Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

Objectives: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population. Material and methods: Endometrial cancer patients’ archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not. Results: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively). Conclusions: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients

Clinicopathologic characteristics and prognosis comparison of the uterine high grade endometrial carcinomas

Objectives: Grade 3 endometrioid adenocarcinomas (G3 EAC), type two endometrial carcinomas (Type 2 EC), and alsouterine carcinosarcomas (UCS) are considered as high-grade endometrial adenocarcinomas. The aim of this study was tocompare the clinicopathologic features and survival of patients with UCS, G3 EAC, Type2 EC.Material and methods: We included two hundred and thirty-five patients in this study. Patients were divided into threegroups according to the type of tumor as uterine G3 EAC (group 1, n = 62), Type 2 EC (serous, clear and mixed types; group 2,n = 93), and UCS (group 3, n = 80). We compared the groups according to age, initial symptom, surgical approach, stage,myometrial invasion (MI), lymph node invasion (LNI), lymphovascular space invasion (LVSI), adjuvant therapy, and survival.When comparing the survival outcomes the Kaplan-Meier analysis was performed.Results: The groups were similar according to age, menopausal status, nulliparity, initial symptoms, stage, LVSI, and LNI.Positive cytology was determined significantly more in group 3. There was a significant difference between the groups interms of myometrial invasion degree. Optimal cytoreduction was similar among the groups. The primary adjuvant treatmentwas chemotherapy for UCS and Type2 EAC whereas radiotherapy was the main adjuvant treatment for G3 EAC. Therewere no significant differences among the groups according to overall survival (OS) (p = 0.290).Conclusions: Although the survival difference among the groups can not be revealed, these patients have different clinicaland pathological features and they should be considered as different groups

A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Cukurova technique)

WOS: 000409158200036PubMed ID: 28720378Objective. Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: RO) is one of the main factors affecting survival [1-3]. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases. Methods. A 55 year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intraabdominal disease. Upon laparotomy, omental cake adherent to pelvis-filling mass, disseminated implants on the diaphragm, meso of the descending colon and small intestine were observed. The mass invaded the rectosigmoid colon, uterus, adnexa and the bladder resulting in frozen pelvis. Palpable retroperitoneal pelvic and para-aortic lymph nodes were detected. On the other side, stomach, anti-mesenteric surfaces and mesentery root of the small bowel were tumor-free. Hence, upon these perioperative and preoperative imaging findings, complete cytoreduction was thought to be achievable. Therefore, primary cytoreduction was performed. Total omentectomy, hysterectomy with bilateral salpingo-oophorectomy, rectosigmoid low anterior resection and retroperitoneal lymphadenectomy were performed. With the assistance of an injector needle connected to the insufflator tube (as in laparostopic surgery), carbon dioxide gas was blown into the right retroperitoneal area and subsequently peritoneum was rapidly stripped up to the right diaphragm. The same procedure was then applied to the diaphragm and meso of the bowels, respectively. Owing to this technique, total stripping of all involved peritoneal surfaces was clearly facilitated and RO goal was reached. Results. Gas insufflation caused convenient detachment of the peritoneal surfaces along their anatomical line which led to concluding the stripping procedures easily, rapidly and safely without bleeding. Thus, according to our experience, about 10 to 15 min per procedure are saved in such cases. Potential complications of CO2 gas used here are not superior to those in transperitoneal or retroperitoneal laparoscopic procedures. During the operation, patient was followed-up for potential complications such as subcutaneous emphysema and CO2 gas embolism.Thus, hourly blood gas was monitored. Another potential complication is injury of the vessels while inserting the needle which can be avoided by cautious inserting under the peritoneal surfaces superficially and using transillumination. In case such injuries happen, tamponing is a sufficient measure. In our serial, no perioperative complications belonging to this technique were encountered. However, long term outcomes such as precise time difference, difference in blood loss, complication rates, adhesions, morbidity associated with this technique and its impact on survival of the patients with advanced ovarian cancer have yet to be investigated. Therefore, a prospective study to validate this technique's long-term usefulness has been initiated in our clinic. Conclusion. We believe that this practical and effective technique will offer significant improvements in efforts to achieve complete cytoreduction. (C) 2017 Elsevier Inc. All rights reserved

Spatial distribution and source identification of persistent organic pollutants in the sediments of the Yesilirmak River and coastal area in the Black Sea

