Background: Epithelial ovarian cancer is an aggressive malignancy with poor prognosis despite advances in multimodal treatment. The systemic immune-inflammation index (SII) has emerged as a prognostic biomarker in various cancers; however, the impact of surgery-induced inflammatory changes remains unclear. Methods: This study evaluated the prognostic significance of postoperative changes in SII among patients with epithelial ovarian cancer undergoing primary surgery. Data from 374 patients treated at Samsung Medical Center and Kangbuk Samsung Hospital between 2016 and 2021 were retrospectively reviewed. SII was calculated from complete blood counts obtained within one month before surgery and on postoperative day 1. The percentage change in SII was analyzed, and the optimal cutoff was determined using receiver operating characteristic curve analysis. Survival outcomes were assessed using Kaplan–Meier and multivariable Cox regression models. Results: Patients with a postoperative SII increase > 98.4% (Group 2) had significantly poorer overall (HR = 1.86, p = 0.009) and progression-free survival (HR = 1.30, p = 0.112) compared with those with smaller changes (Group 1). Discussion: High-grade histology, serous subtype, and greater intraoperative blood loss were associated with higher postoperative SII. A marked postoperative increase in SII independently predicted poor survival, suggesting that dynamic inflammatory responses rather than static baseline levels provide additional prognostic information. Conclusions: Perioperative SII monitoring, easily obtainable from routine blood tests, may help identify high-risk patients who could benefit from intensified surveillance or adjuvant treatment. Prospective multicenter studies are warranted to validate these findings and explore whether perioperative modulation of systemic inflammation can improve outcomes.

A bstract: Background/Objectives: Single-port access (SPA) laparoscopic surgery has gained popularity due to its cosmetic benefits and reduced postoperative pain. However, concerns persist regarding the increased risk of adhesions due to the larger umbilical incision. This study aims to contribute to personalized medicine by evaluating the effectiveness of applying an anti-adhesive agent (Guardix SG^®, HanmiPharmaceutical Co., Ltd., Seoul, Korea) at the umbilical incision and identifying patient-specific risk factors for adhesion formation in SPA laparoscopic surgeries. Methods: In this randomized prospective study, 55 female patients with benign gynecological conditions were enrolled. Participants were randomly assigned to either an intervention group, which received the anti-adhesive agent at both the surgical and umbilical sites, or a control group, which received it only at the surgical site. Participants returned for outpatient visits 1–3 months post-surgery to assess incision site complications, including adhesions. Results: The overall adhesion rate was 10.9%, with 13.3% in the control group and 8% in the intervention group, though the difference was not statistically significant (p = 0.678). Infection rates were 6.7% in the control group and 4% in the intervention group; however, there was no significant difference in complications. Logistic regression identified pre-existing adhesions as a significant risk factor (p = 0.0379; OR = 6.909). Conclusions: Although the adhesion barrier showed a trend toward reducing umbilical adhesions, the difference was not statistically significant. The application of the adhesion barrier did not influence incision site complications, confirming its safety. Our findings highlight the need for personalized approaches to adhesion prevention, considering individual patient characteristics and risk factors. Further larger studies are necessary to explore adhesion prevention in a more personalized manner for individual patients in this context.

Uterine rupture during pregnancy, while quite rare, can have devastating consequences for both mother and fetus if it does occur. Uterine surgery is recognized risk factor for uterine rupture during pregnancy. Presently, adenomyomectomy is performed not infrequently as a treatment for infertility. However, the potential adverse outcomes associated with this procedure have not been extensively investigated. We report a case of spontaneous uterine rupture at 22 weeks of gestation following adenomyomectomy, leading to a stillbirth and maternal hypovolemic shock due to severe hemorrhage. If a pregnant woman with a history of uterine surgery presents with sudden abdominal pain, uterine rupture must be considered as a differential diagnosis. Given that spontaneous uterine rupture after adenomyomectomy can occur in the second trimester of pregnancy, it is crucial for patients with adenomyosis desiring to conceive to carefully consider the implications and risk of undergoing adenomyomectomy.

