Sevtap Seyfettinoglu

Background: This study aimed to evaluate the impact of postoperative immunonutrition on vaginal cuff healing in well-nourished patients undergoing laparoscopic surgery for endometrial cancer. The secondary objective was to assess postoperative complications occurring within 30 days. Methods: This prospective observational cohort study included patients who underwent laparoscopic surgery for endometrial cancer. Patients receiving postoperative oral immune-modulating diets were compared with those managed with a standard postoperative diet. Vaginal cuff healing assessed at postoperative 4th and 6th weeks. Postoperative complications within 30 days were recorded prospectively. Results: A total of 131 patients were included [immunonutrition group, n = 69; control group, n = 62]. At the 4th postoperative week, complete vaginal cuff healing was observed in 84.1% of the immunonutrition group and 75.8% of the control group [p = 0.24]. By the 6th postoperative week, complete healing rates were comparable [96.6% vs. 93.1%, p = 0.43]. In multivariable analysis, vaginal cuff closure time was independently associated with delayed cuff healing [p = 0.02]. Postoperative morbidity did not differ between groups. Conclusions: Vaginal cuff healing after laparoscopic surgery for endometrial cancer was primarily influenced by surgical factors, particularly vaginal cuff closure time, rather than postoperative immunonutrition.

Background:This study aimed to evaluate the impact of postoperative immunonutrition on vaginal cuff healing in well-nourished patients undergoing laparoscopic surgery for endometrial cancer. The secondary objective was to assess postoperative complications occurring within 30 days.Methods:This prospective observational cohort study included patients who underwent laparoscopic surgery for endometrial cancer. Patients receiving postoperative oral im-mune-modulating diets were compared with those managed with a standard postoperative diet. Vaginal cuff healing assessed at postoperative 4th and 6th weeks. Postoperative complications within 30 days were recorded prospective-ly.Results:A total of 127 patients were included [immunonutrition group, n = 66; control group, n = 61]. At the 4th postoperative week, complete vaginal cuff healing was observed in 86.2% of the immunonutrition group and 74.6% of the control group [p = 0.17]. By the 6th postoperative week, complete healing rates were comparable [96.7% vs. 93.8%, p = 0.72]. In multivariable analysis, vaginal cuff closure time was independently associated with delayed cuff healing [p = 0.02]. Postoperative morbidity did not differ between groups. Conclusion:Vaginal cuff healing after laparoscopic surgery for endometrial cancer was primarily influenced by surgical factors, particularly vaginal cuff closure time, rather than postoperative immunonutrition.

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for cervical tissue regeneration. Methods: This prospective observational study included 28 patients who underwent MESC due to abnormal cervical cytology or biopsy-confirmed cervical intraepithelial neoplasia. Preoperative, postoperative one month and six month cervical measurements were obtained using two-dimensional transvaginal ultrasonography. Monthly colposcopic evaluations were conducted, cervical biopsies were taken at the third month, and a cytological assessment was performed at the sixth month. Cervical volume and length regeneration were calculated and analyzed in relation to the dimensions of the excised cone. Regeneration percentages and their correlations with excised tissue dimensions were evaluated using paired t-tests and Pearson correlation analysis. Results: Mean cervical volume and length regeneration rates at six months were 84.61% ± 5.64 and 86.36% ± 3.33, respectively. The transformation zone was histologically visible in 32.1% of patients at three months and cytologically in 75.9% at six months. An inverse correlation was observed between both cone volume and length and cervical regeneration (p < 0.005). Patients with larger preoperative cervical dimensions exhibited a higher regenerative capacity. Positive surgical margins were found in only one patient (3.4%), and no high-grade cytologic abnormalities were noted at follow-up. Conclusions: MESC may enable substantial cervical regeneration within six months. Larger excisions impair healing and delay transformation zone reformation, which may inform the optimal timing for initiating gynecological and colposcopic examinations, as well as for performing cervical interventions when indicated.

Objectives: Persistent Human Papillomavirus (HPV) infection in the cervix and the preinvasive lesions it causes are significant risk factors for cervical cancer. Therefore, a treatment strategy is necessary to facilitate the clearance of HPV and prevent the progression of preinvasive lesions without causing cervical tissue destruction. This study aimed to evaluate the effectiveness of a vaginal adsorbent gel composed of a hydroxyethyl cellulose matrix formulation containing dispersed silicon dioxide, antioxidant sodium selenite, deflamin, and citric acid in patients with HPV infection. Methods: The study was designed as a retrospective cohort study and involved 449 women infected with HPV. For the purposes of the study, the patients were divided into two groups: the treatment group (TG) comprised 207 patients who used the vaginal gel daily for a period of three months, while the control group (CG), consisting of 242 patients, received no treatment under an “active surveillance” protocol. The study’s endpoints encompassed the domains of cytology, histology, and HPV clearance. Results: The regression rate of smear pathologies was 24.8% in the control group and 29.0% in the group using the vaginal adsorbent gel. In the first year, the histological regression rate in cervical biopsies was 49.3% in the treatment group and 19.4% in the control group, with a significant difference between groups (p < 0.001). Moreover, the clearance rate of HPV types was found to be significantly higher in the group using the vaginal adsorbent gel. Conclusions: The findings of this study suggest that the outpatient treatment approach can effectively prevent the oncogenic progression of cervical dysplasia. This alternative method has been shown to be efficacious in preventing the progression of cervical dysplasia and promoting regression. Furthermore, the efficacy of this gel in eradicating HPV has been demonstrated within a 12-month period.

