Esra Bilir

Correspondence on ‘Cardiophrenic and costophrenic lymphadenectomy in advanced ovarian cancer by prediaphragmatic subxiphoid approach: PS technique’ by Stanciu

Highlights from the 24th European Congress on Gynaecological Oncology in Istanbul: an ENYGO-IJGC Fellows compilation

Urinary incontinence management in patients with primary endometrial cancer: A cross-sectional study by the European Network of Young Gynaecologic Oncologists (ENYGO)

Urinary incontinence is a common issue yet frequently overlooked in patients with endometrial cancer, especially post-treatment. Both advanced age and obesity as shared risk factors for endometrial cancer and urinary incontinence compound this burden. We hypothesized that there is insufficient awareness and suboptimal integration of urinary incontinence management into endometrial cancer care. The European Network of Young Gynaecologic Oncologists (ENYGO) team conducted a cross-sectional online survey from February to November 2024 using SurveyMonkey, targeting healthcare professionals involved in gynecologic oncology care. The 31-item questionnaire covered demographics, diagnostics, treatment protocols, and urinary incontinence-related practices. Statistical analysis was performed using SPSS V28.0, including descriptive statistics, normality testing, and appropriate reporting of mean ± SD or median with interquartile ranges. Our final analysis included 85 complete responses. Respondents were from 31 countries, with a median age of 38 years, and 55.3% of them were female. Although 65.9% of institutions had urogynecologists, only 3.5% of respondents had formal urogynecology training. Urinary incontinence was most frequently discussed before surgery (27.1%) and least before targeted therapy (9.4%). Radiation therapy was identified by 75.4% as the main contributor to urinary incontinence. While 96.5% asked about urinary incontinence during follow-up, only 14.1% managed it post-treatment. Major barriers included lack of training (54.1%) and resources (31.8%). Notably, 58.8% expressed interest in further training. Despite high reported awareness of urinary incontinence, proactive assessment and management remain inconsistent in endometrial cancer care. Structured education, interdisciplinary collaboration, and guideline development are needed to optimize quality of life outcomes.

Global survey on training and practice in sentinel lymph node mapping for endometrial and cervical cancer among early-career gynecologic oncologists

This survey was designed to evaluate exposure to sentinel mapping for cervical and endometrial cancers in addition to the quality and availability of surgical training in sentinel procedures around the world. Furthermore, we aimed to identify obstacles in surgical training in the sentinel procedure to support the adoption of this technique in clinical practice. A 52-item survey was developed and computed using Qualtrics XM and SurveyMonkey software. The target population were members of the European Society of Gynaecological Oncology and the International Gynecological Cancer Society aged ≤40 years. The study invitation was disseminated within both organizations' database. The survey hyperlink was active between September and December 2022. Respondents using the same Internet Protocol address were excluded to avoid duplication of responses. Responses to <50% questions were excluded. Overall, 238 respondents joined the survey, and 182 (76.5%) provided answers that met the inclusion criteria. Sentinel mapping was implemented for a longer period and used more frequently in endometrial than in cervical carcinoma; 55% of the responders were initially trained in systematic lymph node dissection, and 22% were not yet trained in any lymph node staging. The main challenges in applying sentinel procedure for early-career gynecologic oncologists were no access to hands-on training (n = 22, 12.1%) and no clinical routine in performing systematic pelvic (n = 15, 8.2%) and para-aortic (n = 35, 19.2%) lymph node dissection in case of failed mapping. Although sentinel lymph node biopsy is integrated in cervical and endometrial cancer guidelines, a significant number of institutions do not implement this procedure in clinical routine, and 22% of early-career gynecologic oncologists are not trained in any type of surgical lymph node staging. Support for sentinel mapping in national guidelines and guided training opportunities are needed to apply this method globally.

Current practice with operative hysteroscopy for fertility preservation in endometrial cancer and endometrial premalignancies

The primary aim was to analyze the current practices on the use of operative hysteroscopy for preserving fertility in patients diagnosed with endometrial cancer and premalignancies. Our secondary objectives included investigating medical therapy and analyzing reported pregnancy-related outcomes subsequent to fertility preservation procedures. We performed a semi-systematic literature review on PubMed, employing pertinent terms related to hysteroscopy, fertility preservation, and endometrial cancer and premalignancies. Patients undergoing operative hysteroscopy with or without following medical treatment were included. We adhered to the PRISMA 2020 statement and utilized Covidence software to manage our systematic review. We performed a pooled analysis on various outcomes. Our final analysis included 15 studies evaluating 458 patients, where 238 (52.0%) were diagnosed with endometrial cancer, and 220 (48.0%) had endometrial premalignancies. With 146 pregnancies in our study, the overall pregnancy rate was 31.9%. Among these, 97 resulted in live births, accounting for 66.4% of the reported pregnancies. In terms of medical treatment, various forms of progestins were reported. Complications or adverse effects related to operative hysteroscopy were not reported in more than half of the studies. Among those studies that did report them, no complications nor adverse effects were documented. After hysteroscopic resection, complete response to medical treatment has been reported in 65.5% of the overall cases. Our review sheds light on the contemporary landscape of operative hysteroscopy for fertility preservation in endometrial cancer and premalignancies. Future studies should include the integration of molecular classification into fertility-preserving management of endometrial malignancies to offer a more personalized and precise strategy.