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ObjectiveHuman chorionic gonadotropin (hCG) is a glycoprotein hormone expressed in a variety of tumors and is correlated with advanced stage disease and poor prognosis. This study aimed to determine hCG expression immunohistochemically in endometrial specimens obtained from patients with normal endometrium, endometrial hyperplasia, and endometrial carcinoma, and to determine if there is a correlation between invasiveness and hCG positivity.MethodsThe histologic materials and medical records for patients diagnosed with normal endometrium, endometrial hyperplasia with/without atypia, and endometrial carcinoma between September 2017 and September 2020 were retrospectively reviewed. Immunohistochemical staining for hCG was performed and analyzed semi-quantitatively.ResultsA total of 96 patients were included: normal endometrium (27.1%) (n=26); endometrial hyperplasia without atypia (25%) (n=24); atypical endometrial hyperplasia (22.9%) (n=22); endometrioid endometrial cancer (25%) (n=24). Median age of the patients was 48 (range 28–81) years. hCG was positive in 8.3% of patients with endometrial hyperplasia without atypia, 18.2% in those with atypical endometrial hyperplasia, and 41.7% in those with endometrial cancer (pConclusionhCG is expressed to a significantly greater degree in patients with atypical endometrial hyperplasia and endometrial carcinoma and it may be potentially used as a marker for these lesions.

© 2022 Informa UK Limited, trading as Taylor & Francis Group.In our retrospective cohort study, we aimed to determine the role of endometrial thickness (ET) in isolated male factor infertile women in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo cycles. The patients were classified as having an endometrial thickness of 14 mm (n: 50) according to their ETs on the human chorionic gonadotropin (hCG) day. The overall clinical pregnancy rate was 37.4%, and no significant difference was found between the groups (p =.262). There was no significant difference between live birth rates (p =.094), but the highest pregnancy (46%) and live birth (34%) rates were found in the group with >14 mm ET. The increase in ET in IVF cycles increases pregnancy rates, albeit partially. When it is desired to determine a cut-off value, it can be said that pregnancy rates increase significantly in thicknesses of 14 mm and above.Impact StatementWhat is already known on this subject? When the literature is examined, many studies conclude that clinical pregnancy rates increase with the increase in endometrial thickness (ET) in IVF cycles, but there are also studies that argue the opposite. There is no study in the literature investigating the effect of ET on clinical pregnancy rates in patients with isolated male factor infertility. What do the results of this study add? In support of the literature, an increase in ET was found to be associated with an increase in clinical pregnancy rates, regardless of male and female factors. Although pregnancy occurs in thin endometriums, abortion rates are undesirably high. What are the implications of these findings for clinical practice and/or further research? Although the risk of abortion is high in thin endometriums, live birth rates are satisfactory. As a result, thin endometrium does not require cycle cancellation.

Postoperative ileus (POI) is a form of intestinal paralysis that is seen especially after surgical procedures performed by entering the abdominal cavity. POI is common, particularly after abdominal surgery, with an incidence of 8-30%. The initial phase of postoperative paralytic ileus is treated with decompression using a nasogastric tube to correct electrolyte imbalances, with analgesia applied as needed. Prokinetic compounds have been used to prevent ileus and control pain (such as serotonin receptor antagonists, neostigmine, alvimopan, and ghrelin agonists), along with early mobilization, minimally invasive surgery, early introduction of solid food into the diet, thoracic epidural analgesia, and fluids. Coffee has been shown to accelerate postoperative bowel movements. However, despite extensive research on the physiological impacts of coffee, little is acknowledged regarding how it affects the gut. Coffee increases colonic motility within 4 min of consumption. In the postoperative period, the number of intestinal vocals heard by auscultation of intestinal vocals, first gas and first defecation times of patients who consume coffee are smaller/shorter than patients who do not consume coffee. Patients who drink coffee also have shorter hospital stays.

© 2022 Japan Society of Obstetrics and Gynecology.Aim: To evaluate the success of local methotrexate (MTX) treatment, the side-effect profile and its fertility effect in patients diagnosed with cesarean scar pregnancy. Materials: This retrospective cohort study included 56 cesarean scar pregnancy patients who applied to Erciyes University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2012 and January 2022 and were treated with ultrasound-guided local MTX. The results of 56 patients with cesarean scar pregnancy who underwent transvaginal ultrasound-guided single-dose local MTX treatment were evaluated. First, the contents of the sac were aspirated, and then 50 mg of MTX was injected into the gestational sac. Results: The median gestational age at diagnosis was 7 weeks 2 days. The mean beta human chorionic gonadotrophin level was 31 345 ± 37 838 (range: 113–233 835 mIU/mL). Fifty-four patients were successfully treated with local MTX therapy. The interval between the first MTX injection and the normalization of beta human chorionic gonadotrophin was 55.2 ± 41.0 days. None of our patients required surgical treatment. Beta human chorionic gonadotrophin values did not decrease in one patient and she was treated with systemic MTX. Local MTX therapy could not be applied to one patient for technical reasons. Only one patient needed blood transfusion after local MTX. Thirteen patients become pregnant after treatment (76%). No systemic side effects related to MTX were observed in any of the patients. Conclusion: Transvaginal ultrasound-guided single-dose local MTX treatment is an effective, safe, and fertility-preserving treatment method for cesarean scar pregnancy.

Objective: Investigate the relationship between the maximum standardize uptake value (SUVmax) values and the prognostic factors in endometrioid-type endometrial cancer (EEC) patients undergoing preoperative positron emission tomography / computed tomography (PET/CT).Study Design: We reviewed retrospectively the records of patients with EEC diagnosis who underwent hysterectomy in Gynecologic Oncology Clinic of Tepecik Training and Research Hospital between January 2010 and January 2017 in this retrospective study. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values of SUVmax for predicting clinical parameters. The area under the ROC curve (AUC) is presented as a measure of discrimination.Results: It was calculated that the SUVmax values in the uterine tumor were higher and statistically significant in the presence of advanced stage (III-IV), histologic grade III, deep myometrial invasion (≥1 / 2) and large tumor size (≥4 cm) from prognostic factors. The SUVmax values of the groups with and without cervical invasion did not different from each other. In order to use the SUVmax value as a diagnostic test in the ROC analysis, the AUC values were as follows; the grade of advanced stage tumor was 0,685, the grade 3 tumor was 0,797, the depth of myometrial invasion was 0,781, and the size of the large tumor was 0,905.Conclusion: SUVmax value in primary uterine tumor was found to be higher in prognostic factors in patients with advanced stage, high grade, deep myometrial invasion and large tumor.

© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.Aim: This multicenter investigation was performed to evaluate the adjuvant treatment options, prognostic factors, and patterns of recurrence in patients with grade 3 endometrioid endometrial cancer (G3-EEC). Materials and methods: The medical reports of patients undergoing at least total hysterectomy and salpingo-oophorectomy for G3-EEC between 1996 and 2018 at 11 gynecological oncology centers were analyzed. Optimal surgery was defined as removal of all disease except for residual nodules with a maximum diameter ≤ 1 cm, as determined at completion of the primary operation. Adequate systematic lymphadenectomy was defined as the removal of at least 15 pelvic and at least 5 paraaortic LNs. Results: The study population consists of 465 women with G3-EEC. The 5-year disease-free survival (DFS) and overall survival (OS) rates of the entire cohort are 50.3% and 57.6%, respectively. Adequate systematic lymphadenectomy was achieved in 429 (92.2%) patients. Optimal surgery was achieved in 135 (75.0%) patients in advanced stage. Inadequate lymphadenectomy (DFS; HR 3.4, 95% CI 3.0–5.6; P = 0.016—OS; HR 3.2, 95% CI 1.6–6.5; P = 0.019) was independent prognostic factors for 5-year DFS and OS. Conclusion: Inadequate lymphadenectomy and LVSI were independent prognostic factors for worse DFS and OS in women with stage I–II G3-EEC. Adequate lymphadenectomy and optimal surgery were independent prognostic factors for better DFS and OS in women with stage III–IV G3-EEC.

OBJECTIVE: To investigate the factors affecting recurrence development and time of disease-free survival in stage I malignant germ cell over tumor (MGCOT) patients. MATERIAL AND METHODS: Records of 27 patients who received MGCOT diagnosis between January 1998 and January 2016 in the gynecology oncology clinic of Tepecik Training and Research Hospital were reviewed retrospectively. Patients with CA125 value> 35, age ≥24, patients without lymph node sampling, patients without chemotherapy, patients with tumor size> 10 cm, and capsule invasion were evaluated from prognostic factors. RESULTS: We received 27 MGCOT patients to study. Seven (25.9%) of the patients had only surgery and 20 (74.1%) patients received adjuvant chemotherapy after surgery. All 20 patients received bleomycin, etoposide and cisplatin (BEP) protocol. Four patients (14.8%) developed recurrence. Patients with high CA125 (> 35) values and those who did not receive chemotherapy from prognostic factors were found to increase risk of relapse according to univariant logistic regression analysis. The risk factors affecting the time of disease-free survival were high CA125 and patients who did not receive chemotherapy according to Cox-regression analysis. CONCLUSIONS: In patients with stage I malignant germ cell over tumor, high CA125 values and no adjuvant chemotherapy appear to significantly increase recurrence development and shorten disease-free survival. KEYWORDS: Germ cell tumors; Ovarian tumors; Ovarian cancer; Ovarian germ cell tumors

BackgroundThere is a paucity of data on whether pre-operative walking and functional capacity has a direct association with post-operative gastrointestinal function in patients who have undergone surgery to treat gynecologic cancers.ObjectiveTo explore the relationship between pre-operative walking and post-operative recovery of bowel function.MethodsThis randomized trial was performed from January 1, 2018 to August 31, 2018. All patients had a diagnosis of endometrial or ovarian cancer and were scheduled for comprehensive staging. Group A served as the control group who did not walk regularly on the last night before surgery. Patients in group B walked for 30 min at an average speed of 3 km/h from 20.00 to 20.30 and 21.30. to 22.00 on the last night before surgery under the supervision of a nurse or doctor. The study was registered with clinicaltrials.gov (no: NCT03553121).ResultsA total of 85 patients were enrolled: 43 patients were assigned to the walking group and 42 to the control group. There were no significant differences in demographics between the groups. Median age was 57.3±8.5 in the control and 59.9±9.1 in the walking group. In addition, 28 patients had endometrial cancer and 14 had ovarian cancer in the control group. 33 patients and 10 patients in the walking group had endometrial and ovarian cancer, respectively. The mean time to first flatus was shorter in the walking group than in the control group (32.5±10.4 vs 40.6±16.9 hours, respectively; p=0.010). In addition, the time to first defecation was significantly shorter in the walking group (62.8±26.7 vs 91.4±51.8 hours; p=0.002). Patients who walked before surgery were less likely to have post-operative paralytic ileus (25.0% vs 60.7%; p=0.003). Walking before the operative period and laparoscopic surgery independently protected against the development of post-operative paralytic ileus.ConclusionWalking before surgery expedited time to bowel motility and ability to tolerate food. In addition, this method significantly decreased the risk of post-operative paralytic ileus.We consider that walking before surgery may be integrated into the pre-operative management of patients under going surgery for gynecologic cancers.Clinical trial registrationclinicaltrial.org record number: NCT03553121

In this study, our aim was to determine the differences between intrauterine growth restriction (IUGR) and normal birth weight fetuses in terms of ischemia modified albumin (IMA) levels. For this purpose, we measured ischemia modified albumin levels in the cord blood of fetuses and the mothers.This study is a prospective study conducted at University of Health Sciences Tepecik Training and Research Hospital between January 2018 and December 2019. According to the inclusion/exclusion criteria, 227 patients were included in the study. Participants were divided into two groups according to the presence (patient group) or absence (control group) of intrauterine growth restriction (IUGR). In addition to routine parameters recorded during pregnancy, the IMA levels and Doppler USG findings of all participants were recorded.The mean cord blood serum IMA levels of the patient group were significantly elevated compared to controls (p = 0.038). Whereas mean maternal blood serum IMA levels were similar among groups (p = 0.453). The cord blood and mother blood serum IMA levels were not significantly different with regard to the presence or absence of perinatal asphyxia.In the literature, studies evaluating IMA levels in the cord and maternal blood of IUGR fetuses are limited. In IUGR patients, IMA level is expected to increase and in our study, IMA levels were significantly increased but the presence of oxidative stress has not been found to affect IMA levels.