Surface sediments from the Yes,ilirmak River and the near coastal area in the Black Sea were collected using sediment traps to assess the spatial distributions of persistent organic pollutants and find their potential sources. Analyses were carried out to determine the concentrations of the persistent organic pollutants of seventeen polychlorinated dibenzo-p-dioxins and dibenzofurans, sixteen polycyclic aromatic hydrocarbons, seven polychlorinated biphenyls, and eight organochlorine pesticides using high-resolution gas chromatography-mass spectrometry and gas chromatography-tandem mass spectrometry systems. Analysis showed that the three main components of persistent organic pollutants (polychlorinated dibenzo-p-dioxins and dibenzofurans, polycyclic aromatic hydrocarbons, and organochlorine pesticides) primary sources are industrial activities. In addition, the widespread occurrence of persistent organic pollutants in the watershed surface sediments taken from the Yes,ilirmak River basin showed that agricultural and urban areas are also diffuse persistent organic pollutants sources

Prognostic importance of survivin, Ki-67, and topoisomerase II alpha in ovarian carcinoma

WOS: 000330032900024PubMed ID: 23974278Stage, tumor grade and histological subtype determine the clinical behavior in ovarian tumors. Some additional factors are related to tumor cell biology and are the useful predictors for identifying the patients with poor prognosis. The aim of this study is to evaluate the prognostic significance of survivin, Ki-67 and Topoisomerase II alpha (TOPO II alpha) in epithelial ovarian cancer (EOC). Seventy-three patients with EOC were included in this study. Survivin, Ki-67 and TOPO II alpha expressions were studied by immunohistochemistry on formalin-fixed, paraffin-embedded tissue sections. Nuclear staining for all antibodies was scored on a three-tiered system and more than 10 % staining was accepted as expression. The relationship between the expressions of survivin, Ki-67, TOPO II alpha and clinicopathological parameters including age, stage, grade, platinum resistance and survival was evaluated. Survivin, Ki-67 and TOPO II alpha expressions were found in 20, 82 and 86 % of the tumors, respectively. Ki-67 and TOPO II alpha expressions were found to be related to poor overall survival (p = 0.005, 0.004, respectively), while survivin expression was not associated with overall survival. There was no association between TOPO II alpha and Ki-67 expressions and histological subtype, stage or grade. However, we found an important relationship between TOPO II alpha expression and platinum resistance (p = 0.044). Platinum resistance was found to be an independent prognostic factor in EOC. Ki-67 and TOPO II alpha expressions were found to be related to poor overall survival, and TOPO II alpha expression was found to be associated with platinum resistance

Are Uterine Grade 3 Endometrioid Adenocarcinoma and Carcinosarcoma Really Clinically Similar?

WOS: 000469053500001PurposeThe aim of this study was to compare the clinical characteristics and outcomes of the cases with uterine high-grade endometrioid adenocarcinoma (HGEAC) and uterine carcinosarcoma (UCS).MethodsA total of 141 patients were included in this study. Of them, 61 cases had uterine HGEAC (group 1) and 80 had UCS (group 2). Both groups were compared in terms of clinical and pathological characteristics including age, stage, initial symptom, surgical approach, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival. The Kaplan-Meier and Cox proportional hazards models were used to compare the outcomes and prognostic factors.ResultsThere were no statistically significant differences between the groups with regard to age, nulliparity, menopausal status, and the main initial symptom. Both groups were similar in terms of stage, depth of myometrial invasion, and lymph node metastasis. Lymphadenectomy was performed in 74% and 91% of the cases in group 1 and group 2, respectively (p<0.001). LVSI was found to be more frequent in group 1 (p=0.032); however, in group 2, positive cytology was more common (p=0.008). Chemotherapy was the main adjuvant therapy for UCS, while radiotherapy was the main adjuvant therapy for HGEAC. There was no difference between the groups in terms of disease-free survival (DFS); however, overall survival (OS) was found to be longer in group 1 (p=0.029). Histopathologic type and LVSI were determined as independent predictive factors for OS.ConclusionUCSs are clinically more aggressive than HGEAC and should be considered as a separate group of tumors

Genotyping of Vaginal Candida glabrata Isolates Using Microsatellite Marker Analysis and DNA Sequencing to Identify Mutations Associated with Antifungal Resistance

