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Introduction/Background*Self-evaluation and analysis of healthcare practice in a Gynecology Oncology unit represents an advance in the strategy to improve the quality of cancer care, in this case,endometrial cancer, allowing to obtain relevant data on the quality of care practice.MethodologyRetrospective descriptive study carried out in CHUIMI. We included patients diagnosed with endometrial cancer during the study period 2012-2016. We analyzed epidemiological variables, histological type, type of treatment, final FIGO stage and 5-year overall survival.Result(s)*A total of 498 patients were diagnosed with endometrial cancer during this period. Mean age of 64.3 years (range 29–89 years) and a mean BMI of 33.5. 60.2% of the patients were diagnosed in stage IA; 48.7% of which were grade 1 and 2. Type I (endometrioid and mucinous) accounted for 74.3% versus 25.7% type II. 40.8% of the patients were classified as low risk presenting a 5-year survival of 99%. Patients with intermediate risk represented 5.9% and had a 96% 5-year survival. Patients with intermediate-high risk (19.7%) had a 5-year survival of 88%. The patients included in the high-risk group (28.2%), had a 5-year survival of 62%, these differences were statistically significant.We analyzed survival according to the histological type, finding a 5-year overall survival rate of 91.9% in type I, while it was 60.8% fot type II, these differences were statistically significant.Conclusion*The data analyzed in our Gynecology Oncology Unit are similar to those exposed in the literature, there is an important difference in terms of 5-year survival between the low and high risk groups, 99% vs 62% respectively.

Introduction/Background*COVID -19 pandemic has shown a huge impact in health-care systems. In the field of gynecology oncology, we had to postpone routinary tests and check-ups, as well as attend patients that had undergone an oncological process via telephone. Due to their vulnerability, the psychological impact on this patient has been even worse than on other users of the health system. The aim in this study is to evaluate the concerns, global health status and quality of life of patients with gynecological cancer during the pandemic.MethodologyThe GineonCoVID study is a multicenter Spanish study that collect data from a national survey. The anonymous survey consists of 23 questions regarding the personal experience of the patient and modifications in health care during follow up of patient with gynecological malignancies from April to May 2021. The survey has been divided into 3 sections. In this sub-analysis the results of the questions related to anxiety, concerns, quality of life and state of mind of the interviewed patients will be evaluated.Result(s)*376 patients responded to the survey. The median age was 58 years. 43% of the patients were diagnosed with endometrial cancer, 27.3% with ovarian cancer and 24.1% with cervical cancer. 39.6% and 33.6% of patients suffered anxiety and depression respectively during the pandemic. 81% of the patients report having a good quality of life during the last year. Results showed that 54.2% of the respondents are not concerns about viral infection and 67.9% consider that the risk of being infected during follow-up is low. 94% do not perceive changes in follow up, but if they do, 44% believe that clinical health care has experienced a change. 71.4% of the patients are concern about not being able to attend clinical visits.Conclusion*The pandemic could increase anxiety and depression, although it does not appear to worsen the quality of life in patients with gynecological cancer. More than half of the patients consider that they have a low risk of being infected during follow-up but are concerned about not being able to attend clinical visits due to the pandemic.

Introduction/Background*The objective of this study is to describe the results of patients with endometrial adenocarcinoma in early stages, which have undergone a selective sentinel lymphatic node biopsy (SLNB).MethodologyRetrospective observational descriptive study of patients with endometrial cancer treated by robotic surgery with Da Vinci Xi who underwent SLNB by Indocyanine green staining with ultrastratification using 5 sections separated by 200 microns. Study conducted from April 2019 to June 2020. We included 24 patients with early stages Endometrial adenocarcinoma. The technique for performing BSGC was by diluting 25 mg oc ICG in 5 ml of physiological serum and then 1 ml of this dilution in another 10 ml of serum. Subsequently we administered 1 ml of this solution in the cervix at 3 and 9 o’clock points by introducing a 21G needle, 1 cm deep into the cervixResult(s)*The sample had a mean age of 61.3 years and a mean BMI of 28.6. In 2 of the cases (8%) the SN were positive even presenting myometrial infiltration <50% and in three of the cases (12.5%) the SN were not identified. SLNs were located in 98% of cases (n: 23) at the level of the obturator fossa and just in one case (2%) at the level of the external iliac artery and vein.Conclusion*SLNB is an effective technique to assess lymphatic involvement due to adenocarcinoma of the endometrium in early stages.

Introduction/Background*Radical surgery is the main treatment for Borderline Ovarian Tumors. Surgery includes hysterectomy, double adnexectomy, omentectomy and appendectomy if the histological line is mucinous.Due to the excellent prognosis, some authors affirm that it is possible to perform a conservative surgery in young women who have not fulfilled their reproductive desire, without having repercussions in terms of overall survival.The objective of the study was to know the treatment and the overall survival of the Borderline Ovarian Tumors in young women.MethodologyA retrospective cohort study was conducted. The study period was from January 2012 to January 2020. A total of 131 women with Borderline Ovarian Tumors were included in the study. Information was collected about: demographic data, diagnosis, type of surgery performed, disease-free survival, and overall survival. Two cohorts were established: conservative treatment (n = 37) vs radical treatment (n = 94).Result(s)*131 women with a diagnosis of Borderline Ovarian Tumors were diagnosed, representing 16.7% of all the malignant ovarian tumors within this period (n = 784). 91.5% were diagnosed in Stage I according to the FIGO classification and the most histological line frequent was the mucinous (49.2%). The risk of global relapse was 6.2% and overall survival was 95.4%.Regarding the group of patients who underwent conservative surgery, the risk of relapse was 13.5% (n = 5) compared to 3.2% (n = 3) in the group radical treatment, (p = 0.042).The Overall survival was 100% in women with conservative surgery compared to radical surgery, 94.6%, (p = 0.130).Conclusion*Borderline Ovarian Tumors present excellent prognosis, obtaining great positive results in overall survival regarding the performance of conservative surgery in young women with unfulfilled reproductive desire.

Introduction/Background*The most important prognostic factor in cervical cancer is lymph node involvement. Up to 24% of patients with a negative CT scan show histological lymph node disease.The gold standard is histopathological study,but surgery is not exempt from possible complications (even laparoscopic approach). We intend to know the sensitivity and specificity of PET/CT in paraortic lymph node staging in LACC with negative CT.MethodologyRetrospective study of patients with LACC who have undergone laparoscopic paraortic lymphadenectomy and previously had performed a PET/CT. The indication for paraortic surgical staging in patients with LACC is a negative CT scan for disease at the paraortic level.Result(s)*The mean age of the patients with cervical cancer was 52.7 years (range 23-97 years). 69% were in advanced stages at the time of diagnosis. It should be noted that 35.5% of patients diagnosed in advanced stages underwent paraortic surgical staging. We have performed 227 laparoscopic paraortic lymphadenectomies in patients with LACC, 14% with metastatic involvement. In 52 patients we had a PET/CT prior to paraortic lymphadenectomy. In the group of patients with negative PET (n = 45), we found that surgical staging was negative in 95.5% (n = 43). Meanwhile in patients with positive PET at the paraortic level (n = 7), we found that in 4 cases it was confirmed lymph node involvement in histology and in 3 cases they were false positives (predictive value 57.2% positive)Conclusion*The specificity of PET/CT for paraortic lymph node staging in LCCA with Negative CT scan is 93.4%, and the sensitivity is 66.6% in our series. If this trend is confirmed, we could consider modifying our strategy in the indication for paraortic surgical staging: in case of advanced stages with negative CT and PET/CT for lymphatic involvement , do not perform paraortic lymphadenectomy (negative predictive value of 95.5%) and in cases of negative CT and positive PET, consider performing lymphadenectomy paraortic (positive predictive value of 57.2%).

Introduction/Background*The objective of the study was to determine whether the addition of adjuvant chemotherapy to chemoradiotherapy improves overall survival in patients with locally advanced cervical cancer (LACC).MethodologyRetrospective observational cohort study. We included patients with diagnosis of LACC, (Stages IIIA, IIIB, IIIC1, IIIC2 or IVA according to FIGO 2018), who received adjuvant chemotherapy (carboplatin and paclitaxel), during the period of study from 2013 to 2018 (n: 35), comparing it with a control group (n: 38).Result(s)*73 patients were included in the study from which 35 received adjuvant treatment with chemotherapy. The survival rate at 3 and 5 years was 77.1% and 68.6% for the group who received adjuvant and 10.5% and 7.9% for those who did not. (p <0.001, p <0.001, respectively). Gastrointestinal, genitourinary, and neuropathic toxicities were observed during chemotherapy, but only 3.1% and 0% were grade 3 or 4 respectively. The most severe toxicites were haematologic, in terms of neutropenia (G3/4: 33.4%) and anemia (G3/4: 33.4%). Only 5 patients (14,3%) needed to suspend chemotherapy treatment.Conclusion*Adjuvant chemotherapy in patients with LACC significantly improved survival disease-free and overall survival with acceptable toxicity percentages. Prospective trials are needed to confirm these findings.

