Background: This study aimed to investigate the adding value of MRI over CT for preoperative cytoreductive surgery with hyperthermic intraperitoneal chemotherapies (CRS/HIPEC). Methods: Imaging and intraoperative peritoneal cancer index (PCI) were calculated in 62 patients with peritoneal metastasis. Predictive models for the completeness of cytoreductive score using PCI data were established using decision tree algorithms. Results: In gastric cancer patients, a large discrepancy and poor agreement was appreciated between CT and surgical PCI, and a nonsignificant difference was noted between MRI and surgical PCI. In colon cancer patients, a better agreement and higher correlation with a smaller error was observed in PCI score using MRI than in that using CT. However, the addition of MRI to CT was limited for appendiceal and ovarian cancer patients. For predicting incomplete cytoreduction, CT models yielded inadequate accuracy while MRI models were more accurate with fair discrimination ability. Conclusions: CT was suitable for estimating PCI and surgery outcome in appendiceal and ovarian cancer patients, while further MRI in addition to CT was recommended for colon and gastric cancer patients. However, for classifying patients with peritoneal carcinomatosis into complete and incomplete cytoreduction, MRI was more effective than CT.

Breast, ovarian, and uterine corpus cancers are common female cancers and categorized as hormone‐related diseases. Previous studies reported a unidirectional relationship for each cancer, but few studied the reciprocal association in the same cohort. A population‐based study was carried out in Taiwan to test the hypothesis that there are pairwise bidirectional associations among these cancers. Using the same cohort of 110,112 cases with primary female cancers including uterine corpus cancer (11,146 cases), ovarian cancer (12,139 cases), or breast cancer (86,827 cases) from the Taiwan Cancer Registry from 1979 to 2008, the pairwise risks of second cancer among uterine corpus, ovary, and breast cancer cases were evaluated by standardized incidence ratios (SIRs) and the corresponding 95% confidence intervals (CIs) to quantify the excess of second malignancies. A reciprocal relationship was found for these three female cancers, particularly most prominent between uterine and ovarian cancers, followed by breast and uterine cancers as well as breast and ovarian cancers. The overall risk of second cancers was highest within the first 5 years after the diagnosis of primary cancer. The bidirectional relationships suggest common risk factors among these three female cancers. This is the largest cohort study to focus on the bidirectional associations among hormone‐related cancers in Asian women, and these results could aid in the development of early prevention strategies and follow‐up surveillance programs.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/ HIPEC) for peritoneal surface malignancy can effectively control the disease, however it is also associated with adverse effects which may affect quality of life (QoL). To investigate early perioperative QoL after CRS/HIPEC, which has not been discussed in Taiwan. This single institution, observational cohort study enrolled patients who received CRS/HIPEC. We assessed QoL using the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T) and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Participants completed the questionnaires before CRS/HIPEC (S1), at the first outpatient follow-up (S2), and 3 mo after CRS/HIPEC (S3). Fifty-eight patients were analyzed. There was no significant perioperative difference in global health status. Significant changes in physical and role functioning scores decreased at S2, and fatigue and pain scores increased at S2 but returned to baseline at S3. Multiple regression analysis showed that age and performance status were significantly correlated with QoL. In the MDASI-T questionnaire, distress/feeling upset and lack of appetite had the highest scores at S1, compared to fatigue and distress/feeling upset at S2, and fatigue and lack of appetite at S3. The leading interference items were working at S1 and S2 and activity at S3. MDASI-T scores were significantly negatively correlated with the EORTC QLQ-C30 results. QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC. Our findings can help with preoperative consultation and perioperative care.

Background: Rising sedentary behaviour and consumption of sugar‐sweetened beverages and ultra‐processed foods have increased the risk and earlier onset of obesity in children. Objectives: To define controlled attenuation parameter (CAP) cut‐off values in healthy children, assess the prevalence of metabolic dysfunction‐associated steatotic liver disease (MASLD) in children with overweight and obesity, and establish an appropriate starting age for MASLD screening in our population. Methods: Healthy primary school children were recruited. Hepatic steatosis was assessed using CAP, and body composition data were collected during two periods: August 2020–March 2021 and February 2023–May 2024. Results: Of 1653 participants (mean age 9.5 ± 1.7 years), 976 children with normal weight were used to establish reference intervals. Hepatic steatosis was defined as a CAP above 247 dB/m (97.5th percentile). The prevalences of MASLD in children with overweight and obesity were 0% and 16%, respectively, in school grade 1, which increased to 19% and 75% in school grade 6 ( p < 0.001). Conclusions: Screening for hepatic steatosis associated with obesity should begin as early as school grade 1, while screening for children with overweight may be more appropriate by school grade 6. These findings emphasise the need for age‐ and weight‐specific screening strategies for children with overweight and obesity.

To report a rare case of severe endometriosis complicated by deep vein thrombosis (DVT) and pulmonary embolism (PE) without hormone exposure, and review similar cases in the literature. A 44-year-old woman with severe endometriosis adenomyosis without hormone therapy history, presented with menorrhagia, dysmenorrhea, and an extremely high serum cancer antigen (CA)-125 level (1065.2 U/mL). Prior to scheduled surgery, she developed mild swelling over her left leg and was found to have extensive DVT over left common femoral to popliteal veins and bilateral multi-focal PE. After anticoagulation therapy and inferior vena cava filter placement, she underwent laparotomic total hysterectomy, bilateral salpingectomy, and ovarian tumor excision. Pathology confirmed endometriosis without malignancy. Postoperative follow-up revealed a normalized CA-125 level and resolution of thromboembolism. This case emphasizes the importance of considering thrombotic complications in endometriosis patients with an extremely high CA-125 level, even without hormone exposure or vascular compression.

The risk of critical limb ischemia (CLI) which causes ischemic pain or ischemic loss in the arteries of the lower extremities in long-term uterine cancer (UC) survivors remains unclear, especially in Asian patients, who are younger at the diagnosis of UC than their Western counterparts. To conduct a nationwide population-based study to assess the risk of CLI in UC long-term survivors. UC survivors, defined as those who survived for longer than 5 years after the diagnosis, were identified and matched at a 1:4 ratio with normal controls. Stratified Cox models were used to assess the risk of CLI. From 2000 to 2005, 1889 UC survivors who received surgery alone or surgery combined with radiotherapy (RT) were classified into younger (onset age < 50 years, n = 894) and older (onset age ≥ 50 years, n = 995) groups. While compared with normal controls, the younger patients with diabetes, hypertension, and receiving hormone replacement therapy (HRT) were more likely to develop CLI. In contrast, the risk of CLI was associated with adjuvant RT, obesity, hypertension, and HRT in the older group. Among the UC survivors, those who were diagnosed at an advanced age (> 65 years, aHR = 2.48, P = 0.011), had hypertension (aHR = 2.18, P = 0.008) or received HRT (aHR = 3.52, P = 0.020) were at a higher risk of CLI. In this nationwide study, we found that the risk factors associated with CLI were similar in both cohorts except for adjuvant RT that was negligible in the younger group, but positive in the older group. Among the survivors, hypertension, advanced age, and HRT were more hazardous than RT. Secondary prevention should include CLI as a late complication in UC survivorship programs.