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Background Cesarean scar defects (CSD) are caused by cesarean sections and cause various symptoms. Although there has been no previous consensus on the name of this condition for a long time, it has been named cesarean scar disorder (CSDi). Methods This review summarizes the definition, prevalence, and etiology of CSD, as well as the pathophysiology and treatment of CSDi. We focused on surgical therapy and examined the effects and procedures of laparoscopy, hysteroscopy, and transvaginal surgery. Main findings The definition of CSD was proposed as an anechoic lesion with a depth of at least 2 mm because of the varied prevalence, owing to the lack of consensus. CSD incidence depends on the number of times, procedure, and situation of cesarean sections. Histopathological findings in CSD are fibrosis and adenomyosis, and chronic inflammation in the uterine and pelvic cavities decreases fertility in women with CSDi. Although the surgical procedures are not standardized, laparoscopic, hysteroscopic, and transvaginal surgeries are effective. Conclusion The cause and pathology of CSDi are becoming clear. However, there is variability in the prevalence and treatment strategies. Therefore, it is necessary to conduct further studies using the same definitions. The chronic inflammation that occurs in cesarean scar defect spreads into the uterine cavity and reduces fertility. Such secondary infertility has been termed cesarean scar disorder. This condition can be cured by endoscopic surgery.

Purpose To explore the histopathological findings of cesarean scar defect (CSD) and the immunological component in women with cesarean scar syndrome (CSS). Methods This retrospective study was conducted in a university hospital and a public hospital. A total of 63 patients with secondary infertility due to CSS who underwent laparoscopic resection of the CSD lesion were enrolled (CSS group), and 21 patients who underwent hysterectomy with a history of cesarean section were enrolled as control (non‐CSS group). We compared the differences in histopathological findings of CSD lesions by hematoxylin and eosin staining and immunohistochemistry for CD3, CD20, CD56, CD68, CD138, myeloperoxidase, and tryptase between the two groups. Results The frequency of presence of endometrium on the CSD surface was significantly lower (p = 0.0023) and that of adenomyosis was significantly higher (p = 0.0195) in the CSS group than in the non‐CSS group. The number of CD3‐, CD20‐, CD68‐, and tryptase‐positive cells was significantly lower in the CSS group than in the non‐CSS group; however, the number of CD138‐positive cells was significantly higher in the CSS group (p = 0.0042). Conclusions This study suggested that the absence of endometrium, presence of adenomyosis, and chronic inflammation in CSD contributes to secondary infertility due to CSS.

Background Cesarean scar defects can lead to long-term complications, such as cesarean scar disorders, cesarean scar pregnancy, and the risk of uterine scar dehiscence and rupture in subsequent pregnancy. However, the optimal closure technique to prevent the development of cesarean scar defects (CSD) remains unclear. Therefore, this study aimed to explore whether two-layer interrupted versus two-layer continuous sutures could prevent the formation of CSD. Methods A randomized controlled trial was conducted in a single university hospital in Japan. We recruited pregnant women with ≥ 20 primary or previous cesarean sections. Participants were randomly assigned to either a two-layer interrupted or a two-layer continuous suture group. Residual myometrial thickness (RMT) and the depth of CSD were measured using sonohysterography, 6–8 months post-cesarean section. In addition, the rate of severe CSD, defined as a loss of over 50% of the myometrium, was examined. Results Of the 220 study participants, 43 dropped out; 89 in the interrupted group and 88 in the continuous group underwent sonohysterography. No significant difference in RMT was observed in the interrupted and continuous groups (median 8.1 [interquartile range, 6.2–9.9] mm and 7.9 [4.6–10.3] mm, respectively). However, the incidence of severe CSD in the interrupted group was significantly lower than that in the continuous group (2% versus 22%, p  < 0.0001). Multivariate logistic regression analysis revealed that the factors contributing to developing severe CSD were interrupted suture (odds ratio [OR]: 0.04, 95% confidence interval [95%CI]: 0.006–0.281, p  = 0.0011), the difference in myometrial thickness between the fundal and cervical sides at the center of the uterine wound before suturing (OR: 1.65, 95%CI: 1.144–2.367, p  = 0.0072), and retroversion of the uterus at 6–8 months after cesarean section (OR: 3.42, 95%CI: 1.074–10.946, p  = 0.0374). Conclusion This study suggested that two-layer interrupted sutures are superior to two-layer continuous sutures in preventing the development of severe CSD. Trial registration Clinical trial identification number: University Hospital Medical Information Network registration code, UMIN000040601. URL of the registration site: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046334 .

This study evaluated the effects of double-layer interrupted sutures (DIS) and double-layer continuous sutures (DCS) on uterine blood flow and residual myometrial thickness (RMT) in cynomolgus monkeys after cesarean section (CS). In DIS (  = 8) and DCS (  = 8) groups, uterine blood flow was assessed at 6 months post-CS using MRI by Ktrans. RMT was measured by T2-weighted magnetic resonance imaging (MRI) at 6 months. Laparoscopic evaluations were performed at 2 and 6 months. At 6 months, Ktrans was significantly higher in the DIS group 6. RMT at the suture site did not differ significantly between groups. Adhesions were observed in three DIS and two DCS animals. Nonadhesive DIS animals had significantly higher Ktrans and greater RMT at 6 months compared with adhesive DIS animals. Nonadhesive DIS exhibited significantly higher Ktrans and greater RMT at 6 months than nonadhesive DCS. While overall differences were limited, exploratory findings indicate that DIS demonstrated superior uterine blood flow compared with DCS. Nonadhesive DIS animals exhibited greater RMT than adhesive DIS animals, suggesting a potential benefit of adhesion prevention.

This study aimed to identify predictors of pelvic lymph node metastasis in low-risk endometrial cancer, defined as cases with no more than half myometrial invasion, preoperative endometrial biopsy results indicating endometrioid carcinoma Grade 1 (G1) or Grade 2 (G2), and no extrauterine spread. Among the factors examined, we focused on the tumor volume index derived from MRI, calculated by multiplying the maximum longitudinal diameter along the uterine axis, the maximum anteroposterior diameter on the sagittal plane, and the maximum transverse diameter on the horizontal plane. A retrospective analysis was conducted on 117 patients who underwent the standard treatment protocol (total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection) at our institution from July 1, 2014, to December 31, 2023. Pelvic lymph node metastasis was observed in seven cases (5.9%). Univariate analysis showed a significant association with serum cancer antigen-125 (CA-125) level (p=0.035) and tumor volume index (p=0.003). A receiver operating characteristic (ROC) analysis revealed that a tumor volume index cutoff of 38 cm³ yielded an area under the curve (AUC) of 0.83, with a true positive fraction (TPF) of 0.86 and a false positive fraction (FPF) of 0.15. Multivariate analysis also identified a tumor volume index (≥38 cm³) as an independent predictive factor (odds ratio 26.3, 95% confidence interval 2.6-272, p=0.006). Cases with a tumor volume index ≥38 cm³ accounted for 23 cases (20% of all) of the cohort; among these, six cases (25%) had pelvic lymph node metastases. In contrast, the metastasis rate was only one case (1%) in 94 cases (80% of all) with a tumor volume index <38 cm³. These findings suggest that the tumor volume index is useful for evaluating the risk of pelvic lymph node metastasis in low-risk endometrial cancer, contributing to decision-making on whether to perform pelvic lymph node dissection and risk stratification for sentinel lymph node navigation surgery.

BackgroundThe goal of this study is to assess the oncologic outcomes of elderly patients who underwent hysterectomy for endometrial cancer across three variables: hysterectomy approach, lymph node resection, and adjuvant therapy.MethodsHospital records of patients aged ≥ 70 years who underwent hysterectomy for endometrial cancer were obtained from 19 institutions. Patients were categorized into three risk groups: low, intermediate, and high. In each group, disease-free survival and overall survival were compared according to hysterectomy approach, lymph node resection, and adjuvant therapy using Kaplan–Meier method. Cox regression analysis with a 95% confidence interval was performed to estimate relative risk (RR) of death.ResultsA total of 1246 patients were included. In the low-risk group, the adjusted RR for death for minimally invasive surgery (MIS) versus laparotomy and lymph node resection versus no lymph node resection were 0.64 (0.24–1.72) and 0.52 (0.24–1.12), respectively. In the intermediate-risk group, the adjusted RR for death for MIS versus laparotomy, lymph node resection versus no lymph node resection, and adjuvant therapy versus no adjuvant therapy were 0.80 (0.36–1.77), 0.60 (0.37–0.98), and 0.89 (0.55–1.46), respectively. In the high-risk group, the adjusted RRs for death for lymph node resection versus no lymph node resection and adjuvant therapy versus no adjuvant therapy were 0.56 (0.37–0.86) and 0.60 (0.38–0.96), respectively.ConclusionsMIS is not inferior to laparotomy in uterine-confined diseases. Lymph node resection improved the outcome for all disease stages and histological types. In contrast, adjuvant therapy improved the outcomes only in high-risk patients.