Introduction/Background*The objective is to know our degree of compliance with the ESGO 2019 quality indicators in surgical management of cervical cancerMethodologyRetrospective study of patients with cervical cancer who underwent laparoscopic radical hysterectomy in the period between 2008-2018.Multiple variables were analyzed related with histopathological study,surgical complications,adyuvant treatments,follow-up and current status of the patients.Result(s)*109 radical hysterectomies were performed for cervical cancer during the study period.Average age is 46.5 years (range 25-76 years).Most of the patients (n = 101) had stage IB1.The mean tumor size is 1.8 cm (0.4-5 cm).In the first 30 days after surgery,3 fistulas were detected.In 99.1% the margins were free of disease,only one patient presented margin involvement.Two patients had a tumor stage greater than IB1 (1 IB2 and 1 IIA2).The mean number of lymph nodes extracted was 19.8, of those being affected 11.9% (n = 12). 18.3% (n = 20) received adjuvant treatment with radiotherapy + concomitant chemotherapy,of these 13 were for positive lymph nodes.Therefore, the rate of patients who received adjuvant treatment with N0 was 8.3%.We have only had one recurrence in less than two years of follow up (1/93).Conclusion*HUMIC is a reference in gynecological oncology for the province of Las Palmas with trained personnel with exclusive dedication (QI2) and participating in multicenter studies (QI 3).It has a multidisciplinary tumor board where all patients are presented according to recommendations of scientific societies (QI4-5)before and after surgery (QI6-7).We present a 2.7% urological fistula (QI8 and QI9 <3%) all of them during learning curve and a patient with BMI of 38. We reached a 99.1% rate of free margins of disease (QI10> 97%).In 2% we found a staging greater tan IB1 (QI11 <10%).Pelvic lymphadenectomy or SLN (Sentix) was performed at 100% the patients (QI13> 98%).8.3% received adjuvant treatment with N0 (QI15 <15%). If there is indication, fertility sparing treatment is offered and currently it is performed in our center (QI14 100%).We had a 2-year recurrence rate of 1% (QI12 <10%).The only indicator we do not reach is the number of cases (minimum QI1 of 15),since our mean is 10 radical hysterectomies per year.Nevertheless,last year we performed 15 surgeries,wich,given our geographical location,we think it allows us to continue as a Reference Center

Introduction/Background*It is important to know the survival data of patients with ovarian cancer treated in our unit,the variables associated with the prognosis and the degree of compliance with the standards in the surgical management of ovarian cancerMethodologyRetrospective study of patients with ovarian cancer diagnosed and treated in CHUIMI in the period between 2006-2015.We studied epidemiological variables,stage at diagnosis,type of treatment,histopathological study,follow up and current status of patients.Result(s)*The total number of patients diagnosed with ovarian cancer in the study period was 331,with a mean age of 57.84 years (range 26–85 years).69.8% were in advanced stages at the time of diagnosis (Stage I 23.9% (79),Stage II 6.3% (21),Stage III 54.1% (179) and Stage IV 15.7% (52).Regarding the histological type,serous was the most frequent representing 49.8% of the sample, followed by endometrioid with 16.3% and clear cells with 10.9%.We found that endometrioid,clear cells and mucinous types were more frequent in the grupo diagnosed with eraly stages versus the serous type that were more associated with the advanced disease.Overall survival (OS) at 5 years is 40.8% for the complete series. 83.3% for stages I, 72.2% for stages II, 29.1% for stages III and there are no patients in stage IV who lived after 5 years. In stages III, the most frequent therapeutic approach is initial surgery in 41.1%, followed by neoadjuvant chemotherapy in 30.3%. Stage III patients receiving surgery + adjuvant chemotherapy showed an OS of 47% at 5 years (median survival 44 months) meanwhile those who received neoadyuvant chemotherapy and get the surgery in second place showed an OS of 27.1% (median survival 35 months).When we studied the effect of tumor residue after surgery in stage III patients, the OS when the surgery was complete was 52,9% at five years, 15% if there were residual tumour, regardless of the size. Initial surgery was performed in 58% of all stages III-IV (objective> 50%). Complete citoreduction was achieved in 51% of all stages III-IV (minimum objective> 50%, optimal> 65%)Conclusion*Our epidemiological and survival data coincide with what has been published in the literature.Having surgeons with experience in the management of peritoneal carcinomatosis will allow to increase the rate of complete citoreductions

