demographics and clinical characteristics, except for age, were generally the same between the 2 groups. The operative outcomes including operative time, uterine weight, estimated blood loss, hemoglobin change, hospital stay, and transfusion rate were not different between the 2 groups. Adhesiolysis was required more in the previous cesarean section group (p = .002). LESS failure requiring additional trocars occurred more often in the previous cesarean section group (p = .041), but the rates of conversion to laparotomy were not different (p = .327). The overall surgical complication rate except transfusion was 2.67% in this study. Two cases of urologic problems with ureter injury or bladder injury were reported in the previous cesarean section group. In the no previous cesarean section group, there were 2 urologic problems. Conclusion: LESS-H is a feasible procedure with a lateral approach or vaginal approach for bladder dissection, even in patients with previous cesarean section. [Copyright &y& Elsevier]

Abstract: Objective: To compare perioperative outcomes, including pain, between single-port access (SPA) and conventional laparoscopy in patients with presumed benign gynecological adnexal diseases. Study design A retrospective cohort study was performed at Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. All operations in each group were performed consecutively by a single surgeon. Results: A total of 188 patients were enrolled, with 94 patients per group. Baseline characteristics before surgery were similar between groups. Visual analogue scale pain scores 24h after laparoscopy were lower in the SPA group than in the conventional laparoscopy group (2, 0–7 vs. 3, 2–6 P =0.006). In addition, we found that the SPA group had less supplementary analgesic use (parenteral Ketoprofen intramuscular injection, 1 ampule=100mg) per patient after surgery compared to that in the conventional group (1 ampule, 0–7 vs. 2 ampule, 0–6, P =0.010). Conclusions: These results add to the evidence suggesting an advantage of SPA laparoscopy over conventional laparoscopy in terms of decreasing postoperative pain. Additional large, randomized controlled trials are needed to confirm these findings and to investigate long-term outcomes such as quality of life and cosmesis. [Copyright &y& Elsevier]

Abstract: Study Objective: To compare learning curves for laparoendoscopic single-site surgery (LESS) for ovarian tumors according to the type of procedure (oophorectomy vs cystectomy). Design: A prospective cohort study. (Canadian Task Force Classification II-2). Setting: University hospital. Patients: One hundred fifteen patients who planned to undergo LESS for ovarian tumors by a surgeon between May 2008 and August 2010. Interventions: LESS. Measurements and Main Results: The learning curve was assessed through the graph between the operative time and sequence of cases. Proficiency, defined as the point at which the slope of the learning curve became less steep, and surgical outcome were compared between the two surgery groups. LESS was successfully completed in 103 of 115 patients (94.8%). Learning curve for oophorectomies (n = 59) showed a continued slow slope with no apparent proficiency, suggesting oophorectomies did not pose an initial technical challenge. However, proficiency in cystectomies (n = 56) was evident at the thirty-third case. Furthermore, the oophorectomy group had a shorter operative time and less need for additional ports than the cystectomy group (69.4 minutes vs 100.1 minutes; 5.1% vs 14.3%). Conclusion: Oophorectomy rather than cystectomy is recommended as the initial procedure to start with LESS for ovarian tumors. [Copyright &y& Elsevier]

Purpose: The aim of this study was to compare the efficacy and toxicity of consolidation chemotherapy after concurrent chemoradiation (CCRT) and CCRT alone in patients with locally advanced cervical carcinoma. Methods and Materials: Using medical records from January 2001 to December 2007, 39 patients treated with consolidation chemotherapy after CCRT (Group 1) were matched to 39 patients treated with CCRT alone (Group 2). Consolidation chemotherapy consisted of three additional cycles of chemotherapy with cisplatin 60 mg/m2 (Day 1) and 5-fluorouracil 1,000 mg/m2 per day (Days 1−5) given every 3 weeks. The primary endpoint was overall survival. Results: During a median follow-up period of 35 months (range, 8−96 months), 10 (25.6%) and 16 (41.0%) patients showed disease progression in Groups 1 and 2, respectively. Distant recurrence with or without locoregional/lymphogenous recurrence occurred more frequently in Group 2 than in Group 1 (23.1% vs. 7.7%, p = 0.06). By contreast, there was no difference in locoregional or lymphogenous recurrence between the two groups. The rate of overall survival was higher in Group 1 than in Group 2 (92.7% vs. 69.9%, p = 0.042), whereas the difference in progression-free survival between the groups was not statistically significant (70.1% vs. 55.1%, p = 0.079). Although the difference was not statistically significant, neutropenia was more common in Group 1 than in Group 2 (10.9% vs. 4.7%, p = 0.07). Conclusions: Consolidation chemotherapy after CCRT may improve survival and reduce distant recurrence without additional toxicity compared to CCRT alone in patients with locally advanced cervical carcinoma. [Copyright &y& Elsevier]