Aim: The clinicopathologic characteristics, recurrence patterns, and survival of patients with grade 3 endometrial cancer (G3-EAC) and uterine carcinosarcoma (UCS) were compared. Materials and Methods: The medical records of patients treated for G3-EAC and UCS between January 1996 and December 2016 at 11 gynecologic oncology centers in Turkey and Germany were analyzed. Results: Of all patients included in the study, 161 (45.1%) were diagnosed with UCS and 196 (54.9%) with G3-EAC at FIGO stage I–II (early stage) disease. The recurrence rate was higher in patients with UCS than in those with G3-EAC (17.4 vs. 9.2%, p = 0.02). The 5-year disease-free survival (DFS; 75.2 and 80.8%, respectively; p = 0.03) and overall survival (OS; 79.4 and 83.4%, respectively; p = 0.04) rates were significantly lower in the UCS group compared to the G3-EAC group. UCS histology was an independent prognostic factor for decreased 5-year DFS (HR 1.8, 95% CI 1.2–3.2; p = 0.034) and OS (HR 2.7, 95% CI 1.3–6.9; p = 0.041) rates. Conclusions: The recurrence rate was higher in UCS patients than in G3-EAC patients, regardless of disease stage. DFS and OS were of shorter duration in UCS than in G3-EAC patients. Adequate systematic lymphadenectomy and omentectomy were an independent prognostic factor for increased 5-year DFS and OS rates.

Aim: Pelvic organ prolapse, the hernniation of the pelvic organs or beyond the vaginal walls. Vitamin D deficiency appears to be cause for pelvic muscle weakness. The aim of this study is to investigate the lack of vitamin D in patients with uterine prolapse.Methods: The records of patients were evaluated retrospectively in peri- and postmenopausal age group who were diagnosed with ICS stage 3-4 uterine prolapse based on vaginal examination and operated between February 2015-2016 in Izmir Tepecik Education and Research Hospital Gyneology and Obstetrics clinic. The files of 40 patients with ICS stage 0 in the peri- and postmenopausal period, whose 25 (OH) vitamin D were measured at the same time with the patient group and who underwent surgery due to any gynecologic indication, were evaluated as control group. Women were excluded if they had any medical conditions known to impair absorption or metabolism of vitamin D, or to be a major cause of fecal incontinence including Stage ≥3 chronic kidney disease, chronic liver disease, gastric bypass, colovaginal fistula, and pelvic irradiation.Results: 40 patients’ and 40 control cases’ data who met the study criteria were recorded. The patient group had a lower level of 25 (OH) vitamin D (9,5 ± 14,0 ng/ml) than the control group (15,3 ± 20,3 ng/ml). Furthermore, 25 (OH) vitamin D deficiency (25 [OH] vitamin D level

WOS: 000429369600013 PubMed ID: 29662718 Objective: We aimed to investigate the correlation of the size and volume of uterine tumors obtained using positron emission tomography/computed tomography (PET/CT) and pathology specimens in patients with endometrioid-type endometrial cancer (EEC) in the premenopausal period, and to compare the results with those of postmenopausal women. In the premenopausal period, the endometrium uses more glucose than in the postmenopausal period. Therefore, the measurement of uterine tumor size using PET/CT in the premenopausal period may normally be different. Materials and Methods: In this retrospective study, we reviewed the records of patients who were diagnosed as having EEC and underwent hysterectomy. Only patients who underwent preoperative PET/CT imaging were included in the study. The thickness and volume of the uterine lesion, and its maximum standardized uptake value as obtained using PET/CT and hysterectomy pathology specimens were recorded. Results: Tumor size (p= 0.051) and volume (p= 0.404) were not found to be correlated with the imaging method used in premenopausal women and pathologic specimens. However, there was a correlation in postmenopausal women (p< 0.001 for tumor size and p< 0.001 for tumor volume). PET/CT has higher sensitivity, specificity, and positive predictive value in the postmenopausal period in the detection of > 20 mm uterine tumors. Conclusion: PET/CT has a limited role in the measurement of the size of uterine lesions in all patients, especially in the premenopausal period; therefore, we recommend that frozen-section examinations be used intraoperatively to decide on lymph node dissection.

The aim of this study was to examine the associations between microcystic, elongated, and fragmented (MELF) pattern and other prognostic factors and lymph node involvement, disease-free survival, and overall survival (OS) using a case-control group consisting of grade I-II endometrioid endometrial carcinoma (EEC) patients with/without lymph node involvement. The files of the patients were searched electronically for all hysterectomy specimens with a diagnosis of grade I-II EEC of the uterine body from January 1, 2008 to July 31, 2014. Lymph node involvement was detected in 27 patients who were histologically diagnosed with grade I-II EEC, and these patients made up the case group. Using a dependent random sampling method, 28 grade I-II EEC patients without lymph node involvement were selected. According to multivariate regression analysis, lymphovascular space invasion [odds ratio, 23.5; 95% confidence interval (CI), 2.4-223.5] and MELF pattern (odds ratio, 13.3; 95% CI, 1.4-121.8) were significant predictors of lymph node involvement. There was recurrence in 15.8% of cases that showed a MELF pattern and in 19.4% of those that did not (P=0.738). According to Kaplan-Meier analysis, the MELF pattern revealed no significant differences in disease-free survival (hazard ratio, 1.0; 95% CI, 0.1-36.5), whereas the effect on OS was significant (hazard ratio, 2.2; 95% CI, 1.3-4.2). The presence of MELF pattern was a substantial risk factor for detecting lymph node involvement in patients with grade I-II EEC. The MELF pattern may be important for identifying which patients need staging surgery, in addition to its effect on the OS.

