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Endometrial cancer (EC) is the sixth most common cancer and the fourth leading cause of death among women worldwide. Early detection and treatment are associated with a favourable prognosis and reduction in mortality. Unlike other common cancers, however, screening strategies lack the required sensitivity, specificity and accuracy to be successfully implemented in clinical practice and current diagnostic approaches are invasive, costly and time consuming. Such limitations highlight the unmet need to develop diagnostic and screening alternatives for EC, which should be accurate, rapid, minimally invasive and cost-effective. Vibrational spectroscopic techniques, Mid-Infrared Absorption Spectroscopy and Raman, exploit the atomic vibrational absorption induced by interaction of light and a biological sample, to generate a unique spectral response: a “biochemical fingerprint”. These are non-destructive techniques and, combined with multivariate statistical analysis, have been shown over the last decade to provide discrimination between cancerous and healthy samples, demonstrating a promising role in both cancer screening and diagnosis. The aim of this review is to collate available evidence, in order to provide insight into the present status of the application of vibrational biospectroscopy in endometrial cancer diagnosis and screening, and to assess future prospects.

Background and Objectives: Previous surgical approach comparisons in endometrial cancer may be confounded by inadequate control for tumour biology—the primary driver of outcomes. This study provides the first surgical approach comparison incorporating molecular classification to control for case selection bias. Materials and Methods: Retrospective analysis of 512 consecutive patients with stage I–II endometrial cancer (FIGO 2009) treated with open (n = 83), laparoscopic (n = 278), or robotic (n = 151) surgery between 2018 and 2024. Molecular classification was available for 219 patients (42.8%) using TCGA criteria and incorporated into analyses to control for case selection bias, with molecular subtype incorporated to control for biological bias rather than as a primary endpoint. Primary outcomes included perioperative metrics and oncological safety. The primary objective was to determine whether apparent surgical outcome differences reflect genuine technique effects or case selection bias based on tumour biology. Results: Molecular subtype distribution varied significantly by surgical approach, with high-risk subtypes concentrated in open surgery, explaining apparent outcome differences. After controlling for molecular subtype and other confounders, minimally invasive approaches demonstrated superior perioperative outcomes: reduced blood loss (laparoscopic 129.8 mL, robotic 157.9 mL vs. open 261.4 mL, p < 0.001), shorter hospital stays (2.4 and 2.2 vs. 5.3 days, p < 0.001), and lower complications (5.7% and 6.6% vs. 21.6%, p < 0.001). In our cohort, recurrence-free survival showed significant differences favouring minimally invasive approaches, with 2-year RFS rates of 92.8%, 96.4%, and 100.0% (p = 0.008) and 3-year RFS rates of 90.4%, 95.0%, and 100.0% (p = 0.003) for open, laparoscopic, and robotic surgery, respectively, although robotic surgery had a shorter follow-up (median 33 vs. 42 months). Within-approach exploratory analyses revealed that p53-abnormal tumours were associated with significantly longer operative times and greater blood loss across all surgical approaches (p < 0.05), although complication rates did not differ significantly by molecular subtype within any approach (open p = 0.124, laparoscopic p = 0.656, robotic p = 0.287). Apparent surgical approach differences largely reflected appropriate case selection based on tumour biology rather than technique superiority. Conclusions: When controlling for tumour biology, minimally invasive approaches offer superior perioperative outcomes with equivalent oncological safety. Higher complication rates in open surgery primarily reflect the inherent morbidity of this approach and appropriate surgeon selection for high-risk cases. Within-approach analyses suggest possible molecular influences on operative parameters that warrant prospective validation. Molecular stratification is essential for fair surgical approach comparison in the contemporary era.

Background Current surgical planning in robotic gynaecology relies heavily on pathological diagnosis, yet operating theatre utilisation may depend more on procedural requirements. Recent advances in machine learning-based surgical prediction have highlighted the need for more accurate planning models whilst challenging fundamental assumptions about surgical complexity. Objectives To compare the impact of procedural requirements versus traditional complexity markers on operating time and complications in robotic gynaecological surgery, and to develop a practical framework for procedure-based surgical planning that could complement contemporary machine learning approaches. Methods Retrospective analysis of 80 consecutive robotic gynaecological surgeries (2021–2024) at a single tertiary centre. We examined relationships between procedural requirements (lymphadenectomy, adhesiolysis), traditional complexity markers (BMI > 35, pathology type, previous surgery), and outcomes (operating time, complications). A Preoperative Procedural Demand Score (PPDS) was developed and validated against pathology-based predictions. Multivariable regression analysis included β-coefficients, confidence intervals, and comprehensive model diagnostics. Results Procedural requirements explained operating time variation better than pathology type. Standard procedures averaged 135.4 ± 28.6 min. Adding lymphadenectomy increased time by 33.1 min (95% CI: 24.8–41.4), adhesiolysis by 19.8 min (95% CI: 11.5–28.1). Traditional complexity markers showed minimal impact: BMI > 35 added 8.1 min (95% CI: -7.2 to 23.4, p  = 0.42), previous surgery 7.6 min (95% CI: -8.4 to 23.6, p  = 0.48). All complications (6.3%) were minor (Clavien-Dindo Grade I-II). Operating time decreased from 178.0 ± 47.2 to 135.9 ± 36.8 min between study halves ( p  < 0.001), whilst intraoperative complications decreased from 12.5 to 0% ( p  = 0.02), despite similar case complexity. Conclusions This study demonstrates that procedural requirements better predict operating time than traditional markers in robotic gynaecological surgery, representing a novel conceptual framework for surgical planning. However, the single-centre design and modest predictive accuracy compared to contemporary machine learning approaches indicate that comprehensive multi-centre prospective validation is essential before recommending widespread adoption. The excellent safety profile across all complexity levels supports the feasibility of robotic surgery in traditionally “complex” cases, though larger studies are needed to establish definitive safety parameters.

Background: Pivotal clinical trials have led to the routine clinical use of PARP inhibitor (PARPi) (olaparib, niraparib, or rucaparib) maintenance therapy in high-grade serous tubo-ovarian and peritoneal cancers. Whether various PARPis have comparable clinical impact in the real-world is an area of ongoing investigation. Methods: We conducted a retrospective study of all patients who received PARPi maintenance therapy at Nottingham Cancer Centre from October 2017 to April 2025. Clinical data were extracted from multidisciplinary team electronic health records, including age, BRCA mutation status, HRD status, treatment history, type of PARP inhibitor received, progression-free survival (PFS), and overall survival (OS). Results: A total of 177 patients had received PARPi therapy with a mean age of 63 years at diagnosis. In all, 94/177 (53.1%) had received PARPi as primary maintenance, while 83/177 (46.9%) were treated in the recurrent setting. All together, 25/177 (14.1%) had BRCA1 germline mutation and 21/177 (11.9%) had BRCA2 germline mutation. In the primary olaparib setting, PFS was significantly better in BRCA2 germline-mutated patients compared to BRCA1 germline-mutated patients [median PFS was not reached vs. 29.0 months, respectively, p = 0.002]. In BRCA, wild-type patients receiving primary niraparib, median PFS was 11 months. Median PFS for patients with upfront surgery was 37 months compared to 19 months in the interval debulking group but not significant (p = 0.49). In the recurrent setting, there was no significant difference in median PFS between niraparib and rucaparib [10 months vs. 9 months, p = 0.594]. Conclusions: BRCA2 germline-mutated patients obtained significantly greater benefit from olaparib compared to BRCA1-mutated patients. PFS benefit from niraparib (primary or recurrent setting) is comparable to clinical trials. There was no difference in benefit between niraparib and rucaparib in the recurrent setting.

ObjectivesWe consider expert opinion and its incorporation into a planned meta-analysis as a way of adjusting for anticipated publication bias. We conduct an elicitation exercise among eligible British Gynaecological Cancer Society (BGCS) members with expertise in gynaecology.DesignExpert elicitation exercise.SettingBGCS.ParticipantsMembers of the BGCS with expertise in gynaecology.MethodsExperts were presented with details of a planned prospective systematic review and meta-analysis, assessing overall survival for the extent of excision of residual disease (RD) after primary surgery for advanced epithelial ovarian cancer. Participants were asked views on the likelihood of different studies (varied in the size of the study population and the RD thresholds being compared) not being published. Descriptive statistics were produced and opinions on total number of missing studies by sample size and magnitude of effect size estimated.ResultsEighteen expert respondents were included. Responders perceived publication bias to be a possibility for comparisons of RD <1 cm versus RD=0 cm, but more so for comparisons involving higher volume suboptimal RD thresholds. However, experts’ perceived publication bias in comparisons of RD=0 cm versus suboptimal RD thresholds did not translate into many elicited missing studies in Part B of the elicitation exercise. The median number of missing studies estimated by responders for the main comparison of RD<1 cm versus RD=0 cm was 10 (IQR: 5–20), with the number of missing studies influenced by whether the effect size was equivocal. The median number of missing studies estimated for suboptimal RD versus RD=0 cm was lower.ConclusionsThe results may raise awareness that a degree of scepticism is needed when reviewing studies comparing RD <1 cm versus RD=0 cm. There is also a belief among respondents that comparisons involving RD=0 cm and suboptimal thresholds (>1 cm) are likely to be impacted by publication bias, but this is unlikely to attenuate effect estimates in meta-analyses.

