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Routine omentectomy is generally not performed in patients with endometrial cancer unless there is evidence of gross omental metastases. The aim of the current study was to evaluate the role of omentectomy in the staging of clinical stage I high-grade endometrial carcinoma and its impact on overall survival.Patients in the National Cancer Database who presented between 2010 and 2015 with clinical stage I serous, clear cell, carcinosarcoma, or grade 3 endometrioid carcinoma and underwent hysterectomy with lymphadenectomy were selected. Patients who did and did not receive an omentectomy were identified and clinico-pathological characteristics were compared. Overall survival was evaluated for patients diagnosed between 2010 and 2014 who had at least one month of follow-up following generation of Kaplan-Meier curves and comparison with the log-rank test. A Cox model was constructed to control for confounders.A total of 9097 patients were identified, and 36.3% underwent an omentectomy. Patients who underwent omentectomy were more likely to be managed in academic institutions (50% vs. 44%, p 0.001). They were also more likely to have an open surgery (48.2% vs. 27.2%, p 0.001) and receive adjuvant chemotherapy (54.7% vs. 38.2%, p 0.001). There was no difference in overall survival between patients who did and did not undergo omentectomy, p = 0.61; the 3-year OS rates were 82.3% and 82.2%, respectively. After controlling for confounders, the performance of an omentectomy was not associated with better survival (hazard ratio [HR]: 0.94, 95% confidence intervals [CI]: 0.84, 1.05).Routine omentectomy may not be associated with a survival benefit for patients with clinical stage I high-grade endometrial carcinoma.

Conservative treatment of a pregnant woman with moderate dysplasia that progressed to microinvasive carcinoma within 6 months is presented along with a review of the relevant literature to date. Pregnancy does not necessarily create special difficulties for the detection and diagnosis of cervical lesions as long as the patient is followed carefully. In this case, close observation using cytology and colposcopy along with colposcopically directed excisional biopsy postponed the need for more aggressive intervention, while minimizing possible disruption of the pregnancy and danger to the mother and infant. A simple hysterectomy performed 6 weeks postpartum proved successful and the cancer has not recurred.

Thirteen patients with a variety of advanced gynecologic malignancies were administered BCG via the dorsal lymphatics of the lower extremity in addition to standard accepted forms of therapy. Prolonged febrile courses, lymphangitis and suppurative adenitis were observed along the lymphatic pathway of the injected lower limbs. There was no correlation between reaction to a standard anergy panel and survival. There was also no correlation between reaction to a standard anergy panel and the inflammatory response to intralymphatic BCG (ILP-BCG). There was, however, a positive correlation between the inflammatory response to ILP-BCG and survival. Intralymphatic administration of immunostimulants may conceivably be of value as ancillary therapy for use in gynecologic malignancy. However, complications of this approach to immunotherapy are significant and the method should not be used until complications are decreased.

Eighty-five patients underwent a surgical staging procedure during a 2-year period. Fifty-eight of these patients were evaluated in relation to the histologic grade of their squamous carcinoma of the cervix. An increased incidence of extrapelvic lymph node metastasis is associated with poorly differentiated tumors and with parametrial extension of the primary tumor regardless of histologic grade. Surgical staging is suggested for patients with parametrial extension of their tumor or for patients with poorly differentiated tumors.