Elevated Preoperative CA125 or CA19-9 in Borderline Ovarian Tumors: Could It Be Suggestive of Advanced Stage or a Poor Prognosis?

OBJECTIVES: To investigate whether elevated levels of CA125 (≥35 U/mL) and CA19-9 (≥37 U/mL) suggest advanced-stage disease (defined as stage II or higher) or poor prognosis in patients with borderline ovarian tumors (BOTs). STUDY DESIGN: We retrospectively identified 591 patients with BOTs. Multivariate logistic regressions and Cox proportional hazard regressions were used to determine the clinicopathologic factors associated with the presence of advanced-stage disease and the prognostic factors associated with recurrence-free survival. RESULTS: CA125 was elevated more often in serous than in mucinous tumors (50.6 vs. 35.5%; p = 0.003), whereas CA19-9 was elevated more often in mucinous than serous tumors (33.6 vs. 15.3%; p = 0.001). An elevated CA125 level was independently associated with the presence of advanced-stage disease in serous (p = 0.005) and in mucinous BOTs (p = 0.015). However, preoperative elevation of CA19-9, unlike CA125, was not associated with the advanced-stage disease. Elevated preoperative CA125 level (p = 0.037) was an independent prognostic factor for recurrence-free survival in patients with serous BOTs. However, neither CA125 nor CA19-9 had prognostic significance in mucinous BOTs. CONCLUSIONS: Elevated preoperative CA125, unlike CA19-9, is a diagnostic and prognostic biomarker associated with the presence of advanced-stage disease and risk of relapse in patients with serous BOTs.

Single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy.

The objective of this prospective observational study, performed in a university hospital and a tertiary care center, was to describe the surgical technique and our initial experience with single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy (SPLA-TUM). During July and August 2012, 15 women with symptomatic subserosal or superficial intramural myomas (≤ 8 cm) underwent SPLA-TUM. Mean (SD) operative time was 64.9 (9.5) minutes, hemoglobin change was 1.2 (0.5) g/dL, return of bowel activity was 32.8 (3.5) hours, and length of hospital stay was 3.1 (0.4) days. In 1 patient (6.7%), SPLA-TUM did not provide a satisfactory surgical field, and thus the procedure was converted to single-port laparoscopic myomectomy. There were no surgical or wound complications. Compared with single-port laparoscopic myomectomy, SPLA-TUM, which was designed by integrating the surgical techniques of single-port laparoscopy and laparotomy, can reduce operative time by enabling comfortable suturing and reliable knot tying while maintaining the advantages of single-port laparoscopy. SPLA-TUM is a feasible alternative in selected patients with symptomatic myomas.

The overtreatment risk of see-and-treat strategy in management of abnormal cervical cytology.

BACKGROUND: To evaluate the feasibility of conization without a prior punch biopsy for patients with abnormal cytology. METHODS: A retrospective review was performed for 700 patients who underwent conization at a single institution from January 2003 to August 2012. Each of these patients was assigned to one of two groups, either the 'see-and-treat' group or the 'three-step' group, depending on whether the patient had undergone a punch biopsy before conization or not. The final histologic results of two groups were compared. RESULTS: The overtreatment risk was higher in the 'see-and-treat' group in patients with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASCUS/LSIL) cytology (64.7% in the 'see-and-treat' group vs. 36.5% in the 'three-step' group; p = 0.001). There was no significant statistical difference in the rate of cervical dysplasia or invasive carcinoma in patients with high-grade squamous intraepithelial lesion (HSIL) cytology between groups (91.8% in the 'see-and-treat' group vs. 93.5% in the 'three-step' group; p = 0.793). CONCLUSION: The patients with HSIL on cytology can be managed by a 'see-and-treat' strategy with a low risk of overtreatment. On the other hand, the 'three-step' management is more appropriate in patients with ASCUS/LSIL cytology.

Public perception of "scarless" laparoendoscopic single-site surgery in gynecology.

OBJECTIVE: To investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group. METHODS: An anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women ≤40 years and middle-aged women >40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale. RESULTS: All of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5±3.5 vs. 11.8±4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%). CONCLUSION: Based on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.

Efficacy of TachoSil(®) in preventing hemorrhage after loop electrosurgical excision procedure.

STUDY OBJECTIVE: To assess the utility of TachoSil for achieving hemostasis after loop electrosurgical excision procedure (LEEP). DESIGN: Case-control study (Canadian Task Force Classification II-2). SETTING: University hospital. PATIENTS: One hundred seventy-three patients who underwent LEEP. INTERVENTIONS: Patients were managed by LEEP with application of TachoSil (TachoSil group, n=75) or without application of TachoSil (control group, n=94). MEASUREMENTS AND MAIN RESULTS: Patient characteristics (age, specimen depth, resection margin, LEEP histopathology, or use of TachoSil) except for parity were similar between the two study groups. Severe bleeding requiring any intervention developed in 14% of patients (24 of 169 patients), without any statistically significant difference between the two groups (11% in the TachoSil group vs. 17% in the control group; P=0.274). On the logistic regression analysis, other potential clinico-pathologic parameters, including age, parity, specimen depth, involvement of the resection margin, and LEEP histopathology, were not correlated with severe bleeding after LEEP. CONCLUSION: The use of TachoSil may not reduce the incidence of severe bleeding after LEEP.