Houssein El Hajj

A computer synoptic operative report versus a report dictated by a surgeon in advanced ovarian cancer

To evaluate the role of a computer synoptic operative report in enhancing the quality and completeness of surgical reporting for advanced ovarian cancer surgeries. The study was conducted at a tertiary cancer center between January 2016 and September 2021, and the computer synoptic operative report was implemented in May 2019. The study compared two cohorts: the first consisted of the 'before computer synoptic operative report (P1)' period, during which the operative reports were dictated freely by the surgeons, and the second consisted of the 'after computer synoptic operative report (P2)' period, during which all surgeons used the computer synoptic operative report. The study analyzed 227 operative reports, with 104 during period 1 (P1) and 123 during period 2 (P2). The use of the computer synoptic operative report improved the completeness and quality of the surgical information documented in advanced ovarian cancer surgeries.

Rectal sparing in modified posterior exenteration: description of the technique in 10 steps

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

Stage IA3 endometrial cancer in the FIGO 2023 classification: a case of clarity or complexity?

Synchronous endometrial and ovarian endometrioid carcinomas, found in up to 10% of ovarian and 5% of endometrial cancers, remain without clear diagnostic criteria or standardized treatment approaches. The 2023 International Federation of Gynaecology and Obstetrics (FIGO) classification clarified staging, categorizing confined disease as stage IA3 or IIIA1, significantly impacting treatment decisions. In our study of 25 patients with concurrent endometrial and ovarian tumors, centralized pathology review and treatment were conducted to compare the 2009 versus the 2023 FIGO classifications. We found that applying the 2023 classification and European Society of Gynaecological Oncology risk stratification led to stage shifts in 5 patients (20%): 2 were downstaged (no adjuvant therapy needed), and 3 were upstaged (high risk). Among the 11 patients whose disease was limited to the uterus and ovaries, 5 met the criteria for stage IA3 and none experienced recurrence, including 2 patients managed with surgery alone. The FIGO 2023 stage IA3 classification enables more precise risk stratification, particularly, in cases with low-grade tumors, estrogen receptor positivity, and favorable molecular profiles (POLE-mutated or p53 wild-type and non-specific molecular profile). However, it raises 2 critical issues: the need for appropriate staging surgery and the debate regarding the optimal grading system for ovarian endometrioid carcinoma.

Best original research presented at the 26th European Congress on Gynaecological Oncology: Best of ESGO 2025

Global practice patterns of sentinel lymph node biopsy in endometrial cancer: a survey from the European Network of Young Gynecologic Oncologists (ENYGO)

This survey aimed to evaluate trends in sentinel lymph node (SLN) biopsy for endometrial cancer among members of the European Society of Gynecologic Oncology (ESGO) and the International Gynecologic Cancer Society (IGCS). We conducted an online cross-sectional survey among gynecologic oncologists over 40 years of age consisting of 30 questions. It was distributed to ESGO and IGCS members via Survey Monkey and Qualtrics between September and December 2022. Surveys were excluded in the analysis if >50% of questions were incomplete. Statistical analysis, performed with SPSS version 27.0. A total of 302 (70.2%) of 430 participants completed the survey, with 159 (52.6%) affiliated with ESGO and 143 (47.4%) with IGCS. The majority were male 206 (68.2%), and 170 (56.3%) were based in Europe. Most respondents (n = 261, 86.4%) were certified gynecologic oncologists. Indocyanine green was the most common tracer used (n = 234, 77.5%), with higher rates of blue dye injections among IGCS respondents (p = .002). The predominant injection volume was 4 cm This study showed significant variations in SLN biopsy practices for endometrial cancer, underscoring the need for global standardization through harmonized guidelines, consistent training, and international collaboration to improve staging accuracy and patient outcomes.

Intracystic endometrioid borderline tumor

Splenectomy in epithelial ovarian cancer surgery

Splenectomy is performed in 4-32% of cytoreductive surgeries for ovarian cancer. The objective of our study was to assess splenectomy and evaluate its impact on overall and disease-free survival. We conducted a retrospective single-center study between January 2000 and December 2016. Patients who underwent a cytoreduction for epithelial ovarian cancer, regardless of stage and surgical approach, were eligible for the study. Patients deemed not operable were excluded from the study. Patients were stratified into two groups, splenectomy or no splenectomy. A univariate analysis followed by a multivariate analysis was conducted to evaluate the postoperative complications after splenectomy and the overall and disease-free survival. This cohort included 464 patients. Disease stages, peritoneal carcinomatosis scores, and the rate of radical surgery (Pomel classification) were significantly higher in the splenectomy group, p=0.04, p<0.0001, and p<0.001, respectively. However, no significant difference was found in the rate of complete cytoreduction between the two groups (p=0.26) after multivariate analysis. In univariate analysis, splenectomy was significantly associated with extensive surgical procedures. In multivariate analysis, the two more prevalent complications in the splenectomy group were the risk of abdominopelvic lymphocele (overall response (OR) =4.2; p=0.01) and blood transfusion (OR=2.4; p=0.008). The average length of hospital stay was significantly longer in the splenectomy group, 17.4 vs 14.6 days (p<0.0001). The delay in adjuvant chemotherapy was longer in the splenectomy group (p=0.001). There was no significant difference in overall and disease-free survival (p=0.09) and (p=0.79), respectively. Splenectomy may be considered an acceptable and safe procedure; however, with no impact on overall or disease-free survival. In addition, it is associated with longer hospital stay and longer time to chemotherapy.

