Publications by authors named "Duygu Altın"

17 Publications

  • Page 1 of 1

A short review of current implementations of sentinel lymph node mapping in gynecologic cancers.

J Turk Ger Gynecol Assoc 2021 Jun 10. Epub 2021 Jun 10.

Department of Gynecology and Obstetrics, Ankara University Faculty of Medicine, Ankara, Turkey.

Lymph node metastasis both upstages the disease and alters adjuvant treatment plans in gynecologic cancers. Since minority of the patients have nodal metastasis, many patients unnecessarily undergo complete lymphadenectomy and face its morbidities. Sentinel lymph node (SLN) mapping is an alternative for evaluation of lymph nodes with lesser side effects. Although it is yet an experimental approach in ovarian cancer, it has been incorporated into guidelines for endometrial, cervical and vulvar cancers. We aimed to summarize the current situation of SLN mapping in gynecologic cancers.
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http://dx.doi.org/10.4274/jtgga.galenos.2021.2021.0025DOI Listing
June 2021

Comparison of two intraoperative examination methods for the diagnosis of sentinel lymph node metastasis in clinically early stage endometrial cancer: A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-003).

Eur J Obstet Gynecol Reprod Biol 2021 Jun 20;261:72-77. Epub 2021 Apr 20.

Koç University School of Medicine, Department of Gynecology and Obstetrics, İstanbul, Turkey.

Objective: This study evaluated diagnostic accuracy of intraoperative sentinel lymph node (SLN) frozen section examination and scrape cytology as a possible solution for management of SLN positive patients.

Study Design: Clinically early-stage endometrial cancer patients who underwent SLN algorithm and intraoperative SLN examination were analyzed. Findings were compared with final pathology results and diagnostic accuracy of frozen section and scrape cytology were evaluated.

Results: Of the 208 eligible patients, 100 patients (48 %) had frozen section examination and 108 (52 %) had scrape cytology of the SLN. Intraoperative examination and final pathology were negative for metastasis in 187/208 (90 %) cases. The rest 21 cases had metastatic SLNs according to final pathology. 12 of 21 (57 %) metastases were classified as macrometastasis. Intraoperative examination of SLNs correctly identified 13 cases (true positive) and missed 8 cases (false negative). Five of 8 false negative cases had micrometastasis or isolated tumor cells. Considering identification of macrometastasis, sensitivity and negative predictive value were 85.71 % and 98.94 %, respectively, for the frozen section and 60.00 % and 98.15 %, respectively, for the scrape cytology.

Conclusion: Frozen section examination of SLN has higher sensitivity in detecting macrometastasis compared to scrape cytology and it could help the surgeon in decision for further lymphadenectomy intraoperatively.
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http://dx.doi.org/10.1016/j.ejogrb.2021.04.009DOI Listing
June 2021

Management of gynecological cancers in the COVID-19 era: a survey from Turkey

J Turk Ger Gynecol Assoc 2020 12;21(4):265-271

Department of Obstetrics and Gynecology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey

Objective: This study aimed to investigate how gynecologic oncologists modified their patient management during Coronavirus disease-2019 (COVID-19) in Turkey.

Material And Methods: An online survey was sent to gynecologic oncology specialists and fellows in Turkey. It included management questions about strategies for newly diagnosed or recurrent endometrial, cervical, ovarian and vulvar cancer during the pandemic. Participants were asked if treatment of these cancers can be delayed or not and, if yes, the duration of delay.

Results: 32.9% of surgeons prescribed oral or intrauterine progesterone for early stage, low-grade endometrial cancer. Conversely, 65.7% and 45.7% of the most surgeons did not change their management for early stage high-grade and advanced stage endometrial cancers respectively, as they perform surgery. 58% and 67.1% of the surgeons continued to prefer standard surgical treatment for microinvasive and early stage cervical cancers, respectively. Radiotherapy was preferred administered with hypofractionated doses for locally advanced cervical cancer (57.1%). While 67.1% of surgeons operated early stage ovarian cancer patients, 50% administered neoadjuvant chemotherapy (NACT) to all advanced stage ovarian cancers and 50% administered more cycles of NACT in preference to interval debulking surgery. 93.7% of the surgeons responded that treatment should not be delayed beyond eight weeks.

