Mehmet Coskun Salman

Predictors of lymphocyst development following lymphadenectomy in patients with gynecologic cancer

Abstract Objective To evaluate the incidence of lymphocyst formation in patients undergoing pelvic and/or para‐aortic lymphadenectomy for gynecologic malignancies and identify associated factors. Methods A retrospective analysis was performed on 614 patients who underwent lymphadenectomy for primary endometrial, ovarian, or cervical cancer at Hacettepe University between 2014 and 2019. Results Of the 614 patients, 276 (45%) had endometrial cancer, 262 (42.6%) had ovarian cancer, and 76 (12.4%) had cervical cancer. Postoperative lymphocyst formation occurred in 187 patients (30.5%), predominantly in the pelvic region (91.4%). Lymphocyst incidence was not significantly influenced by primary cancer type. Factors such as age, menopausal status, the extent of surgery and the use of pelvic drains or absorbable hemostats did not significantly affect lymphocyst formation. However, para‐aortic lymphadenectomy, neoadjuvant therapy, adjuvant therapy, and the number of lymph nodes removed were identified as significant factors contributing to the development of lymphocysts. In multivariate analysis, only para‐aortic lymphadenectomy (OR 2.17, 95% CI: 1.26–3.73) and neoadjuvant therapy (OR 2.31, 95% CI: 1.28–4.19) were found to be independent parameters associated with lymphocyst development. Symptomatic or complicated lymphocysts requiring intervention occurred in 16 patients (8.6%), representing 2.6% of the total patient cohort. The most common reason for intervention was infection within the lymphocyst. Conclusion Lymphocyst formation is a frequent complication following gynecologic cancer surgery, often remaining asymptomatic and detected incidentally during routine follow‐ups. Lymphocysts are generally not a cause for concern, but they can lead to complications like infection, which requires intervention.

Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High–Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001)

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases.