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Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects. [ABSTRACT FROM AUTHOR]

Simple Summary: The therapeutic effect of Poly-ADP-ribose polymerase (PARP) inhibitor has been demonstrated in ovarian cancer patients with BRCA mutation or homologous recombination deficiency (HRD). HRD analysis at diagnosis determines treatment eligibility in ovarian cancer. In classifying the HRD patient group, different results may be observed depending on the test methods, and evidence of the possibility of differences in HRD prevalence between races was shown through representative clinical trial results. Accordingly, we are going to suggest the influence of individual treatment for ovarian cancer. Among ovarian cancer patients with BRCA mutation or homologous recombination deficiency (HRD), the efficacy of Poly-ADP-ribose polymerase (PARP) inhibitors such as olaparib, niraparib, veliparib, and rucaparib has been proven in a number of clinical trials. BRCA mutation and HRD are currently indicated for PARP inhibitor maintenance treatment in ovarian cancer. HRD diagnostic tests examine various components, resulting in different HRD status definitions and, as a result, different treatment decisions. A number of HRD diagnostic tests exist, but test results provided by different companies may differ as they use different methods and different cutoffs. HRD prevalence difference was shown between PARP inhibitor maintenance trials. It is important to select an appropriate method that can present accurate HRD phenotypes to predict sensitivity to PARP inhibitors so that patients who are most likely to benefit from treatment are selected. Additionally, in the subset data of the PARP inhibitor maintenance trials, there was a difference in HRD prevalence by race as higher HRD prevalence in Japanese and Chinese ovarian cancer patients was shown. Further large-scale investigations on racial differences in HRD prevalence are needed and this may contribute to changes in determining the treatment plan and personalized treatment in ovarian cancer patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Epithelial ovarian cancer (EOC) is leading cause of death in gynecologic cancer, and finding prognostic factors is important for establishing treatment plans. OBJECTIVE: The aim of this study was to investigate the prognostic value of the multiplication of neutrophil and monocyte counts (MNM) in epithelial ovarian cancer (EOC). METHODS: Data were retrospectively collected from Samsung Medical Center for EOC patients treated from January 2002 to December 2012. MNM was determined by multiplying neutrophil and monocyte counts and dividing by 10,000. Sensitivity and specificity of markers were assessed using receiver operating characteristic curves. RESULTS: We included 674 patients with EOC. For predicting overall survival (OS), the area under the curve for MNM was 0.607 (95% CI, 0.554-0.661) with sensitivity 55.2% and specificity 63.2% (cut-off value 197.40). The ability of MNM to determine OS was similar to that of the previously validated NLR and PLR. When the cohort was divided by cut-off values, poorer survival outcomes were observed in the group with higher MNM. Higher MNM was associated with advanced stage and presence of residual disease after primary treatment. CONCLUSIONS: Elevated pretreatment MNM is an independent predictor of poor survival and can be a useful biomarker in patients with EOC. [ABSTRACT FROM AUTHOR]

Background: Olaparib maintenance therapy has shown efficacy and tolerability in patients with platinum-sensitive, high-grade serous recurrent ovarian cancer (HSROC) with BRCA1/2 mutation (BRCAm). Our aim was to present real-world experience with olaparib in Korea. Method: We included HSROC patients with BRCAm treated with olaparib maintenance at four institutions in Korea between 2016 and 2018. Medical records were reviewed for clinico-pathologic characteristics, objective response, survival outcomes, and safety. Results: One hundred HSROC patients with BRCAm were included. BRCA1 mutation was present in 71 patients (71.0%), and BRCA2 mutation was present in 23 patients (23.0%). In terms of the best objective response with olaparib maintenance in 53 patients with partial remission from most recent chemotherapy, complete remission occurred in 12 (22.6%) and partial remission in four (7.5%), while 33 patients (62.3%) had stable disease. The 24 month progression-free survival was 42.4%, and 24 month overall survival was 82.1%. Grade 3 or more adverse events were as follows: anemia in 14 patients (14.0%), neutropenia in seven patients (7.0%), thrombocytopenia in two patients (2.0%), oral mucositis in one patient (1.0%), and soft tissue infection in one patient (1.0%). Conclusions: The safety and effectiveness of olaparib maintenance treatment in a real-world study were consistent with those reported in previous clinical trials. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine possible prognostic factors in patients with uterine leiomyosarcoma (LMS). Methods This study retrospectively investigated 48 patients with uterine LMS treated in Samsung Medical Center between 2008 and 2017. To analyze the prognostic significance of factors for recurrence-free survival (RFS), overall survival (OS), and survival after recurrence, the log-rank test and Cox proportional hazards model were used for univariate and multivariate analysis. Results Of the 48 patients, twenty-nine patients (60.4%) experienced recurrence and 16 patients (33.3%) died within a median follow-up period of 20 months (range, 3-99months). On multivariate analysis, older age, presence of residual tumor after surgery, lower mitotic count, and history of adjuvant radiotherapy at first treatment were significantly associated with better RFS. Presence of residual tumor after surgery and severe nuclear atypia were associated with poor OS. In analysis of survival after recurrence, hematogenous recurrence, severe nuclear atypia, and presence of residual tumor at primary surgery were significantly associated with worse prognosis. Notably, residual tumor status at primary surgery was associated with RFS, OS, and survival after recurrence. Conclusions We demonstrated possible prognostic factors for RFS, OS, and survival after recurrence for patients with LMS. These results may provide useful information for patients with LMS. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of proximal tube destruction at the uterine cornu by additional application of a sealing device., Methods: A single-center randomized trial was conducted on 40 patients receiving a laparo-endoscopic single-site hysterectomy with opportunistic salpingectomy. We randomized patients into two groups at the time of admission to determine the laterality of additional thermal cauterization. Additional thermal cauterization for 10 seconds was applied on the right cornu in one group and on the left cornu in the other group. Three pieces of cornual tissue from each cornu were biopsied. One gynecological pathologist examined the cornual tissue to determine the residual tubal epithelium (TE) and thermal destruction of the specimens., Results: Of the 40 patients enrolled in this study between September 2012 and July 2014, samples of 26 patients were subjected to tissue analysis. Residual TE was found in the cornu in 73.1% (19/26) and 65.4 % (17/26) of tissues from the side of no additional cauterization (NO) and the side of additional cauterization (AD), respectively ( p < 0.001). Residual TE was detected in 5.3% (1/19) and 94.1% (16/17) of the specimens from the NO and AD groups, respectively., Conclusion: We observed that a high incidence of residual TE and efficacious cauterization-induced thermal destruction was achieved following 10 seconds of additional cauterization. These results suggest that additional cauterization of the uterine cornu using the sealing device effectively destroys residual TE after salpingectomy., Competing Interests: Conflicts of interest: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.