Rationale and study design of the CHIPPI-1808 trial: a phase III randomized clinical trial evaluating hyperthermic intraperitoneal chemotherapy (HIPEC) for stage III ovarian cancer patients treated with primary or interval cytoreductive surgery

Ovarian cancer remains the most lethal gynecologic malignancy with high recurrence rates. Because recurrence involves primarily the peritoneum, intraperitoneal chemotherapy is being evaluated as a new approach to treat microscopic peritoneal disease. One trial showed that cisplatin-paclitaxel intraperitoneal chemotherapy with intravenous paclitaxel improved survival but increased morbidity. Another trial reported a significant improvement in overall survival (OS) and disease-free survival (DFS) without increasing the morbidity (P = 0.76) or mortality rates (hazard ratio 0.67, P = 0.02) after adding hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreduction. The current trial aims to evaluate the impact of adding HIPEC to primary or interval cytoreductive surgery for epithelial ovarian cancer (EOC) on the efficacy, safety, treatment feasibility, and quality of life. This is an international, multicenter, open-label, randomized (1 : 1), two-arm, phase III clinical trial that will enroll 432 patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage III EOC. Patients are randomized to receive or not HIPEC with the standard of care. Inclusion criteria include patients with FIGO stage III EOC, Fallopian tube carcinoma or primary peritoneal cancer who undergo complete primary or interval cytoreduction. The primary objective is to assess DFS of the addition of HIPEC. Secondary objectives are the assessment of OS, safety, return to intended oncologic treatment, quality of life and the trade-off between efficacy and morbidity. The results might help extend the indications of HIPEC to include patients undergoing primary cytoreduction, providing a standardized protocol for HIPEC in EOC management and reliable information on the quality of life after adding HIPEC.

Surgical treatment of vaginal and vulvar melanoma: a 18-year retrospective study

Vaginal and vulvar melanomas are rare and seems to have extremely poor prognosis, often diagnosed with locally advance stage, with difficulties to obtain free surgical margin. The aim of this study was to describe long term outcomes of vaginal and vulvar melanomas after surgical treatment. Retrospective observationnal cohort study between January 2002 and december 2020 at Gustave-Roussy Institute. A total of 57 patients were treated for vulvar and vaginal melanoma between january 2002 and december 2020. Among them 38.6 % (22/57) had surgery for vaginal (10/22) or vulvar melanoma (12/22). The main symptoms at diagnosis were vaginal bleeding for 40.9 % (n = 9/22), and vaginal mass for 36.4 % (n = 8/22) of the patients. Median tumor size was 15 mm (10-30). Free margins was obtained in 55.5 % of the cases (n = 12/20). Mutation (c-KIT, BRAF, NRAF) were found in 27 .3 % of the patients (6/22). Median progression free survival was 7.5 (5-11) months and overall survival 24 (12-41) months. Vaginal and vulvar melanoma have a poor prognosis. Extensive surgery with anterior or posterior pelvectomy shoud only be performed to obtained free margin with caution in well selected patient. Radiological lymph node should contraindicate primary surgical strategy. Neodjuvant immunotherapy could help to obtained free margin in patient with high risk of invaded margin, these patients should be included in randomized controlled clinical trials.

Fertility preservation in gynecologic oncology: evaluating knowledge, practices, and barriers among French healthcare providers

To assess the knowledge, practices, and referral patterns of health care professionals and fertility preservation specialists regarding fertility preservation in gynecologic oncology in France. In this cross sectional study, an electronic questionnaire was distributed between June 2023 and January 2024 to health care professionals in metropolitan and overseas territories. It included sections on demographics, fertility preservation practices, and technical knowledge, with tailored sections for physicians who are specialists and non-specialists in reproductive medicine. Sixty-four professionals participated (mean experience: 12 years); 65.6% (42/64) were gynecologic surgeons, and 18.8% (12/64) were specialists in reproductive medicine. Among non-specialists (52/64), 82.7% (43/52) routinely discussed fertility with patients of childbearing age, and 94.2% (49/52) had referred patients for fertility preservation. The mean knowledge score was 1.4/6. Only 23.1% (12/52) reported having written materials for patients, and 65.4% (34/52) indicated that no fertility specialist was present at multidisciplinary meetings. All reproductive medicine specialists (n = 12) reported access to oocyte and ovarian tissue cryopreservation, but 83.3% (10/12) believed patients were under-referred. They emphasized the need for systematic discussions of fertility preservation in multidisciplinary settings and highlighted risks associated with ovarian stimulation and tissue reimplantation. The upper age limit for oocyte cryopreservation was generally under 40 years. Pregnancy outcomes following fertility preservation were limited, primarily in cases of borderline ovarian tumors. Fertility preservation is recognized as a critical component of gynecologic oncology care, but significant gaps remain in knowledge, referrals, and integration into multidisciplinary care. Strengthening collaboration between oncology and fertility teams, standardizing care pathways, and enhancing education for health care providers are essential steps to improving access and outcomes for patients.