Drain placement is a common practice after major surgeries to prevent collection accumulation in the operation field, follow up against the risk of bleeding or anastomotic leakage, and facilitate wound healing, especially in patients with large amounts of ascites such as ovarian cancer. Although port site recurrences have been described after laparoscopic surgery, metastasis to the previous drain site rarely occurs after laparotomy in gynecologic cancer patients. Cutaneous involvement originating from uterine sarcoma is particularly unusual. Albeit rare, malignant-cell seeding along an artificial percutaneous tract should be kept in mind when deciding to place a drain. We present a case of uterine undifferentiated sarcoma recurrence at the surgical drain site after one year later of primary tumour resection.

Malignant Melanoma (MM) is a tumor with an extremely poor prognosis and is very rare in adolescents. The prognosis of the disease in this population is different from that of adults. The condition can be diagnosed at a metastatic stage. Gynecological metastases of MMs often occur in the endometrium. More rarely, metastases can be detected in the ovaries. Although it is rare in adolescents, MM cases should be evaluated regarding ovarian metastases. It should be noted that adolescents can be asymptomatic no matter how large the mass is. This case report presents a case with a primary melanoma lesion in the leg and a metastatic ovarian mass detected in imaging studies performed five months after the initial diagnosis. The mass detected in the ovary in the case was removed by salphingoopherectomy. The diagnosis of metastasis was confirmed by immunohistochemical staining. Sentinel lymph node biopsy was performed concurrently with oophorectomy. Malignant melanomas may rarely metastasize gynecologically. Metastases should be considered in the differential diagnosis of adnexal mass in patients with melanoma, and the treatment plan should be arranged accordingly.

Objective Primary debulking surgery has been the preferred surgical route and is still considered a quality indicator for advanced ovarian cancer surgery. However, a significant number of patients are not amenable to upfront surgery. Neoadjuvant chemotherapy and interval debulking surgery may be the most suitable approach for this group. This study aimed to evaluate a novel score for prediction of the cytoreduction results at primary debulking surgery for ovarian cancer patients. Methods This observational prospective study was conducted at a tertiary gynecologic oncology center between December 2020 and August 2022. Presumed primary stage III-IV epithelial ovarian carcinoma cases were included. Borderline tumors, and metastatic or non-epithelial ovarian malignancies, were excluded. Based on imaging findings, points were assigned to each anticipated surgical procedure required for complete cytoreduction. The sum of these points was multiplied by the patient’s Eastern Cooperative Oncology Group (ECOG) score, and thus, the Cukurova-clinic score was established. Furthermore, the required surgical procedures based on laparoscopic evaluation were recorded, and the score was readjusted and calculated to obtain the Cukurova score. Results One hundred and fourteen patients were included in the study. Primary debulking surgery was performed in 70% of cases. Among them, complete cytoreduction (Cukurova score ≤12) was obtained in 97.3% of cases. Complete cytoreduction was not achieved in cases with Cukurova score >12. The odds ratio of 90-day mortality was 13.4 for patients with Cukurova score >12, compared with those with Cukurova score ≤12. Conclusion The Cukurova score is a model for classifying advanced ovarian cancer patients who may be candidates for primary debulking surgery.

