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Objectives1.To audit complications following ovarian cancer surgery (Clavien-Dindo classification) and their impact on oncologic outcome 2. To determine risk factors associated with postoperative complications.MethodsElectronic medical records of women who underwent surgery for epithelial ovarian cancer between January 2016 – December 2018 were audited. Design : Retrospective nested case control study. Cases: Patients with post-operative complications. Control: Those without complications. Setting: Department of gynaecologic oncology. Statistical analysis: SPSS v20 was used to analyse data. Chi square/Fischer test , ANOVA and multivariate regression were used to assess risk factors of complications.ResultsOver 36 months, 370 women underwent surgery .Fifty percent (188/370) underwent primary cytoreduction and 74% had advanced disease (273/370). Optimal cytoreduction was achieved in 84% (273/370). The post-operative complication rate was 35% (129/370) ,over a median period of 5 days (0 to 53) : 24 % (89/370) and 10% (37/370) had grade 1–2 complications and grade 3–4 complications respectively . The 30 day mortality was 0.8 % (3/370). Advanced disease (p=0.027) , high complexity of surgery (p=0.015), and intraoperative blood loss (p=0.001) were independently associated with increased rate of complications. The median time to recur was 17 months (12.6 to 21.3 months). Kaplan-Meir curve for survival showed a median recurrence free period of 20, 13 and 11 months respectively in the complication free, grade 1–2 and grade 3–4 complication group respectively, with a log rank value of 0.214.ConclusionsOvarian cancer surgery is associated with an acceptable complication rate and patients should be selected with discretion .

Global Navigation Satellite System (GNSS) measured Total Electron Content (TEC) is now widely used to study the near and far-field coseismic ionospheric perturbations (CIP). The generation of near field (~500–600 km surrounding an epicenter) CIP is mainly attributed to the coseismic crustal deformation. The azimuthal distribution of near field CIP may contain information on the seismic/tectonic source characteristics of rupture propagation direction and thrust orientations. However, numerous studies cautioned that before deriving the listed source characteristics based on coseismic TEC signatures, the contribution of non-tectonic forcing mechanisms needs to be examined. These mechanisms which are operative at ionospheric altitudes are classified as the i) orientation between the geomagnetic field and tectonically induced atmospheric wave perturbations ii) orientation between the GNSS satellite line of sight (LOS) geometry and coseismic atmospheric wave perturbations and iii) ambient electron density gradients. So far, the combined effects of these mechanisms have not been quantified. We propose a 3D geometrical model, based on acoustic ray tracing in space and time to estimate the combined effects of non-tectonic forcing mechanisms on the manifestations of GNSS measured near field CIP. Further, this model is tested on earthquakes occurring at different latitudes with a view to quickly quantify the collective effects of these mechanisms. We presume that this simple and direct 3D model would induce and enhance a proper perception among the researchers about the tectonic source characteristics derived based on the corresponding ionospheric manifestations.

Using the specific satellite line of sight geometry and station location with respect to the source, Thomas et al . [Scientific Reports, https://doi.org/10.1038/s41598-018-30476-9 ] developed a method to infer the detection altitude of co-seismic ionospheric perturbations observed in Global Positioning System (GPS) – Total Electron Content (TEC) measurements during the Mw 7.4 March 9, 2011 Sanriku-Oki earthquake, a foreshock of the Mw 9.0, March 11, 2011 Tohoku-Oki earthquake. Therefore, in addition to the spatio-temporal evolution, the altitude information of the seismically induced ionospheric signatures can also be derived now using GPS-TEC technique. However, this method considered a point source, in terms of a small rupture area (~90 km) during the Tohoku foreshock, for the generation of seismo-acoustic waves in 3D space and time. In this article, we explore further efficacy of GPS-TEC technique during co-seismic ionospheric sounding for an extended seismic source varying simultaneously in space and time akin to the rupture of Mw 9.0 Tohoku-Oki mainshock and the limitations to be aware of in such context. With the successful execution of the method by Thomas et al . during the Tohoku-Oki mainshock, we not only estimate the detection altitude of GPS-TEC derived co-seismic ionospheric signatures but also delineate, for the first time, distinct ground seismic sources responsible for the generation of these perturbations, which evolved during the initial 60 seconds of the rupture. Simulated tsunami water excitation over the fault region, to envisage the evolution of crustal deformation in space and time along the rupture, formed the base for our model analysis. Further, the simulated water displacement assists our proposed novel approach to delineate the ground seismic sources entirely based on the ensuing ionospheric perturbations which were otherwise not well reproduced by the ground rupture process within this stipulated time. Despite providing the novel information on the segmentation of the Tohoku-Oki seismic source based on the co-seismic ionospheric response to the initial 60 seconds of the event, our model could not reproduce precise rupture kinematics over this period. This shortcoming is also credited to the specific GPS satellite-station viewing geometries.

ObjectivesEndometrial cancer treated surgically followed by tailored adjuvant treatment has shown to have very good prognosis. The quality of surgical care should be optimal for attaining the maximum survival benefit. To standardize surgical management, ESGO has put forth quality indicators. To audit the surgical care provided at our centre we wanted to assess the compliance to these indicators and find areas of improvement.MethodsThis is a retrospective audit done in the Department of Gynaecologic Oncology. Electronic medical records of patients who underwent surgical management of carcinoma endometrium from Jan2020-Dec2021 were assessed.ResultsA total of 163 patients had undergone primary surgery and 2 patients for recurrence. The audit showed that the target for categories of general indicators and pre-operative work-up were met. There was lack in compliance of the intraoperative management, with only 34% among presumed early-stage disease undergoing successful MIS, 31% undergoing sentinel lymph node procedure and 53% among them being done using indocyanine green with 18% bilateral mapping rate. None of the patients had complete molecular classification. Compliance of adjuvant treatment provided was adequate. Minimal required elements in surgical reports were in 81% and pathological reports in 91% of patients falling short of the set target.Abstract EP154/#912 Table 1Abstract EP154/#912 Table 2ConclusionsThe audit helped us identify the need to increase MIS, use and adapt sentinel lymph node procedure with ICG dye more aggressively. There also is a need for improvement in documentation of pertinent information on surgical and pathology reporting. Molecular classification should be routinely incorporated into the diagnostic algorithm to aid in adjuvant therapy.

Objectives To compare the prevalence and detection of human papilloma virus (HPV) DNA from urine and self-collected vaginal samples of women with cervical neoplasia. Methods In this cross-sectional study, approved by the institutional review board, 40 women attending the Gynaecologic Oncology clinic with an abnormal Pap smear or cervical biopsy were recruited for the study after obtaining informed consent. Women were asked to self-collect urine and vaginal samples. If positive for HPV DNA, genotyping was done either by CHUV assay or the linear array. The acceptability of the two self-collected methods was assessed by a questionnaire. Results HPV DNA was detected in 24 (60%) of the urine samples and in 33 (83%) of the vaginal samples. Excepting one vaginal sample where low risk type was only detected, all other vaginal samples and all positive urine samples had high-risk HPV. HPV 16 was the most common genotype isolated from urine and vaginal samples. Self-collection of vaginal samples was acceptable to most and, 60% preferred it over physician collection. Most (65%) women preferred collecting urine over vaginal self-sampling, the agreement between urine and vaginal samples was fair (PABAK = 0.350, p  = 0.062). For type specific HPV, there was moderate agreement for HPV 16 (PABAK = 0.650, p  = 0.355) and moderate agreement (PABAK = 0.450, p  = 0.007) for HPV 16/18/both. Conclusion The agreement between urine HPV and vaginal HPV for HPV 16 and 18 genotypes was moderate. Detection of high-risk HPV in urine is a promising alternative to detection from self-collected vaginal samples.

GPS-derived Total Electron Content (TEC) is an integrated quantity; hence it is difficult to relate the detection of ionospheric perturbations in TEC to a precise altitude. As TEC is weighted by the maximum ionospheric density, the corresponding altitude (hmF2) is, generally, assumed as the perturbation detection altitude. To investigate the validity of this assumption in detail, we conduct an accurate analysis of the GPS-TEC measured early ionospheric signatures related to the vertical surface displacement of the Mw 7.4 Sanriku-Oki earthquake (Sanriku-Oki Tohoku foreshock). Using 3D acoustic ray tracing model to describe the evolution of the propagating seismo-acoustic wave in space and time, we demonstrate how to infer the detection altitude of these early signatures in TEC. We determine that the signatures can be detected at altitudes up to ~130 km below the hmF2. This peculiar behaviour is attributed to the satellite line of sight (LOS) geometry and station location with respect to the source, which allows one to sound the co-seismic ionospheric signatures directly above the rupture area. We show that the early onset times correspond to crossing of the LOS with the acoustic wavefront at lower ionospheric altitudes. To support the proposed approach, we further reconstruct the seismo-acoustic induced ionospheric signatures for a moving satellite in the presence of a geomagnetic field. Both the 3D acoustic ray tracing model and the synthetic waveforms from the 3D coupled model substantiate the observed onset time of the ionospheric signatures. Moreover, our simple 3D acoustic ray tracing approach allows one to extend this analysis to azimuths different than that of the station-source line.

To retrospectively describe the clinicopathological profile and treatment outcome of sex cord ovarian tumours (SCOTs), from a single institution. Patients who operated for SCOT between January 2011 and December 2020 were identified from the institution's discharge summaries. Treatment details and oncologic outcomes were analyzed using descriptive statistics, SPSS statistics version 21. Progression-free survival and overall survival were plotted using the Kaplan-Meier method. Over 10 years, 120 patients underwent surgery with 73 (61%) malignant SCOTs. Eight (6.6%) were referred with recurrence. Granulosa cell histology (61/73, 83.5%) and federation of gynaecology and obstetrics (FIGO) stage I disease (57/65, 78.62%) were predominant. Three (3/26,11.53%) had lymph node involvement. Adjuvant chemotherapy was advised in 53.4% (39/73).Over a median period of 47 months (1-130 months), eleven (15.06%) patients recurred (5-year recurrence rate: 9.58%) and 6 died (5-year survival rate: 89.04%).Among 65 patients with upfront disease, 9 (13.8%) recurred over a median period of 46 months (1-65 months) with 4 disease-related deaths. On univariate analysis, incomplete cytoreduction hazard ratios (HR 58.391, 95% CI 5.042-674.854), advanced FIGO stage (HR 15.931, 3.74-67.89) and nongranulosa histology was associated with recurrence. On multivariate analysis, advanced FIGO stage (HR 20.099, 95% CI 3.75-107.711) and non granulosa histology (HR 31.35, 95% 2.801-350.897 ) remained significant. Lymphadenectomy and adjuvant chemotherapy did not prevent recurrence.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Background Molecular subtyping of endometrial carcinomas (EC) has been shown to classify tumors into prognostically relevant groups. Characterizing EC with a limited number of markers viz., POLE mutations, p53 mutations, and MMR status, can provide valuable information. Design Paraffin sections of a cohort of 48 EC from a tertiary care center were characterized for the above-mentioned molecular markers and analyzed in the context of survival. Methods Formalin fixed paraffin embedded tissues from 48 EC were characterized for POLE mutations by Sanger sequencing (exons 9–14), for MMR (MLH1, MH2, MSH6) using immunohistochemistry (IHC) and copy number (high/low) using p53 IHC. Mutational status was integrated along with the clinicopathological details and survival analysis performed. Results Eleven (22.9%) patients were MMR deficient, 3 (6.3%) had POLE mutation, while 2 (4.1%) had both POLE and P53 mutations (regarded as multiple classifiers). Twelve (25%) patients were found to have P53 mutations, while the remaining 20 (41.7%) had no specific molecular profile (NSMP). Median follow-up duration was 43.5 (2–62) months with 8 recurrences and 9 deaths. Tumors with POLE mutation had the most favorable prognosis followed by the NSMP and the MMR mutated group while the P53 and multiple classifier groups had the worst prognosis in terms of OS (Log-rank p : 0.006) and PFS (Log-rank p : 0.001). Conclusion The integration of molecular-clinicopathologic data for endometrial cancer classification, through cost-effective, clinically applicable assays appears to be a highly objective tool that can be adopted even in resource-limited settings. It has the potential to cause a shift in the paradigm of EC pathology and management practice.