Conclusion: Most Turkish gynecologic oncologists modified their management of gynecologic cancers due to the COVID-19 pandemic. While chemotherapy was preferred for ovarian cancer, postponement of the surgery, with or without non-surgical options, was considered for early stage, low-grade endometrial cancer. Treatment of gynecologic cancers should be decided on a case by case basis, taking into account local COVID-19 infection rates and availability of health facilities. Prognosis is also an important consideration if delay is contemplated. Standard treatment and normal time-frames should be used if possible. If not, a postponement for a maximum of eight weeks or referral to another center were acceptable alternatives.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726458PMC
December 2020

Can risk groups accurately predict non-sentinel lymph node metastasis in sentinel lymph node-positive endometrial cancer patients? A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-004).

J Surg Oncol 2021 Feb 1;123(2):638-645. Epub 2020 Dec 1.

Department of Gynecology and Obstetrics, Koç University School of Medicine, İstanbul, Turkey.

Background And Objectives: The purpose of this study was to find out the risk factors associated with non-sentinel lymph node metastasis and determine the incidence of non-sentinel lymph node metastasis according to risk groups in sentinel lymph node (SLN)-positive endometrial cancer patients.

Methods: Patients who underwent at least bilateral pelvic lymphadenectomy after SLN mapping were retrospectively analyzed. Patients were categorized into low, intermediate, high-intermediate, and high-risk groups defined by ESMO-ESGO-ESTRO.

Results: Out of 395 eligible patients, 42 patients had SLN metastasis and 16 (38.1%) of them also had non-SLN metastasis. Size of SLN metastasis was the only factor associated with non-SLN metastasis (p = .012) as 13/22 patients with macrometastasis, 2/10 with micrometastasis and 1/10 with isolated tumor cells (ITCs) had non-SLN metastasis. Although all 4 metastases (1.8%) among the low-risk group were limited to SLNs, the non-SLN involvement rate in the high-risk group was 42.9% and all of these were seen in patients with macrometastatic SLNs.

Conclusions: Non-SLN metastasis was more frequent in higher-risk groups and the risk of non-SLN metastasis increased with the size of SLN metastasis. Proceeding to complete lymphadenectomy when SLN is metastatic should further be studied as the effect of leaving metastatic non-SLNs in-situ is not known.
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http://dx.doi.org/10.1002/jso.26310DOI Listing
February 2021

Binary grading may be more appropriate for endometrial cancer

J Turk Ger Gynecol Assoc 2020 09;21(3):163-170

Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey.

Objective: To elucidate the survival consequences of the prognostic factors for endometrial cancer.

Material And Methods: This was a retrospective study of 276 patients diagnosed with endometrial cancer who admitted for staging surgery. The extent of the surgery was determined by clinical staging and preoperative evaluation. The pathology specimens were reassessed by a gynecopathologist. Independent risk factors were revealed for the progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) utilizing Kaplan-Meier and "Cox" proportional analysis.

Results: The median follow up of the patients was 50 months. Of the 29 patients who died, 15 (5.43%) died because of endometrial cancer. Multivariate analysis revealed that independent risk factors for OS and PFS were stage (p=0.002, 0.002, respectively) and grade 3 (G3) histology (p=0.013, 0.015, respectively). Positive peritoneal cytology was an independent risk factor for OS (p=0.024), but not for PFS (p=0.050). Stage (p=0.005) was found to be the only independent risk factor for DSS. Patients with G1 and G2 histology had a similar and more favorable prognosis than patients with G3 histology.

Conclusion: Advanced stage, high-grade tumor and the presence of positive peritoneal cytology were ascertained as independent prognostic factors for endometrial cancer. A binary histological grading system could be simpler and as effective as the current three grade system because grade 1 and 2 patients showed similar prognosis.
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http://dx.doi.org/10.4274/jtgga.galenos.2019.2019.0068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495132PMC
September 2020

Combination of sentinel lymph node mapping and uterine frozen section examination to reduce side-specific lymphadenectomy rate in endometrial cancer: a Turkish Gynecologic Oncology Group study (TRSGO-SLN-002).

