Rainer Kimmig

Background/Objectives: The rising global prevalence of obesity presents an increasing challenge in gynecologic surgery. Although robotic-assisted hysterectomy is widely used, comparative data on perioperative outcomes across body mass index (BMI) categories remain limited. We evaluated whether higher BMI is associated with longer operative duration and increased perioperative complications in robotic-assisted total hysterectomy performed for benign indications. Methods: This retrospective cohort study analyzed 179 patients who underwent robotic-assisted hysterectomy at a German academic medical center between January 2018 and December 2024. Patients were stratified by World Health Organization criteria into normal weight (BMI < 25 kg/m²; n = 51), overweight (BMI 25.0–29.9 kg/m²; n = 59), and obese (BMI ≥ 30 kg/m²; n = 69) groups. The primary outcome was operative time; secondary outcomes included estimated blood loss (EBL), Clavien–Dindo complications, hospital stay, transfusion, and readmission within six weeks. Multivariable regression adjusted for uterine weight, surgeon volume, ASA class, year of surgery, and prior abdominal operations. Results: Operative time increased significantly with BMI (normal: 136.3 ± 68.7 vs. obese: 174.4 ± 74.3 min; p = 0.009). On multivariable analysis, BMI remained an independent predictor of operative time (β = 2.49 min per kg/m², 95% CI 1.01–3.96, p = 0.001) and EBL (β = 15.0 mL per kg/m², 95% CI 1.5–28.5, p = 0.029). Postoperative hemoglobin and transfusion rates did not differ between groups. No significant differences were detected in major complication rates (Clavien–Dindo ≥ III: 4/51 [7.8%], 1/59 [1.7%], 7/69 [10.1%]; p = 0.15), hospital stay, or readmission. High-volume surgeon status (≥30 cases) was independently associated with reduced major complications (OR = 0.16, 95% CI 0.03–0.75, p = 0.020). Conclusions: Robotic-assisted hysterectomy appears clinically feasible across all BMI categories without a detectable increase in major morbidity, although obesity was associated with moderately longer operative times and higher calculated EBL. The study was not powered to detect differences in rare events. Surgeon experience was independently associated with lower complication rates and may help offset the additional technical demands of obesity.

Background: Mismatch repair (MMR) and microsatellite instability (MSI) testing have become essential biomarkers in the molecular classification of endometrial cancer (EC), guiding adjuvant treatment decisions and eligibility for immune checkpoint inhibition. Although international guidelines recommend universal testing, real-world implementation remains heterogeneous. This study aimed to evaluate trends in MMR and MSI testing and associated molecular diagnostics in Germany between 2018 and 2022. Methods: A retrospective multicenter analysis was conducted across German tertiary care centers. Data from patients with histologically confirmed EC between 2018 and 2022 were extracted from standardized electronic pathology records. Annual testing rates for MSI, MMR, POLE, TP53, and L1CAM were analyzed using descriptive statistics and trend analysis (Chi-square test for trend, p < 0.05). Therapeutic data were collected to assess the use of immune checkpoint inhibitors. Results: There was a significant increase in the annual rates of molecular testing for MSI, POLE, TP53, and L1CAM over the five-year observation period (all p < 0.05). TP53 testing showed the highest increase (13.1% → 78.6%), while MSI testing rose from 82.9% to 97.4%. Both POLE and L1CAM testing were virtually absent in 2018 (0% and 1.6%) but reached 15.7% by 2022. Conclusions: This study demonstrates a rapid and substantial implementation of MMR and MSI testing in German clinical practice, reflecting successful translation of trial results into routine care. However, implementation of testing in guidelines appeared time-shifted. For bridging this gap, annual guideline updates seem to be necessary.