Abstract: Background/Purpose: Borderline ovarian tumors (BOTs) are uncommon in the pediatric population, and there have been limited studies that have included a small number of patients. In present study, we evaluated the clinical outcomes and the rates of recurrence of pediatric BOTs with larger sample size than those in previous studies. Methods: A retrospective chart review was performed on 29 patients who were treated for histopathologically confirmed BOTs at our institution between January 1997 and December 2009. Results: Twenty-nine patients (median age, 18 years) had a large-sized tumor (median, 19.8 cm). Abdominal pain was the most common symptom, seen in 82.8% of the patients, followed by abdominal distension. The permanent section histology revealed 25 mucinous (86.2%) and 4 serous type tumors (13.8%). There was considerable discordance between the permanent and frozen sections (rate of concordance, 55.1%). Disease stage was IA in 26 patients (89.7%) and stage IC in the other 3 patients (10.3%). All patients underwent fertility-preserving surgery. Overall, 4 patients (13.8%) experienced a clinically suspicious recurrence requiring surgery. In 2 cases, the suspected recurrences were found to be other benign ovarian tumors. In one case that was initially treated with left ovarian cystectomy for a mucinous BOT, subsequent left salpingo-oophorectomy confirmed recurrence of a mucinous BOT at 16-month follow-up. The last case was a newly developed primary ovarian mucinous carcinoma with no evidence of recurrence of a previous mucinous BOT at 26-month follow-up. Conclusions: This study shows that BOTs in pediatric populations can be successfully treated conservatively to preserve fertility with no apparent increased risk of morbidity or mortality compared with those of more radical surgical options. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of the study was to compare the peri-operative outcomes of single port access (SPA) laparoscopic adnexal surgery and conventional laparoscopic adnexal surgery. Study design: This is a retrospective case-control study matched by body mass index (BMI; kg/m2). A single surgeon (T-JK) performed 17 SPA laparoscopic adnexal surgeries (cases) consecutively between December 2008 and March 2009; 34 conventional laparoscopic adnexal surgeries (controls) were performed by another surgeon who had similar surgical skill at our hospital during the same time period. Data on the SPA laparoscopic adnexal surgery cases were collected prospectively into our data registry after Institutional Review Board (IRB) approval and we reviewed the data on the controls from the electronic medical records with IRB approval. Results: In both groups all procedures were performed without failure. Among preoperative baseline characteristics there was no difference between the two groups including preoperative size of ovarian tumor and bilaterality. The pathology findings were similar; a mature cystic teratoma was the most common pathological feature in both groups. The two groups were comparable with regard to operative outcomes according the surgery type. There were no differences between SPA and conventional groups in median operation time (64min vs. 57.5min, p =0.252), the number of patients that requested additional parenteral non-steroidal anti-inflammatory drugs (7 patients vs. 19 patients, p =0.597), and the absolute decrease (1.3mg/dl vs. 1.1mg/dl, p =0.640) from preoperative hemoglobin to postoperative day 1 measurements. No patient from either cohort required a blood transfusion. There were no complications in either group including umbilical incision complications in the SPA group. Conclusion: Our study demonstrated that SPA laparoscopic adnexal surgery had comparable operative outcomes to conventional laparoscopic adnexal surgery. A prospective comparison is needed for confirmation and to define the role of SPA in gynecological adnexal surgery. [Copyright &y& Elsevier]