Int J Gynecol Cancer 2020 07 30;30(7):1005-1011. Epub 2020 May 30.

Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey.

Objective: This study aimed to find out whether side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy according to "reflex frozen section" analysis of the uterus in case of sentinel lymph node (SLN) mapping failure.

Methods: Patients who underwent surgery for endometrial cancer with an SLN algorithm were stratified as low-risk or high-risk according to the uterine features on the final pathology reports. Two models for low-risk patients were defined to omit side-specific pelvic lymphadenectomy: strategy A included patients with endometrioid histology, grade 1-2, and <50% myometrial invasion irrespective of the tumor diameter; strategy B included all factors of strategy A with the addition of tumor diameter ≤2 cm. Theoretical side-specific pelvic lymphadenectomy rates were calculated for the two strategies, assuming side-specific pelvic lymphadenectomy was omitted if low-risk features were present on reflex uterine frozen examination, and compared with the standard National Comprehensive Cancer Network (NCCN) SLN algorithm.

Results: 372 endometrial cancer patients were analyzed. 230 patients (61.8%) had endometrioid grade 1 or 2 tumors with <50% myometrial invasion (strategy A), and in 123 (53.4%) of these patients the tumor diameter was ≤2 cm (strategy B); 8 (3.5%) of the 230 cases had lymphatic metastasis. None of them were detected by side-specific pelvic lymphadenectomy and metastases were limited to SLNs in 7 patients. At least one pelvic side was not mapped in 107 (28.8%) cases in the entire cohort, and all of these cases would require a side-specific pelvic lymphadenectomy based on the NCCN SLN algorithm. This rate could have been significantly decreased to 11.8% and 19.4% by applying reflex frozen section examination of the uterus using strategy A and strategy B, respectively.

Conclusion: Reflex frozen section examination of the uterus can be a feasible option to decide whether side-specific pelvic lymphadenectomy is necessary for all the patients who failed to map with an SLN algorithm. If low-risk factors are found on frozen section examination, side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy for lymphatic spread.
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http://dx.doi.org/10.1136/ijgc-2020-001353DOI Listing
July 2020

Complementary role of 18F-FDG PET/CT for sentinel lymph node algorithm in endometrial cancer with high-risk factors for lymphatic metastasis.

Nucl Med Commun 2020 Apr;41(4):389-394

Departments of Obstetrics and Gynecology.

Objective: National Comprehensive Cancer Network (NCCN) sentinel lymph node (SLN) algorithm includes 'mandatory steps' for evaluating pelvic lymph nodes, but assessment of paraaortic area is left to surgeon's discretion. In this study, we aimed to investigate the complementary role of preoperative F-FDG PET/computed tomography (CT) scan in detecting pelvic and especially paraaortic lymphatic metastasis in endometrial cancer patients with high-risk factor(s) according to Mayo Clinic Criteria and underwent SLN algorithm.

Methods: Patients who underwent preoperative F-FDG PET/CT scan, intraoperative SLN algorithm followed by systematic lymphadenectomy (LND) and had at least one high-risk criterion for lymphatic metastasis were included in this study. F-FDG PET/CT and SLN algorithm were compared with final histopathological results of systematic LND.

Results: Thirty-eight patients were eligible for the study. Lymphatic metastasis was seen in 10 patients (26.3%). Four cases had paraaortic lymphatic metastases which were together with pelvic (n:2) or isolated (n:2) metastases. SLN algorithm was able to detect all pelvic lymph node metastases. However, isolated paraaortic metastases were diagnosed only by F-FDG PET/CT. In 76 hemipelvises, sensitivity and negative predictive value of SLN algorithm for diagnosis of pelvic nodal metastasis were 100%, while sensitivity, specificity, positive predictive value and negative predictive value of F-FDG PET/CT were 45.4, 95.3, 62.5 and 91.1%, respectively.