WOS: 000339539000012PubMed ID: 23390908Vulvovaginal candidosis is the second most common cause of vaginitis (17-39%) after bacterial vaginosis (22-50%). Since the diagnosis of vulvovaginal candidosis mainly depends on clinical findings without mycologic confirmatory tests and treated empirically, the actual incidence rate of vulvovaginal candidosis is unknown. Approximately 70-90% of vulvovaginal candidosis cases are caused by Candida albicans, however the increasing incidence of C.glabrata infections and its reduced susceptibility to azole drug therapy have generated increasing attention. The epidemiology and population structure of vulvovaginal candidosis due to C.glabrata are poorly characterized. This study was aimed to genotype the C.glabrata strains isolated from vaginal samples in Cukurova region, Turkey by microsatellite markers, to investigate the antifungal susceptibility profiles of the strains and to determine the molecular mechanisms leading to phenotypical azole resistance. A total of 34 unrelated vaginal C.glabrata strains isolated from patients with acute (n= 11) and recurrent (n= 14) vulvovaginal candidosis, control group (n= 9) without vaginitis symptoms, and a reference strain of C.glabrata CBS 138 (ATCC 2001) were included in the study. These isolates were genotyped using multiple-locus variable number tandem repeat analysis of three microsatellite markers (RPM2, MTI, and Cg6). Analysis of microsatellite markers was performed by fragment size determination of RPM2, MTI, and Cg6 PCR products through capillary electrophoresis. For each of the evaluated strains, DNA sequence analysis was performed for one gene (CgERG11) and four loci (CgPDR1, NTM1, TRP1, and URA3) to detect mutations possibly associated with antifungal resistance in each strain. In vitro susceptibility profiles of the strains to 13 antifungals and boric acid were determined according to CLSI document M27-A3 to investigate possible relationships between detected mutations and phenotypic resistance. C.glabrata CBS 138 strain was found to be susceptible to all the antifungals tested, while one of (%2.9) 34 vaginal C.glabrata isolates was found to be dose-dependent susceptible to fluconazole, 13 (38.2%) to itraconazole and 3 (8.8%) to voriconazole. No resistant strain were detected in the study population. Only three isolates were found to be resistant to clotrimazole (8.8%), however no relationship was identified between the genotypes and phenotypic resistance (p> 0.05). Thirteen genotypes were detected by microsatellite marker analysis, with high discrimination power (DP= 0.877). As a result, microsatellite marker analysis was validated as a rapid, reliable method for genotyping C.glabrata strains with good, but not optimal discriminatory power. Further studies examining larger numbers of isolates are needed to verify possible relationships between mutations and phenotypic resistance

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

Five years single institution retrospective analysis of the borderline ovarian tumors'

WOS: 000399391600006Purpose: The aim of this study was to evaluate the borderline ovarian tumor cases who were operated in our clinic Material and Methods: The last 5 years' pathology reports, computer records and archival files of the Cukurova University Medical Faculty Gynecologic Oncology Unit were retrospectively reviewed for the borderline ovarian tumor patients. A total of 41 cases were detected and included in the study. Patients' demographic characteristics, preoperative assessments, operation and pathological features were evaluated Results: Patients' mean age was 41 and 85% of them were premenopausal. Average of the tumor diameter was found to be 10cm in the preoperative ultrasound examination. Mean of the preoperative ca125 value was 120. While total hysterectomy + bilateral salpingo-oophorectomy was applied to 12 cases, unilateral salpingo-oophorectomy was performed in the remaining 29 patients. Lymphadenectomy was carried out in 41.5% of the patients. Serous borderline was the most common histology (70.7%). Majority of the cases was with stage I disease (90.2%). No recurrences were determined among the study population Conclusion: Borderline ovarian tumors have a favorable prognosis and therefore, unilateral salpingo-oophorectomy can be suggested to be a safely treatment approach for patients who desire to protect their fertilit

Comparison of long-term outcome of patients with ST-segment elevation myocardial infarction between pre-COVID-19 and COVID-19 era

Aims: To compare major cardiovascular and cerebrovascular events (MACCE) rates between patients in the pre-COVID-19 era and COVID-19 era, and to assess the impact of the presence of COVID-19 (+) on long-term MACCE in ST-segment elevation myocardial infarction (STEMI) in Turkey