Objectives: The aim of this study is to evaluate the results of advanced stage (stage IIIB-IVB) ovarian cancer (OC) patients with intestinal metastasis, and to investigate the factors that affect survival. Material and methods: Patients who underwent cytoreductive surgery (CS) for FIGO stage IIIB-IVB OC with metastasis in the intestinal system, at Tepecik Research and Treatment Hospital between 2008–2014, were analyzed retrospectively. Patients with borderline ovarian tumor; those who had previously undergone radiation therapy and/or hysterectomy and patients having secondary or tertiary cytoreduction were excluded and 49 patients were included and analyzed in this study. Hysterectomy, bilateral salpingo-oopherectomy, pelvic and para-aortic lymph node sampling, resection of bulky lymph nodes and omentectomy were performed. Optimal cytoreduction was accepted as that which left residual tumor ≤ one cm maximum size. Results: The risk factors affecting OS interval were investigated according to Cox’ regression analysis. Optimality of the primary CS (P = 0.008 and HR = 5.202) and cancer stage (P = 0.016 and HR = 6.083) were found to be statistically significant factors. Conclusions: Achieving optimal CS is the most important aim for the general surgeon carrying out an intestinal resection procedure. Although resection procedures are superior in providing the desired optimal results when compared to excision surgery, their higher complication rates and subsequent lower quality of life must be taken into consideration when choosing either resection or excision methods; surgical intervention should always be kept to the minimum possible.

gokcu, mehmet/0000-0002-3187-2317; Sanci, Muzaffer/0000-0002-8494-4302 WOS: 000538753700014 PubMed ID: 31584305 We compared two transumbilical (TU) routes of surgical specimen retrieval in women with ovarian masses treated via laparoscopy: a bag made from a surgical glove and lateral transabdominal (LTA) retrieval employing a standard endobag. A total of 109 women undergoing laparoscopic surgery to treat benign adnexal masses were retrospectively evaluated between 2014 and 2017. In total, 57 masses were removed via the TU route and 52 via the LTA route. We recorded the ovarian mass size; additional postoperative analgesic drug requirements. Postoperative incisional pain scores were assessed using a 10-cm visual analogue scale (VAS), time to discharge and procedure type. The mean VAS scores at 1h (5.0 +/- 1.7 vs. 6.3 +/- 1.3; p

Sanci, Muzaffer/0000-0002-8494-4302 WOS: 000490372600001 PubMed ID: 31607197 The purpose of this study was to develop and validate a nomogram for individual prediction of recurrence and disease-free survival (DFS) among lymph node (LN)-negative early-stage (I?IIA) cervical cancer (CC) patients treated with Type B or Type C2 hysterectomy. Data were collected from patients diagnosed with CC between 1995 and 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital. A total of 194 cases with stage IA2?IIA CC were evaluated retrospectively. Patients with stage IA2?IIA CC who underwent radical (Type C2) or modified radical (Type B) hysterectomy and pelvic???paraaortic LN dissection with LN negativity were included in the study. The relationships between prognostic factors such as stage, tumour size, parametrial involvement, vaginal cuff margin, endomyometrial infiltration, and lymphovascular space invasion status and DFS were compared using a univariable Cox regression model. When the nomogram was prepared, the scores of the risk factors were collected, and we observed that scores were at least 0 to a maximum of 414 points. The concordance-index for the nomogram was 0.895 (95% confidence interval, 0.79?0.99). The nomogram based on the indicated prognostic factors yielded excellent results in predicting recurrence in early-stage CC patients without LN metastasis who underwent radical hysterectomy.Impact statement What is already known on this subject? Pathology of radical hysterectomy specimens in patients with early-stage cervical cancer provides information that has predictive prognostic potential. In addition to FIGO stage, other important prognostic factors are lymph node status, tumour size, parametrial involvement, vaginal cuff margin status, endomyometrial infiltration, histological type, patient age, lymphovascular space invasion, histological grade, and depth of cervical stromal invasion. What do the results of this study add? In this study, patients with early-stage cervical cancer who underwent radical and modified radical hysterectomy without retroperitoneal lymph node involvement were evaluated, and recurrence development and factors affecting disease-free survival were investigated. A nomogram consisting of factors influencing disease-free survival was constructed. The total score was determined according to the status of all risk factors. This allowed clear definition of the risk for each patient. A nomogram predicting recurrence in patients with stages IA2?IIA cervical cancer with radical hysterectomy without lymph node involvement has not previously been published.

Aim The aim of this study was to investigate the possibility of using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and platelet count and their dynamic changes during chemotherapy to predict suboptimal interval debulking surgery (IDS) in stage IIIC-IVA serous ovarian cancer (OC). Method Patients who underwent IDS after neoadjuvant chemotherapy (NAC) for stage IIIC-IVA serous OC at 3 centers between January 2008 and March 2018 were analyzed retrospectively. All women with complete blood counts both at diagnosis (T0) and after the completion of NAC but prior to IDS (T1) were included. An average of 3 weeks passed between IDS and the last cycle of NAC. Results A total of 214 patients were found suitable for the study. Suboptimal surgery was performed in 25.2% of the patients and optimal surgery was performed in 74.8%. The rate of change in NLR was calculated as [(NLR T0 – NLR T1)/NLR T0] × 100. A higher rate of change in NLR was found in the optimal surgery group. Recovery of thrombocytosis (When platelet count before NAC was >400,000/mm3, recovery of thrombocytosis was defined as ≤400,000/mm3 after NAC.) was found to have 85.7% sensitivity and 64.8% specificity in predicting suboptimal surgery (P 17%) and recovery of thrombocytosis significantly predicted suboptimal surgery. Conclusion To identify the likelihood of suboptimal surgery in advanced stage OC patients who undergo IDS after NAC, the dynamic change in NLR values can be examined.