Background Triple-negative breast cancer (TNBC) is the most aggressive breast cancer (BC) subtype, with a worse outcome, highlighting the need for novel biomarkers to treat patients accordingly. This study aimed to evaluate the presence of prostate-specific membrane antigen (PSMA) and programmed death-ligand 1 (PD-L1) on DTCs in the bone marrow of TNBC patients before and after neo-adjuvant chemotherapy, to provide critical insights into their prognostic and therapeutic potential. Methods We investigated the expression of PSMA and PD-L1 in disseminated, cytokeratin (CK)-positive tumor cells (DTCs) from the bone marrow of TNBC patients before (55 patients) and after (47 patients) neo-adjuvant treatment using triple immunofluorescence stainings and VyCAP platform analysis. A weighted scoring system was developed to quantify PSMA and PD-L1 expression on DTCs, categorizing patients into negative, low/intermediate, and high expression groups. Statistical analyses included Spearman’s correlation, Wilcoxon signed-rank, chi-square, and McNemar’s tests, with significance set at p < 0.05. Results At baseline, 69% of patients exhibited CK + PSMAhighCD45- DTCs, which significantly decreased to 9% post-therapy ( p < 0.001). Similarly, CK + PD-L1highCD45- DTCs declined from 43–27% after therapy ( p = 0.045). Based on our scoring system, most patients initially classified as PSMA-high transitioned to PSMA-negative (n = 20, p < 0.001), while only one patient remained PSMA-high post-therapy. Post-NACT, a strong inverse correlation emerged between CK + PD-L1highCD45- and CK + PSMA-CD45- cells ( p = 0.010), and dual-positive phenotypes decreased to 4% ( p < 0.001). Presence of PSMA + DTCs at diagnosis was associated with shorter progression-free ( p = 0.002, HR = 16.1) and overall survival ( p = 0.016, HR = 2.1). Patients transitioning from PSMA-high to PSMA-negative post-therapy had improved overall survival compared to those remaining PSMA-high ( p < 0.001, HR = 1). Conclusions PSMA and PD-L1 are frequently overexpressed on DTCs of TNBC patients, predominantly before the administration of NACT. PSMA-positive DTCs emerged as a significantly poor prognostic factor, holding promise as a biomarker for identifying individuals at higher risk of relapse. It also provides a potential therapeutic target. Similarly, the presence and persistence of PD-L1-positive DTCs suggests their utility as biomarkers to stratify patients for ICI therapies.

Objectives: Ovarian cancer is the deadliest gynaecologic malignancy. Due to the lack of reliable biomarkers for the detection of the early disease, most patients are diagnosed at an advanced stage resulting in poor survival. We therefore aimed at establishing novel CA-125 glycovariant assays to improve the diagnostic sensitivity and specificity of ovarian cancer. Methods: Blood samples of 184 patients with epithelial ovarian cancers (EOC), 127 benign ovarian tumors, and 115 healthy controls were measured using GLYVAR™ Ovarian I and II assays (Uniogen) and the conventional CA-125 protein assay (CanAg CA-125 EIA, Fujirebio). Results: The two glycovariant assays differentiated benign and malignant ovarian masses with 88.0 % sensitivity at 99 % specificity, whereas CA-125 showed 72.8 % sensitivity. The improved performance was most evident in patients with borderline or moderately elevated CA-125 concentration at diagnosis, which is a challenging group for differential diagnostics. The CA-125 glycovariant assays showed 2.5 times higher sensitivity (33.3 % with CA-125 vs. 83.3 % with the CA-125 glycovariants) at 94 % specificity. CA-125 glycovariants corrected 82.4 % of false positive results given by CA-125 concentrations with the commonly used cutoff 35 U/mL. Importantly, the CA-125 glycovariant assays detected 63.6 % of early-stage serous carcinomas from benign and healthy controls with very high 99 % specificity, while CA-125 had a sensitivity of only 45.5 %, representing a 40 % increase. Conclusions: This is the first study describing the clinical performance of GLYVAR Ovarian I and II assays in ovarian cancer diagnostics. The results indicate that the CA-125 glycovariant assays have remarkable potential to improve ovarian cancer diagnostics.