BACKGROUND:To compare outcomes between older (≥ 70 years) and younger (< 70 years) patients with surgically treated endometrial cancer, evaluating the Prognostic Nutritional Index (PNI), Systemic Immune-Inflammation Index (SII), and Age-Adjusted Charlson Comorbidity Index (ACCI). METHODS:This retrospective cohort study included 319 patients who underwent surgery at a tertiary center (2014-2024). Demographics, pathology, treatment, and outcomes were analyzed. Perioperative morbidity was graded (Clavien-Dindo). Frailty (ACCI), PNI, and SII were assessed. Overall survival and disease-specific survival were analyzed in parallel; Kaplan-Meier analyses were performed overall and stratified by stage and histology. Major morbidity was analyzed with multivariable logistic regression. RESULTS:Of 319 patients, 93 (29.2%) were aged ≥ 70 years. Older patients more frequently exhibited high-grade histology, advanced stage, ASA III-IV status, high ACCI, and low PNI. Admissions to the intensive care unit were higher in older patients, but major morbidity (4.3% vs. 3.5%; p = 0.60) and 30-day mortality (1.1% vs. 0.9%; p = 0.60) were comparable between groups. Low PNI demonstrated moderate discriminatory ability for major complications. In multivariable analysis, low PNI (odds ratio 5.78; p = 0.012) and ASA III-IV (odds ratio 3.89; p = 0.047) were independently associated with major morbidity, whereas age ≥ 70 was not. For overall survival, higher PNI remained protective (hazard ratio 0.48 per 5-point increase; p < 0.001) and ASA III-IV predicted worse outcomes (hazard ratio 3.80; p = 0.002); however, chronological age was not an independent predictor. CONCLUSION:Older age is associated with more aggressive tumor biology but not with higher rates of major complications. PNI and ASA class are independent predictors of major morbidity and survival and should be integrated into perioperative risk stratification rather than using chronological age alone.

Introduction:Adult-type granulosa cell tumors (AGCTs) are rare ovarian neoplasms with a low overall incidence of recurrence, and also data on secondary recurrence and survival after relapse remain limited. This study aimed to identify factors associated with secondary recurrence and survival after recurrence in patients with recurrent AGCTs. Methods:This multicenter retrospective study included 52 patients with recurrent AGCTs identified among 484 patients treated between 2000 and 2023. Clinical characteristics, treatment modalities, and outcomes were analyzed, with a particular focus on factors associated with secondary recurrence and survival after first recurrence. Recurrence-free survival and overall survival after first recurrence (OS-FR) were evaluated using Kaplan-Meier analysis. Results:The mean follow-up duration was 99.2 ± 61.5 months. Secondary recurrence occurred in 17 patients (32.7%). A serum CA-125 level >35 U/mL at the time of first recurrence was significantly associated with an increased risk of secondary recurrence (p=0.01). Factors significantly associated with improved OS-FR included a CA-125 level ≤35 U/mL at initial diagnosis and at first recurrence, absence of residual disease following surgery for the first recurrence, and administration of salvage chemotherapy (all p<0.05). In subgroup analysis, salvage chemotherapy was associated with improved OS-FR in patients with residual disease or those who did not undergo surgery (p < 0.01), but not in patients who achieved complete cytoreduction (p = 0.67). Conclusions:Secondary recurrence remains a significant clinical challenge in AGCTs. Serum CA-125 levels, surgical outcomes at first recurrence, and the use of salvage chemotherapy may help management strategies in recurrent disease.

