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After salpingectomy, recurrent ectopic pregnancies occur in the contralateral fallopian tube. Here, we present a case of ipsilateral remnant fallopian tube pregnancy in a 30-year-old woman with a history of incomplete prior operation to remove the middle region of the left fallopian tube following fallopian tube isthmus pregnancy 6 years earlier. During the previous salpingectomy, the left fallopian tube was not completely observed because of adhesions to the pelvic peritoneum and sigmoid colon; a partial remnant may have been present. The patient presented with lower abdominal pain 6 weeks after the most recent menstrual cycle, and transvaginal ultrasonography revealed a remnant left fallopian tube ectopic pregnancy. A 4 cm-sized mass identified at the distal end of the remnant left fallopian tube and the proximal remnant tube were laparoscopically removed. The possibility of an ipsilateral remnant tubal pregnancy should be carefully considered in spontaneous pregnancy after partial fallopian tube resection. [ABSTRACT FROM AUTHOR]

Recent theories propose that most epithelial ovarian cancer (EOC), depending on histological type, originate from other gynecological tissues and involve the ovary secondarily. According to these theories, any protective effect of salpingectomy and tubal ligation may vary by histological type. The study aim was to examine the association between salpingectomy and tubal ligation, respectively, and risk of EOC, with a focus on associations specific for histological types. We identified EOC cases and matching controls in national registries and gathered information on surgical procedures and potential confounders. Conditional logistic regression was used to estimate odds ratio (OR) with 95% confidence interval (CI) of EOC related to salpingectomy and tubal ligation, respectively, overall and stratified by histological type. Furthermore, we investigated the association according to timing of the procedures. Our study comprised 16,822 EOC cases. Each case was matched with 40 controls. There was an overall EOC risk reduction after unilateral (OR = 0.73; 95% CI: 0.60–0.87) and bilateral salpingectomy (OR = 0.46; 95% CI: 0.31–0.67). A slight risk reduction was seen among women with previous tubal ligation (OR = 0.91; 95% CI: 0.83–0.99). For salpingectomy, the risk reduction increased with increasing time since the surgical procedure and was only present among women younger than 50 years at salpingectomy. Unilateral and bilateral salpingectomy was associated with a risk reduction for most histological types. The association between previous salpingectomy and reduced risk of several histological subtypes of EOC supports the suggested theories about the site of origin of EOC and may be of clinical importance. • Salpingectomy is associated with a greater risk reduction for EOC than tubal ligation. • A substantial risk reduction for all histological types of EOC was seen after bilateral salpingectomy. • The risk reduction of EOC increased with increasing time since the salpingectomy. • Further investigation of the impact of salpingectomy on EOC development could improve recommendations for EOC prevention. [ABSTRACT FROM AUTHOR]

Background: Ectopic pregnancy (EP) is defined as embryo implantation in a location other than the uterine cavity. Objective: We aimed to evaluate the expression of several genes, which may play a role in EP, in the ampulla region of fallopian tubes and endometrial tissue of women with EP. Materials and Methods: In this case-control study, 5 women who underwent salpingectomy due to EP, comprised the 5 pseudo-pregnant women as a control group. These participants referred to the Royan Institute, Shariati, and Arash hospital, Tehran, Iran during 2019-2021. We evaluated the expressions of vascular endothelial growth factor A, mucin-1, colony-stimulating factor-1, heparin-binding epidermal growth factor-like growth factor (HBEGF), and fibroblast growth factor 2 genes in the fallopian tube and endometrium of EP cases by real-time polymerase chain reaction using specific primers. Results: The vascular endothelial growth factor expression was significantly higher in the ampulla region of the controls. However, no significant differences were observed in endometrial tissue. Assessments of colony-stimulating factor-1 and fibroblast growth factor 2 showed no significant differences between the case and control groups. HBEGF showed significantly higher expression in the ampulla region of EP cases, but no significant difference was observed in HBEGF expression in the endometrial tissues of the study groups. Mucin-1 expression was significantly higher in both study regions of the EP cases. Conclusion: Our results have strongly suggested that these genes play important roles in proper implantation, and disruptions in their expression patterns could lead to EP. However, more studies are needed to confirm the current findings. [ABSTRACT FROM AUTHOR]

Endosalpingiosis is characterized by the presence of ectopic, benign glands with a fallopian tube‐like ciliated epithelium. Florid cystic endosalpingiosis (FCE) is a rare type of endosalpingiosis and presents with tumor‐like lesions. In general, FCE has no specific clinical features. In this case, extensive pelvic multiple Müllerian cysts were first observed and removed during the patient's second cesarean section. Lesions relapsed after a year. Therefore, the patient underwent total hysterectomy and bilateral salpingectomy; pathology revealed that the patient had FCE. According to imaging studies during the follow up, recurrent and progressive multiple pelvic and extra‐pelvic cysts were observed. The patient had no obvious symptoms, and the results of her laboratory tests were within normal limits. Ultrasound‐guided aspiration and lauromacrogol sclerotherapy were performed, and in the past year, the cysts have stabilized without progression. This is the first reported case of recurrent FCE after total hysterectomy and bilateral salpingectomy with a 5‐year follow up. A literature review and novel ideas for diagnosing and managing FCE based on this case are also presented. Synopsis: The etiology, diagnostic procedure, and management of refractory florid cystic endosalpingiosis were reviewed and discussed, and a novel effective treatment regimen is presented. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Choriocarcinoma of the fallopian tube is extremely rare and highly susceptible to early metastasis. Clinical manifestations of ectopic pregnancy and choriocarcinoma are the same, and all patients with ectopic pregnancy should be evaluated for choriocarcinoma based on histopathological findings. Adjuvant chemotherapy (after surgery) is the proposed treatment for tubal choriocarcinoma. Choriocarcinoma is a malignant epithelial tumor of the chorionic villi that often manifests after a normal or molar pregnancy. The primary tubal choriocarcinoma associated with ectopic pregnancy is extremely rare and can be misdiagnosed as an ectopic pregnancy since symptoms including vaginal bleeding, amenorrhea, elevated beta‐human chorionic gonadotropin (BHCG) levels, and pelvic pain are shared. A 34‐year‐old G4P3003 woman presented with a one‐week history of vaginal bleeding and right lower abdominal pain, which had intensified a day before admission. Clinical and paraclinical examinations pointed to a ruptured tubal pregnancy; hence, an emergency laparotomy was performed, and a right salpingectomy was carried out on the patient. However, a nonsignificant decline in BHCG level was observed, and histological examination revealed tubal choriocarcinoma; hence, a metastasis workup was carried out, yet no metastasis was detected. Six sessions of chemotherapy consisting of Etoposide, Methotrexate, Dactinomycin, Cyclophosphamide, and Vincristine (EMA‐CO) were administered without complication, in such a way that the BHCG level normalized after three sessions of chemotherapy. Evaluations after 1 year from the completion of chemotherapy revealed that the patient had no subsequent problems. Choriocarcinoma of the fallopian tube is extremely rare and highly susceptible to early metastasis. Clinical manifestations of ectopic pregnancy and choriocarcinoma are the same, and all patients with ectopic pregnancy should be evaluated for choriocarcinoma based on histopathological findings. Metastasis workup should be considered for all individuals with choriocarcinoma. Adjuvant chemotherapy (after surgery) is the proposed treatment for tubal choriocarcinoma. [ABSTRACT FROM AUTHOR]

In this study, our aim was to evaluate the subsequent fertility status of women treated with different methods for ectopic pregnancy. Patients diagnosed with ectopic pregnancy between January 2012 and July 2020 were included in the study. Fertility outcomes of the patients treated with medical or surgical options were questioned. In the study, 659 patients who met the eligibility criteria were included. A single dose of MTX was administered in 37 patients (32.2%) and two doses of MTX were applied in 14 patients (12.2%) and surgery was preferred in 64 patients (55.7%) in the infertile group. In 213 patients (39.2%) in the fertile group, MTX was administered as a single dose while two doses of MTX and surgery was preferred in 49 patients (9.0%) and 282 patients (51.8%), respectively. No statistically significant difference was detected between the groups according to treatment approaches. There was no significant difference regarding fertility outcomes following different types of treatments for ectopic pregnancy. For this reason, the methods to be chosen for the treatment of ectopic pregnancy should be evaluated according to the individual factors of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pregnancy accounts for approximately 2% of all pregnancies and is the most common cause of pregnancy-related mortality in the first trimester. Our aim was to study the preoperative clinical factors affecting the choice of laparoscopic approach to tubal ectopic pregnancy. Materials and methods: This was a retrospective cross-sectional study of tubal ectopic pregnancy cases that were managed by laparoscopy at an academic university hospital in the period January 2010 to December 2018. Cases that were managed medically or conservatively and laparoscopic cases that were converted to laparotomy were excluded. Cases where the surgical approach of laparoscopy or laparotomy were determined by the patients’ choice were also excluded. Results: The laparoscopy rate was 49.4%. The mean age was 32.04 years. Compared with laparotomy, laparoscopy was significantly associated with low parity (less than 3) (p=0.008), a low level of initial beta-human chorionic gonadotrophin (p=0.032), fewer cases of adnexal mass (p=0.000451), hemoperitoneum (p=0.000072), ruptured ectopic (p=0.000261), and more cases of bowel adhesions (p=0.0095). There was no significant difference between laparoscopy and laparotomy regarding the risk factors of ectopic pregnancy. Salpingectomy and salpingostomy were not significantly different between the two surgical approaches (p=0.643). Twenty-eight laparoscopic cases were converted to laparotomy. Conclusion: The laparoscopic approach to ectopic pregnancy was affected by parity, presenting symptoms of pain and vomiting, mean initial beta-human chorionic gonadotrophin, the presence of adnexal mass, the presence of hemoperitoneum, and the rupture of the ectopic. Bowel adhesions were seen more frequently in laparoscopy than laparotomy. Salpingectomy and salpingostomy were no different between laparoscopy and laparotomy. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the association between past infertility and the type and timing of menopause in midlife women? SUMMARY ANSWER Women with a history of infertility were more likely to experience surgical menopause overall and had elevated risk of earlier surgical menopause until age 43 years but experienced no differences in the timing of natural menopause. WHAT IS KNOWN ALREADY Infertility is experienced by 12–25% of women and is thought to reveal a propensity for poor health outcomes, such as chronic illness, later in life. However, little is known about whether infertility is linked with characteristics of the menopausal transition as women age, despite possible shared underlying pathways involving ovarian function and gynecologic disease. STUDY DESIGN, SIZE, DURATION Secondary analysis of a prospective cohort study of 13 243 midlife females recruited in Phase 1 of the Alberta's Tomorrow Project (Alberta, Canada) and followed approximately every 4 years (2000–2022). PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected through standardized self-report questionnaires. History of infertility, defined as ever trying to become pregnant for more than 1 year without conceiving, was measured at baseline. Menopause characteristics were measured at each study follow-up. Menopause type was defined as premenopause, natural menopause, surgical menopause (bilateral oophorectomy), or indeterminate menopause (premenopausal hysterectomy with ovarian conservation). Timing of natural menopause was defined as the age at 1 full year after the final menstrual period, and timing of surgical and indeterminate menopause was defined as the age at the time of surgery. We used flexible parametric survival analysis for the outcome of menopause timing with age as the underlying time scale and multinomial logistic regression for the outcome of menopause type. Multivariable models controlled for race/ethnicity, education, parity, previous pregnancy loss, and smoking. Sensitivity analyses additionally accounted for birth history, menopausal hormone therapy, body mass index, chronic medical conditions, and age at baseline. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 18.2% of women reported a history of infertility. Past infertility was associated with earlier timing of surgical menopause exclusively before age 43 years (age 35: adjusted hazard ratio 3.13, 95% CI 1.95–5.02; age 40: adjusted hazard ratio 1.83, 95% CI 1.40–2.40; age 45: adjusted hazard ratio 1.13, 95% CI 0.87–1.46) as well as greater odds of experiencing surgical menopause compared to natural menopause (adjusted odds ratio 1.40, 95% CI 1.18–1.66). Infertility was not associated with the timing of natural or indeterminate menopause. LIMITATIONS, REASONS FOR CAUTION Information on the underlying cause of infertility and related interventions was not collected, which precluded us from disentangling whether associations differed by infertility cause and treatment. Residual confounding is possible given that some covariates were measured at baseline and may not have temporally preceded infertility. WIDER IMPLICATIONS OF THE FINDINGS Women with a history of infertility were more likely to experience early surgical menopause and may therefore benefit from preemptive screening and treatment for gynecologic diseases to reduce bilateral oophorectomy, where clinically appropriate, and its associated health risks in midlife. Moreover, the lack of association between infertility and timing of natural menopause adds to the emerging knowledge that diminishing ovarian reserve does not appear to be a primary biological mechanism of infertility nor its downstream implications for women's health. STUDY FUNDING/COMPETING INTEREST(S) Alberta's Tomorrow Project is only possible due to the commitment of its research participants, its staff and its funders: Alberta Health, Alberta Cancer Foundation, Canadian Partnership Against Cancer and Health Canada, and substantial in-kind funding from Alberta Health Services. The views expressed herein represent the views of the author(s) and not of Alberta's Tomorrow Project or any of its funders. This secondary analysis is funded by Project Grant Priority Funding in Women's Health Research from the Canadian Institutes of Health Research (Grant no. 491439). N.V.S. is supported by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research. H.K.B. is supported by the Canada Research Chairs Program. E.A.B. is supported by an Early Career Investigator Award in Maternal, Reproductive, Child and Youth Health from the Canadian Institutes of Health Research. A.K.S. has received honoraria from Pfizer, Lupin, Bio-Syent, and Eisai and has received grant funding from Pfizer. N.V.S. H.K.B. and E.A.B. have no conflicts of interest to report. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

High-grade serous carcinoma (HGSC) is the most common type of pelvic cancer among women. Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of HGSC. Herein, we report a rare occurrence of STIC in patients undergoing surgery for benign indications without a family history of ovarian cancer. A 77-year-old woman underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for uterine prolapse. Pathological examination revealed bilateral STIC without ovarian abnormalities, and no other abnormal findings were noted. Another patient, a 49-year-old woman, underwent laparoscopic total hysterectomy and bilateral salpingectomy for uterine fibroids. STIC lesions were observed in both fallopian tubes. Subsequently, a staging was performed. No additional lesions were found, and the patient was followedup through imaging and blood tests. As reports of STIC lesions are rare, data on their clinical outcomes and management strategies are limited. In this report, we present cases of incidental STIC in benign surgery and discuss its proper interpretation and management. Through the early detection of STIC lesions, patients with risk factors can be identified in advance, which will allow prevention and early detection of ovarian cancer. Opportunistic salpingectomy was also actively discussed in this regard.

This article discusses the diagnostic challenges posed by gastric-type mucinous neoplasms of the ovary. These tumors can be difficult to identify as they share characteristics with malignant tumors. The article presents a case study of a 43-year-old patient with a history of endometriosis who underwent surgery for a cystic mass in the right adnexa. The histology revealed a mucinous neoplasm in the ovary and an infiltrating endocervical adenocarcinoma of gastric type. The article emphasizes the importance of identifying atypical cases of recurrent adnexal lesions to prevent misdiagnosis. [Extracted from the article]

Ectopic pregnancy is the implantation of the developing embryo outside the uterine cavity. It usually occurs in the fallopian tubes. One of the critical complications of ectopic pregnancy is rupture. The most common symptoms of ectopic pregnancy rupture are vaginal bleeding and abdominal pain. In atypical presentations, the diagnosis is based on suspicion. Herein, we presented a case of ruptured ectopic pregnancy with an atypical presentation. The diagnosis of ruptured ectopic pregnancy should be considered when women with childbearing potential apply to the emergency department. [ABSTRACT FROM AUTHOR]

Key Clinical Message Choriocarcinoma of the fallopian tube is extremely rare and highly susceptible to early metastasis. Clinical manifestations of ectopic pregnancy and choriocarcinoma are the same, and all patients with ectopic pregnancy should be evaluated for choriocarcinoma based on histopathological findings. Adjuvant chemotherapy (after surgery) is the proposed treatment for tubal choriocarcinoma. Abstract Choriocarcinoma is a malignant epithelial tumor of the chorionic villi that often manifests after a normal or molar pregnancy. The primary tubal choriocarcinoma associated with ectopic pregnancy is extremely rare and can be misdiagnosed as an ectopic pregnancy since symptoms including vaginal bleeding, amenorrhea, elevated beta‐human chorionic gonadotropin (BHCG) levels, and pelvic pain are shared. A 34‐year‐old G4P3003 woman presented with a one‐week history of vaginal bleeding and right lower abdominal pain, which had intensified a day before admission. Clinical and paraclinical examinations pointed to a ruptured tubal pregnancy; hence, an emergency laparotomy was performed, and a right salpingectomy was carried out on the patient. However, a nonsignificant decline in BHCG level was observed, and histological examination revealed tubal choriocarcinoma; hence, a metastasis workup was carried out, yet no metastasis was detected. Six sessions of chemotherapy consisting of Etoposide, Methotrexate, Dactinomycin, Cyclophosphamide, and Vincristine (EMA‐CO) were administered without complication, in such a way that the BHCG level normalized after three sessions of chemotherapy. Evaluations after 1 year from the completion of chemotherapy revealed that the patient had no subsequent problems. Choriocarcinoma of the fallopian tube is extremely rare and highly susceptible to early metastasis. Clinical manifestations of ectopic pregnancy and choriocarcinoma are the same, and all patients with ectopic pregnancy should be evaluated for choriocarcinoma based on histopathological findings. Metastasis workup should be considered for all individuals with choriocarcinoma. Adjuvant chemotherapy (after surgery) is the proposed treatment for tubal choriocarcinoma.