Introduction/BackgroundEndometrial cancer represents the most common gynaecological malignancy and lymph node metastasis is the most common form of extrauterine spread of the cancer. Surgical staging of early-stage endometrial cancer, involving lymph node assessment, is of outmost importance. Sentinel lymph node (SLN) biopsy has lately been widely adopted from gynaecological oncologists worldwide as a method of lymph node assessment, as it is related to lower morbidity and less complications compared to systematic lymphadenectomy. This is a video of our technique for robotic para-aortic SLN biopsy.MethodologyIn our centre 1 ml of Indocyanine green (ICG) is injected in the cervix, at 3 and 9 o’clock position respectively. The steps of the procedure involve a peritoneal incision over the bifurcation of the aorta and dissection of the loose areolar tissue until the vessels are exposed. Cranial reflection of the duodenum is essential for better exposure of the para-aortic space. The ICG filter is then applied on the robotic camera in order for the SLN to be identified. The sentinel lymph node is then removed using monopolar energy.ResultsAs shown in the video, this minimally invasive technique is associated with minimal bleeding and does not add more than 20–30 min of total surgical time. The patients are usually discharged home the following day.ConclusionRobotic para-aortic SLN biopsy for high-risk subtypes and high-grade endometrial cancers, is a procedure that allows accurate staging of the cancer and at the same time, it is associated with less risks and complications compared to full lymph-node dissection. Detection rates of the SLN are high, when a standardised technique is followed in centres with expertise in performing this procedure.DisclosuresNothing to disclose.

Introduction/BackgroundIn females in the UK, ovarian cancer is the 6th most common cancer, with around 7,500 new cases every year. Ovarian cancer accounts for 4% of all new cancer cases in females in the UK with a lifetime risk of 1.4%. About 70% of epithelial ovarian cancers are of the high grade Serous type which are derived from precursors (serous tubal intraepithelial carcinoma) in the fimbriae of the fallopian tubes.Oncological recommendations in many countries suggest removal of both tubes as a method of primary prevention in post reproductive women undergoing abdomino-pelvic surgery and also as a means of permanent contraception (including at Caesarean Section). This is commonly referred to as ‘opportunistic bilateral salpingectomy’.MethodologyA Comprehensive search was performed on PubMed to review current literature on opportunistic salpingectomy (including at time of Caesarean section), Ovarian Cancer Risk Reduction and permanent contraception.ResultsAwareness of salpingectomy reducing the risk of ovarian cancer amongst physicians and the general public has increased over the past few years. Opportunistic salpingectomy is safe, cost effective and has minimal complications.Major reasons for not performing opportunistic salpingectomy included increased operating time and fear of increased morbidity/complications.ConclusionOpportunistic salpingectomy decreases the risk of ovarian cancer in the general population and has the potential to be more cost effective in the long term. Operative times for opportunistic bilateral salpingectomy at Caesarean section are minimally increased compared to performing sterilization by bilateral tubal ligation.Further research should be carried out into long-term survival outcomes and also the current knowledge and attitude of gynaecologists regarding this procedure in the UK and Europe as a whole.DisclosuresNone of the authors have any disclosures nor conflicts of interest.

Introduction/BackgroundThe standard of care for treating advanced ovarian cancer is a combination of maximal effort cytoreductive surgery and chemotherapy. Survival rates following surgery for advanced ovarian cancer vary between different studies. A large study from the UK reported a mean overall survival of 37 months following surgery. The present study reports the mortality and morbidity data following maximal effort cytoreductive surgery in 139 patients treated in the Nottingham Cancer Centre 2014–2020.MethodologyData regarding patients undergoing maximal effort cytoreductive surgery between April 2014 and December 2020 were collected retrospectively and analysed using SPSS software. Kaplan-Meier survival curves were generated for mortality data. Local data was benchmarked and compared to the published literature.Results139 cases were identified. The most common histological type was high grade serous cancer (68.3%), followed by clear cell adenocarcinoma. 72% of patients had stage 3 and 4 disease at presentation. The mean operative duration was 422 minutes and macroscopic cytoreduction was achieved in 84.9% of patients. A multimodal surgical approach included bowel resection (51%), stoma formation (31.6%), splenectomy (38.1%) and diaphragmatic peritonectomy (79%). The median length of stay in ITU was 2 days. Common complications were anaemia related to surgical blood loss requiring blood transfusion, infection and wound dehiscence. The 3-year OS of the patients in our cohort was 61% and the 5-year OS of patients operated between April 2014 and November 2018 was 50%. The median OS was 47 months. Median survival of cases where complete cytoreduction was achieved was 51 months; in cases of incomplete cytoreduction the median survival was 31 months.ConclusionOur data, in line with other published studies, emphasise the importance of maximal effort cytoreductive surgery as part of the treatment for patients with advanced ovarian cancer. We have shown survival and complication rates comparable to similar studies in this field.DisclosuresNothing to disclose.Abstract 185 Figure 1