Abstract: Study Objective: To present our initial experience with single-port access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) in a large uterus weighing in excess of 500 g. Design: A prospective single-center study (Canadian Task Force classification III). Setting: University hospital Patients: Fifteen patients with an extirpated uterine weight of more than 500 g were enrolled from May 2008 to September 2009. Interventions: SPA-LAVH. Measurements and Main Results: There were 11 cases with uterine myomas and 4 cases of adenomyosis. All patients had symptoms related to these diagnoses including menorrhagia, dysmenorrhea, and pelvic pressure symptoms such as urinary frequency. The median and range are used to describe data not distributed normally. The median operation time, weight of the uterus, and estimated blood loss were 125 minutes (80 to 236 minutes), 690 g (503 to 1260 g), and 500 mL (150 to 1000 mL), respectively. There was a significant linear correlation between the operation time and the extirpated uterine weight (p < .002). Thirteen procedures were successfully performed with SPA-LAVH. The SPA procedure failed in 2 cases: 1 (uterine weight, 732 g) required 1 ancillary 5-mm port to manipulate with a myoma screw, and in the other we inserted 1 additional 15-mm port to use for a laparoscopic morcellator. There were no umbilical complications, additional procedures, or surgical complications. Conclusion: The SPA-LAVH procedure for a large uterus weighing in excess of 500 g was as safe and effective as the conventional LAVH. Additional experience and continued investigation are warranted. [Copyright &y& Elsevier]

Abstract: We evaluated the feasibility, safety, and operative outcome of management of myomas and adenomyosis using single-port access subtotal hysterectomy with transcervical morcellation using a wound retractor and a surgical glove. We conclude the single-port access subtotal hysterectomy is safe and effective and results in almost no visible scar. With more experience and advanced instruments, this surgical procedure can offer a safe and effective option to hysterectomy with an excellent cosmetic outcome. [Copyright &y& Elsevier]

Abstract: Study Objective: To estimate the feasibility, safety, and operative outcomes for the management of adnexal masses by single port access (SPA) laparoscopy with a wound retractor and a surgical glove. Design: A prospective single-center study (Canadian Task Force classification III). Setting: University hospital. Patients: Twenty-four well selected patients with adnexal masses on imaging scans recruited from June 2008 through January 2009. Interventions: Single port access laparoscopic adnexal surgery. Measurements and Main Results: Single port access laparoscopic adnexal surgery was successfully completed in 22 of 24 patients. The median age of the patients was 45 years (range 23-63 years), and the median body mass index was 22 (range 18-29). The median tumor size was 5cm (range 3-12cm). The median operative time was 70minutes (range 40-128minutes). The estimated blood loss was minimal (range 10-100mL). The postoperative course was uneventful in all patients. The median postoperative hospital stay was 1 day (range 1-3 days). No postoperative complications were observed at follow-up. The 2 failed cases were as follow: 1 required an additional trocar for adequate adhesiolysis, and the other a staging laparotomy because of the finding of a borderline ovarian malignancy on frozen section pathologic study. Conclusion: The single port access laparoscopic adnexal surgery was safe and feasible and provided almost no visual scar. [Copyright &y& Elsevier]

Abstract: Study Objective: To present our initial experience with single port–access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) by use of a wound retractor and a glove. Design: Continuing, prospective study (Canadian Task Force classification II-3). Setting: University teaching, research hospital, and a tertiary care center. Patients: We performed the SPA-LAVH in 24 patients from May 6, 2008, through October 8, 2008. Interventions: All cases of SPA-LAVH were performed by a single surgeon (T. J. K.). Measurements and Main Results: We analyzed the data to determine the outcome of SPA-LAVH and compared the initial 10 cases (group A) and the latter 14 cases (group B) to consider the learning curve. Median and range are used to describe non-normal data. A total of 24 consecutive patients have undergone SPA-LAVH, for benign gynecologic conditions, including 16 uterine myomas and 8 cases of adenomyosis, regardless of body mass index or previous abdominal or pelvic surgery. All cases but 3 were performed exclusively through a single port. The median operative time, weight of the uterus, and estimated blood loss were 119minutes (range 90 to 255minutes), 347g (range 225 to 732g), and 400mL (range 100 to 1000mL), respectively. The decline in hemoglobin from before surgery to postoperative day 1 was from 0.7 to 4.3g/dL, with a median of 2.05g/dL. The median hospital stay (postoperative day) was 3 days (range 3 to 7). When we compared the operative outcomes between the 2 groups, there was a tendency toward a decreased operative time in group B, although the difference was not significant. However, there was a significant decrease in the estimated blood loss and hospital stay in group B (p=.00,=.04, respectively). Conclusion: The SPA-LAVH was safe and effective, and the procedure could be learned over a short period of time. Additional experience and continued investigation are warranted. Journal of Minimally Invasive Gynecology [Copyright &y& Elsevier]