Purpose: The current study aimed to investigate the prognostic clinicopathological factors of synchronous and metachronous ovarian metastasis (OM) from colorectal cancer (CRC) in patients with and without oophorectomy. Methods: Female patients with OM from CRC who underwent primary tumor resection at our institution from January 2013 to December 2020 were evaluated. Results: Of 661 female patients, 22 (3.3%) were diagnosed with OM. Among 22 patients with OM, 12 underwent OM resection. Twenty (91%) patients had extra OM upon diagnosis. Thirteen (59%) patients in the non-surgery group had peritoneal dissemination at surgery or on computed tomography scan or positron emission tomography-computed tomography. Two patients in the OM surgery group had emergency surgery because of abdominal pain. Four patients had postoperative complications, and the median duration of hospital admission was 16.5 days. The median survival time from OM diagnosis to mortality was 20.9 months. Then, the association between the clinicopathological factors and overall survival (OS) was investigated. Tumor location and surgery were found to be related to OS (p = 0.03, 0.006, respectively) in the univariate analysis. However, only surgery was associated with OS (p = 0.02) in the multivariate analysis. Conclusion: Surgery is an important prognostic clinicopathological factor of OM from CRC. OM tumors should be resected because OM surgery is less likely to cause complications and symptoms. [ABSTRACT FROM AUTHOR]

Ovarian endometriomas have a negative impact on a patient's reproductive potential and are likely to cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-Müllerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclerotherapy and combined techniques. The optimal surgical approach remains a matter of debate. Our review aimed to summarize the literature on the impact of surgical management of endometrioma on AMH, AFC and fertility outcomes. Cystectomy may reduce recurrence rates and increase chances of spontaneous conception. However, a postoperative reduction in AMH is to be anticipated, despite there being evidence of recovery during follow-up. The reduction in ovarian reserve is likely multi-factorial. Cystectomy does not appear to significantly reduce, and may even increase, AFC. Ablative methods achieve an ovarian-tissue-sparing effect, and improved ovarian reserve, compared to cystectomy, has been demonstrated. A single study reported on AMH and AFC post sclerotherapy, and both were significantly reduced. AMH levels may be useful in predicting the chances of conception postoperatively. None of the aforementioned approaches has a clearly demonstrated superiority in terms of overall chances of conception. Surgical management of endometrioma may, overall, improve the probability of pregnancy. Evidence on its value before medically assisted reproduction (MAR) is conflicting; however, a combination of surgery followed by MAR may achieve the optimal fertility outcome. In view of the complexity of available evidence, individualization of care, combined with optimal surgical technique, is highly recommended. [ABSTRACT FROM AUTHOR]

Background: Preoperative assessment of the histological type of ovarian cancer is essential to determine the appropriate treatment strategy. Tumor location may be helpful in this regard. The purpose of this study was to compare the position of endometriosis-associated (EAOCs) and non-associated (non-EAOCs) ovarian cancer relative to the uterus using MRI. Methods: This retrospective study included patients with pathologically confirmed malignant epithelial ovarian tumors who underwent MRI at our hospital between January 2015 and January 2023. T2-weighted images of the sagittal and axial sections of the long axis of the uterine body were used for the analysis. Three blinded experienced radiologists independently interpreted the images and assessed whether the ovarian tumor was attached to the uterus, and the angle between the uterus and the tumor was measured. The presence of attachment and the measured angles were compared for each histology. In addition, the angles between EAOCs, including endometrioid carcinomas (ECs) and clear cell carcinomas (CCCs), were compared with non-EAOCs. Results: In total, 184 women (mean age, 56 years; age range, 20–91 years) were evaluated. High-grade serous carcinomas (HGSCs) were significantly smaller than the others and had significantly less uterine attachment than CCCs (p < 0.01 for all readers). According to the mean of the measured angles, CCCs were positioned significantly more posteriorly than HGSCs and mucinous carcinomas (p < 0.02), and EAOCs were positioned significantly more posteriorly to the uterus than non-EAOCs (p < 0.01). Conclusion: HGSCs are often not attached to the uterus, and EAOCs are positioned more posteriorly to the uterus than non-EAOCs. Critical relevance statement: High-grade serous carcinomas were often not attached to the uterus, and endometriosis-associated ovarian cancers were positioned more posteriorly to the uterus than non-endometriosis-associated ovarian cancers. Key points: • The position of the ovarian tumor can be determined using MRI. • High-grade serous carcinomas had less attachment to the uterus. • Endometriosis-associated cancers were positioned more posteriorly to the uterus. • The location of ovarian tumors is helpful in estimating histology. [ABSTRACT FROM AUTHOR]

Purpose: The most prevalent and aggressive subtype of epithelial ovarian carcinoma (EOC), high-grade serous carcinoma (HGSC), originates in many cases from the fallopian tubes. Because of poor prognosis and lack of effective screening for early detection, opportunistic salpingectomy (OS) for prevention of EOC is being implemented into clinical routine in several countries worldwide. Taking the opportunity of a gynecological surgery in women at average cancer risk, extramural fallopian tubes are completely resected preserving the ovaries with their infundibulopelvic blood supply. Until recently, only 13 of the 130 national partner societies of the International Federation of Obstetrics and Gynecology (FIGO) have published a statement on OS. This study aimed to analyze the acceptance of OS in Germany. Methods: (1) Survey of German gynecologists in 2015 and 2022 by the Department of Gynecology of the Jena University Hospital in co-operation with the Department of Gynecology at Charité-University Medicine Berlin with support of NOGGO e. V. and AGO e. V. (2) Salpingectomy numbers in Germany for years 2005–2020 as retrieved from the Federal Statistical Office of Germany (Destatis). Results: (1) Survey: Number of participants was 203 in 2015 and 166 in 2022, respectively. Nearly all respondents (2015: 92%, 2022: 98%) have already performed bilateral salpingectomy without oophorectomy in combination with benign hysterectomy with the intention to reduce the risk for malignant (2015: 96%, 2022: 97%) and benign (2015: 47%, 2022: 38%) disorders. Compared to 2015 (56.6%), considerably more survey participants performed OS in > 50% or in all cases in 2022 (89.0%). Recommendation of OS for all women with completed family planning at benign pelvic surgery was approved by 68% in 2015 and 74% in 2022. (2) Case number analysis: In 2020, four times more cases of salpingectomy were reported by German public hospitals compared to 2005 (n = 50,398 vs. n = 12,286). Of all inpatient hysterectomies in German hospitals in 2020, 45% were combined with salpingectomy, and more than 65% in women at the age of 35 to 49 years. Conclusion: Mounting scientific plausibility regarding involvement of fallopian tubes in the pathogenesis of EOC led to change of clinical acceptance of OS in many countries including in Germany. Case number data and widespread expert judgment demonstrate that OS has become a routine procedure in Germany and a de facto standard for primary prevention of EOC. [ABSTRACT FROM AUTHOR]

Background: Ovarian metastasis from gastric cancer (GC) is characterized by aggressive biological behavior and poor outcome. Currently, there is no standard treatment mode for such patients. Thus, we evaluated the efficacy of conversion therapy in patients with synchronous ovarian metastasis from GC in this study. Methods: About 219 GC patients with ovarian metastasis in 2011–2020 were enrolled. Two groups were established based on the different treatment: the conversion therapy group (chemotherapy combined with surgical resection, CS group) and the non‐conversion therapy group (NCS group). Propensity score matching (PSM) was used to analyze the efficacy of different treatment modes on the prognosis of these patients. Results: Ninety‐two patients were included according to PSM results, with 46 patients each in CS and NCS groups. The median overall survival (OS) in the CS group was notably better than that in the NCS group (p < 0.001). Twenty‐six patients (56.52%) in the CS group achieved R0 resection, and they had a better prognosis (p = 0.003). Compared with patients who underwent simultaneous gastrectomy and ovarian metastasectomy (CSb group), those who underwent ovarian metastasectomy before systemic chemotherapy (CSa group) had a higher R0 resection rate (p = 0.016) and longer survival time (p = 0.002). A total of 38 patients (41.30%) across both groups received hyperthermic intraperitoneal chemotherapy (HIPEC), and these patients had a better survival (p = 0.043). Conclusion: The conversion therapy is safe and effective for patients with synchronous ovarian metastasis from GC and can improve their prognosis. However, our results need to be confirmed by more randomized controlled clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: Despite the growing understanding of the carcinogenesis of pelvic high-grade serous carcinoma (HGSC) of the ovary and peritoneum and its precursor lesion serous tubal intraepithelial carcinoma (STIC), evidence-based proven recommendations on the clinical management of patients with STIC are lacking so far. Methods: A questionnaire containing 21 questions was developed to explore the clinical experience with patients with the diagnosis of STICs and the diagnostic, surgical and histopathological approaches in Germany. Overall, 540 clinical heads of department in all German gynaecological centres were asked to participate. Results: 131 questionnaires (response rate 24.3%) were included in this survey. 45.8% of the respondents had treated one to three STIC patients during their career. 75.6% of the respondents performed opportunistic bilateral salpingectomies during other gynaecological surgeries. Most of the participants (31.3%) started with the SEE-FIM (Sectioning and Extensively Examining the FIMbria) protocol in 2014. It was requested by 39.7% centres for prophylactic salpingectomies, by 13.7% for both prophylactic and opportunistic salpingectomies and by 22.1% for neither of both. 38.2%, 1.5% and 24.4% of the participants would use the laparoscopic, transverse and midline laparotomic approach for a surgical staging procedure, respectively. 25.6% (54.7%) of the respondents recommended a hysterectomy in premenopausal (versus postmenopausal) patients with a STIC, 24.4% (88.4%) a bilateral oophorectomy and 50.0% (4.7%) an affected side oophorectomy (all p values < 0.001). Omentectomy, pelvic and para-aortic lymphadenectomy would be performed by 60.5% (64.0%), 9.3% (11.6%) and 9.3% (11.6%) of respondents in premenopausal (versus postmenopausal) patients (all p values > 0.05). Conclusion: Our survey highlights significant inconsistency in the management of patients with STIC. Prospective data are urgently needed to elucidate the clinical impact of a STIC lesion and its clinical management. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes after laparoscopic cystectomy versus laser vaporization in women of reproductive age with ovarian endometrioma. Evidence review: Our systematic review and meta-analysis was registered in PROSPERO (CRD42021281781) and was done according to the PRISMA 2020 checklist. Studies (published until October 2021) were identified by searching PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov databases (key words "cystectomy", "laser vaporization", and "endometrioma"). The search was conducted independently by two investigators (L.P. and S.I.). Inclusion criteria were: women of reproductive age undergoing surgery for symptomatic endometriomas larger than 30 mm. The exclusion criteria were: women who undergo conservative treatment. Outcomes were: risk ratio for recurrence, ovarian reserve and pregnancy rates. The studies included were randomized clinical trials (RCTs) and nonrandomized clinical trials (prospective controlled, prospective cohort, retrospective studies, and other types of studies) that included a minimum of 10 patients and written in English. Tools recommended by the Cochrane Society achieved risk-of-bias assessment. Results: Totally, 874 studies were found, 9 studies were included in qualitative synthesis (822 patients). All the authors compared the efficacy and safety of cystectomy or laser vaporization in reproductive-aged women with ovarian endometrioma. The overall risk of bias for the randomized trials was 80% 'some concerns' and 20% 'low', and for the cohort studies, 50% 'some concerns' and 50% 'low'. The primary meta-analysis focused on recurrence rates (4 studies included) with no statistically significant differences found between these two interventions (RR = 0.53, 95% CI 0.24 to 1.21, P = 0.13). The next meta-analysis estimated antral follicle count (3 studies) which was significantly lower in cystectomy group (RR = – 2.56, 95% CI – 3.71 to – 1.42, P < 0.0001). Pregnancy rates were analyzed in 3 studies with no statistically significant difference (RR = 0.96, 95% CI 0.81 to 1.14, P = 0.64). Conclusions: There was no statistical difference in the recurrence rate and pregnancy rates, but the antral follicle count was higher in the laser vaporization group. However, we need more clinical trials to make stronger recommendations. [ABSTRACT FROM AUTHOR]

Hysterectomy, most often performed because of bleeding disorders or uterine leiomyoma, is one of the most common major surgical procedures in women and is usually performed during the perimenopausal period on ages 45–55 years. Hysterectomy may be combined with bilateral salpingo-oophorectomy, as a risk-reducing procedure to minimize the risk of ovarian cancer. An open question is whether concomitant oophorectomy, with cessation of ovarian androgen secretion, has any long-term effects on sexual function. In the present prospective cohort study of women undergoing benign hysterectomy, the long-term (10–12 years) effects on sexual function and changes in sex hormone levels were investigated in women having undergone perimenopausal hysterectomy, with or without concomitant bilateral salpingo-oophorectomy. Originally, 491 women (mean age around 50 years) were operated with (patient preference) either only hysterectomy (HYST) or hysterectomy plus bilateral salpingo-oophorectomy (HYST + BSO), and 441 women (90%; HYST; n = 271 and HYST + BSO; n = 170) completed a one-year survey. In the present study, 185 women (42%) of the cohort with one-year follow up participated in the long-term follow up after 10–12 years. Follow-up was with the 10-item McCoy Female Sex Questionnaire and blood analysis of levels of testosterone, estradiol and sexual-hormone-binding globulin. The results showed that specific aspects of sexual function were lower after HYST + BSO compared to HYST 10–12 years after surgery. These lowered items were frequency of sexual fantasies, enjoyment of sexual activity, sexual arousal, and orgasmic frequency. No long-term differences in sex hormone levels were found between the two groups. In conclusion, some items related to sexual function were lower after HYST + BSO in a long-term perspective study, although the levels of testosterone were unaltered. This finding may have implications for clinical recommendations concerning prophylactic salpingo-oophorectomy or for hysterectomy during the perimenopausal age. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to assess the effect of unilateral salpingectomy on the number of mature follicles in the ipsilateral ovary during an assisted reproductive technology (ART) stimulation cycle, as compared to the contralateral ovary. Methods: This was a retrospective, single-center, case–control cohort study conducted from 2017 to 2022. Patients from 18 to 43 years old who underwent at least one ART cycle before and after a unilateral salpingectomy were included. The number of recruited follicles, including mature (≥16 mm) and intermediate follicles (13–15.5 mm), on the salpingectomy side (case) were compared to those present on the contralateral ovary (control) during an ART attempt. To take into account the inter-ovarian variability, the comparison was performed on two ART cycles, performed before then after the salpingectomy. Results: Overall, 24 patients were included in our study. While the number of mature follicles was similar in both ovaries before surgery, the mean number of mature follicles was significantly reduced after salpingectomy in the operated side, as compared to the control side, being, respectively 3.00 vs. 5.08 (p = 0.048). There was no significant difference between the intermediate and total recruited follicles. Conclusions: Our study suggests that salpingectomy may impact the follicle recruitment on the ipsilateral side by altering the vascularization during mesosalpinx coagulation. Gynecologists should be mindful of this concept and accurately set surgical indications. Beyond the indication, this emphasizes the critical role of having infertility surgeons sensitive to fertility preservation for optimal management of ART patients. Further studies with larger patient populations are required to confirm these results. [ABSTRACT FROM AUTHOR]

Essure® implant is a permanently implanted minimally invasive birth control device for women (female sterilisation) widely used between 2002 and 2018. Many adverse events were reported by patients. Increasingly removal procedures have been performed in symptomatic patients. However, there is a lack of in-depth studies on clinical improvement after Essure® removal. We aimed to review all clinical studies about symptoms and quality of life (QoL) after removal procedures. A review of literature in electronic search in Medline and Embase databases from January 2002 to January 2022 using the following keywords: Essure; Essure removal; quality of life; symptomatology improvement. Out of 764 articles in the initial database, 18 clinical studies were eligible for inclusion in our literature review. Overall clinical improvement rates after removal ranged from 21% to 98%. All symptoms were less frequent after Essure® removal, although with large discrepancies between studies. Lack of improvement was reported between 1% to 15% of patients. Rate of patients with improvement of QoL after removal ranged from 58 to 98%. The pain was reported as significantly reduced after the surgery. In the available literature, Essure® removal in symptomatic patients may improve symptoms and quality of life. This should be discussed in the benefits and risks ratio before deciding on the best option of management. Essure® removal in symptomatic patients may improve symptoms and quality of life. [ABSTRACT FROM AUTHOR]

Many concerns have been raised about adverse effects related to Essure® device. Several pathophysiological hypotheses have been proposed including allergic reactions, Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants, galvanic corrosion with release of heavy metals and inflammation. In the present study, we aimed to focus on inflammation process by performing a histopathological evaluation of Fallopian tubes in symptomatic patients with Essure® removal. A cross-sectional study with identification of the type of inflammatory response and characterisation of inflammatory cells in the surrounding tubal tissue around the Essure® (STTE) and at distance from the implant. Histopathological and clinical correlations were also investigated. In the STTE from 47 cases, acute inflammation was observed in 3/47 (6.4%) cases. Chronic inflammation with lymphocytes (42.5%, 20/47) was associated with a significant higher pre-operative pain score (p =.03). Fibrosis was noted in 43/47 (91.5%) cases. Fibrosis without lymphocytes (51.1%, 24/47) was statistically associated with significant reduced pain (p =.04). At distance from the Essure® implant, only chronic inflammation with lymphocytes was present in 10/47 (21.7%) cases. Inflammation response do not seem to be enough to explain all the Essure-related adverse outcomes, suggesting the involvement of other biological mechanisms. NCT03281564 Inflammation and fibrosis are found in the surrounding tubal tissue around the Essure®. Inflammation process alone doesn't seem to be enough to explain symptomatology. [ABSTRACT FROM AUTHOR]

The article focuses on the barriers that patients face when seeking permanent contraception methods, such as tubal surgery and vasectomy. It mentions Insurance restrictions, limited availability of clinicians and operating rooms, religious hospital policies, and inconvenience to patients are among the obstacles that hinder access to these procedures.

The purpose of this study was to compare single-port access (SPA) laparoscopy and SPA robot assisted laparoscopy (RAL) for endometriosis with respect to ovarian reserve preservation and surgical outcomes. Clinical factors affecting any reduction in ovarian function after surgery were also evaluated. Patients with endometriosis who underwent SPA laparoscopy (n = 87) or RAL (n = 78) were retrospectively reviewed. Patients' baseline characteristics, including the severity of endometriosis and surgical outcomes including surgical complexity, were collected. To assess the preservation of ovarian reserve after surgery, serum anti-Müllerian hormone (AMH) levels before surgery, at two weeks, and at three months after surgery were collected. Age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. The severity of endometriosis was higher in the RAL group than in the SPA group. There were no significant differences in other clinical baseline characteristics, including preoperative AMH levels. For surgical outcomes, radical surgery was more frequently performed in the RAL group. In univariate and multivariate linear regression analyses, age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. Incorporating surgical approaches and risk factors for postoperative ovarian function decrease, RAL was more beneficial than SPA laparoscopy for the preservation of ovarian reserve in patients with mild endometriosis (stage I/II) (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 33.51 ± 19.98 vs. 23.58 ± 14.98, p = 0.04) and in patients who underwent non-complex surgery (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 37.89 ± 22.37 vs. 22.37 ± 17.49, p = 0.022). SPA RAL may have advantages over SPA laparoscopy in ovarian function preservation, especially in patients with mild endometriosis and patients who have undergone a non-complex surgery. [ABSTRACT FROM AUTHOR]

The article focuses on a lecture by Joseph V. Sakran, MD, MPH, MPA, FACS, discussing how health care professionals can drive social change beyond the bedside. The topics include the importance of civic engagement, authentic communication, strategy and innovation, and the 4 "P"s - Purpose, Passion, Patience, and Perseverance - in effecting policy changes to advance and protect public health.

Tubal surgery's role in infertile women with unilateral tubal pathology (e.g. hydrosalpinx, tubal occlusion) who desire spontaneous or intrauterine insemination (IUI) conception where in-vitro fertilisation is infeasible remains unclear. To conduct a systematic review on fertility outcomes in women with unilateral tubal pathology desiring to conceive spontaneously or via IUI and to find guidance to support therapeutic tubal procedures to help these women conceive. Using a protocol registered on PROSPERO (ID CRD42021248720), we searched PubMed, EMBASE, CINAHL, and Cochrane Library from inception until June 2022. Bibliographies were reviewed to identify other relevant articles. Two authors independently selected and extracted data. Disagreements were resolved by a third author. Studies presenting fertility outcome data in infertile women with unilateral tubal pathologies desiring spontaneous or IUI conception were included. Methodologic quality was assessed using a modified Newcastle Ottawa Scale for observational studies and the Institute of Health Economics Quality Appraisal Checklist for case series. Primary outcomes collated included cumulative pregnancy rate (CPR) and pregnancy rate per cycle (PR/cycle). Secondary outcomes such as ectopic pregnancy, birth outcomes, and pelvic inflammatory disease were collated. These were stratified by the types of unilateral tubal occlusion (UTO) i.e. hydrosalpinx, proximal tubal occlusion (PTO), or distal tubal occlusion (DTO) Two studies reported spontaneous or IUI pregnancies after treatment of unilateral hydrosalpinx with one reporting a pregnancy rate of 88% within 5.6 months on average. Thirteen studies compared IUI outcomes between women with UTO vs unexplained infertility and bilateral tubal patency (controls). Almost all were retrospective cohort studies and identified UTO by hysterosalpingography. In general, PTOs had no difference in PR/cycle and CPR compared to controls and significantly higher PR/cycle to DTOs. Women with DTOs had minimal incremental CPR benefit with each additional IUI cycle. Therapeutic salpingectomy or tubal occlusion improve IUI or spontaneous conception in women with hydrosalpinx, although more prospective studies are needed. While significant study heterogeneity hampered assessment of fertility outcomes, overall, infertile women with PTOs had similar IUI pregnancy outcomes to those with bilateral tubal patency while DTOs had inferior PR/cycle. This review highlights significant deficiencies in the evidence guiding management for this group of patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Even though the fallopian tubes are commonly encountered surgical specimens in histopathology, there exists a paucity of data that describe the incidence and types of pathologies that can be encountered in the fallopian tubes. The present study was taken up as a small attempt to bridge this gap and describe the various fallopian tube lesions which can be encountered in routine practice. Materials and Methods: The fallopian tubes that were received, either separately or as a part of other gynecological specimens, during the 5-year study were included. Specimens were routinely fixed, processed and sectioned. The Sectioning and Extensively Examining the Fimbriated End of the fallopian tube protocol for grossing was used in cases associated with malignancies. Results: A total of 5256 fallopian tubes were received from 3258 patients during the study. The age ranged between 12 and 70 years. The most common clinical indication for salpingectomy in the present study was uterus related (51.9%). Of the total 5256 fallopian tubes examined, 29.8% tubes showed some pathology. The most common clinically diagnosed tubal pathology, in the present study, was tubal ectopic gestation. The most common clinically undiagnosed finding was hydrosalpinx. Conclusion: It is essential to extensively gross and microscopically examine all fallopian tube specimens to identify precursor lesions and help in patient workup and treatment. [ABSTRACT FROM AUTHOR]

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Background: Laparoscopy for benign ovarian pathology is the appropriate surgical approach and it has many well-known advantages. Minimal invasive gynecological surgery increases the quality of life of the patient. The learning process of laparoscopy is difficult and requires many interventions to acquire manual skills. The objectives of the study were to assess the learning process of laparoscopy for adnexal pathology surgery performed by beginner laparoscopists. Materials and Methods: This study included three gynecological surgeons who were beginners in laparoscopy and who were named A, B, and C. We collected information about patients, diagnosis, surgical technique, and complications. Results: We have analyzed the data from 159 patients. The most frequent primary diagnosis was functional ovarian cyst, and the laparoscopic cystectomy was performed in 49.1% of interventions. The need to convert a laparoscopy into laparotomy was necessary in 1.3% of patients. There were no cases of reintervention, blood transfusion, or ureteral lesions. The duration of the surgical intervention varied statistically significantly according to patient's BMI and to the surgeon. After 20 laparoscopic interventions, a significant improvement was found in the time needed to perform ovarian cystectomy (operators A and B) and salpingectomy (operator C). Conclusions: The process of learning laparoscopy is laborious and difficult. We found a significant decrease in operating time after a twenty laparoscopic interventions. [ABSTRACT FROM AUTHOR]

Objective: As one of the cancers that seriously threatens women's health, ovarian cancer has a high morbidity and mortality rate. Surgery and chemotherapy are the basic treatment strategies for ovarian cancer, and chemotherapy resistance is a significant factor in affecting the prognosis, survival cycle, and recurrence of ovarian cancer. This article aims to analyze articles about ovarian cancer and drug resistance via bibliometric software, offering new ideas and directions for researchers in this field. Methods: Both Citespace and Vosviewer are bibliometric software on the Java platform. Articles were collected on ovarian cancer and drug resistance in the Web of Science Core Collection database from 2013 to 2022. The countries, institutions, journals, authors, keywords, and references were analyzed, and the development status of this field was indicated from multiple perspectives. Results: Studies on ovarian cancer and drug resistance generally showed an increasing trend from 2013 to 2022. The People's Republic of China and Chinese institutions contributed more to this field. Gynecologic Oncology published the most articles, and the journal with the most citations was Cancer Research. Li Li was the author with the most publications, and Siegel RL was the author with the most citations. Through burst detection, it can be found that the research hotspots in this field mainly focused on the in-depth exploration of the drug resistance mechanism of ovarian cancer and the progress of PARP inhibitors and bevacizumab in the treatment of ovarian cancer. Conclusions: Many studies on the mechanism of drug resistance in ovarian cancer have been discovered; however, the deeper mechanism remains to be explored. Compared with traditional chemotherapy drugs, PARP inhibitors and bevacizumab have shown better efficacy, but PARP inhibitors have initially shown drug resistance. The future direction of this field should be to overcome the resistance of existing drugs and actively develop new ones. [ABSTRACT FROM AUTHOR]

Herein, we are presenting a case of a 33-year-old woman who presented to the emergency department complaining of persistent lower abdominal pain of one-day duration. Physical examination revealed abdominal tenderness with right lower quadrant rebound tenderness. Computed tomography abdomen/pelvis showed a 6 cm possible necrotic mass of the left ovary with moderate amount of complex ascites. A laparoscopic left oophorectomy with bilateral salpingectomy, right ovarian biopsy, and appendectomy were performed without complications. The cut surface of the left ovary showed a 9.7 cm × 8 cm × 4 cm ovarian mass, and the cut surface revealed multiple gray-tan friable papillary excrescence. Microscopic evaluation showed findings consistent with left and right ovarian serous borderline tumor (SBT). Subsequently, a tumor staging was conducted with total laparoscopic hysterectomy, pelvic and periaortic lymph node dissection, and omentectomy. The endometrium sections showed several small foci of SBT within the endometrial stroma, consistent with non-invasive implants of the endometrium. The omentum and lymph nodes were all negative for malignancy. SBTs associated with endometrial implants are very rare with only one case reported in the literature. Their existence can cause diagnostic challenges, and they should be acknowledged for early diagnosis and to plan for patient's treatment and outcome. [ABSTRACT FROM AUTHOR]

Purpose: Chemotherapy (CTX) is an important part of the treatment strategy of stage II–IV ovarian cancer. CTX modifications, such as delays, dose reductions or premature terminations might have a negative impact on overall survival (OS) and progression free survival (PFS). The goal of this study was to determine the incidence and predictors of CTX modifications and their influence on survival. Methods: An observational retrospective cohort analysis of 192 ovarian cancer patients who were treated at the Department of Obstetrics and Gynaecology, Technical University Munich, Germany, according to international guidelines was performed including from 2009 to 2013. A potential association between patient and disease characteristics and CTX modifications was tested with multivariate logistic regression. OS and PFS were estimated by Kaplan–Meier analysis. Results: 44.8% (86/192) received a modification of CTX. 34 (17.7%) women discontinued CTX prematurely, 17 (8.9%) underwent a dose reduction, 16 (8.3%) experienced a CTX delay and 10 (5.2%) had both a delay and a dose modification. In nine (4.7%) patients, the dose needed to be divided. Leukopenia (p < 0.001) and anaemia (p = 0.003) were significantly more common in patients with CTX modifications. Significant predictors for CTX modifications were a history of thrombosis or embolism (p < 0.001) and residual tumour postoperatively (p = 0.003). Patients with CTX modifications showed a significantly lower OS as well as PFS (p < 0.001), even after adjustment for prognostic factors such as age, body-mass-index, residual tumour, histology, FIGO stage and grading (p = 0.005 for OS and p = 0.001 for PFS). Conclusion: CTX modifications have a negative impact on survival. Significant predictors for such modifications are a history of thrombosis or embolism and the presence of residual postoperative tumour. Further studies are needed to avoid CTX modifications and to improve survival of ovarian cancer patients. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the anesthetic and cardiorespiratory effects of two anesthetic protocols for salpingectomy or deferentectomy in capuchin monkeys (Sapajus sp). Materials and Methods: Five capuchin monkeys (5 per group) received ketamine (20 mg/kg) combined with midazolam (0.5 mg/kg; group KM) or dexmedetomidine (5 μg/kg; group KD) intramuscularly. Anesthesia is induced with propofol intravenously and maintained with isoflurane. Before the start of surgery, fentanyl 3 μg/kg was administered IV, and continuous infusion (10 μg/kg/min) IV was started. Times and quality of anesthetic recovery were evaluated postoperatively. Results: KM and KD resulted in adequate chemical restraint. KD resulted in bradycardia. Intraoperative heart rate and systolic blood pressure were higher in KM than in KD. Both groups had smooth recovery. Time to standing was longer in KM than in KD. Conclusion: Both protocols allowed the performance of surgeries, with few cardiorespiratory effects. Anesthetic recovery was smooth and shorter in KD group. [ABSTRACT FROM AUTHOR]

Search terms included high-intensity focused ultrasound ablation OR HIFU OR ablation, abdominal wall endometriosis OR cesarean scar endometriosis, operative therapy OR surgery OR operations. Search terms included endometriosis and six coexisting benign gynaecological conditions; adenomyosis, fibroids, endometrial polyps (EPs), polycystic ovarian syndrome (PCOS), benign ovarian cysts (BOC) and pelvic inflammatory disease (PID). B Conclusions: b Women with endometriosis who have coexisting adenomyosis have lower conception rates compared to those with endometriosis only. [Extracted from the article]

