Candost Hanedan

A novel technique for transdiaphragmatic latero-pericardial cardiophrenic lymph node excision using the minimally invasive surgical access procedure in patient with advanced stage ovarian cancer

This study reports the first case of transdiaphragmatic lateropericardial cardiophrenic lymph node excision using the GelPOINT™ mini access platform in a patient with advanced-stage ovarian cancer. A 69-year-old woman with high-grade serous epithelial ovarian cancer. Cardiophrenic lymph node dissection is vital in advanced ovarian cancer surgery, as enlarged nodes are linked to poor prognosis. No clear guidelines exist for operating on patients with enlarged cardiophrenic lymph nodes [1,2]. These nodes are categorized by location relative to the heart: anterior, median (lateropericardial), and posterior [3]. Cardiophrenic lymph node resection can be performed using transdiaphragmatic, transxiphoid, or transthoracic approaches with video-assisted thoracoscopic surgery [4]. In cases with suspicious nodes on imaging, removing them is essential for optimal cytoreduction and accurate staging. In this case, preoperative computed tomography revealed suspicious cardiophrenic lymph nodes measuring 16×13 mm and 10×8 mm, located near the xiphoid process and lateral pericardium. A 30 mm diaphragm incision was made 60 mm from the xiphoid process. An Alexis O-wound retractor was used, and the GelPOINT™ mini platform was introduced with three ports, including one for the camera. A 30-degree optic scope was used to excise the node with LigaSure. When we needed smoke management, we used an aspirator. With this method, we were able to access distally located cardiophrenic lymph nodes with a small incision. Transdiaphragmatic excision of the cardiophrenic lymph node using the mini access platform can be performed effectively with a smaller incision, demonstrating the feasibility and safety of this minimally invasive technique in managing such cases.

The impact of human papillomavirus 16/18 positivity on cyberchondria levels in women undergoing colposcopy

SUMMARY OBJECTIVE: The negative consequences of the widespread use of the Internet for health-related information have recently become a topic of research. Recently, the impact of internet information-seeking on anxiety has been defined as cyberchondria, and a standardized scoring system has been developed to document it. However, the significance of this scoring system in gynecologic oncology has not yet been established. Therefore, the aim of this study was to evaluate the impact of human papillomavirus 16/18 positivity on the level of cyberchondria in women with human papillomavirus positivity undergoing colposcopy. METHODS: The study included 333 women with human papillomavirus 16/18 and other high-risk human papillomavirus positivity who underwent colposcopy in the gynecologic oncology clinic. Participants were divided into two groups: human papillomavirus 16/18 positive (Group 1, n=201) and other high-risk human papillomavirus positive (Group 2, n=132). Both groups were administered the short form of the Cyberchondria Severity Scale (CSS-12). Demographic and clinical findings and cyberchondria scores were compared between the groups. RESULTS: The median ages of the study groups were 36 (26–59) and 40 (25–63) years, respectively (p=0.004). Both groups had similar body mass index, parity, menopausal status, and educational levels (p>0.05). When comparing the four subscales and the total score, the excessiveness (11 [3–15] vs. 9 [3–15], p<0.001, respectively) and the total CSS-12 score (31 [12–55] vs. 28 [12–49], p=0.002, respectively) were statistically significantly different between the two groups. CONCLUSIONS: In women with human papillomavirus 16/18 positivity undergoing colposcopy, cyberchondria levels were found to be significantly higher. Specifically, excessive information-seeking behavior significantly contributed to this elevated level of cyberchondria.

Prognostic factors of adult granulosa cell tumors of the ovary: a Turkish retrospective multicenter study

To define the clinical, histopathological features and the prognostic factors affecting survival in patients with adult granulosa cell tumors of the ovary (AGCT). A 322 patients whose final pathologic outcome was AGCT treated at nine tertiary oncology centers between 1988 and 2021 participated in the study. The mean age of the patients was 51.3±11.8 years and ranged from 21 to 82 years. According to the International Federation of Gynecology and Obstetrics 2014, 250 (77.6%) patients were stage I, 24 (7.5%) patients were stage II, 20 (6.2%) patients were stage III, and 3 (7.8%) were stage IV. Lymphadenectomy was added to the surgical procedure in 210 (65.2%) patients. Lymph node involvement was noted in seven (3.3%) patients. Peritoneal cytology was positive in 19 (5.9%) patients, and 13 (4%) had metastases in the omentum. Of 285 patients who underwent hysterectomy, 19 (6.7%) had complex hyperplasia with atypia/endometrial intraepithelial neoplasia, and 8 (2.8%) had grade 1 endometrioid endometrial carcinoma. It was found that 93 (28.9%) patients in the study group received adjuvant treatment. Bleomycin, etoposide, cisplatin was the most commonly used chemotherapy protocol. The median follow-up time of the study group was 41 months (range, 1-276 months). It was noted that 34 (10.6%) patients relapsed during this period, and 9 (2.8%) patients died because of the disease. The entire cohort had a 5-year disease-free survival (DFS) of 86% and a 5-year disease-specific survival of 98%. Recurrences were observed only in the pelvis in 13 patients and the extra-abdominal region in 7 patients. The recurrence rate increased 6.168-fold in patients with positive peritoneal cytology (95% confidence interval [CI]=1.914-19.878; p=0.002), 3.755-fold in stage II-IV (95% CI=1.275-11.063; p=0.016), and 2.517-fold in postmenopausal women (95% CI=1.017-6.233; p=0.046) increased. In this study, lymph node involvement was detected in 3.3% of patients with AGCT. Therefore, it was concluded that lymphadenectomy can be avoided in primary surgical treatment. Positive peritoneal cytology, stage, and menopausal status were independent prognostic predictors of DFS.