Conclusions: Although SLN algorithm has an excellent diagnostic value for pelvic nodal metastasis, paraaortic metastasis might be underdiagnosed. F-FDG PET/CT may be a feasible tool to exclude paraaortic lymphatic metastasis in high-risk patients for lymphatic metastasis who will undergo SLN algorithm.
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http://dx.doi.org/10.1097/MNM.0000000000001157DOI Listing
April 2020

Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001).

Int J Gynecol Cancer 2020 03 18;30(3):299-304. Epub 2019 Dec 18.

Obstetrics and Gynecology, Koc University Medical Faculty, Istanbul, Turkey.

Objective: The aim of this multicenter study was to evaluate the feasibility of sentinel lymph node (SLN) mapping in clinically uterine confined endometrial cancer.

Methods: Patients who underwent primary surgery for endometrial cancer with an SLN algorithm were reviewed. Indocyanine green or blue dye was used as a tracer. SLNs and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. SLNs were ultrastaged on final pathology.

Results: 357 eligible patients were analyzed. Median age was 59 years. Median number of resected SLNs was 2 (range 1-12) per patient. Minimal invasive and open surgeries were performed in 264 (73.9%) and 93 (26.1%) patients, respectively. Indocyanine green was used in 231 (64.7%) and blue dye in 126 (35.3%) patients. The dyes were injected into the cervix in 355 (99.4%) patients. The overall and bilateral SLN detection rates were 91.9% and 71.4%, respectively. The mapping rates using indocyanine green or blue dye were comparable (P=0.526). There were 43 (12%) patients with lymphatic metastasis. The SLN algorithm was not able to detect 3 of 43 patients who had isolated paraaortic metastasis. After SLN biopsy, complete pelvic lymphadenectomy was performed in 286 (80.1%) patients. Sensitivity and negative predictive value were both 100% for the detection of pelvic lymph node metastases. In addition, 117 (32.8%) patients underwent completion paraaortic lymphadenectomy after SLN biopsy. In these patients, sensitivity for detecting metastases to pelvic and/or paraaortic lymph nodes was 90.3% with a negative predictive value of 96.6%. The risk of non-SLN involvement in patients with macrometastatic SLNs, micrometastatic SLNs, and isolated tumor cells in SLNs were 61.2%, 14.3% and 0%, respectively.

Conclusions: SLN biopsy had good accuracy in detecting lymphatic metastasis. However, one-third of cases with metastatic SLNs also had non-SLN involvement and this risk increased to two-thirds of cases with macrometastatic SLNs. The effect of leaving these nodes in situ on survival should be evaluated in further studies.
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http://dx.doi.org/10.1136/ijgc-2019-000847DOI Listing
March 2020

Risk factors for failure of sentinel lymph node mapping using indocyanine green/near-infrared fluorescent imaging in endometrial cancer.

Arch Gynecol Obstet 2019 06 29;299(6):1667-1672. Epub 2019 Mar 29.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, 06100, Ankara, Turkey.

Purpose: Side-specific systematic lymphadenectomy is suggested if sentinel lymph node (SLN) mapping failed in early stages endometrial cancer. This study aimed to evaluate the risk factors associated with failed mapping which may lead to modify SLN mapping technique, increase the success of SLN mapping and reduce the necessity of systematic lymphadenectomy.

Methods: Patients with early stage endometrial cancer were included in this study. All patients underwent SLN mapping with indocyanine green/near-infrared compatible surgical platforms. Indocyanine green was injected intracervical. "Bilateral mapping" and "failed bilateral SLN mapping (unilateral or bilateral failed mapping)" groups were compared for demographic, clinical, surgical, and pathological features.

Results: 101 cases were analyzed. The overall, unilateral, and bilateral SLN detection rates were 94.1%, 19.8%, and 74.3%, respectively. The failed (unilateral or no mapping) bilateral detection rate was 25.7%. Failed bilateral mapping rates were higher in patients with longer cervical and uterine longitudinal lengths, deep myometrial invasion and larger tumor size without statistical significance. Body mass index and operation type were not related with failed mapping. Increasing number of operations or injection of larger volume of indocyanine green (4 mL vs. 2 mL) did not improve mapping rate significantly.