Amaç: 40 mm’den küçük grade I-II endometrioid tip endometriyum kanseri (EEC) hastalarında ameliyat öncesi periferal kan örneğinden bakılan tam kan sayımında elde edilen nötrofil/ lenfosit oranı (NLO) ve platelet/ lenfosit oranı (PLO) değerleri ile prognostik faktörler (myometriyal invazyon derinliği, servikal invazyon, lenf nodu tutulumu, ve evre) arasındaki ilişkiyi araştırmakdır. Gereçler ve Yöntem: Bu çalışmada, Ocak 2013-Ocak 2016 tarihleri arasında Tepecik Eğitim ve Araştırma Hastanesi Jinekolojik Onkoloji kliniğinde, EEC tanısını alan ve histerektomi ve retroperitoneal lenfadenektomi işlemi yapılan hastaların kayıtlarını retrospektif olarak gözden geçirdik. Sadece 40 mm’den küçük tümörü olan ve grade I-II hastalar incelendi ve çalışmaya dahil edildi. EEC'de prediktif prognostik faktörlerin optimal eşik (cut-off) değerini belirlemek için ROC (Receiver operating characteristic) eğrisi analizi kullanıldı. Bulgular: Hastaların prognostik faktörlerinden derin myometriyal invazyon, servikal invazyon varlığı, lenf nodu metastazı varlığı ve ileri evre tümörü olanlarda NLO, PLO ve CA125 değerlerinin daha yüksek olduğu ve tüm sonuçların istatiksel olarak anlamlı olduğu tespit edildi. Yapılan ROC analizinde ileri evre, lenf nodu metastazı ve derin myometriyal invazyon için en yüksek eğri altında kalan alana sahip faktörün NLO olduğu bulundu. Ancak servikal invazyon için en yüksek eğri altında kalan alana PLO değerinin sahip olduğu gösterildi. Sonuç: Prognostik faktörlerden ileri evre, lenf nodu metastazı, derin myometriyal invazyon ve servikal stromal invazyon varlığında grade I-II

gokcu, mehmet/0000-0002-3187-2317; Sanci, Muzaffer/0000-0002-8494-4302; Budak, Adnan/0000-0003-4145-3973 WOS: 000452135200003 PubMed ID: 30508210 Objectives: The aim of this study was to assess the treatment options and survival of uterine cervical cancer (UCC) patients who develop isolated pulmonary metastases (IPM) and to establish risk factors for IPM. Material and Methods: Data from patients diagnosed with UCC between June 1991 and January 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital, were investigated. In total, 43 cases with IPM were evaluated retrospectively. Additionally, 172 control patients diagnosed with UCC without recurrence were matched according to the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage when the tumor was diagnosed. They were selected using a dependent random sampling method. Results: Of the 890 patients with UCC, 43 (4.8%) had IPM. The presence of lymphovascular space invasion (LVSI) and a mid-corpuscular volume (MCV) < 80 fL were statistically significant prognostic factors for IPM development in UCC patients according to univariate regression analyses, and the presence of LVSI, a hemoglobin level < 12 g/dL, and an MCV < 80 fL were statistically significant according to the multivariate regression analyses. We were unable to assess the role of lymph node status (involvement or reactive) as a prognostic factor in the development of IPM, because only seven patients (16.2%) in the case group underwent lymph node dissection. Conclusions: IPM typically develops within the first 3 years after the diagnosis of UCC, and survival is generally poor. An MCV < 80 fL and the presence of LVSI are significant risk factors for IPM development.

Aim We sought to identify risk factors and management options for uterine cervical cancer (UCC) patients with a vertebral metastasis (VM) treated over the course of 23 years. Methods Among 844 UCC patients, 18 were diagnosed with a VM. Thirty-six control patients with UCC but without recurrence were matched to these 18 in terms of stage and histological tumor type using a dependent random sampling method. A logistic regression analysis was used to identify factors prognostic of VM; the results are presented as odds ratios with 95% confidence intervals (CIs). Results The mean survival time after VM treatment commenced was 12.1 ± 2.7 months (95% CI, 5.3–12.6 months) in patients who received chemotherapy (CT) and 15.0 ± 2.3 months (95% CI, 9.7–14.2 months) in those treated via chemoradiotherapy (CRT) (P = 0.566). In patients who underwent CT, the 1- and 2-year survival rates after recurrence were 19.2% and 0%, respectively. However, these figures were 50% and 8.3% in those treated via CRT. Both lymphovascular space invasion and mean corpuscular volume were risk factors for VM. Cox regression analysis showed that these prognostic factors had no effect on survival duration after recurrence. The locations and percentages of vertebra metastasis were as follows: 11.1% lumbar 4, 27.7% lumbar 5, 22.2% lumbar 4-5, 16.7% lumbar 3-4-5, 5.6% lumbar 2-3, 5.6% lumbar 2-3-4, 5.6% lumbar 3-4-5/sacral 1, and 5.6% thoracic 11-12/lumbar 1-2. Conclusions We found that patients with lymphovascular space invasion were at high risk of isolated VM and that the survival times after CT and CRT were similar. Because most VMs are seen in the vertebral space within the borders of radiation therapy, borders of external beam radiotherapy should be carefully determined for each patient.

Postpartum hemorrhage is a potentially life-threatening, albeit preventable, condition that persists as a leading cause of maternal death. It occurs mostly during the third stage of labor, and active management of the third stage of labor (AMTSL) can prevent its occurrence. AMTSL is a recommended series of steps, including the provision of uterotonic drugs immediately upon fetal delivery, controlled cord traction, and massage of the uterine fundus, as developed by the World Health Organization. Here, we present current opinion and protocols for AMTSL.

