Background and Objectives: Ovarian cancer surgery requires multiple radical resections with a high risk of complications. The aim of this single-centre, retrospective study was to determine the best method for predicting Clavien–Dindo grade ≥ III complications using machine learning techniques. Material and Methods: The study included 179 patients who underwent surgery at the gynaecological oncology department of Antalya Training and Research Hospital between January 2015 and December 2020. The data were randomly split into training set n = 134 (75%) and test set n = 45 (25%). We used 49 predictors to develop the best algorithm. Mean absolute error, root mean squared error, correlation coefficients, Mathew’s correlation coefficient, and F1 score were used to determine the best performing algorithm. Cohens’ kappa value was evaluated to analyse the consistency of the model with real data. The relationship between these predicted values and the actual values were then summarised using a confusion matrix. True positive (TP) rate, False positive (FP) rate, precision, recall, and Area under the curve (AUC) values were evaluated to demonstrate clinical usability and classification skills. Results: 139 patients (77.65%) had no morbidity or grade I-II CDC morbidity, while 40 patients (22.35%) had grade III or higher CDC morbidity. BayesNet was found to be the most effective prediction model. No dominant parameter was observed in the Bayesian net importance matrix plot. The true positive (TP) rate was 76%, false positive (FP) rate was 15.6%, recall rate (sensitivity) was 76.9%, and overall accuracy was 82.2% A receiver operating characteristic (ROC) analysis was performed to estimate CDC grade ≥ III. AUC was 0.863 with a statistical significance of p < 0.001, indicating a high degree of accuracy. Conclusions: The Bayesian network model achieved the highest accuracy compared to all other models in predicting CDC Grade ≥ III complications following epithelial ovarian cancer surgery.

Background: It is crucial to predict the response to chemotherapy and identify prognostic markers for recurrence and survival in patients with epithelial ovarian cancer (EOC), in order to effectively manage patient care. The CA-125 elimination rate constant K (KELIM) has recently been developed as a means of assessing the chemotherapy response and has been tested mainly in patients enrolled in randomized controlled trials. The objective of this study was to investigate whether the KELIM score is a prognostic marker for progression-free survival (PFS) and overall survival (OS) in EOC, utilizing its role in predicting the chemotherapy response in real-life settings. Method: Demographic, surgical, and survival data of patients with EOC operated on in Antalya Training and Research Hospital between January 2015 and December 2021 were obtained from the electronic gynecological oncology clinic database system and analyzed retrospectively. Results: A total of 102 patients with EOC were included; 30 patients (29.4%) had a KELIM score ≥ 1 and 72 (70.6%) patients had a KELIM score < 1. In the group with a KELIM score < 1, recurrence and refractory disease occurred in 49 patients, while it was 11 patients in the group with a KELIM score ≥ 1 (p = 0.004). PFS was 12 months and 32 months in the groups with KELIM scores of <1 and ≥1, respectively (p = 0.012). There was no difference between groups regarding OS (p = 0.139). In the whole group, KELIM score (<1 vs. ≥1) and type of surgery (IDS vs. PDS) were found to be independent prognostic factors for PFS (RR = 0.44; 95%CI: 0.22–0.88; p = 0.021 and RR = 2.97; 95%CI: 1.76–5.01; p < 0.001, respectively). Conclusion: We found that a favorable KELIM score was associated with better PFS in all groups of patients undergoing surgery for EOC in a real-life setting. With the increasing number of studies, the KELIM score will play an important role in providing better guidance to clinicians at the initial presentation of patients and in subsequent treatment planning.

Background/Objectives: This study was designed to investigate the relationship between peripheral hematological inflammation markers, namely, neutrophil/lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune inflammation index (SII), and systemic inflammatory response index (SIRI) and high-grade cervical lesions (CIN2+). Methods: A retrospective cohort analysis was conducted on 358 patients who underwent cervical excision procedures. Patients were divided into two groups: <CIN2 and CIN2+. Preoperative complete blood count data were used to calculate the inflammation indices. HPV genotypes were also recorded. Logistic regression and ROC analyses were performed to evaluate the predictive performance. Results: CIN2+ lesions were detected in 69.6% of participants. In the univariate analysis, only age and HPV 16 positivity (p < 0.005) showed a significant association with the presence of CIN2+. NLR, PLR, MLR, SII, and SIRI values did not show significant differences between groups (all p > 0.05). In the multivariate analysis, increasing age was independently associated with a decrease in the risk of CIN2+ (OR = 0.96, 95% CI: 0.94–0.99), while HPV 16 positivity was associated with an increase in risk (OR = 2.44, 95% CI: 1.43–4.18). ROC analysis showed that combining age and HPV 16 status improved the specificity (85.1%) of predicting CIN2+ compared to using age alone (42.2%). Conclusions: Peripheral haematological inflammation markers (NLR, PLR, MLR, SII, and SIRI) did not show predictive value in predicting CIN2+ lesions. However, age and HPV 16 infection were found to be independent predictors. These findings suggest that haematological indices may reflect systemic inflammatory responses but are not sufficient on their own for the detection of CIN2+. HPV genotyping is of critical importance for the early detection of high-grade lesions.