Conclusion: Cervical indocyanine green injection may overcome the negative effect of obesity on bilateral mapping. Although there was a negative correlation trend between the longitudinal cervical and uterine lengths and bilateral mapping, this possible relation needs to be confirmed in further studies.
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http://dx.doi.org/10.1007/s00404-019-05137-5DOI Listing
June 2019

Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma: a Turkish Gynecologic Oncology Study

Balkan Med J 2019 07 15;36(4):229-234. Epub 2019 Mar 15.

Department of Gynecologic Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Background: Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial.

Aims: To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma.

Study Design: Cross-sectional study.

Methods: Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied.

Results: The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (<75 vs ≥75 years) was the only independent prognostic factor for recurrence (hazard ratio: 3.8, 95% CI=1.10-13.14, p=0.035) in multivariate analysis. None of the factors were significantly associated with cancer-specific survival.

Conclusion: Advanced age was the only independent factor for disease-free survival in stage I uterine carcinosarcoma. Performing any adjuvant therapy following comprehensive lymphadenectomy was not related to the improved survival of the stage I disease.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2019.2018.12.75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636652PMC
July 2019

Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy: A randomized controlled trial.

Eur J Obstet Gynecol Reprod Biol 2019 Mar 9;234:38-42. Epub 2019 Jan 9.

Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.

Objectives: To assess the effect of monopolar coagulation vs cut mode during colpotomy at total laparoscopic hysterectomy on vaginal cuff dehiscence.

Study Design: We conducted this randomized controlled trial at a university hospital's department of obstetrics and gynecology from September 2016 through January 2018. Enrolled women were randomized 1:1 to monopolar coagulation or cut modes during colpotomy. We followed up 100 participants in the coagulation arm and 99 in the cut arm for ongoing data collection for 12 weeks after surgery. Exclusion criteria were suspicion of pregnancy, previous radiation therapy, uterine size exceeding 20 weeks' gestation, contraindication for high intraabdominal pressure, clinical advanced stage malignant disease, and conversion to laparotomy before completion of colpotomy. Differences between groups for categorical variables were analyzed by chi-square test and the comparisons of continuous variables between groups were analyzed by Student's t-test RESULTS: The study groups were comparable regarding demographics and perioperative parameters. The rate of vaginal cuff dehiscence in coagulation group (1%) was similar to that of cut group (0%) (p = 0.995). The other vaginal cuff related complication rates were also similar.

Conclusion: Monopolar coagulation and cut modes during colpotomy at total laparoscopic hysterectomy have similar vaginal cuff dehiscence rates and both energy modes seem acceptable for colpotomy.
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http://dx.doi.org/10.1016/j.ejogrb.2018.12.034DOI Listing
March 2019

Extrapelvic Sentinel Lymph Nodes in Endometrial Cancer Patients With Unmapped Pelvic Side: A Brief Report.

Int J Gynecol Cancer 2018 05;28(4):700-703

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.

Objective: The aim of the study was to evaluate extrapelvic sentinel lymph nodes (SLNs) in clinical early-stage endometrial cancer patients with unmapped pelvic side(s) during fluorescent imaging-based sentinel mapping.

Materials And Methods: Eligible patients underwent sentinel mapping using cervical injection of indocyanine green and near-infrared florescent imaging compatible endoscopic systems. Pelvic SLNs were identified and resected. If bilateral mapping was not achieved, upper lymph nodes areas including presacral, upper common iliac, and para-aortic caval regions were explored for any SLN. Systematic lymphadenectomy was performed after applying SLN algorithm steps.

Results: In 24 of 101 patients, bilateral pelvic mapping was not achieved. Bilateral unmapping was seen in 4 of 24 and unilateral pelvic side mapping in 20 of 24 patients. There was no extrapelvic SLN among 4 cases with bilateral pelvic unmapping, whereas 8 (40%) of 20 patients with unilateral pelvic mapping had extrapelvic SLNs. Five of extrapelvic SLNs were in presacral, 2 in upper common iliac, and 1 in paracaval regions.

Conclusions: Observing for extrapelvic SLNs in cases with unmapped pelvic side(s) could increase detection rate of SLN mapping in clinical early-stage endometrial cancer.
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http://dx.doi.org/10.1097/IGC.0000000000001224DOI Listing
May 2018

Bipolar Energy Instruments in Laparoscopic Uterine Cancer Surgery: A Randomized Study.

J Laparoendosc Adv Surg Tech A 2018 Jun 11;28(6):645-649. Epub 2018 Jan 11.

1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey .

Objective: To compare the perioperative outcomes of patients with uterine cancer, who were operated using advanced or conventional bipolar instruments.

Materials And Methods: Patients with clinically early-stage endometrial cancer were randomized to advanced (LigaSure) or conventional (Robi forceps) bipolar groups. Surgeries were performed by laparoscopy. Hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymphadenectomy were done in all cases. Primary endpoint of the study was to compare operation time for 2 groups. Other perioperative outcomes were also compared. ClinicalTrials.gov identifier number of the study was NCT02822820.

Results: Sixty-eight cases with endometrial cancer were randomized to 2 groups and each group included 34 subjects. Mean age and body mass index of all cases were 56.8 ± 10.4 years and 31.1 ± 5.3 kg/m, respectively. Mean operation time was found significantly shorter in advanced bipolar group (134.2 ± 29.7 minutes versus 163.5 ± 27.7 minutes, P < .001). The other variables investigated such as intraoperative blood loss, duration of hospital stay, and postoperative pain scores did not show statistically significant difference between the groups.

Conclusion: Operation time was shorter in advanced bipolar group, however, advanced and conventional bipolar energy instruments were comparable for other perioperative outcomes in laparoscopic endometrial cancer surgery.
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http://dx.doi.org/10.1089/lap.2017.0639DOI Listing
June 2018

Laparoscopic near-infrared fluorescent imaging as an alternative option for sentinel lymph node mapping in endometrial cancer: A prospective study.

Int J Surg 2017 Nov 14;47:13-17. Epub 2017 Sep 14.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.

Background: To evaluate feasibility of sentinel lymph node (SLN) mapping by using near-infrared fluorescent imaging and indocyanine green (NIR/ICG) integrated laparoscopic system in clinically uterine-confined endometrial cancer.

Materials And Methods: Patients with clinically early-stage endometrial cancer were included in this prospective study. ICG was injected to the uterine cervix and NIR/ICG integrated laparoscopic system (Spies Full HD D-Light P ICG technology, Karl Storz, Tuttlingen, Germany) was used during the operations. SLN and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed following SLN algorithm steps.

Results: Seventy-one eligible patients were analyzed. The overall, unilateral and bilateral SLN detection rates were 95.7%, 18.3%, 77.4%, respectively. There were 8 (11.2%) patients with lymph node metastasis. One of them was isolated para-aortic node metastasis. Negative predictive value, sensitivity and false negative rate for detecting lymphatic spread were 98.4%, 87.5% and 1.5%, respectively.

Conclusion: Sentinel lymph node mapping can easily be performed with high accuracy by using NIR/ICG integrated conventional laparoscopic system in endometrial cancer and almost all lymphatic spread can be detected.
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http://dx.doi.org/10.1016/j.ijsu.2017.09.015DOI Listing
November 2017

Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone.

J Gynecol Oncol 2017 Sep 16;28(5):e65. Epub 2017 Jun 16.

Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey.

Objective: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone.

Methods: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected.

Results: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors.

Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.
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http://dx.doi.org/10.3802/jgo.2017.28.e65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540724PMC
September 2017

Sentinel lymph node biopsy to exclude lymphatic spread in placental site trophoblastic tumour.

J Obstet Gynaecol 2017 Nov 9;37(8):1102-1103. Epub 2017 Jun 9.

a Department of Obstetrics and Gynecology , Ankara University School of Medicine , Ankara , Turkey.

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http://dx.doi.org/10.1080/01443615.2017.1312316DOI Listing
November 2017