Aim: The aim of this study was to investigate the treatment options and survival of cervical cancer (CC) patients who develop isolated vaginal metastasis (IVM), and to establish risk factors for IVM. Patients and Methods: A total of 21 cases with IVM were evaluated retrospectively. In addition, 42 control patients diagnosed with CC without recurrence were matched. Tumor size, depth of stromal invasion (DOI), lymphovascular space invasion (LVSI), and size of vaginal and lymph node metastases were analyzed in accordance with the pathology reports. Patients who had IVM were investigated in terms of treatment options (chemotherapy (CT), radiotherapy (RT), or chemoradiotherapy (CRT)) and survival. Results: After detection of IVM, the 1-, 3-, and 5-year survival rates were 57.1, 23.8, and 9.5%, respectively. The mean survival time after metastasis detection was 23.1 ± 31.3 months. LVSI, DOI ≥ 1/2, hemoglobin < 12 g/dl, postmenopausal status, and tumor size ≥ 4 cm were independent risk factors for IVM. The 5-year survival rates were 30.0% for patients receiving RT, 17.1% for patients receiving CRT, and 0% for patients receiving CT. Conclusion: IVM typically develops within the first 2 years after the diagnosis of CC, and survival is generally poor. RT was the most effective treatment in patients with IVM.

Metastases to the female genital tract from extra-genital malignancies are very uncommon and have a poor prognosis. The most common extra-genital primary sites are breast and gastrointestinal system. The ovaries are frequent targets of metastasis for malignant tumors. Distinction between primary and metastatic tumors is important because misinterpretation of a metastatic tumor as primary tumor may lead to inappropriate management and suboptimal treatment outcome. The routes of tumor spread to the genital system are variable such as lymphatic and hematogenous metastasis or direct extension. Multidisciplinary approach is required to management and follow-up for these patients. J Clin Exp Invest 2015; 6 (4): 406-413 Key words: Female genital tract, extragenital malignancies, multidisciplinary approach

Sanci, Muzaffer/0000-0002-8494-4302; Budak, Adnan/0000-0003-4145-3973; gokcu, mehmet/0000-0002-3187-2317 WOS: 000455400500002 PubMed ID: 30618033 Objectives: This study was performed to investigate prognostic factors status at smaller tumors in patients with stage IB1 cervical cancer (CC) who underwent modified radical or radical hysterectomy. Matherial and metods: Data from patients diagnosed with CC between January 1995 and January 2017 at the Gynecological Oncology Department,Tepecik Training and Research Hospital and Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey, were investigated. A total of 182 stage IB1 CC cases were evaluated retrospectively. Results: Patients were divided into two groups according to tumor size ( < 2 cm and >= 2 cm). There were no complications associated with the operation in patients with a tumor size < 2 cm. Among patients with a tumor size >= 2 cm, however, 0.9% (n = 1) developed bladder laceration, 0.9% (n = 1) rectum laceration, and 0.9% (n = 1) pulmonary emboli (P = 0.583). The rates of intermediate risk factors (depth of stromal invasion and lymphovascular space invasion) were significantly higher and lymph node involvement significantly more frequent in patients with a tumor size >= 2 cm. However, there were no significant differences in parametrial invasion or vaginal margin involvement between the two groups. Conclusions: Intermediate risk factors and lymph node metastasis were significantly less frequent in patients with small tumors measuring < 2 cm. However, although parametrial involvement and vaginal margin involvement were less common in patients with small tumors compared with large tumors(>= 2 cm), the differences were not significant.

AimThe aim of this study was to evaluate whether adenomyosis had an effect on myometrial tumor invasion, stage of the disease, and survival in endometrial cancer.MethodsEndometrial cancer patients encountered between 2007 and 2016 were identified from pathology records. Patients who underwent suboptimal surgical or medical treatment or with insufficient clinical or surgical data were excluded. Patients diagnosed as having concurrent adenomyosis constituted the study group. Control group patients were randomly selected in a paired design according to the tumor grades in the study group, and for each tumor grade, 4 times as many as patients were included. Tumor stage, histologic type and grade, myometrial invasion, lymphovascular space invasion, presence and location of the adenomyosis in myometrial wall, distance from endometrial line, tumor in adenomyosis, adjuvant treatment, and relapse were primary outcomes.Age, body mass index, medical comorbidities, and type of operation were also recorded. Univariate and multivariate Cox proportional hazards regression models were performed for overall survival.ResultsOf those 1242 endometrial cancer patients, 80 with concurrent adenomyosis were identified and compared with 320 patients without adenomyosis following a paired selection based on tumor grade. Higher rates of myometrial invasion, lymphovascular space invasion, tumor diameter, and adjuvant treatments were found in the nonadenomyosis group compared with adenomyosis group (P ≤ 0.001). In patients with adenomyosis, rates of early-stage disease and overall survival were significantly higher compared with the control group (P = 0.001 and 0.01, respectively).ConclusionsOur results showed that adenomyosis is significantly associated with lower stage in endometrial cancer that may suggest a possible limiting effect on endometrial cancer spread. In addition, despite similar rates in disease-free survival and endometrial cancer–related death, overall survival rate was significantly higher in the presence of adenomyosis and might be considered as a good prognostic factor for endometrial cancer.

Aim: The aim of this study was to investigate the risk factors for recurrence in patients with low-risk endometrial cancer (EC). Patients and Methods: This retrospective study was performed using 10 gynecological oncology department databases. Patients who met the following criteria were included in the study: (a) endometrioid-type histology, (b) histological grade 1 or 2, (c) no or < 50% myometrial invasion, (d) no intraoperative evidence of extrauterine spread, and (e) the patient underwent at least a pelvic lymphadenectomy. Recurrence was detected in 56 patients who were histologically diagnosed with low-risk EC, and these patients made up the case group. A total of 224 patients with low-risk EC without recurrence were selected (control group) using a dependent random sampling method. The case and control groups were match-paired in terms of grade, stage, and operative technique. Results: Lymphovascular space invasion (LVSI) (odds ratio (OR) 5.8, 95% confidence interval (CI) 2.0-16.9; p = 0.001) and primary tumor diameter (PTD) ≥ 20 mm (OR 6.6, 95% CI 2.7-15.8; p < 0.001) were found to be independent risk factors for recurrence in women with low-risk EC. Conclusion: The presence of LVSI and PTD ≥ 20 mm seem to be significant risk factors for recurrence in women with low-risk EC.

