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Laparoscopic hysterectomy is a commonly performed procedure. However, one high-risk complication is vaginal cuff dehiscence. Currently, there is no standardization regarding thread material or suturing technique for vaginal cuff closure. Therefore, this study aimed to compare extracorporeal and intracorporeal suturing techniques for vaginal cuff closure using a pelvic trainer model. Eighteen experts in laparoscopic surgery performed vaginal cuff closures with interrupted sutures using intracorporeal knotting, extracorporeal knotting and continuous, unidirectional barbed sutures. While using an artificial tissue suturing pad in a pelvic trainer, experts performed vaginal cuff closure using each technique according to block randomization. Task completion time, tension resistance, and the number of errors were recorded. After completing the exercises, participants answered a questionnaire concerning the suturing techniques and their performance. Experts completed suturing more quickly ( p  < 0.001, p  < 0.001, respectively) and with improved tension resistance ( p  < 0.001, p  < 0.001) when using barbed suturing compared to intracorporeal and extracorporeal knotting. Furthermore, the intracorporeal knotting technique was performed faster ( p  = 0.04) and achieved greater tension resistance ( p  = 0.023) compared to extracorporeal knotting. The number of laparoscopic surgeries performed per year was positively correlated with vaginal cuff closure duration ( p  = 0.007). Barbed suturing was a time-saving technique with improved tension resistance for vaginal cuff closure.

Background A high percentage of epithelial ovarian cancers (EOC) express the estrogen receptor (ER), which is an ideal target for endocrine therapy. Letrozole is a proven, potent aromatase inhibitor, extensively tested and used in the treatment of ER positive breast cancer. In addition, it seems a potent drug for patients with heavily pre-treated OC as demonstrated in several distinctive settings. However, it has never been evaluated prospectively in a maintenance setting for ovarian cancer after standard of care. The here proposed trial aims to define a population of EOC patients, who would benefit from the effectiveness of the generic agent letrozole, with little expected toxicity and thus beneficial impact on overall quality of life (QoL). Methods In this international multicenter randomized, placebo-controlled phase III trial at clinical centers in Switzerland, Germany and Austria, we plan to include 540 patients with primary, newly diagnosed FIGO Stage II to IV and histologically confirmed low- or high-grade serous or endometrioid epithelial ovarian/fallopian tube/peritoneal cancer. Patients are randomized in a 1:1 ratio into two groups: receiving blinded study treatment (letrozole or placebo tablets). When assuming a HR of 0.7, a median PFS of 18 months in the control arm and a median PFS of 25.7 months in the treatment arm, a two-sided alpha level of 5%, 3.5 years recruitment and 1.5 years observation time, we expect 330 events to have occurred within these 5 years in the total cohort yielding a power of 90%. Follow-up data for the whole cohort will be collected for up to 10 years and for the low-grade cancer for up to 12 years. Discussion The here proposed randomized phase III trial aims to identify patients with EOC in the maintenance setting, who benefit from the effectiveness of the letrozole, by proving its efficacy whilst maintaining a high standard of QoL due to the limited toxicity expected in comparison to the current alternative drugs on the market for this treatment phase. Trial registration This trial is registered at clinicaltrials.gov under the identifier NCT04111978 . Registered 02 October 2019.