Amaç Bu çalışmanın amacı jinekolojik malignitelerin cerrahi tedavisi sonrası yoğun bakım ünitesine (YBÜ) yatış ve prognoz ile ilişkili faktörleri araştırmaktır. Gereç ve Yöntem: Bu çalışma, 1 Aralık 2022 ile 1 Aralık 2023 tarihleri arasında jinekolojik onkolojik cerrahi uygulanan ve sonrasında YBÜ izlenen hastaları kapsayan retrospektif bir kohort analizi olarak tasarlanmıştır. Bulgular Çalışma döneminde jinekolojik onkolojik cerrahi geçiren ve YBÜ kabul edilen 57 hastanın verileri analiz edildi. Medyan yaş 61,47, medyan vücut kitle indeksi 27 kg/m2, Amerikan Anesteziyoloji Derneği skoru 3±2,5 idi. YBÜ kabul için en yaygın endikasyon %73,6 (n=42) ile hemodinamik instabilite iken, bunu %15,7 (n=9) ile solunum yetmezliği, %10,5 (n=6) yerine solunum yetmezliği ve diğer nedenler izlendi. Charlson komorbidite indeksi, laktat ve baz açığı düzeyleri 3 gün ve üzeri YBÜ’de kalan hastalarda daha yüksek, albümin değerleri ise daha düşüktü (p=0,04, p=0,004, p=0,034, p=0,025). Çalışma süresi boyunca sadece 2 hastada (%3,5) mortalite gelişti. Sonuç Elektif jinekolojik onkoloji cerrahisi sonrası YBÜ takibi için en yaygın endikasyon hemodinamik instabilite olup, genel olarak YBÜ mortalitesi düşük ve YBÜ yatış süresi kısadır.

Invasion of the wall of the digestive system by ovarian cancer cells isn’t so rare. On the other hand, fistula formation between the tumor and digestive system is an uncommon status. We described a patient with ovarian serous carcinoma that was fistulized into jejenum and formed a region composed of stool and tumor surrounded and limited by small intestines recognized during surgery. This diagnosis should be kept in mind while preparing a patient for ovarian cancer surgery if the patient has acute abdomen or abdominal pain incompatible with the extent of the tumor.

This case report presents two rare cases and aims to highlight arterial thromboembolism (ATE) as a rare but potentially devastating complication following gynecologic oncology surgery. Chronic kidney disease (CKD) has been demonstrated to heighten susceptibility to thrombotic events through a variety of mechanisms, including endothelial dysfunction, uremia-associated platelet activation, impaired fibrinolysis, and systemic inflammation. In addition, other systemic and perioperative risk factors-including advanced age, malignancy-associated hypercoagulability, smoking history, hypertension, atherosclerosis, sepsis, and perioperative hemodynamic instability-may also contribute to the development of arterial thromboembolism. This report presents two rare cases of early postoperative ATE leading to acute limb ischemia, amputation, and death in patients with advanced ovarian malignancy and concomitant CKD.In the first instance, a 51-year-old female patient was diagnosed with end-stage CKD and required long-term dialysis. She subsequently underwent a surgical procedure for high-grade serous ovarian carcinoma. Severe postoperative ATE manifested on postoperative day 1, rapidly progressing to extensive ischemia. Despite escalating treatment from prophylactic to therapeutic anticoagulation and vasodilator therapy, the patient's condition continued to deteriorate, ultimately resulting in the need for amputation. The patient succumbed on postoperative day 35 due to complications from sepsis and multi-organ failure. In the second case, a 71-year-old woman with advanced-stage CKD (non-dialysis-dependent) underwent primary cytoreductive surgery for ovarian mucinous carcinoma. Bilateral lower-extremity arterial thrombosis developed on postoperative day 2, with absent distal perfusion. Despite aggressive anticoagulation and prostacyclin therapy, thigh-level amputation was necessary, and the patient succumbed on postoperative day 18 due to multi-organ failure.These cases suggest that CKD may increase susceptibility to postoperative arterial thromboembolism and may be an important predisposing factor rather than an independent causal risk factor. ATE development in this setting is likely multifactorial and should not be interpreted as a direct cause-effect relationship based on two cases. In this high-risk population, ATE may progress rapidly and remain refractory to medical therapy. Early postoperative peripheral perfusion monitoring and multidisciplinary management are essential.