ObjectiveThe aim of this study was to investigate the effect of different surgical approaches, adjuvant therapy, and pathological characteristics on oncological outcomes in patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer (EC).MethodsA multicenter, retrospective department database review was performed to identify patients with FIGO 2009 stage II EC who underwent surgical staging between 2002 and 2015 at 5 gynecologic oncology centers in Turkey.ResultsOriginal pathology reports of 4867 patients who underwent surgical treatment for EC were analyzed. The study group consisted of 250 FIGO stage II patients. Of these patients, 203 (81.2%) had endometrioid and 47 (18.8%) had nonendometrioid histologic subtype of EC. Whereas 199 patients (79.6%) underwent type I hysterectomy, the remaining 51 patients (20.4%) underwent radical hysterectomy. Of the 250 patients, 208 patients (83.2%) had adjuvant therapy including radiotherapy (pelvic external beam radiotherapy and/or vaginal brachytherapy [VBT]) and/or platinum-based chemotherapy. Disease recurred in 29 patients (11.6%). The 5-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 82% and 85%, respectively. Multivariate analysis showed that only adjuvant treatment (P = 0.001; hazard ratio, 4.02; 95% confidence interval, 1.72–9.36) was significantly associated with DFS. According to multivariate analysis, only age older than 60 years (P = 0.01; hazard ratio, 3.03; 95% confidence interval, 1.3–7.04) was identified as an independent risk factor for OS. However, there were no differences in OS when evaluated by grade, histology, tumor size, type of hysterectomy, or adjuvant treatment.ConclusionsIn stage II EC, adjuvant external beam radiotherapy ± VBT were associated with increased DFS but not OS. However, the benefit of VBT alone on DFS could not be demonstrated. Only age was an independent risk factor for OS. Type of hysterectomy and histologic subtype of the tumor for patients with uterus-confined disease improved neither DFS nor OS in our study group.

To investigate clinicopathological characteristics and oncological outcome of women with microinvasive BOTs. A retrospective multicenter case–control study was conducted on 902 patients with BOT, who underwent surgery from January 2002 to December 2015 at six participating gynecologic oncology centers from Turkey. Among 902 patients, 69 had microinvasive BOT. For every patient with microinvasive BOT, two controls were randomly selected from another database based on decade of age and stage of disease at diagnosis. The clinical–pathological characteristics and oncological outcomes were compared between BOT patients with and without stromal microinvasion. Risk factors for poor oncological outcomes were investigated in a multivariate analysis model. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method. Patients with microinvasive BOT had a significantly higher rate of recurrence than patients without microinvasive BOT (17.4 vs 7.8%, OR 3.55, %95 CI 1.091–11.59, p = 0.03). Stage at diagnosis (stage I versus II/III) and type of surgery (cystectomy versus others) were found as other significant prognostic factors for recurrence in multivariate analysis (OR 8.63, %95 CI 2.48–29.9, p = 0.001 and OR 19.4, %95 CI 3.59–105.6, p = 0.001, respectively). Stromal microinvasion was found as a prognostic factor for significantly shorter DFS (26.7 vs 11.9 months, p = 0.031, log rank). However, there was no significant difference in OS between two groups (p = 0.99, log rank). Stromal microinvasion is significantly associated with decreased DFS. In addition, our study confirms that the risk of recurrence is higher in patients with microinvasive BOT.

Aim: Estrogen receptor (ER), progesterone receptor (PR), and Ki-67 and P53 receptor levels in endometrial curettage material were investigated for their ability to predict lymph node (LN) involvement in patients with endometrioid-type endometrial cancer (EEC). Methods: This retrospective study was based on a review of the records of patients who were diagnosed with EEC and underwent both hysterectomy and systematic retroperitoneal lymphadenectomy at the Gynecologic Oncology Clinic of Tepecik Training and Research Hospital, Turkey, between January 2008 and August 2017. Results: The curettage materials of 138 EEC patients were analyzed for ER, PR and P53 and Ki-67 receptor levels. According to the pathology results, the median pelvic LN count was 20 (range: 12-49) and the para-aortic LN count was 14 (10-46). Retroperitoneal LN involvement was present in 18 patients (13.0%). The association of LN involvement with all receptors was significant. The combined ratio of the 2 groups of markers ([P53 + Ki67]/[ER + PR]) (≥0.71) was an independent risk factor for LN involvement. In addition, in a univariate logistic regression analysis all receptors were significant predictors of LN involvement. Conclusions: In the detection of LN involvement, determination of the receptor status in curettage material has a high sensitivity and specificity. In EEC patients, receptor levels in curettage materials can be evaluated to detect LN involvement preoperatively.

ObjectivesThe aim of this retrospective multicenter study was to investigate the frequency of extrauterine metastasis and to evaluate the importance of surgical staging and adjuvant treatment among patients with noninvasive uterine papillary serous carcinoma (UPSC) of the endometrium.Materials and MethodsA multicenter, retrospective department database review was performed to identify patients with UPSC of the endometrium who underwent surgical staging between 2000 and 2015 at 4 Gynecologic Oncology Centers in Turkey. Demographic, clinicopathological, and survival data were collected.ResultsA total of 182 patients with primary UPSC of the endometrium were identified. Of these, 33 (18.1%) had tumors limited to the endometrium with no myometrial invasion. Twenty (60.6%) of these 33 patients had no extrauterine involvement and International Federation of Gynecology and Obstetrics 2009 stage 1A disease was diagnosed after complete staging. The remaining 13 (39.4%) patients had disease beyond the uterine corpus including 5 with omental, 3 with adnexal, 1 with cervical stromal involvement, 1 with disease in the pelvic lymph nodes, and 1 with isolated para-aortic lymph node metastasis. Two patients had metastases in more than one location including omentum/adnexa/pelvic–para-aortic lymph nodes and omentum/pelvic–para-aortic lymph nodes, respectively. Of the 20 patients with disease confined to the endometrium, 6 (30%) patients received adjuvant treatment.ConclusionsNoninvasive UPSC has a high tendency for extrauterine spread and omentum is the most commonly involved location. Therefore, comprehensive surgical staging including omentectomy and pelvic–para-aortic lymph node dissection is mandatory in this group of patients. Risk of extrauterine spread is significantly associated with the presence of lymphovascular space invasion, elevated preoperative CA 125 levels, and positive peritoneal cytology. Adjuvant therapy for women with endometrium-confined disease improves neither progression-free survival nor overall survival.