Guidelines recommend risk-reducing bilateral salpingo-oophorectomy (RRSO) for women with pathogenic variants of non-BRCA and Lynch syndrome-associated ovarian cancer susceptibility genes. Optimal timing and findings at the time of RRSO for these women remains unclear. We sought to characterize practice patterns and frequency of occult gynecologic cancers for these women at our two institutions. Women with germline ovarian cancer susceptibility gene pathogenic variants who underwent RRSO between 1/2000–9/2019 were reviewed in an IRB-approved study. All patients were asymptomatic with no suspicion for malignancy at time of RRSO. Clinico-pathologic characteristics were extracted from the medical records. 26 Non-BRCA (9 BRIP1 , 9 RAD51C , and 8 RAD51D) and 75 Lynch (36 MLH1 , 18 MSH2 , 21 MSH6) pathogenic variants carriers were identified. Median age at time of RRSO was 47. There were no occurrences of occult ovarian or fallopian tube cancer in either group. Two patients (3%) in the Lynch group had occult endometrial cancer. Median follow up was 18 and 35 months for non-BRCA and Lynch patients, respectively. No patient developed primary peritoneal cancer upon follow up. Post-surgical complications occurred in 9/101 (9%) of patients. Hormone replacement therapy (HRT) was rarely used despite reported post-menopausal symptoms in 6/25 (23%) and 7/75 (37%) patients, respectively. No occult ovarian or tubal cancers were observed in either group. No recurrent or primary gynecologic-related cancers occurred upon follow-up. Despite frequent menopausal symptoms, HRT use was rare. Both groups experienced surgical complications when hysterectomy and/or concurrent colon surgery was performed suggesting concurrent surgeries should only be performed when indicated. • Median age of RRSO was 47 yo with no occult ovarian/fallopian tube cancer supporting current RRSO guidelines. • Surgical complications in this population were largely seen with concomitant hysterectomy and colectomy. • There was very low uptake in post-surgery hormone replacement therapy in these patients undergoing RRSO. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests the fallopian tube as the site of origin of BRCA1/2-associated high-grade ovarian cancers. Several ongoing trials are evaluating salpingectomy with delayed oophorectomy (RRSDO) for ovarian cancer risk reduction and patients are beginning to ask their clinicians about this surgical option. This study sought to systematically review the available literature examining patient preferences regarding RRSDO and risk-reducing salpingo-oophorectomy (RRSO) to provide clinicians with an understanding of patient values, concerns, and priorities surrounding ovarian cancer risk-reducing surgery. We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42023400690). We searched key electronic databases to identify studies evaluating acceptance and surgical decision-making regarding RRSO and RRSDO among patients with an increased risk of ovarian cancer. The search yielded 239 results, among which six publications met the systematic review inclusion criteria. Acceptance of RRSDO was evaluated in all studies and ranged from 34% to 71%. Factors positively impacting patients' acceptance of RRSDO included: avoidance of surgical menopause, preservation of fertility, concerns about sexual dysfunction, family history of breast cancer, and avoidance of hormone replacement therapy. Factors limiting this acceptance reported by patients included concerns regarding oncologic safety, surgical timing, and surgical complications. To date, few studies have explored patient perspectives surrounding RRSDO. Collectively, the limited data available indicate a high level of acceptance among BRCA1/2 carriers, and provides insight regarding both facilitating and limiting factors associated with patient preferences to better equip clinicians in the counseling and support of their patients. • This systematic review explores patient preferences related to risk-reducing salpingectomy with delayed oophorectomy(RRSDO). • The current literature suggests acceptance rates of RRSDO range between 34 and 71%. • Factors that facilitate RRSDO acceptance include avoiding surgical menopause, preservation of fertility and sexual function. • Limiting factors of RRSDO acceptance are concerns about oncologic safety, surgical complications, and breast cancer history. • More inclusive trials in cancer genetics are needed to move towards improved health equity in this field. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Complete bilateral salpingectomy (CBS) can decrease the risk of developing ovarian cancer, although adoption of CBS at cesarean delivery (CD) for permanent contraception has been low. The primary objective was to measure the annual rates of CBS at CD before and after an educational initiative. The secondary objective was to assess rates of providers who offer CBS at CD and their comfort level with the procedure. METHODS: We performed an observational study of OBGYN physicians who perform CD at a single institution. We compared the annual rates of CBS among CD with permanent contraception procedures from the year before and the year after an in-person OBGYN Grand Rounds presentation on December 5, 2019 reviewing the latest research on opportunistic CBS at the time of CD. To evaluate the secondary objectives, anonymous surveys were administered to physicians in-person the month before the presentation. The statistical analysis included chi-square, Fisher’s exact test, T-test, ANOVA, and the Cochran-Armitage trend test. RESULTS: After our educational intervention, annual rates of CBS at CD increased from 5.1% [12/05/2018– 12/04/2019] to 31.8% [12/5/2019–12/4/2020] (p<0.001), and up to 52% in the last study quarter (p<0.001). Surgical outcomes were similar between tubal ligation and CBS, except for a 5-minute increased total operative time for CBS (p=0.005). Fifty physicians completed the survey prior to the presentation (93% response rate). All physicians offered CBS at time of hysterectomy and interval sterilization, while only 36% offered CBS at time of CD. More physicians felt comfortable performing a CBS with bipolar electrocautery (90%) than suture ligation (56%). CONCLUSION: Our presentation-based educational initiative was associated with a significant increase in performance of CBS at the time of CD. [ABSTRACT FROM AUTHOR]

Surgical abnormalities of the adnexa in children and adolescents include a variety of ovarian and paraovarian lesions ranging from benign functional cysts to malignant tumors, torsion of the ovary and/or the fallopian tube, and adnexal infectious lesions ranging from salpingitis to tubo‐ovarian abscesses. Presentations vary from asymptomatic pelvic masses to acute abdomen, and some ovarian tumors might present with precocious puberty or virilization. Acute pain might be caused by hemorrhage or rupture of ovarian or paraovarian cysts, adnexal torsion or adnexal infection. Differential diagnosis of adnexal masses should include peri‐appendiceal abscess in all age groups, and endometriomas and ectopic pregnancy in adolescents. This review provides guidance on the differentiation between adnexal abnormalities, based on important clues from clinical assessment and diagnostic workup, and ultimately on the decision making about the need for surgery, its level of urgency, and the type of surgery to clinicians of all specialties involved in the care of young females. Synopsis: An overview of the most important aspects of the surgical disorders of adnexa in children and adolescents. [ABSTRACT FROM AUTHOR]

Background: The management of ectopic pregnancy is widely debated. Salpingectomy, salpingostomy, and expectant management are widely performed, but the best approach in terms of keeping good future spontaneous fertility chances is yet to be determined. Material and methods: We performed a retrospective analysis (Clinical Trial ID: NCT05479786) of the medical records of patients with an ultrasonographic or surgical diagnosis of tubal ectopic pregnancy that were admitted to the University of Debrecen Clinical Centre between 2012 and 2020. Results: A total of 312 patients were included in the analysis. Patients managed expectantly and patients treated with salpingostomy had significantly higher rates of clinical pregnancy than patients treated with salpingectomy. Pregnancy outcomes and recurrence rates were comparable between the study groups. Salpingectomy was found to decrease the likelihood of conceiving spontaneously by 65%. A stratified analysis based on serum β-HCG levels demonstrated that all treatment modalities carry the same reproductive opportunities for patients presenting with β-HCG levels ≤ 1745 IU/L. Conclusion: Salpingectomy was found to decrease the patient's chance of achieving a natural conception. Conservative approaches should be considered with caution only when the patient's clinical condition permits, and the patient is appropriately counseled. [ABSTRACT FROM AUTHOR]

Objective ·To compare the pregnancy outcomes of infertile women with bilateral severe hydrosalpinx receiving neosalpingostomy or salpingectomy. Methods ·The single-center prospective cohort study from 2005 to 2012 focused on pregnancy outcomes of infertile women aged 20-40 years, with bilateral severe hydrosalpinx, undergoing bilateral neosalpingostomy or salpingectomy in International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine. The choice for treatment was based on a shared decision approach, and the participants were divided into the neosalpingostomy group and salpingectomy group. After registration of baseline characteristics, including age, birth place, reproductive history, preoperative hysterosalpingography results, surgical findings, and pregnancy outcomes, women were followed up on an annual basis until July 2020 for the occurrence of live birth by outpatient follow-up or telephone questionnaire. Intention-to-treat analysis and per-protocol analysis were applied to compare the pregnancy outcomes. Kaplan-Meier analysis and COX proportional hazard model were used to analyze the reproductive outcomes. In addition, subgroup analysis was performed based on age stratification. The main outcome measures were live birth rate, cumulative live birth rate, and factors affecting live birth. Secondary outcome measures included the mode of conception, time to live birth, biochemical pregnancy rate, clinical miscarriage rate, and ectopic pregnancy rate. Results ·A total of 113 women were included in the analysis, 58 women underwent bilateral neosalpingostomy, and 55 women underwent bilateral salpingectomy. The study demonstrated that in infertile women with bilateral severe hydrosalpinx, bilateral salpingectomy achieved higher cumulative live birth rate than bilateral neosalpingostomy (76.36% vs 62.07, HR=2.18,95%CI 1.37-3.45). In the neosalpingostomy group, 34.48% (20/58) live births were obtained after in vitro fertilization treatment, and 27.59% (16/58) live births were obtained through spontaneous conception which mainly occurred within 3 years after initial neosalpingostomy, while all live births in the salpingectomy group were obtained after assisted reproductive therapy. However, the risk of ectopic pregnancy was higher in the neosalpingostomy group than that in the salpingectomy group (20.69% vs 1.82%, P<0.001). No statistically significant differences regarding biochemical pregnancy and clinical miscarriage between the two groups were found. During the subgroup analysis, the cumulative live birth rate of the salpingectomy group (n=51) was significantly higher than that of the neosalpingostomy group (n=48) in women younger than 35 years old (HR=2.25, 95%CI 1.39-3.66), while between two groups of women aged 35 years old or older, there was no statistically significant difference in the cumulative live birth rate (HR=1.60, 95%CI 0.36-7.19). In addition, after adjustment for confounding factors including age, previous abortion history, fibroid, benign ovarian cyst, and endometriosis, COX proportional hazard analysis revealed that salpingectomy was positively correlated to live birth compared with neosalpingostomy (aHR=1.94, 95%CI 1.18-3.18). Conclusion ·For infertile women with bilateral severe hydrosalpinx, neosalpingostomy provides the possibility for spontaneous conception but also brings about certain risk of ectopic pregnancy. Bilateral salpingectomy can achieve higher cumulative live birth rate while receiving postoperative in vitro fertilization treatment. [ABSTRACT FROM AUTHOR]

Background: Many people were found with pulmonary nodules during physical examinations. It is of great practical significance to discriminate benign and malignant nodules by using data mining technology. Methods: The subjects' demographic data, baseline examination results, and annual follow‐up low‐dose spiral computerized tomography (LDCT) results were recorded. The findings from annual physical examinations of positive nodules, including highly suspicious nodules and clinically tentative benign nodules, was analyzed. The extreme gradient boosting (XGBoost) model was constructed and the Grid Search CV method was used to select the super parameters. External unit data were used as an external validation set to evaluate the generalization performance of the model. Results: A total of 135,503 physical examinees were enrolled. Baseline testing found that 27,636 (20.40%) participants had clinically tentative benign nodules and 611 (0.45%) participants had highly suspicious nodules. The proportion of highly suspicious nodules in participants with negative baseline was about 0.12%–0.46%, which was lower than the baseline level except the follow‐up of >5 years. In the 27,636 participants with clinically tentative benign nodules, only in the first year of LDCT re‐examination was the proportion of highly suspicious nodules (1.40%) significantly greater than that of baseline screening (0.45%) (p < 0.001), and the proportion of highly suspicious nodules was not different between the baseline screening and other follow‐up years (p > 0.05). Furthermore, 322 cases with benign nodules and 196 patients with malignant nodules confirmed by surgery and pathology were compared. A model and the top 15 most important clinical variables were determined by XGBoost algorithm. The area under the curve (AUC) of the model was 0.76 [95% CI: 0.67–0.84], and the accuracy was 0.75. The sensitivity and specificity of the model under this threshold were 0.78 and 0.73, respectively. In the validation of model using external data, the AUC was 0.87 and the accuracy was 0.80. The sensitivity and specificity were 0.83 and 0.77, respectively. Conclusions: It is important that pulmonary nodules could be more accurately identified at the first LDCT examination. A model with 15 variables which are routinely measured in the clinic could be helpful to distinguish benign and malignant nodules. It could help the radiological team issue a more accurate report; and it may guide the clinical team regarding LDCT follow‐up. [ABSTRACT FROM AUTHOR]

Objective: To examine the trends and characteristics of ovarian conservation at time of hysterectomy in cervical carcinoma in situ. Methods: This is a retrospective cohort study examining the Healthcare Cost and Utilization Project's National Inpatient Sample, January 2016 to December 2019. The study population included 6605 patients aged less than 65 years with cervical carcinoma in situ who underwent hysterectomy. Exposure allocation was the adnexal procedure status (ovarian conservation vs. oophorectomy). Main outcome measures were temporal trends of ovarian conservation over time and per patient age. A classification‐tree was constructed to examine utilization patterns of ovarian conservation. Results: Ovarian conservation was performed in 57.2% of patients. Ovarian conservation rates were unchanged over time (P‐trend = 0.219). Ovarian conservation rates remained stable until age 40 years, ranging from 88.0% to 78.6% (P‐trend = 0.236), after which time the rate sharply decreased from 78.6% to 19.1% (P‐trend <0.001). In a multivariable analysis, younger age, fewer comorbidities, higher household income, vaginal hysterectomy, and surgery at small bed capacity non‐rural hospitals were associated with ovarian conservation (all, P < 0.05). There were 17 utilization patterns of ovarian conservation for which the rate ranged from 17.2% to 94.4% (absolute rate difference 77.2%, P < 0.001). Conclusion: Decrease in the utilization of ovarian conservation at hysterectomy for cervical carcinoma in situ occurred at age 40 years, which is earlier than expected. Synopsis: Decrease in the utilization of ovarian conservation at hysterectomy for cervical carcinoma in situ occurred at age 40 years, which was earlier than expected. [ABSTRACT FROM AUTHOR]

When women require hysterectomy for a benign condition, the ovaries are sometimes removed at the same time, primarily to prevent future ovarian cancer. This article provides new information about how hysterectomy affects other possible outcomes, such as heart attack, stroke, other types of cancer, and life expectancy. Visual Abstract. Bilateral Salpingo-oophorectomy and Long-Term Health Consequences.: When women require hysterectomy for a benign condition, the ovaries are sometimes removed at the same time, primarily to prevent future ovarian cancer. This article provides new information about how hysterectomy affects other possible outcomes, such as heart attack, stroke, other types of cancer, and life expectancy. Background: More evidence is needed to substantiate current recommendations about removing ovaries during hysterectomy for benign conditions. Objective: To compare long-term outcomes in women with and without bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign conditions. Design: Emulated target trial using data from a population-based cohort. Setting: Women in Denmark aged 20 years or older during 1977 to 2017. Participants: 142 985 women with hysterectomy for a benign condition, 22 974 with BSO and 120 011 without. Intervention: Benign hysterectomy with or without BSO. Measurements: The primary outcomes were overall hospitalization for cardiovascular disease (CVD), overall cancer incidence, and all-cause mortality through December 2018. Results: Compared with women without BSO, women with BSO who were younger than 45 years at surgery had a higher 10-year cumulative risk for hospitalization for CVD (risk difference [RD], 1.19 percentage points [95% CI, 0.09 to 2.43 percentage points]). Women with BSO had a higher 10-year cumulative risk for cancer for ages 45 to 54 years (RD, 0.73 percentage point [CI, 0.05 to 1.38 percentage points]), 55 to 64 years (RD, 1.92 percentage points [CI, 0.69 to 3.25 percentage points]), and 65 years or older (RD, 2.54 percentage points [CI, 0.91 to 4.25 percentage points]). Women with BSO had higher 10-year mortality in all age groups, although the differences were statistically significant only for ages 45 to 54 years (RD, 0.79 percentage point [CI, 0.27 to 1.30 percentage points]). The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older. Limitation: Age was a proxy for menopausal status. Conclusion: The authors find that these results support current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer and suggest a cautious approach in postmenopausal women. Primary Funding Source: The Danish Cancer Society's Scientific Committee and the Mermaid Project. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to evaluate the effects of multi-dose methotrexate (MTX) or subsequent salpingectomy on ovarian reserve and explain the conditions that cause the change in serum anti-müllerian hormone (AMH) levels. Material and methods: Our department had 58 tubal ectopic pregnancy (EP) patients treated with a multiple-dose MTX protocol or subsequent salpingectomy between 2017-2020. Serum AMH level was measured in each patient before the medication and 3-6 months after therapy. Patients' details were recorded and analyzed later. Results: The mean AMH value decreased in 32 patients (-17.8%), increased in 26 patients (+31.5%) (p < 0.0001). In the group with an increase, there was a significantly high number of patients with a polycystic ovary (PCO) condition compared to the other group (p = 0.0001). The post-treatment serum AMH levels increased in patients with PCO, whereas those decreased in patients without PCO (p < 0.001). Conclusions: Multiple-dose MTX or subsequent salpingectomy treatment in tubal ectopic pregnancy (EP) patients might not refer to significant differences in patients' AMH levels. Remarkably, post-treatment AMH levels were significantly increased in EP patients with PCO and decreased in those without this condition. PCO may be a protective condition for ovarian reserve. [ABSTRACT FROM AUTHOR]

Endometriosis is defined by the presence of endometrial-like tissue (glands and stroma) outside of the uterine cavity. According to the HAS and European recommendations of ESHRE, surgery is a complementary therapeutic option whose indication becomes legitimate in response to failure of (i) medicinal therapies (hormonal and non-hormonal analgesics), (ii) supports, or AMP techniques. The main problem in practice is to define the benefit/risk of the intervention as well as possible with the patient, to specify its timing in the patient's care pathway. If various clinical situations seem easier to understand from a surgical point of view, questions remain about the number of surgeries in a patient's care pathway (particularly ovarian surgery and its consequences on the ovarian reserve), their incomplete nature or sometimes at risk of complications, which raises many issues. We propose to summarize in this work the evidence available to date in the literature related to the feasibility of excision surgery of endometriotic lesions, and to discuss its aspiration to be "unique, planned and concerted". [ABSTRACT FROM AUTHOR]