Background Vision is an important and defining element of laparoscopy and significantly affects the outcome of surgery in terms of time, error, and precision. Several new imaging systems have become available for laparoscopic surgery, including three-dimensional (3D) high-definition (HD) and two-dimensional (2D) ultra-high-resolution (4K) monitors. 3D HD systems offer a number of potential benefits to surgeons and patients over traditional 2D systems, including reduced operating time, blood loss, and hospital stay. However, the performance of 3D systems against the new, ultra-high definition 4K systems is barely known and highly controversial. There is a paucity of studies comparing them in clinical settings. The aim of this study is to compare 2D 4K and 3D HD perspectives in gastric bypass surgery. Methods Forty-eight patients with an indication for gastric bypass will be randomized to receive laparoscopic gastric bypass surgery using either 2D 4K or 3D HD systems. The operations will be performed by a well-coordinated team of three senior surgeons. The primary outcome is operative time. Secondary outcomes include intraoperative complications, blood loss, operator workload as assessed by the validated Surg-TLX questionnaire, and postoperative complications according to the Clavien-Dindo classification. An interim analysis is planned after enrollment of 12 participants for each group. Discussion This prospective, randomized trial is designed to test the hypothesis that the use of a 3D HD system will result in a significant improvement in operative time compared to a 2D 4K system in bariatric surgery. The objective is to provide clinical evidence for new laparoscopic imaging systems and to evaluate potential benefits. Trial registration This trial is registered at clinicaltrials.gov under the identifier NCT05895058. Registered 30 May 2023. BASEC2023-D0014 [Registry ID Swissethics, approved 3 May 2023]. SNCTP000005489 [SNCTP study register, last updated 13 July 2023].

Background Exposure to paclitaxel and carboplatin has the risk of developing hypersensitivity reactions (HSRs), which could necessitate using less effective treatments to avoid anaphylaxis. Desensitization to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen; therefore, this study investigated rates and benefits of successful desensitization in patients with gynecologic cancers (GC). Methods We collected data from 241 patients with GC who had at least one cycle of platinum or taxane chemotherapy. The rate of HSRs and successful desensitization were evaluated, and an outcome analysis was conducted. Results The rate of HSRs to platinum and taxane was 6.39% and 13.07%, respectively. We observed a 100% success rate of desensitization in our cohort. Patients with HSR were significantly younger (57.1 vs. 64.9 years, p = 0.030) in the taxane cohort. Importantly, the overall survival (OS) of patients with platinum and taxane HSRs who underwent desensitization was comparable to that of patients with no HSRs (platinum vs. controls; median OS 60.36 vs. 60.39 months, p = 0.31; taxane vs. controls; OS 80.29 vs. 60.00 months, p = 0.59). Conclusion Thus, we show that desensitization for platinum and taxane HSRs is safe and effective, resulting in an outcome that is well comparable to patients without HSR. Based on these observations, desensitization procedures might be considered as standard of care before switching to less effective treatment for patients with GC.

Introduction Contralateral axillary lymph node metastasis (CALNM) in breast cancer (BC) is considered a distant metastasis, marking stage 4cancer. Therefore, it is generally treated as an incurable disease. However, in clinical practice, staging and treatment remain controversial due to a paucity of data, and the St. Gallen 2021 consensus panel recommended a curative approach in patients with oligometastatic disease. Aberrant lymph node (LN) drainage following previous surgery or radiotherapy is common. Therefore, CALNM may be considered a regional event rather than systemic disease, and a re-sentinel procedure aided by lymphoscintigraphy permits adequate regional staging. Case report Here, we report a 37-year-old patient with Lynch syndrome who presented with CALNM in an ipsilateral relapse of a moderately differentiated invasive ductal BC ( ER 90%, PR 30%, HER2 negative, Ki-67 25%, microsatellite stable), 3 years after the initial diagnosis. Lymphoscintigraphy detected a positive sentinel LN in the contralateral axilla despite no sign of LN involvement or distant metastases on FDG PET/CT or MRI. The patient underwent bilateral mastectomy with sentinel node dissection, surgical reconstruction with histological confirmation of the CALNM, left axillary dissection, adjuvant chemotherapy, and anti-hormone therapy. In addition to her regular BC follow-up visits, the patient will undergo annual colonoscopy, gastroscopy, abdominal, and vaginal ultrasound screening. In January 2023, the patient was free of progression for 23 months after initiation of treatment for recurrent BC and CALNM. Conclusion This case highlights the value of delayed lymphoscintigraphy and the contribution of sentinel procedure for local control in the setting of recurrent BC. Aberrant lymph node drainage following previous surgery may be the underlying cause of CALNM. We propose that CALNM without evidence of systemic metastasis should be considered a regional event in recurrent BC, and thus, a curative approach can be pursued. The next AJCC BC staging should clarify the role of CALNM in recurrent BC to allow for the development of specific treatment guidelines.