Introduction/BackgroundLymphadenectomy is performed during surgical treatment of gynaecological malignancies for their therapeutic and prognostic significance. These procedures are performed close to multiple vascular structures with high risk of serious intraoperative injuries and bleeding. Many retrospective studies showed the advantages of surgery in patients with long disease-free interval, resectable disease, limited number of metastatic sites, absence of ascites, and good performance status. However, the frequency of isolated lymph node recurrence is actually rare, between 1–6%. In these patients, surgery could be of particular benefit.MethodologyWe discuss case of eradication of isolated para-aortic lymph nodal recurrence, after 22 months, in a patient diagnosed with stage 3B vaginal clear cell carcinoma and treated with primary chemo-radiotherapy. During routine follow-up scans, an enlarged left Para-aortic lymph node detected which was showed to be active disease on PET/CT scan with no evidence of local recurrence in the pelvis. After MDT discussion and discussion of the management options with the patient, she opted for surgery.ResultsThe patient had Midline laparotomyPara-aortic lymph nodes were found densely adherent to the aorto-caval ligament/bone. Complete infra-renal Para-aortic lymphadenectomy was done. No intraoperative complications and the recovery period was unremarkable. The Histology result revealed that 2/7 lymph nodes are positive. The postoperative MDT meeting decision was to consider adjuvant PA lymph node radiotherapy. The patient has completed adjuvant radiotherapy to the Para-aortic strip. Postoperative CT chest, abdomen pelvis will be arranged as baseline to monitor the progress.ConclusionFrom our clinical point of view, surgery is considered a safe and effective option for management of isolated Para-aortic lymph nodal recurrence, with a significantly less postoperative hospital stay and low morbidity. However; it should be reserved for oncologic surgeons trained in major surgical procedures. Additionally; large multi-centre randomized clinical trials are needed to follow up the overall outcomes of this procedure.DisclosuresNothing to disclose.Abstract 420 Figure 1PET CT scan, showed active disesase in PALNAbstract 420 Figure 2Showed infra renal para-aortic lymphadenectomy and aorto-caval space after eradication of nodal reccurence

Introduction/BackgroundThe management of gynaecological malignancies often involves surgical intervention, radiotherapy, chemotherapy or a combination of the above. Minimally invasive surgical techniques lead to reduced hospital stay and complications. Robot-assisted surgery allows for precise tissue handling via wristed instrumentation and 3D camera view and also improved ergonomics for the surgeon, which is extremely useful in the management of morbidly obese and frail patients.MethodologyData were retrospectively collected for all the cases of robotic hysterectomies over a period of 5 years. Data analysis was performed using SPSS software.Results183 cases were included in the analysis. The median age and BMI of the study population was 64 and 31.6 respectively. Endometrial cancer was the main indication for the operation (69% of cases). Other indications included atypical endometrial hyperplasia, cervical cancer, persistent CIN, CGIN, pelvic cysts and persistent menorrhagia. The median operative time was 150 minutes (including 30–40 minutes anesthetic and patient positioning time). 51 cases had a sentinel lymph node biopsy, 49 had a full pelvic lymph node dissection, 36 had omental biopsy and 5 cases had para-aortic lymph node sampling. The median hospital stay was 2 days. Conversion to laparotomy did not happen in any case, however 2 cases returned to theatre due to intra-abdominal bleeding. 25 cases (13.6%) developed a post-operative complication, most commonly sepsis, thigh numbness and hyponatremia.ConclusionRobot-assisted surgery is a safe minimally invasive technique for the treatment of gynaecological cancer. It has several advantages, including very low laparotomy conversion rate, reduced hospital stay even for complex procedures, low post-operative complication rate and improved ergonomics for the surgeon. Further research is needed in order to assess the cost-effectiveness of robot-assisted surgery against conventional laparoscopic techniques.DisclosuresN/A