Hasan Aykut Tuncer

The insolvable problem; survival effect of lymphadenectomy in advanced stage ovarian cancer

In this study, we aimed to evaluate the effect of systemic lymphadenectomy on overall and progression free survival in advanced stage of ovarian cancer. The data of ovarian cancer patients who had been admitted to our clinic between March 2008 and December 2019 were collected retrospectively. The patients who had received neo-adjuvant chemotherapy (NACT), those having undergone interval surgery, those who had non-epithelial ovarian cancer, those with residual tumour larger than 1 cm and those with stage I-IIA were excluded from the study. A total of 241 patients with inclusion criteria were included in the study. While 169 patients (70.1%) had undergone systemic lymphadenectomy (SLND), 72 (29.9%) had not. Lymph node involvement was present in 105 out of 169 patients (62.1%) who had undergone SLND. There was no statistically significant difference between the groups in terms of SLND and lymph node involvement for both progression free survival (PFS) and overall survival (OS) (p = 0.577, p = 0.493, p = 0.481, p = 0.849 respectively). When subgroup analysis was performed according to the residual tumor amount, we could not find any statistically significant difference in both PFS and OS in terms of SLND and lymph node involvement in R0 (complete resection) group (p = 0.057, p = 0.917, p = 0.106 and p = 0.980 respectively). We found similar results for patients in the R1 (optimal resection) group. It was found that performing systemic lymphadenectomy had no effect on both progressive and overal survival. It should be kept in mind that the increasing number of malignant lymph nodes removed could have a therapeutic effect in OS. Large numbers of randomized clinical trials are required to enlighten this debatable issue that has been continuing, particularly in the recent two decades.

Evaluation of elderly women with uterin cervical cancer

AbstractBackgroundUterine cervical cancer rates also increase with aging. Especially, the primary treatments of patients with cervical cancer include surgery, chemotherapy, and radiotherapy.AimOur aim is to discuss the effect of clinical and histopathological risk factors on survival in patients over 65 years old with invasive cervical cancer in the light of the literature.Methods and ResultsThe files of 60 patients aged 65 and over who were diagnosed, examined, and treated for invasive cervical uteri cancer between 2004 and 2021 by the gynecological oncology clinic of Akdeniz University were analyzed retrospectively after obtaining approval from the Akdeniz University ethics committee with the number KAEK‐110. Detailed written consent was obtained from all patients and their relatives for data analysis. Patients aged 65 and over who were diagnosed with invasive cervical uteri cancer at all stages who accepted treatment were included in the study. The patients who were not included in the study were those who did not accept treatment, did not continue their follow‐up regularly, were under 65 years of age, had preinvasive cervical lesion, had a second primary cancer, had an unknown stage, and died due to accidents or similar reasons.When the demographic data of 60 cases were examined, the mean age was 70.5, the youngest age was 65, and the oldest age was 84. When we divided them into two groups by age groups, 76.7% were between 65 and 75 years old and 23.3% were over 75 years old. When the data of 60 patients who were referred to our hospital, which was a tertiary center in the 15 years duration, were examined, the mean disease‐progression free survival (PFS) of patients with locally advanced stage was 45 months, however, it was 4 months for metastatic patients, this difference was significant and a statistically significant difference was found between the two groups (p: .001). When the total survival was examined, the mean was 108.7 months in the locally advanced stage group, while it was 2.9 months in metastatic cases, and this difference was also statistically significant between the two groups (p: .001). When we divide the cases into two groups as between 65 and 75 and over 75 years of age, the mean age of disease‐free survival is 76.9 months in the 65–75 years old group, while 16 months in the 76–85 years old group, however, the p value of this difference in PFS between the two groups was not significant (p: 0.154). However, when the total survival was examined, it was seen that the mean was 140.4 in the 65–75 years old group, while it was 56 months in the 76–85 years old group and this difference was significant between the two groups (p: .046).ConclusionIn parallel with the increased population worldwide, advanced age cancer rates are increasing. In parallel with the population growth, it should be remembered that the patients over 65 years of age who were diagnosed with invasive uterine cervical cancer had difficulty in accessing screening tests, late diagnosis and inadequate treatment regimens due to concomitant diseases, resulting in recurrence in a short time and poor clinical symptoms due to short total survival.

