Objective: We aimed to analyze the impact of stage shifts on disease-free survival and overall survival in patients with uterine carcinosarcoma stratified based on FIGO 2009 and 2023 staging systems. Materials and Methods: A total of forty-five patients diagnosed with uterine carcinosarcoma between 2010 and 2024 were included in the study. Patients were classified and analyzed according to both the 2009 and the revised 2023 FIGO staging systems to evaluate the impact of the updated staging criteria on oncologic outcomes. The median disease-free (DFS) and overall survival (OS) rates were calculated and compared when stage shifts occurred. Results: A total of 17 upstage shifts (37.7%) occurred between the 2009 and 2023 FIGO staging system. All patients with upstage shifts were stage I patients categorized according to the FIGO 2009 classification. Restaging from the FIGO 2009 to the FIGO 2023 criteria resulted in a reduction in the number of stage I cases and an increase in the number of stage II cases. The two main factors leading to upstage were serous histology and LVSI positivity. The 5-year DFS and OS rates for stage I disease were 80% and 75%, respectively, according to the 2009 FIGO staging system, whereas the 2023 FIGO staging system demonstrated significantly higher rates of 100% for both DFS and OS. In stage II patients, the 5-year DFS and OS rates were 33.5% and 33.7%, respectively, according to the 2009 FIGO staging system, while the 2023 FIGO staging system demonstrated higher rates of 58.8% for DFS and 65% for OS. Conclusions: The revised FIGO 2023 staging system has better performance in predicting disease prognosis than the previous version.

This prospective study aimed to determine the effectiveness of prophylactic subcutaneous retention sutures in the prevention of superficial wound separation in women with a confirmed or suspected cancer who had gynecological surgery by midline laparotomy. This was a non-randomized, controlled intervention study including patients who underwent cancer surgery between May 2018 and August 2019. Patients who underwent midline laparotomy with confirmed or suspected cancer were included and patients who had an early post-operative complication or who underwent surgery again before the removal of stitches were excluded. The independent variables that might predict the superficial wound site dehiscence and prolongation of the hospitalization period were analyzed using logistical regression analysis. A total of 208 patients were included in the study. Age, presence of comorbid diseases, low pre-operative hemoglobin, low pre-operative albumin, higher weight, higher body mass index (BMI), pre- and post-operative blood transfusion, and absence of retention sutures were associated with higher risk of superficial wound separation. Low pre-operative albumin, weight, and BMI were associated with prolonged length of hospital stay. In a multivariate analysis, BMI (OR: 1.12; 95% CI: 1.09 to 1.28, p<0.001) and retention sutures (OR: 0.31; 95% CI: 0.11 to 0.83, p=0.019) retained an independent association with superficial wound separation. In addition, BMI (OR: 1.11; 95% CI: 1.03 to 1.25, p=0.010) and intra-operative complications (OR: 4.10; 95% CI: 1.08 to 15.60, p=0.038) were independent predictors increasing the length of hospital stay, and use of retention sutures (OR: 0.19; 95% CI: 0.05 to 0.66, p=0.009) was an independent predictor decreasing the length of hospital stay. Prophylactic subcutaneous retention sutures reduced superficial wound separation and shortened hospital stay. Prophylactic subcutaneous retention sutures may be considered in patients who undergo gynecological surgery using a midline laparotomy.

Background: Wound complications in gynecologic oncology, especially among patients with overweight and obesity, can significantly impact post-operative recovery and delay the initiation of adjuvant treatment. Although staples are commonly used for vertical incisions, sutures may offer clinical advantages; however, direct comparative data remain limited. This study aimed to compare post-operative wound complication rates between staples and non-absorbable sutures in patients with gynecologic cancer with a body mass index ≥25 kg/m ² and undergoing a vertical incision surgical procedure. Patients and Methods: A retrospective review was conducted at a gynecologic oncology center between January 2022 and September 2023. Patients who underwent midline laparotomy with either staples or 3-0 non-absorbable monofilament sutures for skin closure were included. Patients with prior chemotherapy, benign pathology, or age <18 were excluded. Wound complications—including seroma, hematoma, dehiscence (superficial and fascial), and infection—were recorded within eight weeks postoperatively. Results: Of 72 patients, 29 received staples and 43 received sutures. Wound complications occurred in 41% of the staple group and 21% of the suture group (p = 0.061). Fascial dehiscence was observed in four cases (two in each group). Although rates of dehiscence and infection were higher with staples, differences were not statistically significant. Hospital stay was significantly longer in the staple group (p = 0.045). Conclusion: Although not statistically significant, suture closure was associated with fewer wound complications and a shorter hospital stay, suggesting potential advantages in wound healing. These findings may inform future recommendations, and further prospective studies are warranted.

