The Fourth Edition of the Guidelines for Treatment of Uterine Body Neoplasm was published in 2018. These guidelines include 9 chapters: 1. Overview of the guidelines, 2. Initial treatment for endometrial cancer, 3. Postoperative adjuvant therapy for endometrial cancer, 4. Post-treatment surveillance for endometrial cancer, 5. Treatment for advanced or recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment of uterine carcinosarcoma and uterine sarcoma, 8. Treatment of trophoblastic disease, 9. Document collection; and nine algorithms: 1-3. Initial treatment of endometrial cancer, 4. Postoperative adjuvant treatment for endometrial cancer, 5. Treatment of recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment for uterine carcinosarcoma, 8. Treatment for uterine sarcoma, 9. Treatment for choriocarcinoma. Each chapter includes overviews and clinical questions, and recommendations, objectives, explanation, and references are provided for each clinical question. This revision has no major changes compared to the 3rd edition, but does have some differences: 1) an explanation of the recommendation decision process and conflict of interest considerations have been added in the overview, 2) nurses, pharmacists and patients participated in creation of the guidelines, in addition to physicians, 3) the approach to evidence collection is listed at the end of the guidelines, and 4) for clinical questions that lack evidence or clinical validation, the opinion of the Guidelines Committee is given as a "Recommendations for tomorrow".

Tokunaga H, et al. J Gynecol Oncol. 2021 Feb;32(2):e49. https://doi.org/10.3802/jgo.2021.32.e49

Seino M, et al. J Gynecol Oncol. 2023 Nov;35(1):e15. https://doi.org/10.3802/jgo.2024.35.e15

Introduction: There is a paucity of data on the risk of preterm birth subcategorized by gestational age in pregnancies after the prepregnancy excisional treatment for cervical lesions. Additionally, little is known about the effect of prophylactic cerclage on the risk of preterm birth. The aim of this study was to investigate the risk of preterm birth stratified by gestational period and its reduction by the prophylactic cerclage in women with prior excisional surgery. Material and methods: We retrospectively analyzed a cohort of singleton pregnancies in the Japan Perinatal Registry Network Database (2013–2014, n = 307 001). Cases included pregnancies after the surgery (ie conization and loop electrosurgical excision procedure). Controls comprised the propensity-score matched pregnancies without prepregnancy surgery. The main outcome was the occurrence of preterm birth. The effect of prophylactic cervical cerclage on the risk of preterm birth after the excisional surgery was also examined using cases. Results: In the propensity-score matched population (cases, n = 1389; controls, n = 1389), cases exhibited higher risk of preterm birth and preterm prelabor rupture of membranes (PROM), compared with controls (preterm birth: 25.3 versus 10.6%; preterm PROM: 14.0 versus 3.5%: both p < 0.0001). Odds ratios (OR; 95% confidence interval [CI]) for preterm birth at 22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks were 3.4 [1.8–6.5], 4.6 [2.7–7.7], 2.2 [1.4–3.5], and 2.1 [1.6–2.7], respectively. The association was stronger for preterm PROM at earlier gestational age (22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks: 5.2 [2.3–11.8], 7.1 [3.4–15.0], 3.8 [1.7–8.3], and 3.9 [1.8–4.6], respectively). In cases, 171 underwent the prophylactic cervical cerclage. The occurrence of preterm birth and preterm PROM was comparable between those with and without the cerclage (28.7 versus 24.2, and 12.9 versus 13.3%, respectively). Conclusions: Prepregnancy excisional cervical surgery was associated with the increased risk of preterm birth, especially before 32 weeks of gestation. The prophylactic cerclage did not reduce the risk of preterm birth.