Objective: The effectiveness of paclitaxel-cisplatin-ifosfamide triplet regimen (TIP) was reported to be superior to that of paclitaxel-cisplatin doublet. However, the efficacy of paclitaxel-cisplatin-bevacizumab triplet (TPA) and TIP has not been compared. Here, we compared the efficacy and safety of TIP and TPA in patients with metastatic, recurrent, or persistent cervical cancer. Methods: We retrospectively reviewed the medical records of patients with recurrent, persistent, or metastatic cervical cancer who were at the Samsung Medical Center, Seoul, Korea between January 2005 and September 2018. Of the 161 patients included in the study, 92 had received TIP and 71 had received TPA. For the study, we compared the response rates, progression-free survival (PFS), overall survival (OS), and safety in the 2 treatment groups. Results: The response rates of patients who received TIP and TPA were comparable (64.1% vs 73.2%, P = 0.239). Histology (squamous vs nonsquamous) was the only prognostic factor that affected the response to therapy (odds ratio, 0.259; 95% confidence interval [CI], 0.119-0.562; P = 0.001). The PFS after TIP and TPA treatment was similar: 12.0 months (95%CI, 10.26-13.74) vs 11.5 months (95%CI, 10.18-12.83), respectively. In a Cox proportional hazard model, objective response to therapies was the only independent prognostic factor for both PFS and OS. However, different types of therapy (TIP vs TPA) did not affect the oncological outcomes for either PFS or OS. Although hematologic toxicity was significantly higher in the TIP-treated group than in the TPA-treated group, both regimens were safe and well-tolerated. Conclusions: The effectiveness and safety of TIP was comparable to TPA in terms of response rates, survival, and adverse effects. TIP could be an effective alternative in the treatment of cervical cancer when TPA is contraindicated or unaffordable. [ABSTRACT FROM AUTHOR]

Background: This multicenter study aimed to evaluate the performance of CA 125 and risk of ovarian malignancy algorithm (ROMA) in differentiating epithelial ovarian cancer (EOC) from benign adnexal mass. We consecutively enrolled 782 patients referred to tertiary hospitals with adnexal mass requiring surgical treatment. A total 322 of patients with benign adnexal disease and 327 patients with EOC were included in the analysis. Using reference cut-off values in premenopausal women, ROMA had better specificity (0.926 vs. 0.787, P < 0.001) and accuracy (0.875 vs. 0.777, P < 0.001) than CA 125 alone and comparable sensitivity (0.707 vs. 0.747, P = 0.549). Using optimum cut-off values in premenopausal women, CA 125 and ROMA had comparable specificity (0.922 vs. 0.947, P < 0.001) and accuracy (0.871 vs. 0.868, P = 0.879); however, sensitivity for CA 125 was inferior to that of ROMA (0.707 vs. 0.613, P = 0.039). In postmenopausal women, sensitivity, specificity, and accuracy were comparable between CA 125 alone and ROMA using either reference cut-off values or optimum cut-off values.ROMA showed better diagnostic performance in differentiating EOC from benign adnexal tumors among premenopausal women. However, in postmenopausal women, ROMA did not show any benefit over CA 125 alone. [ABSTRACT FROM AUTHOR]

