Kemal Ozerkan

Prognostic Impact of Pelvic Lymph Node Count in Surgically Staged Endometrial Cancer

Background and Objectives: The prognostic significance of pelvic lymph node (PLN) count in surgically staged endometrial cancer remains controversial. This study aimed to evaluate the impact of PLN count on overall survival (OS), disease-free survival (DFS), and recurrence patterns in a large cohort of patients with endometrial cancer. Materials and Methods: This retrospective cohort study included 560 patients with endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/or para-aortic lymph node assessment between January 2005 and May 2025 at a tertiary referral center. Patients were stratified according to the number of harvested pelvic lymph nodes (≤20 vs. >20). Clinicopathological characteristics, adjuvant treatments, recurrence patterns, and survival outcomes were analyzed. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards regression models. Results: Of the 560 patients, 262 (46.8%) had ≤20 pelvic lymph nodes harvested and 298 (53.2%) had >20. The median follow-up duration was 64.5 months. Patients with >20 pelvic lymph nodes had larger tumors, higher FIGO stage, and more frequent para-aortic lymphadenectomy. In multivariate analysis, age, non-endometrioid histology, advanced FIGO stage, tumor grade, and lymphatic metastasis were independently associated with both OS and DFS. Pelvic lymph node count was not independently associated with OS or DFS. Overall recurrence rates were similar between groups; however, recurrence patterns differed significantly, with distant recurrences more frequent in the ≤20 PLN group and local recurrences more common in the >20 PLN group. Conclusions: In surgically staged endometrial cancer, a higher pelvic lymph node count (>20 nodes) was not independently associated with survival or recurrence outcomes after adjustment for established prognostic factors, although recurrence patterns differed between groups. Survival was primarily determined by age, histologic subtype, FIGO stage, tumor grade, and lymphatic metastasis. Pelvic lymph node count appears to reflect surgical staging intensity and intraoperative risk assessment rather than serving as an independent determinant of prognosis.

Oncological Safety of Intrauterine Manipulator Use in Laparoscopic Hysterectomy for Endometrial Cancer: A Propensity Score-Matched Analysis

Background and Objectives: Minimally invasive surgery is considered the standard of care for early-stage endometrial cancer. However, the oncological safety of intrauterine manipulator (IUM) use during laparoscopic hysterectomy remains controversial. The aim of this study was to evaluate the impact of intrauterine manipulator use during laparoscopic hysterectomy on oncological outcomes in patients with clinically early-stage endometrial cancer. Materials and Methods: In this retrospective cohort study, 612 patients with FIGO 2009 stage I–III endometrial cancer who underwent staging surgery at a tertiary center between January 2010 and May 2025 were included. Clinical and pathological characteristics were compared between laparoscopy (n = 168) and laparotomy (n = 444). To reduce selection bias, propensity score matching (PSM) was performed based on age, histological subtype, and FIGO stage. Kaplan–Meier survival analysis and Cox regression modeling were utilized to evaluate disease-free survival (DFS) and overall survival (OS). Results: After matching, groups were balanced except for higher rates of para-aortic lymphadenectomy and adjuvant therapy in the laparotomy group. IUM use was not associated with increased LVSI or positive peritoneal cytology. Recurrence was more frequent after laparoscopy (10.1% vs. 6.0%, p = 0.028), with inferior 5-year DFS (87.6% vs. 97.4%, HR 5.60, p = 0.0006), while OS was similar (82.0% vs. 87.6%, p = 0.842). In multivariate Cox analysis, independent predictors of worse DFS were non-endometrioid histology (HR 3.57), FIGO stage III (HR 3.06), grade 3 tumors (HR 2.63), and laparoscopic surgery (HR 0.51). For OS, non-endometrioid histology (HR 5.12), stage III disease (HR 2.98), and grade 3 tumors (HR 4.51) were independent adverse factors, whereas surgical approach was not. Conclusions: The use of an intrauterine manipulator in laparoscopic hysterectomy for early-stage endometrial cancer was linked to worse DFS but not OS. These findings suggest caution regarding the routine use of IUMs and highlight the need for prospective randomized trials to clarify their oncological safety.

The Effect of Cervical Blockade in LEEP Procedures Performed Under General Anesthesia: A Randomized Controlled Trial

Objective: To compare the effectiveness of pain and bleeding control between general anesthesia alone and general anesthesia combined with cervical blockade during the loop electrosurgical excision procedure (LEEP). Methods: This prospective, randomized, controlled, open-label, exploratory clinical trial included 40 patients diagnosed with high-grade squamous intraepithelial lesion (HSIL) by colposcopic biopsy. Patients were randomly assigned in a 1:1 ratio: the control group underwent LEEP under general anesthesia only (n = 20), and the study group received general anesthesia with additional local cervical anesthesia (n = 20). Intraoperative bleeding, pain scores, pathological specimen size, surgical margins, and postoperative complications were compared. Results: Demographic data were similarly distributed. Smoking was significantly more prevalent in the control group ( p <.01). Preoperative cervical cytology, HPV DNA results, colposcopic biopsy results, and hemoglobin values were also comparable between the groups. Postoperative hemoglobin values, hemoglobin decrease, specimen size, surgical margin status, or hospital admissions after discharge were similar ( p >.05). However, postoperative pain scores and intraoperative sponge usage were significantly lower in the cervical blockade group ( p <.01). Subgroup analyses showed that smoking had no effect on bleeding rates as well as specimen sizes, which also did not affect bleeding rates and pain scores ( p >.05). Conclusions: Cervical blockade in LEEP performed under general anesthesia significantly reduces bleeding and pain. It does not influence blood transfusions, recovery, hospital readmissions or complications. Cervical blockade may enhance patient comfort and minimize intraoperative morbidity during LEEP. These preliminary findings require confirmation in larger, multicenter, preferably blinded trials.