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N2O is a GHG of environmental concern. It is generated from the nitrous material contained in wastewater and is the sixth most important contributor to N2O emissions. There is a great variety of methods to quantify the emission of N2O in a wastewater treatment plant (WWTP), which present variants among them, such as predetermined values and operational data of the plants. In this paper, we compared three different methods to quantify the N2O emission in 2015 from WWTP in two metropolitan areas with high population density: Mexico City and the Metropolitan Area of Barcelona (MAB). MAB has advanced treatment plants that remove nutrients from wastewater, and Mexico City has only traditional treatment plants. The N2O emission/inhabitant from WWTPs in MAB (3,214,211 inhabitants served) was 40% lower than the plants in Mexico City (1,806,440 inhabitants served). The MAB emission was 0.009 tCO2e/inhabitant and 0.013 tCO2e/inhabitant in Mexico City; these emission values could be considered statistically different with a risk error of 5%. This difference could be due to the fact that MAB has nutrient removal (42% of inhabitants served), and Mexico City has only traditional treatment plants. The results obtained may be influenced by the default emission factors of each methodology. In addition, per capita protein consumption and water consumption per inhabitant are different parameters that must be considered between these zones to quantify and compare the emission of N2O. The integral methods are closer to the reality of the N2O emission when the operating parameters of each plant and wastewater are considered. There should be more research on the reduction of this GHG in wastewater treatment for a correct quantification of these emissions, and more especially in the estimation of N2O emission factors suitable for each treatment plant and study area.

Introduction/BackgroundTreatment of vulvar cancer recurrence will depend on previous treatment. If the patient has already received radiotherapy, surgical rescue is the first option as long as distant metastasis has been ruled out. Complex surgeries such as Pelvic Exenteration (PE) should be assessed individually paying attention to the fragility of the patient. It’s vital to keep in mind that the central objective of PE is to achieve a complete resection. The term ‘composite PE’ denotes a procedure that melds exenteration with pelvic bone resection. This technique could facilitate complete removal of the tumor. Usually it doesn’t pose technical challenges and it doesn’t compromise pelvic girdle stability.MethodologyThis case involves a woman diagnosed in 2015 with squamous cell carcinoma of the vulva after biopsy of a lesion on the left labia majora. Tumorectomy was performed.In 2018 she suffered 1st recurrence in the right part of the vulva. Partial vulvectomy was performed with adjuvant radiotherapy.In 2019 she suffered 2nd recurrence on previous surgical bed. At this point she was reffered to our hospital. In the complementary studies, the MRI showed the tumor in contact with the right lateral edge of the urethra. PET-TC showed one suspicious right inguinal adenopathy. There were no signs of distant metastatic disease.She underwent a composite total pelvic exenteration in which part of superior ramus of pubis and the isquium was removed. Also a double bar wet colostomy was performed. A right extended VRAM flap was made as reconstruction.ResultsThe surgery achieved complete resection of the tumor.One year follow up of the patient have been completely up to now.ConclusionThis case highlights the potential benefits of pubic bone resection in order to achieve ‘no residual disease’.The case presentation was carried out with informed consent and ensuring the preservation of the patient‘s anonymity.DisclosuresThis video did not receive any financial support. Authors declare no competing of interest.

Introduction/BackgroundUreter is a structure frequently affected in gynecological tumors, this conditions its resection on certain surgeries. When it isn’t possible direct anastomosis, Boari-flap is a great options for the reconstruction of the urinary tract.MethodologyCinical case: Patient with a relapse of endometrial cancer infiltrating the left ureter. Partial resection of the proximal ureter is performed, requiring a Boari flap for urinary reconstruction.ResultsVideo explainFirst, it is important to mobilize the bladder to avoid tension of the ureter. We section the bladder longitudinally. Before, it is useful to fill the bladder with saline.Then, we made a longitudinal ureterotomy and we was performed the anastomosis with three triangle-shaped sutures.Before closure of the anastomosis, a double J stent placed into the ureter and bladder.We approach the bladder flap transversely to the ureter and suture from side-to-side. It is possible to fix the bladder to the psoas to remove tension.Finally, we suture the free edges of the bladderConclusionBoari-flap is a useful option for urinary reconstruction in cases of large ureteral resection. Allows tension-free anastomosis with good results.DisclosuresNo disclosure.

Introduction/BackgroundStruma ovarii (SO) is a rare tumor composed of mature thyroid tissue. It represents 5% of all ovarian teratomas and its malignant presentation is even more rare (less than 5%). SO often manifests with symptoms typical of ovarian cysts: intermittent abdominal pain, abdominal mass or bleeding disorders. However, it can occasionally present with complex syndromes: 5% of patients show features of hyperthyroidism or thyroid gland enlargement.MethodologyWe retrospectively searched cases of SO in our center. Data concerning symptomatology, diagnostic approach and treatment was reviewed. Additionally, we aimed to evaluate the current knowledge regarding clinical presentations, ultrasonographic description, use of other complementary tests and therapeutic management. Therefore, a systematical review following PRISMA guidelines was performed.ResultsSix cases with histologically confirmed SO were retrospectively reviewed. Each of the patients consulted for a different reason, was initially suspicious of a different diagnose, suffered a different evolution, and therefore went under a different management. For the systematic review, 13 articles were included in the final analysis after applying inclusion and exclusion criteria. Selected articles provided data for 353 tumours (161 cases classified as benign, including 3 cases of strumosis, and 158 as malignant). Information regarding patients’ characteristics, clinical presentation, thyroid gland affection, diagnostic tests and treatment were collected.ConclusionOur series of patients confirms diagnose based on clinical manifestations or imaging studies is rather complicated, as clinical presentations are widely diverse. Such as reflected in the systematic review, the most common symptoms are abdominal pain and mass. Thyroid gland affection is infrequent. Histological confirmation is required to stablish diagnose. Surgical treatment is sufficient for benign lesions, and even if secondary conditions such as thyroid hyperfunction or ascites occur, these regress upon removal of the tumor. The optimal treatment for malignant SO is extensive pelvic surgery followed by thyroidectomy and radioactive iodine therapy.DisclosuresNothing to declare.Abstract 1066 Table 1Included articles and their basic characteristics. N= number of cases; EEUU: United states of America; NS= not specified.

The eco-efficiency evaluation in wastewater treatment plants (WWTPs) is used to know and improve the environmental and economic efficiency of these processes, systems, products, and services. The eco-efficiency evaluations in WWTP contemplate the inputs to be minimized, the desirable results to be maximized, and the undesired results to be minimized. Data envelopment analysis (DEA) is a widely used method to evaluate the eco-efficiency of WWTPs; integrating several approaches in a single index, traditional DEA models do not take into account the uncertainty in the data. This study evaluates the eco-efficiency of a sample of Catalan WWTPs, considering the uncertainty of the data (DEA tolerance model), and it is for the first time that together with CO 2 , other greenhouse gas (GHG) such as CH 4 and N 2 O are considered as part of the process outputs. GHG emissions were quantified using methods reported in the literature. Seven hundred twenty-nine eco-efficiency scores were estimated for each WWTP instead of a single score like conventional DEA models, analyzing optimistic and pessimistic scenarios. The WWTPs were classified according to the estimated eco-efficiency scores, accounting for the uncertainty in each of the scenarios, and demonstrating the changes in the performance of the WWTPs in the different scenarios. Only two WWTPs were eco-efficient in all the scenarios evaluated. This approach provides essential information to improve efficiency and innovation in the wastewater sector. Graphical abstract

Purpose This study aimed to evaluate the rate and severity of allergic events associated with the use of indocyanine green (ICG) in sentinel lymph node biopsy (SLNB) for patients with early-stage vulvar cancer. The research question focused on whether ICG administration poses a significant risk of allergic reactions, especially in patients with a history of allergies to iodinated contrast. Methods We conducted a retrospective study after prospective multicenter recruitment endorsed by the Spanish Investigational Network Gynecologic Oncology Group. Data on patient demographics, history of allergic reactions, and ICG administration were collected. A systematic literature review was performed to assess existing studies on ICG-related allergic reactions in SLNB. Results Among the 75 patients, 66 (75%) have been exposed to iodinated contrasts and 2 (3%) had a documented iodinated contrast allergy with a mild reaction. There were no intraoperative complications. During the postoperative period, there were only minor complications (15 (20.0%) grade I and 13 (17.3%) grade II of Clavien–Dindo classification), and none associated with the injection of ICG or allergen-based that could be related. The systematic review of 11 studies involved 206 patients and 354 groins. The history of allergy to iodinated contrast was not recorded in any of them. We observed no patients with adverse reactions related to this tracer after peritumoral injection. Conclusion Our findings suggest that peritumoral ICG injection for SLNB in early-stage vulvar cancer could be safe. This study reinforces the potential for ICG to be a reliable tracer in vulvar cancer staging.

