Safety of laparoscopic surgery in the management of endometrioid endometrial cancer.

Background: Laparoscopic surgery has increasingly been preferred in recent years. However, data regarding the safety of laparoscopy in endometrial cancer are not sufficient. The aim of this study was to compare perioperative and oncologic outcomes of laparoscopic and laparotomic staging surgery in patients with endometrioid endometrial cancer and to evaluate the safety and efficacy of laparoscopic surgery in this population. Methods: Data of 278 patients, who underwent surgical staging for endometrioid endometrial cancer at the gynecologic oncology department of a university hospital between 2012 and 2019, were analyzed retrospectively. Demographic, histopathologic, perioperative, and oncologic characteristics were compared between laparoscopy and laparotomy groups. A subgroup of patients with a body mass index (BMI) >30 was further evaluated. Results: Demographic and histopathologic characteristics were similar between the two groups, while laparoscopic surgery was seen to be significantly superior in terms of perioperative outcomes. The number of removed and metastatic lymph nodes was significantly higher in the laparotomy group; however, this difference did not affect the oncologic outcomes, including recurrence and survival rates, and the two groups had similar results in this aspect. The outcomes of the subgroup with BMI >30 were also in accordance with the whole population. Intraoperative complications in laparoscopy were managed successfully. Conclusions: Laparoscopic surgery appears to be advantageous over laparotomy, and depending on the surgical experience, it may be performed safely for surgical staging of endometrioid endometrial cancer.

Intrahepatic cholestasis of pregnancy: are in vitro fertilization pregnancies at risk?

AIM: Single pregnancy patients with intrahepatic cholestasis of pregnancy (ICP) were divided into two groups according to the conception method, as spontaneous and in vitro fertilization (IVF). We aim to compare the maternal, laboratory and perinatal characteristics of both groups. MATERIALS AND METHOD: The records of 10,929 patients who gave birth in the center between October 2011 and July 2019 were analyzed retrospectively from the data processing system records. Maternal, laboratory and perinatal characteristics of 109 single pregnancies (spontaneous n: 91; IVF n: 18) diagnosed with ICP were compared. FINDINGS: The maternal demographic data of both groups were similar (p: .05). In both groups, gestational week, gestational age at birth, birth weight, neonatal intensive care admission rate, meconium-stained amniotic fluid, umbilical cord pH, the 5-minute APGAR score, and the presence of pregnancy complications were similar (p > .05). RESULT: Although ICP is reported with a higher incidence in IVF pregnancies, ICP findings and prognosis are similar to those of spontaneous pregnancies.

Prognostic factors of endometrial cancer in elderly patient group and their effects on survival.

OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC). METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model. RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4- 24.7) and lymph node metastasis (HR: 6.4; 95% CI:1.6-25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0-32.0) was identified as the only independent risk factor affecting 5-year survival. CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival.

Reappraisal of the relationship between 24-hour proteinuria and preeclampsia in terms of the maternal and perinatal outcomes.

Objective: This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications.Methods: We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia.Results: Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery.Conclusion: Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant.

An analysis of 635 consequetive laparoscopic hysterectomy patients in a tertiary referral hospital.

OBJECTIVE: The objective of this retrospective observational study is to analyse the properties of laparoscopic hysterectomy cases that are performed for benign indications and also endometrial cancer indications. Operation time, postoperative complicaton rate, blood transfusion need, and hospitalization time are compared according to benign and malign indications and also body mass index of the patients. MATERIAL AND METHODS: Patients who were operated between September 2012 and December 2017 are included in this study. Patients' age, body mass index, medical histories, operation indications, operation time, pathology reports, pre and postoperative hemoglobine values and postoperative complications are obtained from medical records.Body mass index is classified as underweight for <19 ; normal for 19-25 ; overweight for 25-30 and obese for ≥30. RESULTS: Operation and hospitalization times were significantly higher for high BMI and malign gynecologic indication groups than lower BMI and benign gynecologic indication groups (p:0.0001). Complication rates and transfusion needs were similar in between malign and benign gynecologic disease groups (p :0.443; P:0.670 respectively) and also in between high and lower BMI groups (P:0.813 ; P:0.468 respectively). CONCLUSION: Laparoscopic approach for hysterectomy operations in high BMI patients and endometrial cancer patients seem to be safe in terms of postoperative complication and bleeding that necessitate transfusion.

Successful treatment of hereditary factor VII deficiency presented for the first time with epistaxis in pregnancy: a case report.

OBJECTIVE: To present a rare case with factor VII deficiency (FVIID) that first diagnosed during pregnancy, and to disccuss the ante-, peri- and postpartum management. STUDY DESIGN: A case report and review of the literature. RESULTS: FVIID was diagnosed for the first time in a 23-year-old pregnant woman at the 24th week of gestation due to complaint of intermittent epistaxis. She was successfully treated by ante-, peripartum and postpartum replacement of recombinant FVII (rFVII). She was uneventfully discharged on the 3rd postoperative day and referred to hematology department for further follow-up. CONCLUSION: FVIID, a rare cause of ante- and postpartum hemorrhages that may differently present by other hemorrhages (i.e.: epistaxis), can be optimally managed with replacement of rFVII.