Introduction/Background*Locally advanced endometrial cancer extending to the cervix is a rare presentation of uterine cancer (10-15%). Most of them, are stage II hidden with cervical microscopic extension discovered at the time of the pathological results. A lower percentage of stage II are diagnosed preoperatively. For the latter there, are two action plans: a) radical surgery (radical hysterectomy with bilateral salpingo-oophorectomy, pelvic lavage and lymphadenectomy), b) neoadjuvant radiotherapy followed by simple surgery (Simple hysterectomy with bilateral salpingo-oophorectomy).The main objective was to know the overall survival, analyzed at 3 and 5 years, and the disease-free survival between those patients with a preoperative diagnosis of endometrial cancer stage II versus those patients with postoperative diagnosis.MethodologyLongitudinal cohort study with retrospective analysis was carried out in a third level hospital. Patients diagnosed with endometrial cancer stage II, FIGO 2009, were included. Study period 1998 to 2018.Two cohorts were formed; women who initially received neoadjuvant radiation therapy followed by hysterectomy (preoperative diagnosis stage II) and women who received primary surgical followed by radiation (postoperative diagnosis stage II).The overall survival, 3 and 5 years, and disease-free survival were analyzed.Result(s)*125 patients were included in the study. 29 patients received neoadjuvant treatment with radiotherapy and 96 patients did not receive neoadjuvant treatment. The rate of overall survival at 3 and 5 years was 78.6% in the ‘neoadjuvant’ cohort and 86.3% and 77.9% respectively in the ‘no neoadjuvant’ cohort, not finding differences statistically significant between both groups (p= 0,761).No differences were in terms of disease relapses, local and distance, and in terms of disease-free survival.Conclusion*The application of neoadjuvant radiotherapy (brachytherapy plus external radiotherapy) followed simple hysterectomy in our study population, allows to match the prognosis of patients with clinical endometrial cancer stage II, initially considered less favorable.

Introduction/Background*SENTIX is a prospective cohort multicentric international study on sentinel lymph node (SLN) biopsy without pelvic lymph node dissection (PLND) in patients with early-stage cervical cancer. SLN frozen section (FS) and pathological ultrastaging were mandatory by the protocol. Samples from SLN were reviewed centrally for pathological assessment quality control. Only sites experienced in SLN biopsy technique could join the trial.MethodologyIn total, 47 sites from 18 countries participated in the trial. Patients with FIGO 2009 stages T1A1/LVSI+ – T1B1 (<4 cm or ≤ 2 cm for fertility sparing), with common tumour types and no suspicious lymph nodes on imaging were registered in the trial. Patients remained in the trial after the surgery if SLN were detected on both sides of the pelvis and if SLN were negative on FS histological evaluation. Blue dye, radioactive tracer, indocyanine green or their combinations were all eligible tracers for SLN detection. Intraoperative SLN pathological processing consisted of SLN examination in one randomly selected slice. SLN ultrastaging protocol included a complete processing of all SLN tissue in slices of 2 mm thickness, 2 sections in 150 μm from each block until no tissue left, one stained with H&E and second examined immunohistochemically.Result(s)*Altogether 733 patients were registered until Sentix enrolment closure in October 2020, 83 patients were excluded (table 1) and 650 patients was analysed. Patients` characteristics are shown in table 1. Bilateral SLN detection rate reached 95%. FS detected macrometastases (MAC) in 44 cases and micrometastasis (MIC) in 4 cases. SLN ultrastaging found additional 9 cases with MAC, 26 with micrometastases (MIC) and all 19 cases with isolated tumor cells (ITC). Sensitivity of FS was 83.0% for the detection of MAC, 57.8% for pN1 status (MAC or MIC) and 47.1% for any type of SLN involvement (MAC, MIC, ITC). Table 2.Abstract 950 Table 1Patient’s characteristics (N=733)Abstract 950 Table 2SLN status assessed by frozen section and final ultastaging (N=650)Conclusion*High bilateral detection rate of 95% was achieved in Sentix sites experienced in the SLN biopsy technique. Intraoperative pathological assessment of SLN failed to detect majority of MIC (86.7%), all cases with ITC and 42.2% with pN1 (MIC or MAC).