gokcu, mehmet/0000-0002-3187-2317; Gungorduk, Kemal/0000-0002-2325-1756; Sanci, Muzaffer/0000-0002-8494-4302 WOS: 000397043700011 PubMed ID: 27780709 BACKGROUND: Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation. OBJECTIVE: The purpose of this study was to investigate whether coffee consumption accelerates the recovery of bowel function after complete staging surgery of gynecologic cancers. STUDY DESIGN: In this randomized controlled trial, 114 patients were allocated preoperatively to either postoperative coffee consumption with 3 times daily (n 58) or routine postoperative care without coffee consumption (n 56). Total abdominal hysterectomy and bilateral salpingooophorectomy with systematic pelvic and paraaortic lymphadenectomy were performed on all patients as part of complete staging surgery for endometrial, ovarian, cervical, or tubal cancer. The primary outcome measure was the time to the first passage of flatus after surgery. Secondary outcomes were the time to first defecation, time to first bowel movement, and time to tolerance of a solid diet. RESULTS: The mean time to flatus (30.2 +/- 8.0 vs 40.2 +/- 12.1 hours; P

Objective: To compare the survival and recurrence outcomes of treatment methods which have been applied to cervical cancer cases early and local advanced stages in a retrospective and single center setting.Material and Methods: The records of 844 patients who were diagnosed with cervical cancer and were treated between 1992 and 2015 at the Gynecologic Oncology Clinic of Tepecik Education Research Hospital were retrospectively evaluated. Patients were divided into early stage stage IAIB1 and local advanced stage LIE IB2-IVA groups according to the treatment regimens. Survival analyses were performed by the Kaplan-Meier method and the results were compared with the logrank test.Results: Early stage cervical cancer patients constituted 4 different treatment groups: 88 patients underwent hysterectomy, 16 patients received primary radiotherapy, 103 received adjuvant radiotherapy after hysterectomy and 65 patients received adjuvant chemoradiotherapy after hysterectomy. There was no difference regarding the 5-year disease-free survival outcomes according to treatment modalities for early stage cervical cancer patients, but the overall survival time was lower in the primary radiotherapy group and the recurrence rates were higher.There were 97 patients who received primary radiotherapy, 313 patients who received primary chemoradiotherapy, 50 patients who received adjuvant radiotherapy after hysterectomy, and 82 patients who received adjuvant chemoradiotherapy after hysterectomy in the LIE group. According to the treatment modalities for LIE cervical cancer patients, 5-year disease-free survival and total survival rates were lower in patients receiving primary radiotherapy and recurrence rates were higher in primary radiotherapy group.Conclusion: Among the treatment modalities applied in both early stage and LIE cervical cancer patients, it was statistically significant that the duration of total survival was shorter and recurrence rates were higher in the treatment of primary radiotherapy than the other treatment groups, Amaç: Retrospektif ve tek merkezli olarak servikal kanserli olgulara erken evre ve lokal ileri evrelerde uygulanan tedavi tiplerinin sağkalım ve nüks sonuçlarını karşılaştırmakdır.Gereç ve Yöntemler: Tepecik Eğitim Araştırma Hastanesi Jinekoloji Onkoloji Kliniğinde 1992– 2015 tarihleri arasında serviks kanseri tanısını alan ve tedavi uygulanan 844 hastanın kayıtları retrospektif olarak incelendi. Uygulanan tedavi şekillerine göre erken evre evre IA-IB1 ve lokal ileri evre LİE IB2-IVA gruplarına ayrıldı. Sağkalım analizleri Kaplan-Meier metodu ile yapıldı ve sonuçlar log-rank testi ile karşılaştırıldı.Bulgular: Erken evre serviks kanseri hastalarında histerektomi yapılan 88, primer radyoterapi verilen 16, histerektomi sonrası adjuvan radyoterapi verilen 103 ve histerektomi sonrası adjuvan kemoradyoterapi verilen 65 hasta 4 farklı tedavi grubunu oluşturdu. Erken evre serviks kanseri hastalarına verilen tedavi modalitelerine göre 5 yıllık hastalıksız sağkalım sonuçlarında farklılık olmadığı ancak toplam sağkalım süresinin primer radyoterapi grubunda düşük olduğu ve nüks oranlarının yüksek olduğu görüldü.LİE hastalarda primer radyoterapi verilen 97 hasta, primer kemoradyoterapi verilen 313 hasta, histerektomi sonrası adjuvan radyoterapi verilen 50 hasta, histerektomi sonrası adjuvan kemoradyoterapi verilen 82 hasta olduğu görüldü. LİE serviks kanseri hastalarına verilen tedavi modalitelerine göre 5 yıllık hastalıksız sağkalım ve toplam sağkalım oranlarının primer radyoterapi alan hastalarda daha düşük ve nüks oranlarının primer radyoterapi grubunda daha yüksek olduğu görüldü.Sonuç: Hem erken evre hem de LİE serviks kanserinde uygulanan tedavi grupları arasında, primer radyoterapi tedavisinin diğer gruplardan istatistiksel olarak anlamlı olarak toplam sağkalım süresinin kısa ve nüks görülme oranlarının fazla olduğu gösterildi

WOS: 000385879800002 PubMed ID: 27756415 Background: The optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs. Methods: A retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS. Results: In total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7-1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8-1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8-1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7-1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage >= IC was not an independent prognostic factor for DFS or OS. Conclusions: Patients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.