Jaeman Bae

Developing standardized informed consent for hysterectomy and vulva cancer surgery

Informed consent is a fundamental aspect of surgical care, designed to reinforce patient autonomy, promote shared decision-making, and potentially mitigate legal conflicts by ensuring the provision of comprehensive and consistent information in clinical practice. The Korean Society of Gynecologic Oncology (KSGO) previously published detailed informed consent documents for cervical, endometrial, and ovarian cancer surgery. However, standardized consent forms remain relatively lacking for laparoscopic-robotic hysterectomy performed for non-malignant indications, as well as for vulvar cancer surgery. Hence, the KSGO subcommittee collected, reviewed, and discussed consent forms from domestic medical institutions and subsequently developed informed consent for laparoscopic-robotic hysterectomy and vulvar cancer surgery, aiming to build patient trust and understanding.

Conditional relative survival of patients with endometrial cancer: a Korean National Cancer Registry study

The purpose of this study was to estimate 5-year conditional relative survival (5Y CRS) rates of endometrial cancer (EC) in Korea accounting for time already survived. Subgroup-specific estimates stratified by various patient characteristics were also presented. Using the data from the Korean Central Cancer Registry, 5Y CRS rates were calculated in patients who were diagnosed with EC between 1998 and 2017. The CRS rates were presented by year of diagnosis, age at diagnosis, histology, cancer stage, and treatment received. The 5-year relative survival rate at the time of diagnosis was 89.0% for all cases. The probability of surviving an additional 5 years (i.e., 5Y CRS), if the patient survived 1, 2, 3, 4, and 5 years after diagnosis was 91.8%, 94.1%, 95.6%, 96.5%, and 97.3%, respectively. Patients with poor initial prognoses, i.e., those who were older, had non-endometrioid histology, and high stage, showed the largest improvements in 5Y CRS, reaching >90% for most subgroups, except those with serous histology (88.4%) and distant stage (77.7%). Patients aged ≥70 years had the highest probability of death in the 1st and 2nd years after diagnosis (13.8 and 11.0%), but the conditional probability of death in the 3rd, 4th, and 5th years declined rapidly to 7.3%, 4.5%, and 3.7%, respectively. The CRS rates for patients with EC improved with increased time elapsed from diagnosis. The greatest improvements in 5Y CRS were observed among patients who were older, those with non-endometrioid histology, and those with more advanced disease.

Clinical practice guideline for high-risk human papillomavirus testing in cervical cancer screening: a consensus statement from the Korean Society of Gynecologic Oncology

High-risk human papillomavirus (hrHPV) is a necessary cause of cervical cancer, and hrHPV testing has increasingly been recognized as an effective screening tool that overcomes the limitations of cytology-based screening. However, standardized clinical guidance for the use of hrHPV testing in cervical cancer screening has been limited in Korea, resulting in variability in clinical practice. This consensus-based clinical practice guideline was developed under the auspices of the Korean Society of Gynecologic Oncology through multidisciplinary collaboration involving experts in gynecology, pathology, laboratory medicine, and public health. Relevant domestic and international evidence was systematically reviewed, and input from diverse clinical settings was incorporated through four public hearings. Final recommendations were established through expert consensus. The guideline presents four key recommendations: hrHPV testing may be considered for women aged 25 years or older, with a recommended screening interval of 3 to <5 years; screening assays should differentiate HPV genotypes 16 and 18 and detect other high-risk types, with preference given to clinically validated tests; testing should be performed in appropriately equipped settings with standardized specimen handling and reporting, including documentation of HPV 16/18 status in positive cases; and hrHPV testing should be conducted under rigorous internal and external quality control systems. This guideline aims to support consistent and rational implementation of hrHPV testing in cervical cancer screening in Korea.

Clinical practice guidelines for cervical cancer: the Korean Society of Gynecologic Oncology guidelines

This fifth revised version of the Korean Society of Gynecologic Oncology practice guidelines for the management of cervical cancer incorporates recent research findings and changes in treatment strategies based on version 4.0 released in 2020. Each key question was developed by focusing on recent notable insights and crucial contemporary issues in the field of cervical cancer. These questions were evaluated for their significance and impact on the current treatment and were finalized through voting by the development committee. The selected key questions were as follows: the efficacy and safety of immune checkpoint inhibitors as first- or second-line treatment for recurrent or metastatic cervical cancer; the oncologic safety of minimally invasive radical hysterectomy in early stage cervical cancer; the efficacy and safety of adjuvant systemic treatment after concurrent chemoradiotherapy in locally advanced cervical cancer; and the oncologic safety of sentinel lymph node mapping compared to pelvic lymph node dissection. The recommendations, directions, and strengths of this guideline were based on systematic reviews and meta-analyses, and were finally confirmed through public hearings and external reviews. In this study, we describe the revised practice guidelines for the management of cervical cancer.

Conditional relative survival of cervical cancer: a Korean National Cancer Registry Study

Conditional relative survival (CRS) considers changes in prognosis over time and may offer more useful estimates for survivors. We aimed to investigate CRS among patients with cervical cancer stratified by various factors that influence survival probability. This nationwide retrospective study used data from the Korean Central Cancer Registry. We included 78,606 patients diagnosed with cervical cancer as their first cancer between January 1, 1996 and December 31, 2015, and who were followed until December 31, 2016. CRS and the conditional probabilities of death for the following 1 year were stratified by age at diagnosis, histology, cancer stage, treatment, year of diagnosis, and social deprivation index. The 5-year relative survival rate at the time of diagnosis was 80.6% for all cases. The probability of surviving an additional 5 years conditioned on having already survived 1, 2, 3, 4, and 5 years after diagnosis was 85.7%, 90.6%, 93.5%, 95.3%, and 94.3%, respectively. Patients with poorer initial survival estimates (older, advanced stage, non-squamous cell histology) generally showed the largest increases in CRS over time. Patients aged ≥70 years had the highest probability of death in the first year after diagnosis (24.5%), but the conditional probability of death in the 2nd, 3rd, 4th, and 5th years declined abruptly to 13.1%, 7.5%, 5.4%, and 3.9%, respectively. The CRS rates for patients with cervical cancer improved over time, particularly among patients with poorer initial prognoses. Our estimates enable patients to make better informed decisions regarding follow-up care and their personal life.

Perioperative outcomes in patients with very low‐risk endometrial cancer undergoing surgery without lymph node dissection: Results from KGOG 2021

AbstractAimTo evaluate the perioperative outcomes of patients with endometrial cancer meeting the Korean Gynecologic Oncology Group (KGOG) criteria who underwent surgery without lymph node dissection.MethodsThis study included 153 patients who met the KGOG criteria: (1) endometrioid histology, (2) myometrial invasion &lt;50%, (3) tumor confined to the corpus, (4) no lymph node &gt;1 cm, and (5) serum CA125 ≤ 35 U/mL. The patients underwent surgery without lymph node dissection at 11 hospitals in Korea between February 2020 and May 2024. Perioperative outcomes were collected prospectively.ResultsAmong the 153 patients, 89 (58%) underwent surgery without lymph node removal, while 64 (42%) underwent surgery with lymph node removal. Minimally invasive surgery was performed in &gt;90% of cases, with a conversion rate to laparotomy of 1%. The mean surgery time was 109.37 ± 37.67 min. Estimated blood loss was minimal (93.74 ± 93.13 mL), with a mean hemoglobin drop of 1.32 ± 1.01 g/dL. Transfusions were required in only three patients (2%). Postoperative hospital stays exceeded 2 days in 51% of cases. Lymph node metastasis was observed in just one case (1%). Adverse events included 52 grade 1 and 2 grade 2 events (e.g., headache, paresthesia). Patients undergoing lymph node removal (primarily sentinel lymph node biopsy) had significantly longer surgery times and postoperative hospital stays compared to those without lymph node removal.ConclusionSurgery without lymph node dissection demonstrated excellent perioperative outcomes and minimal adverse events in patients meeting KGOG criteria.