Wound Complications in Patients with Overweight, Obesity, and Gynecologic Cancer: A Retrospective Analysis of Staple Versus Suture Closure

Background: Wound complications in gynecologic oncology, especially among patients with overweight and obesity, can significantly impact post-operative recovery and delay the initiation of adjuvant treatment. Although staples are commonly used for vertical incisions, sutures may offer clinical advantages; however, direct comparative data remain limited. This study aimed to compare post-operative wound complication rates between staples and non-absorbable sutures in patients with gynecologic cancer with a body mass index ≥25 kg/m 2 and undergoing a vertical incision surgical procedure. Patients and Methods: A retrospective review was conducted at a gynecologic oncology center between January 2022 and September 2023. Patients who underwent midline laparotomy with either staples or 3-0 non-absorbable monofilament sutures for skin closure were included. Patients with prior chemotherapy, benign pathology, or age <18 were excluded. Wound complications—including seroma, hematoma, dehiscence (superficial and fascial), and infection—were recorded within eight weeks postoperatively. Results: Of 72 patients, 29 received staples and 43 received sutures. Wound complications occurred in 41% of the staple group and 21% of the suture group (p = 0.061). Fascial dehiscence was observed in four cases (two in each group). Although rates of dehiscence and infection were higher with staples, differences were not statistically significant. Hospital stay was significantly longer in the staple group (p = 0.045). Conclusion: Although not statistically significant, suture closure was associated with fewer wound complications and a shorter hospital stay, suggesting potential advantages in wound healing. These findings may inform future recommendations, and further prospective studies are warranted.

Factors Associated with Para-Aortic Lymph Node Metastasis in High-Risk Endometrial Cancer

Background and Objectives: Para-aortic lymph node involvement is a key prognostic factor in high-risk endometrial cancer. This study aimed to identify factors associated with para-aortic lymph node metastasis and to assess their predictive value for surgical decision-making. Materials and Methods: A retrospective analysis was conducted on 81 patients with high-risk endometrial cancer who underwent systematic pelvic and para-aortic lymphadenectomy between January 2015 and December 2024. Factors evaluated included histologic subtype, lymphovascular space invasion (LVSI), cervical stromal involvement, depth of myometrial invasion, and tumor diameter. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of para-aortic metastasis. Receiver operating characteristic (ROC) analysis was used to determine the optimal tumor size threshold. Results: Para-aortic lymph node metastasis was identified in 21.0% of patients, and isolated para-aortic metastasis was observed in 2.5%. In univariate analysis, pelvic lymph node positivity, LVSI, cervical stromal invasion, deep myometrial invasion, and tumor size ≥ 3.55 cm were significantly associated with para-aortic spread. Multivariate analysis revealed that pelvic lymph node positivity was the only independent predictor (OR 39.0; 95% CI 5.06–301.46; p < 0.001). Conclusions: Pelvic lymph node status serves as a strong and independent predictor of para-aortic metastasis in high-risk endometrial cancer. A tumor diameter greater than 3.5 cm may also indicate an increased risk of para-aortic spread. These findings suggest that selective and individualized para-aortic assessment strategies may be considered to improve staging accuracy and optimize surgical planning in this patient population.

Comparative Oncologic Outcomes in High-Risk Human Papillomavirus-Positive and -Negative Cervical Intraepithelial Neoplasia

BACKGROUND The clinical significance of high-risk human papillomavirus (HR-HPV)-negative high-grade cervical intraepithelial neoplasia remains unclear. A negative HR-HPV test result can stem from assay limitations (e.g., low viral load, non-covered types) or biological factors (e.g., viral clearance, true HPV-independent pathways). This study aimed to compare recurrence and hysterectomy rates between HR-HPV-positive and HR-HPV-negative women in a cohort of 712 women who underwent cervical conization for cervical intraepithelial neoplasia grade 3 (CIN3). MATERIAL AND METHODS This retrospective, multicenter cohort study analyzed data from 712 women with a histopathological diagnosis of CIN3 between 2014 and 2023. HR-HPV detection and genotyping were performed using the Cobas 4800 (Roche HPV assay) test. A review of patient records was conducted, and statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression models. RESULTS In our cohort of 712 women with CIN3, 9% (n=64) were HR-HPV-negative. The primary finding was that HR-HPV-negative status showed no significant association with the risks of recurrence, progression to cancer, or hysterectomy compared to HR-HPV-positive cases. Specifically, recurrence rates (6.2% vs 12.1%) and the incidence of cervical cancer (2% vs 1.5%) were comparable, with no statistically significant differences (p>0.05 for both). CONCLUSIONS HR-HPV-negative CIN3 is a clinically significant entity that requires management and follow-up equivalent to HR-HPV-positive CIN3, as it demonstrates comparable oncologic outcome.