Objectives: Non-endometrioid endometrial cancers (non-EEC) have different management from endometrioid endometrial cancers. The purpose of this study was to investigate the prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer and discuss the current literature with the findings. Material and methods: The study included two hundred-three patients with non-EEC who underwent surgical treatment and follow-up between January 1996 and December 2018 in a University Hospital Gynecologic Oncology Center. The patients were divided into three groups according to whether omentectomy was performed and the presence of omental metastasis. The patient’s demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion (LVSI), myometrial invasion, lymph node involvement, and survival outcomes were compared between the groups. Results: The study included 203 patients. Twenty-five patients (12%) had omental metastases. LVSI was reported in 57.3%, 88.0%, and 43.2% of the non-omentectomy, no-omental metastasis, and omental metastatic groups, respectively (p = 0.001). The 5-year disease-free survival (DFS) and overall survival (OS) rates according to the tumor grade, peritoneal cytology, and lymphadenectomy were also compared and were found to be statistically similar. The five-year OS rates were 70.6% for the group without omental metastases and 16.2% for the group with omental metastases, respectively (p = 0.001). In the group of omentectomy, the five-year DFS rates were 62.2% in cases without omental metastasis and 13.0% in cases with omental metastasis (p = 0.001). The five-year OS rates of 86.3% and DFS rates of 80.0% in the group without omentectomy. Conclusions: In non-endometrioid tumors, the survival rate was better in the group that did not undergo omentectomy. Based on these results, we can say that omentectomy may not be necessary for non-endometrioid tumors whose omentum is found to be normal in intraoperative visual examination. Objectives: Non-endometrioid endometrial cancers (non-EEC) have different management from endometrioid endometrial cancers. The purpose of this study was to investigate the prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer and discuss the current literature with the findings. Material and methods: The study included two hundred-three patients with non-EEC who underwent surgical treatment and follow-up between January 1996 and December 2018 in a University Hospital Gynecologic Oncology Center. The patients were divided into three groups according to whether omentectomy was performed and the presence of omental metastasis. The patient’s demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion (LVSI), myometrial invasion, lymph node involvement, and survival outcomes were compared between the groups. Results: The study included 203 patients. Twenty-five patients (12%) had omental metastases. LVSI was reported in 57.3%, 88.0%, and 43.2% of the non-omentectomy, no-omental metastasis, and omental metastatic groups, respectively (p = 0.001). The 5-year disease-free survival (DFS) and overall survival (OS) rates according to the tumor grade, peritoneal cytology, and lymphadenectomy were also compared and were found to be statistically similar. The five-year OS rates were 70.6% for the group without omental metastases and 16.2% for the group with omental metastases, respectively (p = 0.001). In the group of omentectomy, the five-year DFS rates were 62.2% in cases without omental metastasis and 13.0% in cases with omental metastasis (p = 0.001). The five-year OS rates of 86.3% and DFS rates of 80.0% in the group without omentectomy. Conclusions: In non-endometrioid tumors, the survival rate was better in the group that did not undergo omentectomy. Based on these results, we can say that omentectomy may not be necessary for non-endometrioid tumors whose omentum is found to be normal in intraoperative visual examination.

Ectopic pregnancy is a pregnancy complication in which the embryo implants outside the uterine cavity. Although medical treatment is chosen first, sometimes a rupture may occur, and surgical treatment may be required. The parameters to predict rupture have been the subject of many studies. This study aimed to compare the efficacy of different methotrexate protocols in the treatment of ectopic pregnancy and determine the parameters and methotrexate treatment protocols that can predict the risk of rupture. A total of 128 patients diagnosed with ectopic pregnancy were included in this study. Patients were separated into three categories based on their treatment protocols. Regarding the occurrence of rupture, all three groups were compared. The hematological parameters and methotrexate treatment protocols were analyzed and compared between groups. The mean age was 31.9 years. Parity was significantly higher in patients who received multiple doses of methotrexate compared to the other groups. There were significant variations observed among the groups regarding parity, initial β-hCG values, hematocrit (HTC), and mean corpuscular volume (MCV) (p = 0.048, p < 0.001, p = 0.019, and p = 0.047, respectively). According to receiver operating characteristic analysis, neutrophil-to-lymphocyte ratio (NLR) levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.05). NLR levels should be examined in ectopic pregnancy, and the possibility of rupture should be considered in cases with high NLR levels. The potential of NLR to predict ectopic pregnancy rupture should be explored in multicenter prospective studies.

Aims: To evaluate the diagnostic performance of the real time shear-wave elastography in patients with endometrial cancer in terms of tumor grade and myometrial invasion depth preoperatively. Methods: In this prospective observational study, forty-eight women who were diagnosed with endometrioid type endometrium cancer in our gynecologic oncology clinic of a tertiary hospital between September 2020-January 2021 in Turkey. All patients underwent an ultrasonographic shear-wave measurements. Mean shear-wave values were measured from the tumor itself. Mean elasticity values were assessed in terms of tumor grade and myometrial invasion depth. Results: The median [%25-%75] shearwave value of the participants was 29.45kPa (5.02-167.21). Shear-wave value for grade 3 endometrial cancer showed a statistically significant difference compared to grade 1 and 2 shear-wave values (p0.05). ROC curve analysis showed significant results to determine the myometrial invasion depth and grade 3 endometrial cancer with the mean shear-wave cut-off values of 28.29 kPa and 57 kPa respectively (p<0.001). Conclusion: Real-time shear-wave elastography is a promising tool to predict the grade 3 tumors and deep myometrial invasion in endometrial cancer patients.