The European Society of Gynaecological Oncology position statement: promoting inclusive surgical ergonomics in gynecological oncology

The European Society of Gynaecological Oncology (ESGO) recognizes that poorly designed instruments and operating room environments contribute to musculoskeletal injuries, fatigue, and burnout, disproportionately affecting female and smaller-stature surgeons. Ergonomic equity is central to ensuring surgical precision, team well-being, and optimal patient outcomes. ESGO calls for close collaboration between surgeons, industry partners, and hospital systems to re-design surgical instruments and equipment. Adaptable grip sizes, adjustable weight distribution, and inclusive workstation designs must be prioritized to accommodate diverse anthropometric needs and improve comfort, dexterity, and performance. INCLUSIVE OPERATING ROOM DESIGN AND STANDARDIZED SUPPORT MEASURES: Operating rooms should be designed to support diverse surgical teams, including surgeons of different statures, hand sizes, and physical capacities. ESGO recommends adjustable tables, consoles, lighting, and pedals, alongside consistent policies for accommodating pregnant and postpartum surgeons through measures such as flexible seating and scheduled breaks. ESGO advocates for the integration of ergonomic training into surgical education and continuing professional development. Standardized guidelines, intraoperative microbreaks, and mentorship initiatives are key strategies to reduce injury risks, enhance surgical longevity, and foster equality, diversity, and inclusion within gynecological oncology.

Health care organization for gynecologic oncology patients fleeing Ukraine: Insights from the European Network of Young Gyne Oncologists survey during the first six months of the military conflict

The Russian invasion of Ukraine in February 2022 caused a mass displacement of over 6 million people, including many women requiring urgent medical care, such as those with gynecologic malignancies. The disruption of cancer treatment in conflict zones poses critical challenges because timely oncologic care is vital for patient survival. This study, conducted by the European Network of Young Gynecologic Oncologists, aimed to assess the health care responses provided to Ukrainian gynecologic oncology patients across European countries during the first 6 months of the conflict. A cross-sectional survey was distributed to European Network of Young Gynecologic Oncologists members between July and August 2022, gathering insights from health care providers about their experiences in managing Ukrainian gynecologic oncology patients. The survey explored the medical needs of displaced patients, challenges encountered, and the resources available. Descriptive statistics were used for data analysis. During the study period, approximately 400 gynecologic oncology patients fleeing Ukraine received care in 38 European health care centers represented by the respondents (N = 50). Surgical interventions (54%), chemotherapy (40%), and specialist consultations (32%) were identified as the most common medical needs. The key barriers to care included language difficulties (44%), lack of previous medical documentation (40%), and inconsistencies in treatment protocols between centers. Psychological support was notably insufficient, with 36% of respondents reporting a lack of adequate resources for addressing mental health needs. The study identifies critical barriers to the continuity of gynecologic oncology care for displaced patients during humanitarian crises. Addressing language barriers, ensuring access to patient medical histories, and providing psychological support are essential to improve care for refugees. The findings underscore the importance for international collaboration and the development of robust frameworks for delivering oncologic care during crises.

Declaration on cervical cancer elimination: literature review and perspectives from early-career clinicians.

Despite effective prevention methods, cervical cancer remains one of the most incident malignancies globally. This literature review and perspectives from early-career clinicians aim to propose actionable recommendations to reduce the global burden of cervical cancer. The authors, representing the early-career clinicians and researchers, patient representatives, epidemiologists, and gynecologic oncology experts, identified 5 key pillars for cervical cancer elimination based on literature reviews and interdisciplinary discussion: (1) raising awareness of human papillomavirus (HPV) and cervical cancer; (2) ensuring evidence-based HPV communication; (3) fostering collaboration with other specialties and organizations; (4) increasing HPV vaccination rates; and (5) improving cervical cancer screening. Achieving the World Health Organization's cervical cancer elimination target by 2030 requires a comprehensive, multi-faceted approach. Our recommendations emphasize the need for targeted awareness campaigns, evidence-based communication, collaboration with various stakeholders, promotion of best practices, and keeping evidence of innovative interventions up-to-date, with intensified efforts in low- and middle-income countries where the burden is the greatest.

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.