Study Objective To report the feasibility of performing robotic single-port surgery including pelvic lymphadenectomy in endometrial cancer. Design Canadian Task Force III. Patient A 49-year-old, multiparous patient diagnosed with well-differentiated Fédération Internationale de Gynécologie et d'Obstétrique stage I endometrioid adenocarcinoma. Setting The patient underwent robotic single-port peritoneal washing, total hysterectomy, bilateral adnexectomy, and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2.5-cm umbilical incision. We used a 5-lumen port for single-site instruments, a 3-dimensional high-definition 8.5-mm endoscope, a 5-mm accessory port, and insufflation channel. Monopolar cautery and a bipolar Maryland dissector were used for lymphadenectomy. Vaginal cuff closure was performed using a needle driver and Maryland dissector with V-lock suture. Near the end of the surgery, the 5-mm assistant port was changed with a 10-mm-sized port. Then, a dissected lymph node in an endobag and a needle used in vaginal cuff closure were removed through the 10-mm port. Interventions Total hysterectomy and bilateral adnexectomy with pelvic lymphadenectomy were performed using robotic single-site platform. Measurements and Main Results The total operative time was 206 minutes. The total vaginal cuff closure time was 22 minutes, and lymphadenectomy took 48 minutes. The estimated blood loss was 100 mL; no intraoperative and postoperative complications occurred. The total number of excised lymph nodes was 11. Conclusion Robotic single-port pelvic lymphadenectomy is feasible. Further studies should be performed to assess the benefits of this procedure. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the clinical characteristics of women with double primary cancers of the colorectum and endometrium and assess the probability of Lynch syndrome.Study Design: We identified 15 women with paraffin-embedded blocks available who were diagnosed, treated and followed for double primary colorectal and endometrial cancers at in a single institution between 1994 and 2014. If there was a family history that met the revised Amsterdam criteria for Lynch syndrome, the woman was considered to have 'clinically defined Lynch syndrome'. If immunohistochemical (IHC) loss of expression of mismatch repair genes (MLH1, MSH2, MSH6, or PMS2) or high microsatellite instability (MSI) was demonstrated in molecular testing, the case was considered 'suspected Lynch syndrome'.Results: The incidence of clinically defined Lynch syndrome according to the revised Amsterdam criteria was 66% (8 of 15). All 8 of the women clinically diagnosed with Lynch syndrome had either abnormal IHC loss or MSI-high, indicating a suspected Lynch syndrome. Furthermore, 27% (4 of 15) experienced second primary colorectal cancer or other Lynch syndrome-related cancers. Overall, 66% (10 of 15) met the criteria for clinically defined Lynch syndrome or suspected Lynch syndrome.Conclusions: Based on our findings, a large percentage (66%) of women with double primary cancers of the colorectum and endometrium are likely to be diagnosed with Lynch syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the characteristics of 35 myomas in 28 patients who underwent laparoendoscopic single-site myomectomy (LESS-M). Study design: Retrospective analysis of 28 patients who underwent LESS-M at Samsung Medical Center from January 2009 to January 2013. Results: The median age of 28 patients was 34 years (range: 27–61) and median body mass index was 21.9 (range: 17.3–28.5). The median number of extracted myomas was one (range: 1–4) and the largest myoma diameter was 6cm (range: 2–15). The total number of extracted myomas was 35 and the types of extracted myoma were subserosal (16 myomas, 45.7%), intramural (nine myomas, 25.7%) and intraligamentary (seven myomas, 20%). In subserosal and intramural myoma, 21 myomas were located at the anterior wall and four myomas were located at the posterior wall of the uterus. Median operation time was 131min (range: 35–232). Estimated intraoperative blood loss was 65mL (range: 20–300), hemoglobin change was 2g/dL (range: 0.5–2.9) and hospital stay was 3 days (range: 1–4). There was no conversion to laparotomy but in one patient (3.6%), LESS-M converted to two-port laparoscopic myomectomy. There was no blood transfusion during and after operation. Intraoperative and postoperative complications did not occur. Conclusion: Careful selection of patients considering the type and location of myomas is important for successful LESS-M. Myomas located in the anterior wall, subserosal or intraligamentary myomas are appropriate for LESS-M. [Copyright &y& Elsevier]

Abstract: Objective: Single-port access (SPA) surgery is a rapidly advancing technique in laparoscopic surgery. Currently, there is limited evidence on the learning curve and complications of performing SPA laparoscopic-assisted vaginal hysterectomies (LAVHs). Study design: One hundred patients who initially planned to undergo a SPA-LAVH for benign indications between May 2008 and October 2009 were enrolled. All operative data were prospectively collected. Patients were arranged in order based on the date of surgery and the outcomes were compared between quartiles (cases 1–25, 26–50, 51–75, and 76–100). Proficiency was defined as the point at which the slope of the curve becomes less steep for operative time. Plateau was defined as the point at which the slope is zero. A comparison of the data on a quartile was performed. Locally weighted regression generated smoothed lines that represent operative time over the sequence of the operations. Results: Most SPA-LAVHs were successful, but additional ports were needed in 5 patients because of pelvic adhesions (n =3) and large uterine size (n =2). There were 3 cases with post-operative complications (hemorrhage, 1; vesicovaginal fistula, 1; and cuff abscess, 1), who were managed without sequelae. Without increased operative morbidities, the operative time decreased from a median of 133.0min (interquartile range, 107.5–162.5min) in the first quartile to a median of 100.0min (interquartile range, 85.0–117.5min) for the last quartile (p =0.011). The proficiency and plateau were determined after approximately 25 and 75 cases, respectively. Conclusions: The SPA-LAVH was safe, effective, and reproducible after training, and with the current technique, had a low rate of complications. [Copyright &y& Elsevier]

To investigate the analgesic efficacy of erector spinae plane block (ESPB) in major gynecologic surgery, expressed as cumulative opioid consumption 24 h after surgery. A single-center, patient-assessor blinded, randomized controlled study. Samsung medical center (tertiary university hospital), between February 2022 to January 2023. Eighty-eight females undergoing major surgery with long midline incision for gynecologic malignancy. Patients were randomly assigned to receive standard systemic analgesia (Control group) or ESPB (ESPB group). ESPB was performed bilaterally at the level of the 9th thoracic vertebra with a mixture of 20 mL of 0.5% ropivacaine and 100 μg of epinephrine. The primary outcome was cumulative opioid consumption at 24 h postoperatively. Secondary outcomes included opioid consumption and pain severity during the 72 h after surgery. The variables regarding postoperative recovery and patient-centered outcomes were compared. The mean cumulative opioid consumption 24 h after surgery was 35.8 mg in the ESPB group, which was not significantly different from 41.4 mg in the control group (mean difference, 5.5 mg; 95% CI -1.7 to 12.8 mg; P = 0.128). However, patient satisfaction regarding analgesia was significantly higher in the ESPB group compared with the control group at 24 h postoperative (median difference, −1; 95% CI -3 to 0; P = 0.038). There were no significant differences in the variables associated with postoperative recovery. ESPB did not reduce opioid consumption during the 24 h postoperative but attenuated pain intensity during the early period after surgery. • Erector spinae plane block (ESPB) did not reduce opioid consumption following major gynecologic surgery. • The potential of ESPB as an adjuvant for postoperative analgesia was observed in relation to pain intensity and patient satisfaction. • ESPB is associated with improved postoperative recovery following major gynecologic surgery. [ABSTRACT FROM AUTHOR]