Background There has been a rise in endometrial cancer (EC) incidence leading to increased mortality. To counter this trend, improving the stratification of post-surgery recurrence risk and anticipating disease relapse and treatment resistance is essential. Liquid biopsy analyses offer a promising tool for these clinical challenges, though the best strategy for applying them in EC must be defined. This study was designed to determine the value of cfDNA/ctDNA monitoring in improving the clinical management of patients with localized and recurrent disease. Methods Plasma samples and uterine aspirates (UA) from 198 EC patients were collected at surgery and over time. The genetic landscape of UAs was characterized using targeted sequencing. Total cfDNA was analyzed for ctDNA presence based on the UA mutational profile. Results High cfDNA levels and detectable ctDNA at baseline correlated with poor prognosis for DFS (p-value < 0.0001; HR = 9.25) and DSS (p-value < 0.0001; HR = 11.20). This remained clinically significant when stratifying tumors by histopathological risk factors. Of note, cfDNA/ctDNA analyses discriminated patients with early post-surgery relapse and the ctDNA kinetics served to identify patients undergoing relapse before any clinical evidence emerged. Conclusions This is the most comprehensive study on cfDNA/ctDNA characterization in EC, demonstrating its value in improving risk stratification and anticipating disease relapse in patients with localized disease. CtDNA kinetics assessment complements current strategies to monitor the disease evolution and the treatment response. Therefore, implementing cfDNA/ctDNA monitoring in clinical routines offers a unique opportunity to improve EC management. Translational relevance The study demonstrates that high levels of cfDNA and detectable ctDNA at baseline are strong indicators of poor prognosis. This enables more accurate risk stratification beyond traditional histopathological factors, allowing clinicians to identify high-risk patients who may benefit from more aggressive treatment and closer monitoring. Moreover, longitudinal analysis of cfDNA/ctDNA can detect disease recurrence months before clinical symptoms or imaging evidence appear. This early warning system offers a significant advantage in clinical practice, providing a window of opportunity for early intervention and potentially improving patient outcomes.

Introduction/BackgroundOne of the unanswered clinical questions in the treatment of the early stage cervical cancer is the surgical approach of sentinel lymph node (SLN). Our proposal is performing a laparoscopic SLN biopsy with a frozen section of the SLN as the first step in the procedure. If lymph nodes are negative for malignancy intraoperative, an open radical hysterectomy can be continue. If lymph nodes are positive for malignancy, the radical hysterectomy is avoided and a paraaortic staging should be performed. In this last scenario, the open surgery is not performed after the laparoscopy, sparing the patient a futile laparotomy.MethodologyPatients were eligible if they had any histological type of invasive carcinoma of the cervix on final pathology with a clinical-stage IA1 to IB2 according to the staging system of the FIGO 2018, no extrauterine disease detected by an imaging test, and a laparoscopic SLN performed. Patients with pelvic or abdominal previous radiotherapy, extrauterine disease, or laparotomic SLN approach were excluded.Patients were categorized a priori into two groups based on the surgical approach of the radical hysterectomy (laparoscopy vs laparotomy).ResultsA total of 88 patients with early-stage cervical cancer between January 2010 and July 2021 were evaluated. Sixty-two patients met the inclusion criteria . Fifty-two patients (84%) had a negative intraoperative SLN performed by laparoscopy: 40 patients who underwent laparoscopic radical hysterectomy vs. 12 with open radical hysterectomy. Ten patients (16%) had a positive intraoperative SLN and the radical hysterectomy was discarded, paraaortic lymphadenectomy was performed and the patients were referred to definitive treatment with chemoradiation.Abstract 2022-RA-971-ESGO Figure 1ConclusionLaparoscopic SLN biopsy with an intraoperative analysis before open radical hysterectomy spare a 16% of futile laparotomies.

Introduction/BackgroundThe DESKTOP III trial has demonstrated a significant survival benefit in AGO-score positive patients who underwent complete cytoreduction at 1st relapse compared to those treated with chemotherapy alone. The question whether eligible patients who missed the opportunity of potentially life prolonging surgery at 1st relapse would benefit from surgery at the time of their second relapse, remains open.MethodologyWe evaluated separately the patients who were randomized in the standard, non-surgical arm of the DESKTOP III trial who then subsequently underwent cytoreductive surgery at a subsequent relapse at investigator’s discretion.ResultsThe median progression-free survival (PFS) counted from randomization of 201 patients in the control arm of DESKTOP III was 14.0 months. 171 (85%) had progressive or relapsing disease and 32 of 171 (19%) underwent cytoreductive surgery. Patients’ median age at this subsequent surgery was 63 years (range: 46 – 78). Complete tumor resection was achieved in 19 patients (60%), while 5 (16%) had postoperative residual disease (n=8 missing data). Sixteen patients (50%) commenced systemic treatment within 90 days from surgery, as documented. Thirty- and 90-day surgical mortality rates were 1 (3%) and 2 (6%), respectively. Within a postoperative median follow-up time of 43.8 months, 12 (38%) deaths were reported. Median overall survival after surgery (OS) was 54.0 months. One- and 2-year OS rates were 91% and 84%, respectively.ConclusionCytoreductive surgery for subsequent ovarian cancer relapse appears feasible and with low mortality in selected patients who received non-surgical treatment at 1st relapse despite a positive AGO -score. Surgery could be considered as an option in carefully selected patients also later in their journey within a specialized gynecological cancer setting.

Agustí et al1 summarized the current evidence for this technique with an overall detection rate of 93.3% and a negative predictive value of 100%. The studies included in the review by Agustí et al are heterogeneous and present mixed but positive results in terms of detection rate and negative predictive value. Sentinel lymph node detection in early-stage ovarian cancer: a systematic review and meta-analysis.