Utku Akgor

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.

Planning and performing simultaneous bariatric surgery and robotic hysterectomy in a super-obese patient with endometrial cancer

Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and endometrial intraepithelial neoplasia (EIN) is the defined precancerous lesion. Obesity is considered a risk factor for both EC and EIN. On the other hand, mortality is often attributed to obesity-related conditions in patients with early-stage EC. Bariatric surgery has been shown to improve oncological outcomes and obesity-related morbidity and mortality in patients with EC. Therefore, combination surgery addressing both uterine disease and obesity is a very recent point of interest. Here, we present a video article to demonstrate the crucial surgical steps for a simultaneous robotic-assisted total laparoscopic hysterectomy and sleeve gastrectomy in a patient with super obesity and EIN. A patient in her 40s with a body mass index of 62.4 kg/m² and a diagnosis of EIN was scheduled for combo surgery. The operation started with sleeve gastrectomy in the reverse Trendelenburg position. The da Vinci Xi Surgical System™ (Intuitive Surgical Inc., Sunnyvale, CA, USA) with left-side docking was used for surgery. After the mobilization of the stomach, gastric resection was performed using a stapler. Following sleeve gastrectomy, the patient was positioned in the Trendelenburg position, and the robotic system was positioned for hysterectomy. Hysterectomy and salpingectomy were performed. The excised stomach and hysterectomy material were removed through the vagina. A frozen examination revealed EC below 2 cm with superficial invasion, and bilateral oophorectomy was performed. The whole surgery took approximately 4 hours. No postoperative complications occurred, and the patient was discharged on the 3rd day.

Response to: Author's reply to: Effect of adjuvant treatment on survival in 2023 FIGO stage IIC endometrial cancer

Effect of adjuvant treatment on survival in 2023 FIGO stage IIC endometrial cancer

OPEC study: An international multicenter study of ovarian preservation in endometrial cancers

AbstractObjectiveTo evaluate the feasibility and oncological safety of ovarian preservation in early stage endometrial adenocarcinoma (EC) patients aged 40 and below.MethodsA total of 11 institutions from eight countries participated in the study. 169 of 5898 patients aged ≤40 years were eligible for the study. Patients with EC treated between March 2007 and January 2019 were retrospectively assessed.ResultsThe median duration of follow‐up after EC diagnosis was 59 months (4–187). Among 169 participants, ovarian preservation surgery (OPS) was performed in 54 (31.9%), and BSO was performed in 115 (68.1%) patients. Although patients younger than 30 years of age were more likely to have OPS than patients aged 30 to 40 years (20.4% vs. 9.6%, P = 0.021), there was no significant difference by the mean age. There were no other relevant baseline differences between OPS and BSO groups. The Kaplan–Meier analysis revealed no difference in either the overall survival (P = 0.955) or recurrence‐free survival (P = 0.068) among patients who underwent OPS, and BSO.ConclusionOPS appears to be safe without having any adverse impact on survival in women aged ≤40 years with FIGO Stage I EC.

Endocervical polyps in high risk human papillomavirus infections

Human papillomavirus (HPV) positive patients with and without endocervical polyps is compared with respect to HPV genotypes and presence of pre-invasive diseases. To our knowledge, this is the first and largest report in the literature examining the endocervical polyps in HPV positive cases. Clinicopathological data for the first one million screening patients (n = 1060 992) from around the entire country during 2015 and 2016 were targeted for this research. Colposcopy, colposcopic surgical diagnostic procedures and final pathology results of 3499 patients with high-risk (HR) HPV-positive were obtained from reference colposcopy centers. Patients with endocervical polyps (n = 243 [6.9 %]) were accepted as experimental arm while patients without any endocervical polyp (n = 3256 [93.1%]) were regarded as the control group. Age, HPV genotype, Pap smear abnormality, and final pathological results were compared between two groups using Student's t-test and cross-tabulation chi-square test. The incidence of endocervical polyp was found to be 6.9 % in HR HPV-positive women. The most common HPV genotypes observed in both groups were HPV 16 or 18. Abnormal cytology reports (≥ ASC-US) were not significantly different between both groups. However, with respect to final pathological diagnosis, patients with endocervical polyp had significantly lower numbers of pre-invasive diseases (31.3% vs 44.2%; p < 0.10). Endocervical polyps may be more common in patients with HR HPV infections. HPV 18 is observed significantly more, in the HR HPV positive endocervical polyp group. Patients with endocervical polyps do not have increased risk for preinvasive cervical diseases.

Impact of adjuvant treatments and risk factors on survival in 2023 FIGO stage IIB endometrial cancer patients: Turkish Gynecologic Oncology Group Study

The aim of this study was to investigate the impact of adjuvant treatments, factors influencing recurrence, and survival data in patients with 2023 International Federation of Gynecology and Obstetrics (FIGO) stage IIB endometrial cancer. A retrospective analysis was conducted on patients with endometrial cancer who underwent surgery between 2005 and 2022 at seven different centers in Turkey. Demographic, clinicopathological, and survival data were collected and analyzed. Among 7323 patients, 565 (7.7%) were classified as 2023 FIGO stage IIB based on pathological results. Of 565 patients, 214 were followed without receiving adjuvant treatment, while 335 (95.4%) received adjuvant radiotherapy, and 16 (4.6%) received radiotherapy and chemotherapy. The locoregional recurrence rate was higher in patients with a tumor size >4 cm (p=0.038) and myometrial invasion >50% (p=0.045). In patients with distant metastasis, the recurrence rate was lower in those with myometrial invasion <50% compared with myometrial invasion ≥50% (p=0.031). The impact of adjuvant treatment on endometrial cancer patients revealed no significant differences for both disease free survival (p=0.85) and overall survival (p=0.54). Subgroup analyses showed that in patients with deep myometrial invasion, adjuvant treatment was associated with a significant increase in overall survival (p=0.044), but there was no effect on disease-free survival (p=0.12). Patients with stage IIB endometrial cancer with myometrial invasion ≥50% were more likely to have locoregional and distant metastases. Adjuvant radiotherapy or chemoradiotherapy did not demonstrate an overall survival benefit in these patients.