Objectives To compare gynecologic patients’ cosmetic satisfaction with surgical wounds after different approaches: laparoendoscopic single-site surgery (LESS), conventional laparoscopic surgery (CLS) and open surgery (OS). Study design This was a prospective study. The primary outcome was the cosmetic satisfaction after LESS, CLS, or OS, measured at 1 and 6 months post-surgery using the well-validated Cosmetic Scale. Multiple linear regression analysis was used to determine whether the surgical approach was independently associated with cosmetic satisfaction or not. Results Of 294 patients enrolled, 84 (28.6%), 129 (43.9%), and 81 patients (27.3%) underwent LESS, CLS, and OS, respectively. Cosmetic Scale scores in the LESS group at 1 month post-surgery was about 7 higher than in the CLS group and 9 higher than in the OS group ( P < 0.001). This difference was maintained also at 6 months post-surgery ( P < 0.001). On multiple linear regression analysis, the surgical approach was independently associated with postoperative cosmetic satisfaction ( P < 0.001). Conclusion Our study found that cosmetic satisfaction after LESS was highest, followed by CLS, then OS. Therefore, physicians should more assertively discuss and consider LESS for gynecologic diseases. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To present 515 LESS surgeries and report the perioperative outcomes and late complications according to the Clavien–Dindo classification. Study design: We performed a prospective single-center study (Canadian Task Force classification II-2). One surgeon trained in minimally invasive surgery performed 515 cases of LESS surgery from May 2008 to September 2011. Results: LESS gynecological surgery was performed on 515 patients (274 total hysterectomies; 26 subtotal hysterectomies; 87 adnexectomies including oophorectomy, salpingectomy, and salpingo-oophorectomy; 100 ovarian cystectomies; 17 myomectomies; 11 others). The median age and body mass index of the patients were 45 years and 22.6kg/m2, respectively. LESS surgery was successfully completed in 493 patients (95.7%) without the need for one or more ancillary ports or conversion to laparotomy. Twenty patients needed one or more additional ports and two cases were converted to laparotomy. One or more additional ports were required most frequently in ovarian cystectomy procedures (12/100, 12%). Thirty-six patients (7.0%) required intraoperative and/or postoperative transfusions. Each of these patients underwent hysterectomy (33/274, 12.0%) or subtotal hysterectomy (3/26, 11.5%). Perioperative complications (<30 postoperative days), excluding transfusions, occurred in 8 patients (1.6%) and included one case each of vault bleeding, vault abscess, stump watery discharge, rectal injury, and vesicovaginal fistula, and three cases of urinary tract injury. Late complications occurred in three patients (0.6%) and included two umbilical hernias and one vault evisceration. The overall complication rate, excluding transfusions, was 2.1% (11/515). Conclusion: The rate of late postoperative complications, including umbilical port site hernia and vault evisceration, was not increased in this study, as compared to previous reports of single-port and conventional laparoscopic surgeries. [Copyright &y& Elsevier]

Abstract: Purpose: Galectin-1 (Gal-1) is a 14-kDa laminin-binding galectin involved in several biological events including regulation of tumour proliferation and metastasis. In this study, we investigated the clinical significance of Gal-1 expression and its functional role in cell proliferation and invasion in epithelial ovarian cancer (EOC). Experimental design: We evaluated the expression of Gal-1 in 52 serous, 11 endometrioid, and 3 mucinous type EOC tumour samples from 66 patients by immunohistochemistry. In vitro experiments were performed to determine the function of Gal-1 in cell survival, proliferation, and invasion in EOC cells using siRNA and anginex, a Gal-1 inhibitor, as well as recombinant Gal-1 protein. Results: Patients with strong Gal-1 peritumoural staining had poorer progression-free survival (PFS) than patients with weak peritumoural staining (p =0.03). Inhibition of Gal-1 by siRNA or anginex resulted in the inhibition of cell growth and proliferation of HeyA8 and SKOV3ip1 cells. Moreover, the ability of cells to migrate was significantly reduced by treatment of cells with Gal-1 siRNA but was increased by treatment of cells with recombinant Gal-1. When we evaluated the interaction between fibroblasts (T HESCs) and cancer cells (A2780-CP20), we found that MMP-2 expression in cancer cells was affected by Gal-1 secreted by fibroblast cells, which suggests that Gal-1 in human fibroblasts might affect the invasive abilities of tumour cells. Conclusion: Our results suggest that Gal-1 expression is a potential prognostic factor for PFS and that Gal-1 could be a novel treatment target in EOC patients. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the oncologic safety and reproductive outcomes in patients with advanced-stage borderline ovarian tumors (BOTs). Study design: The medical records of patients with advanced-stage BOTs who were treated between 1997 and 2009 were reviewed retrospectively. Reproductive outcomes were assessed by telephone interviews. Results: Six (24%) and 19 patients (76%) had stages II and III disease, respectively. Twenty patients (80%) were treated by radical surgery and five patients (20%) underwent fertility-sparing surgery. Five patients (20%) had invasive implants and 20 patients (80%) had non-invasive implants. The median follow-up time was 71.4 months (range, 10–135 months). Four patients relapsed after a median interval of 40 months (range, 16–77 months) following primary treatment. Of these four patients, two who initially had invasive implants relapsed in the form of invasive ovarian carcinoma. Patients with invasive implants (2 of 5 [40%]) tend to relapse more frequently than patients with non-invasive implants (2 of 20 [10%]). Among five women who underwent fertility-sparing surgery, four attempted to conceive and five singleton pregnancies occurred. Conclusion: Patients with advanced-stage BOTs with non-invasive implants have an excellent prognosis. Fertility-sparing surgery should be considered if there are no invasive implants. Indeed, reproductive outcomes after fertility-sparing surgery with non-invasive implants are promising. [Copyright &y& Elsevier]

Abstract: Background: Claudin-7 (CLDN-7) is a tight junction protein that has been shown overexpressed in several human cancers. We investigated prognostic significance of CLDN-7 overexpression in patients with epithelial ovarian carcinoma (EOC) and its functional role on cell proliferation in ovarian carcinoma cell lines. Patients and methods: CLDN-7 expression was evaluated by real-time RT-PCR and immunohistochemical analysis in 71 patients with EOC. We assessed the association of CLDN-7 expressions with prognosis of the patients including sensitivity to platinum-based chemotherapy. In vitro experiment was performed with and without inhibition of CLDN-7 by its siRNA to evaluate the sensitivity of the human ovarian cancer cells to cisplatin chemotherapy. Results: CLDN-7 transcripts in EOCs were significantly up-regulated compared with normal ovarian tissues (P <0.001). The expression of CLDN-7 protein was observed in majority (69/71, 97.1%) of the EOCs but not in normal ovarian tissues (P <0.001). High CLDN-7 expression in primary tumour correlated with shorter progression-free survival (PFS) of the patients (P =0.005) and poor sensitivity to platinum-based chemotherapy (P =0.024). Moreover, CLDN-7 was highly expressed in 2774 and HeyA8 human ovarian cancer cells and inhibition of CLDN-7 by its siRNA significantly enhanced the sensitivity of 2774 and HeyA8 cells to cisplatin treatment. Conclusion: These findings suggest CLDN-7 expression is an independent prognostic factor for PFS and it may play a role in regulating response to platinum-based chemotherapy in the treatment of EOC. [Copyright &y& Elsevier]

Abstract: Objective: To report our initial two hundred single-port access (SPA) gynecologic surgeries and present the perioperative outcomes. Study design: This is a prospective single-center study (Canadian Task Force classification II-2). Two hundred selected patients with gynecological disease were recruited for the study from May 2008 through December 2009 at Samsung Medical Center. Results: Two hundred patients underwent SPA gynecological surgery (105 a total hysterectomy; 11 a subtotal hysterectomy; 43 an oophorectomy; 31 an ovarian cystectomy; 5 a salpingectomy; 2 a myomectomy; 3 adhesiolysis only). The median age and body mass index were 45.5 and 22.9kg/m2, respectively. SPA surgery was successfully completed in 187 patients, without the need for ancillary ports (93.5%). Two cases required a conventional multiport, and nine cases needed one additional port. Two patients were converted to a laparotomy. One intra- and five post-operative complications occurred. The complication rate was 3.2% (6/187). The median operative time was 120min (54–250) for a total hysterectomy, 180 (150–345) for a subtotal hysterectomy, 60 (27–245) for an oophorectomy, 105 (50–185) for a cystectomy, and 60 (30–115) for a salpingectomy. Conclusion: Single-port surgery was safe and feasible for gynecological indications. Further study of single-port surgery is required to determine whether it has significant benefits compared to conventional techniques. [Copyright &y& Elsevier]