Background Cardiotocography (CTG) remains a cornerstone in fetal monitoring, but its interpretation is subject to considerable inter- and intra-observer variability. Artificial intelligence (AI) tools, particularly large language models (LLMs), offer potential to improve diagnostic consistency and reduce clinician workload. Objectives This study aims to evaluate and compare the accuracy of various LLMs in CTG interpretation based on Federation of Gynecology and Obstetrics (FIGO 2015) criteria. Study design An analysis of sixty CTG traces previously classified by clinicians at the University Hospital Basel according to FIGO guidelines was conducted. In a two-run protocol, 30 normal CTG traces were initially presented as screenshots to Chat-GPT-4.0, Google Gemini, Bing Copilot, and DeepSeek. Subsequently, the LLMs that demonstrated adequate interpretation of normal CTGs were tasked to classify another 30 suspicious or pathological CTG traces. Each LLM was asked to classify each CTG trace as normal or abnormal. Results DeepSeek was unable to interpret CTGs and was excluded. Google Gemini showed poor performance (6.7%) on normal CTGs. Chat-GPT-4.0 partially succeeded in correctly classifying the provided CTG traces as normal (46.7%) or abnormal (50%). Bing Copilot accurately interpreted normal CTGs (96.6%) but failed on abnormal ones (0%). Conclusions LLMs show major limitations in the interpretation of CTG traces according to the FIGO criteria.

Oncoplastic breast surgery (OPS) with immediate symmetrization is commonly performed. However, its impact on patient-reported outcomes (PROs) remains uncertain. Patients with stage 0-III breast cancer who underwent OPS (including oncoplastic breast conserving surgery, or nipple- or skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023 who completed a postoperative BREAST-Q questionnaire were identified from a prospectively maintained database. A generalized linear model was used to detect differences in PROs between those who underwent unilateral versus immediate symmetrizing surgery. Of 441 eligible patients, 333 (75.5 ​%) underwent unilateral OPS, while 108 (24.5 ​%) underwent bilateral OPS. Median time to PRO assessment was 35.1 months (Q1-Q3 13.4–49.5). No differences in PROs were identified between patients who underwent unilateral versus bilateral OPS. Short-term surgical morbidity was more common in patients who underwent symmetrizing surgery, which negatively impacted PROs. The present study did not demonstrate any impact of immediate symmetrization on PROs. [Display omitted] •Bilateral oncoplastic surgery is not associated with patient-reported outcomes.•Short-term surgical morbidity is higher after bilateral oncoplastic surgery.•Short-term morbidity is negatively associated with patient-reported outcomes.

Introduction/BackgroundExposure to platinum and taxane-based chemotherapy is associated with the risk of developing hypersensitivity reactions (HSRs), which may necessitate the use of less effective treatments to avoid anaphylaxis. Desensitisation to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen; therefore, this study investigated the current management of HSRs to platinum and/or taxane chemotherapy in patients with gynaecological cancers.MethodologyWe conducted a cross-sectional survey among gynaecological and medical oncologist consisting of 33 questions. SurveyMonkey software was used to create and distribute the questionnaire. The survey was posted online on the ENYGO and Oncoalert social media channels and data were collected from 1) members of ENYGO and ESGO and 2)ESGO/ENYGO followers.ResultsA total of 144 respondents completed the survey and 133 respondents were included in the final analysis. The gender of the participants was balanced with 54.9% female and 45.1% male with an average age of 38 years. The majority of participants were gynaecological oncologists (43.6%) and medical oncologists (33.8%) working mainly in a university hospital (57.1%) and 77.4%(n=103) were involved in chemotherapy treatment. Of these, 79 participants administered platinum and 67 participants taxane-based chemotherapy. The majority of participants experienced more than 5 HSRs to platinum and taxane per year (73.4% and 73.1%, respectively). Pre-medication with antihistamines/steroids and a new attempt at standard infusion with platinum or taxane chemotherapy were used in 84.8% and 92.5% of Grade 1–2 HSRs to platinum and taxane, respectively. In contrast, tolerance induction was used in 49.4% and 41.8% of Grade 3–4 HSRs to platinum and taxane, respectively. Tolerance induction was mainly performed by medical oncologists,allergists and gynaecological oncologists.ConclusionThe majority of participants strongly emphasised the need to standardise the management of platinum and taxane HSR in gynaecological cancer and to develop international guidelines, regardless of their involvement in chemotherapy treatment.DisclosuresAll of the authors have no conflicts of interest to disclose.

Background: Endocrine therapy is the standard-of-care maintenance treatment for estrogen receptor (ER)-positive breast cancers and is increasingly used in low-grade serous ovarian cancer. However, its therapeutic role in the early maintenance setting for ER-positive high-grade serous ovarian cancer (HGSC) remains undefined. Methods: A retrospective analysis was conducted on clinicopathological data from patients with newly diagnosed ER-positive HGSC following completion of adjuvant chemotherapy. Patients received maintenance therapy either with or without the aromatase inhibitor letrozole, in addition to standard maintenance care. ER expression levels and the administration of letrozole were analyzed, along with outcome measures for the entire cohort, with stratification based on residual disease status. Results: A total of 102 patients with newly diagnosed HGSC were included in the analysis, with 64 (62.7%) receiving letrozole and 38 (37.3%) not receiving letrozole. The median ER expression was 70%, with higher expression observed in the letrozole group compared to the no letrozole group (77.5% vs. 60%). No significant correlation was found between ER expression status and therapy response (p = 0.295 and p = 0.176, respectively). Letrozole therapy was well tolerated with no major adverse effects reported. In the overall cohort, maintenance letrozole therapy did not confer a significant improvement in progression-free survival (median 20.56 months vs. 29.34 months, p = 0.53) or overall survival (OS) (median 79.48 months vs. 46.85 months, p = 0.71) over a median follow-up duration of 23.5 months. However, among patients with no residual disease, maintenance letrozole therapy was associated with a statistically significant improvement in OS compared to those not receiving letrozole (median 114 months vs. 46.9 months, p = 0.006). Conclusions: Maintenance letrozole therapy appears to be a well-tolerated and potentially beneficial intervention in a subset of patients with ER-positive HGSC with no residual disease post-treatment. These findings highlight the need for further validation through prospective randomized trials to comprehensively assess the efficacy of endocrine therapy in this setting and its implications for patient quality of life.

Platinum and taxane chemotherapy is associated with the risk of hypersensitivity reactions (HSRs), which may require switching to less effective treatments. Desensitization to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen. Therefore, we aimed to investigate the current management of HSRs to platinum and/or taxane chemotherapy in patients with gynecologic cancers. We conducted an online cross-sectional survey among gynecological and medical oncologists consisting of 33 questions. A total of 144 respondents completed the survey, and 133 respondents were included in the final analysis. Most participants were gynecologic oncologists (43.6%) and medical oncologists (33.8%), and 77.4% (n = 103) were involved in chemotherapy treatment. More than 73% of participants experienced >5 HSRs to platinum and taxane per year. Premedication and a new attempt with platinum or taxane chemotherapy were used in 84.8% and 92.5% of Grade 1–2 HSRs to platinum and taxane, respectively. In contrast, desensitization was used in 49.4% and 41.8% of Grade 3–4 HSRs to platinum and taxane, respectively. Most participants strongly emphasized the need to standardize the management of platinum and taxane HSRs in gynecologic cancer. Our study showed that HSRs in gynecologic cancer are common, but management is variable and the use of desensitization is low. In addition, the need for guidance on the management of platinum- and taxane-induced HSRs in gynecologic cancer was highlighted.