Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience

Objectives: To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center. Material and methods: We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020. Results: A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively. A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05). Conclusions: The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

Stage Iiic Transitional Cell Carcinoma And Serous Carcinoma Of The Ovary Have Similar Outcomes When Treated With Platinum-Based Chemotherapy

Objective: Previous studies reported better outcomes for transitional cell carcinoma (TCC) of the ovary when compared with more common histologic types such as serous epithelial ovarian cancers (EOCs). The aim of this study was to compare the survival outcomes of platinum- based chemotherapy in patients with stage IIIC TCCs and serous EOCs. Material and Methods: Clinicopathologic features and survival data of patients with FIGO stage IIIC TCC and serous EOC who had undergone primary surgery followed by six cycles of intravenous platinum/taxane between 2007 and 2015 were retrieved from the database of Hacettepe University Hospital. Results: We identified 14 (10.9%) TCCs and 114 (89.1%) serous EOCs. The median follow-up duration was 28 months (range, 3-101 months). Univariate analysis revealed that the TCCs and serous EOCs had similar progression-free survival (PFS) and overall survival (OS). Patients with residual disease less than 1 cm had longer OS than patients with residual disease greater than 1 cm (75.0 vs. 45.0 months, p=0.012). Cox regression analysis of all potential prognostic factors showed that the only independent prognostic factor significantly associated with OS was residual disease less than 1 cm [hazard ratio=0.38; 95% confidence interval: (0.19-0.77); p=0.007]. Conclusion: Surgically treated advanced stage TCCs did not have a significantly better prognosis after platinum/taxane-based chemotherapy when compared with serous EOCs. Residual tumor volume after primary surgery was the only independent predictor of OS in patients with EOC. Our results demonstrate the significance of achieving optimal cytoreduction in all histologic subtypes of EOC.PubMedScopu

Pap Smear Screening Among the Postmenopausal Women

OBJECTIVE: To evaluate the effectiveness of routine Pap smear screening in postmenopausal women. STUDY DESIGN: 2060 women applied to menopause outpatient clinic were reviewed retrospectively. Demographic characteristics, the use of hormone therapy, and the history of previous Pap smear were analyzed. RESULTS: The Pap smear results were as; normal in 1320, inflammation in 591, atrophy in 121, metaplasia in 22, ASCUS in 4, HGSIL in 1, and carcinoma in 1. While two of the ASCUS patients had two previous cervical smears which were normal; the other two HGSIL and carcinoma patient had not previous Pap smear. The patients who had ASCUS, colposcopy was applied and three of them were normal. The histopathological analysis of the cervical biopsy in the HGSIL case was squamous cell carcinoma. CONCLUSION: Pap smear screening should be done to postmenopausal women in spite of low efficiency or false positive results

Is the Initial Treatment in Stage IB2 Cervical Carcinoma Neoadjuvant Chemothreapy or Primary Surgery?

OBJECTIVE: It is expected that neoadjuvant chemotherapy (NACT) decrease tumor size, increase the operability and improve surgical-pathologic risk factors so that improve the survival. In this study we evaluated the effect of NACT on surgical-pathologic risk factors and survival. STUDY DESIGN: Between 1993 and 2007, the data of patients with stage IB2 cervical cancer were reviewed. Twenty-four patients who were treated with NACT followed by radical surgery (RS) were compared with 15 patients underwent primary RS. After two or three courses of chemotherapy patients were reassessed and RS was performed to patients whose tumor size was less than 40mm. In both groups all patients underwent type III radical hysterectomy + bilateral salpingo-oophorectomy + systematic paraaortic and bilateral pelvic lymphadenectomy. RESULTS: The mean size of the tumor mass was 50.1mm. Nine patients were acccepted as responder (complete clinical response + partial clinical response) and 15 patients as unresponder (stabile disease) after NACT. The surgical-pathologic risk factors didn’t improve with NACT except for stromal invasion. The median follow-up was 48 months. Overall survival and disease free survival was 86.7% in RS group, this ratio was 80% in NACT unresponder group and 66.7% in NACT responder group (p=0.501). CONCLUSION: NACT didn’t improve either the surgical-pathologic risk factors expect for stromal invasion or survival in patients with stage IB2 cervical carcinoma. It appears that we have disappointment with this treatment modality

Cancer Trends and Incidence and Mortality Patterns in Turkey

Cancer incidence and mortality rates have been increasing in Turkey as most of the developing countries. Besides socioeconomic factors, one of the most prominent attributes of developing countries is the dissimilarity of their age-dependent demographic structure. In Turkey, cancer incidence rates rise due to individual and environmental risk factors as well as due to the improvement in the registry system and to increase in access to health services. According to the data retrieved from the Ministry of Health Department of Cancer Control database cancer incidence rates increased between 2002 and 2005. Incidence rates rose from 133.78 per 100 thousand in 2002 to 173.85 per 100 thousand in 2005. Between 2002 and 2005 the average growth rate of increase for men comes about 9.7%, which is higher than 8.6% for women leading to the widening of incidence gap between man and women. First five frequent cancer types in Turkey are lung (30.13), prostate (24.33), skin (18.91), breast (17.96), stomach (9.92) cancer with an incidence of per 100 thousand. Cancer incidence growth rates for men exceed the cancer incidence growth rate for women. This gap is resulting mainly from lung cancer incidence which is much higher for men. Further extension of the nationwide cancer screening and prevention programs will result in improvement of cancer control.WoSScopu

Uterine Smooth Muscle Tumors of Unknown Malignant Potential (STUMP): A Dilemma for Gynecologists and Pathologists

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) belong to a subcategory of uterine smooth muscle tumors. The clinical behavior of these tumors is also not clarified. It is hard to state which histological features of STUMPs might represent high recurrence rates. The follow up period also has not been mentioned. For clinicians, STUMPs are difficult tumors to manage since they clinically present as ordinary fibroids. For pathologists, diagnosis of these tumors could be difficult because these tumors are rare and a certain level of expertise in gynecological pathology is required to make a correct diagnosis. Here we report a patient with STUMP that subsequently recurred as a leiomyosarcoma, aiming to remind the disease and its recurrence risk even if followed strictly