Background and Objectives: Hysterectomy is a common non-obstetric procedure. Minimally invasive techniques, such as laparoscopy and robot-assisted surgery, have replaced open surgery for benign gynecologic conditions. Robotic surgery offers reduced blood loss and shorter hospital stays but is limited by high costs. Articulating laparoscopic instruments aim to replicate robotic dexterity cost-effectively. However, comparative data on these two approaches in hysterectomy are limited. Materials and Methods: This multicenter study analyzed the outcomes of hysterectomies for benign gynecological diseases using articulating laparoscopic instruments (prospectively recruited) and robot-assisted surgery (retrospectively reviewed). The surgeries were performed by minimally invasive gynecological surgeons in South Korea, Japan, and Taiwan. The baseline characteristics, operative details, and outcomes, including operative time, blood loss, complications, and hospital stay, were compared. Statistical significance was set at p < 0.05. Results: A total of 151 patients were analyzed, including 67 in the articulating laparoscopy group and 84 in the robot-assisted group. The operating times were comparable (114.9 vs. 119.9 min, p = 0.22). The articulating group primarily underwent dual-port surgery (79.1%), whereas the robot-assisted group required four or more ports in 71.4% of the cases (p < 0.001). Postoperative complications occurred in both groups, without a significant difference (9.0% vs. 3.6%, p = 0.17). No severe complications or significant differences in the 30-day readmission rates were observed. Conclusions: Articulating laparoscopic instruments provide outcomes comparable to robot-assisted surgery in hysterectomy while reducing the number of ports required. Further studies are needed to explore the learning curve and long-term impact on surgical outcomes.

Objective: Immune checkpoint inhibitor monotherapy has shown limited efficacy in platinum-resistant ovarian cancer (PROC), although a small subset of patients experiences durable disease control. We evaluated the association between baseline systemic inflammatory markers and the clinical outcomes of pembrolizumab monotherapy. Materials and Methods: We included 95 patients with PROC who received pembrolizumab monotherapy at Samsung Medical Center between 2018 and 2023. Durable disease control was defined as a progression-free survival (PFS) ≥ 6 months. The systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were calculated from the pretreatment complete blood count. Associations with the PFS and overall survival (OS) were evaluated using multivariable Cox regression. Results: Among 94 patients evaluable for 6-month durable disease control, 10 (10.6%) achieved this endpoint. The patients with durable disease control had a lower baseline SIRI than those without durable disease control (median, 0.7 vs. 1.6; p = 0.019). In multivariable analyses, a higher log-transformed SIRI was associated with a shorter PFS (HR, 1.44; 95% CI, 1.13–1.83; p = 0.003) and OS (HR, 2.02; 95% CI, 1.53–2.67; p < 0.001). Conclusions: The baseline SIRI was associated with the PFS and OS in heavily pretreated patients with PROC receiving pembrolizumab monotherapy, and a lower SIRI was associated with durable disease control. The SIRI may provide readily available prognostic information in this setting; however, the data-derived cutoff requires prospective external validation and should not be interpreted as a predictor of the pembrolizumab-specific benefit.

Objective To compare oncologic outcomes of cystectomy versus unilateral salpingo-oophorectomy (USO) in fertility-sparing surgery for borderline ovarian tumors (BOTs) and to identify prognostic factors associated with recurrence.MethodsThis retrospective cohort study included patients with BOTs who underwent fertility-sparing surgery at a single tertiary center. To adjust for selection bias between treatment groups, propensity score–based overlap weighting analysis was applied. Disease-free survival (DFS) and overall survival (OS) were evaluated.ResultsA total of 403 patients were included. In unadjusted analyses, cystectomy was associated with significantly shorter DFS compared with USO. However, after overlap weighting, the trend toward increased recurrence risk with cystectomy was not statistically significant (HR 1.80, 95% CI 0.79–4.12; p = 0.163). Bilaterality (HR 6.23, 95% CI 2.52–15.39, p < 0.001) and serous histology (HR 6.25, 95% CI 2.70–14.29, p < 0.001) were identified as independent prognostic factors for recurrence. Progression to invasive carcinoma occurred in 2.2% of patients, with 2.0% disease-related mortality regardless of the surgical procedure.ConclusionIn fertility-sparing surgery for BOTs, recurrence risk is more influenced by intrinsic tumor characteristics – bilaterality and serous histology – but not by the surgical procedure itself. In appropriately selected patients, cystectomy represents a feasible fertility-preserving option that does not adversely affect OS.