Background: The aim of this study is to compare the concordance of Preoperative Magnetic Resonance Imaging (MRI) and Intraoperative Frozen Section Analysis, widely used worldwide for Endometrial Cancer (EC), with final pathology results, to calculate their sensitivity and specificity, and to evaluate their diagnostic agreement with final pathology results. Positive predictive values for both MRI and frozen section analysis will also be calculated. Methods: In this retrospective cohort study, patients diagnosed with Endometrioid-Type Endometrial Cancer at the Gynecologic Oncology Surgery Department of Akdeniz University Hospital between January 2020 and December 2023 underwent preoperative MRI to assess the depth of myometrial invasion and intraoperative frozen section examination for surgical staging. The results of both methods were compared with the final pathology reports. Results: A total of 88 patients were included in the study. Patient ages ranged from 34 to 80 years, with a mean age of 57.57 years (SD: 9.65), predominantly in the middle-aged and older population. In the assessment of myometrial invasion depth, MRI demonstrated a sensitivity of 81.6% and a specificity of 88%, while frozen section analysis showed a sensitivity of 73.7% and a specificity of 98.0%. Conclusions: In our study, preoperative MRI demonstrated similar sensitivity and specificity to intraoperative frozen section analysis in determining the depth of myometrial invasion in cases of Endometrioid-Type Endometrial Cancer. Therefore, when intraoperative frozen section analysis is not available, MRI findings may assist surgical planning, particularly in centers where frozen section is limited.

Background and Objectives: Para-aortic lymph node involvement is a key prognostic factor in high-risk endometrial cancer. This study aimed to identify factors associated with para-aortic lymph node metastasis and to assess their predictive value for surgical decision-making. Materials and Methods: A retrospective analysis was conducted on 81 patients with high-risk endometrial cancer who underwent systematic pelvic and para-aortic lymphadenectomy between January 2015 and December 2024. Factors evaluated included histologic subtype, lymphovascular space invasion (LVSI), cervical stromal involvement, depth of myometrial invasion, and tumor diameter. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of para-aortic metastasis. Receiver operating characteristic (ROC) analysis was used to determine the optimal tumor size threshold. Results: Para-aortic lymph node metastasis was identified in 21.0% of patients, and isolated para-aortic metastasis was observed in 2.5%. In univariate analysis, pelvic lymph node positivity, LVSI, cervical stromal invasion, deep myometrial invasion, and tumor size ≥ 3.55 cm were significantly associated with para-aortic spread. Multivariate analysis revealed that pelvic lymph node positivity was the only independent predictor (OR 39.0; 95% CI 5.06–301.46; p < 0.001). Conclusions: Pelvic lymph node status serves as a strong and independent predictor of para-aortic metastasis in high-risk endometrial cancer. A tumor diameter greater than 3.5 cm may also indicate an increased risk of para-aortic spread. These findings suggest that selective and individualized para-aortic assessment strategies may be considered to improve staging accuracy and optimize surgical planning in this patient population.

A 42-year-old woman presented with chronic pelvic pain and oligomenorrhea 20 months after her last pregnancy. MRI revealed a cesarean section scar and a large isthmocele causing a complete myometrial defect. Subsequent isthmocele repair and histopathological examination our patient had GATA3, P 63, and PLAP positivity, HPL, and MCAM negativity, and the Ki-67 index was 5-10%. She was diagnosed with APSN because her Ki-67 index was higher than PSN and lower than PSST / ETT and larger tumor size.This case underscores the importance of considering APSN in the differential diagnosis of chronic pelvic pain and oligomenorrhea post pregnancy, highlighting the need for early recognition and appropriate management to prevent progression to more severe trophoblastic tumors such as placental site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT).