Incidence and characteristics of ovarian cancer following endometrial cancer in the emerging era of conservative management of endometrial cancer-Implications for counseling-A SEER analysis.

OBJECTIVE: To assess the ovarian cancer (OC) risk following endometrial cancer (EC) in patients who underwent ovarian preservation as part of the EC staging. STUDY DESIGN: With permission of the Surveillance, Epidemiology and End Results (SEER) program of the United States National Cancer Institute, clinicopathological information of women diagnosed with EC and following OC were analyzed. Incidence of OC and survival according to the surgical approach were studied. Primary analysis was conducted in women up to and including the age of 49 years. RESULTS: A total of 116 patients up to the age of 49 years were diagnosed with EC and following OC. In this group of patients, no differences in incidence (IRR 0.9, CI 0.56-1.49, p = 0.66) or survival rates (p = 0.71) were found comparing ovarian preservation and bilateral salpingo-oophorectomy (BSO) performance. In an overall analysis of women diagnosed with EC and following OC at any age, incidence of OC did not differ between groups (IRR 1.07, CI 0.83-1.39, p = 0.59) yet when including patients older than 49 years old survival rates were shorter in ovarian preservation patients compared to patients with BSO performed as part of their EC treatment. CONCLUSION: Ovarian preservation in EC patients under the age of 49 years may be considered safe, with no impact on OC incidence or survival, benefiting longer natural hormonal status.

The impact of postpartum cervical tear on the occurrence of preterm birth in subsequent pregnancy.

PURPOSE: To examine the occurrence of subsequent preterm birth (PTB) among women who experienced a cervical tear during prior delivery. METHODS: A retrospective study conducted at a single teaching hospital on data from January 1994 to March 2014. The study group included all women who had a cervical tear detected at uterine and cervical examination, performed due to early postpartum hemorrhage. The control group consisted of women who delivered vaginally, experienced an early postpartum hemorrhage, and had an intact cervix at uterine and cervical examination. The control group was matched for maternal age and ethnicity at a ratio of 1:2. Women who had a cervical tear but then did not have a subsequent delivery, or had multiple fetal gestations or cervical cerclage at subsequent pregnancies were excluded. Primary outcome was spontaneous PTB rate (<37 weeks) in the subsequent pregnancy. Secondary outcomes included any PTBs in other subsequent pregnancies. RESULTS: Overall, 389 women were included. Of all cases of cervical tear, 129 were identified eligible and included in the final analysis. The control group included 260 women with an intact cervix. No significant differences were found between the study and control groups in the incidence of spontaneous PTB in the immediate subsequent pregnancy [1.6% (2/129) vs. 3.8% (10/260), respectively, p = 0.35]. The incidence of any spontaneous PTBs in all subsequent pregnancies did not differ also [4.7% (6/129) vs. 7.3% (19/260), respectively, p = 0.31]. CONCLUSION: Cervical tear detected after delivery does not increase the risk of spontaneous PTB in subsequent pregnancies.

Does Patient's Metabolic and Bariatric Surgery Knowledge Predict Optimal Clinical Outcomes?

PURPOSE: Preoperative evaluation and educational training are required before metabolic and bariatric surgery. This study evaluates patient's comprehension prior to the operation and identifies the relationship between certain sociodemographic parameters and surgery outcomes. MATERIALS AND METHODS: An analysis of patients who completed a preoperative questionnaire and underwent metabolic and bariatric surgery between 2019 and 2021 was performed. The questionnaire evaluated surgery preparation and factors influencing weight loss after surgery. RESULTS: In total, 81 patients completed the preoperative questionnaire. Mean age was 44 ± 11.69 years, 63 females (77%). Mean BMI was 42.85 ± 5.72 kg/m2. Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was performed in 10 (12.3%), 28 (34%), and 43 (53%) patients respectively. Out of the patients, 38 (47%) were Israeli born Jews, 14 (17.3%) were Russian born Jews, and 29 (35.8%) were Israeli born Arabs. Mean follow-up was 30.71 ± 8.66 months. Questionnaire scores average was 67.7 ± 16.15. Based on univariate analysis, younger, single, higher educated, fewer offspring, and Israeli born Jews significantly scored higher in the questionnaire (p = 0.03, 0.05, 0.01, 0.0002, 0.02 respectively). Postoperational weight loss was significantly inferior among older patients, revisional procedures, and patients with lower educational levels (p = 0.02, 0.006, 0.05 respectively). Patients with a higher BMI, and fewer offspring had a significantly higher weight loss postoperatively (p = 0.0001, 0.02 respectively). CONCLUSION: The number of factors can influence optimal weight loss following metabolic and bariatric surgery. Identifying groups with certain characteristics and addressing their weaknesses may improve weight loss outcomes.