Background: Persistent cervical human papillomavirus (Human papillomavirus) infection remains a significant public health concern, as it is the primary etiological factor in the development of cervical cancer and its precursor lesions. While prophylactic vaccination and standard screening programs are cornerstones of prevention, a substantial proportion of women with established infection are managed conservatively, often with prolonged follow-up and associated psychological burden. Interest has therefore grown in supportive interventions that may facilitate viral clearance during routine clinical management. Methods: This retrospective cohort study included 239 women with confirmed cervical Human papillomavirus infection followed at a tertiary referral center between February 2023 and August 2025. Participants were classified into a treatment group receiving oral Papivir/Pavirona® twice daily for six months (n = 119) and a control group managed with routine clinical follow-up alone (n = 120). Human papillomavirus DNA testing and cervical cytology were evaluated at baseline and at 6 and 12 months. Results: Human papillomavirus clearance rates were significantly higher in the Papivir/Pavirona® group compared with controls at both 6 and 12 months. Cytological regression was also more frequent in the treatment group at both time points. In multivariate logistic regression analysis, Papivir/Pavirona® use emerged as the only independent predictor of both Human papillomavirus clearance and cytological regression, while demographic, reproductive, behavioral, and virological baseline characteristics were not significantly associated with outcomes. Conclusions: Papivir/Pavirona® supplementation was associated with increased Human papillomavirus clearance and cytological regression rates in women with cervical Human papillomavirus infection, suggesting a potential supportive role alongside standard clinical follow-up.

OBJECTIVE:To demonstrate the advantages of combining robotic-assisted surgery with Indocyanine Green (ICG) fluorescence imaging in the excision of pelvic retroperitoneal schwannomas, with a particular focus on nerve preservation. SETTING:Gynecologic unit of a tertiary center. PARTICIPANTS:A 47-year-old female presented with severe pelvic pain, characterized as intermittent throughout the day and not exacerbated by positional changes or activity, with no additional complaints other than occasional urinary frequency.Magnetic resonance imaging revealed a 5 cm schwannoma located adjacent to the right internal iliac vein and the right hypogastric nerve. INTERVENTIONS:A stepwise narrated video demonstrates the technique using a combined robotic-assisted surgical approach was employed, enhanced by intravenous administration of 6mg ICG at the initiation of retroperitoneal dissection. Real-time ICG fluorescence enabled clear demarcation of the hypervascular schwannoma [1], distinctly contrasting with the non-fluorescent right hypogastric nerve. This contrast facilitated atraumatic nerve lateralization [2],preserving autonomic function and enabling high surgical precision. A focal area of intense fluorescence within the tumor suggested uncapsulated tissue, prompting meticulous inspection of the excision bed, where residual capsular tissue was identified and fully excised from the deep presacral space without vascular injury. The use of robotic instrumentation allowed safe dissection near dense vascular and neural plexuses [3], particularly the internal iliac vein. The specimen and excised residual capsule were extracted transvaginally via posterior colpotomy using an endoscopic retrieval bag, minimizing abdominal trauma and preventing oncologic spillage. CONCLUSION:The combined use of robotic-assisted surgery and ICG significantly enhances intraoperative visualization, facilitates precise dissection within complex pelvic anatomy, and supports critical nerve preservation during pelvic schwannoma resection. This approach minimizes vascular injury, reduces blood loss, and enables complete tumor excision, including residual capsular tissue, without increasing surgical morbidity and faster recovery. As the first reported case of its kind, this technique demonstrates substantial clinical efficacy and offers valuable guidance for advanced gynecologic surgical practice. VIDEO ABSTRACT.

Background/Objectives: Non-ablative local therapies are increasingly used in the conservative management of human papillomavirus (HPV) infection. Coriolus versicolor, an immunomodulatory medicinal mushroom, is one such approach. This study aimed to investigate the effect of a Coriolus versicolor-based vaginal gel on HPV clearance and cervical cytological outcomes. Methods: This retrospective cohort study included 600 women with cervical HPV infection (300 treated with a Coriolus versicolor-based vaginal gel and 300 receiving standard follow-up). Baseline and six-month follow-up assessments included HPV DNA testing and cervical cytology. Results: Baseline demographic characteristics, HPV genotype distribution, infection type, and cytological findings were comparable between the groups. Overall HPV clearance was significantly higher in the treatment group than in the controls (89.3% vs. 44.7%, p < 0.001). Complete clearance of high-risk HPV genotypes, including HPV 16 (77.0% vs. 25.4%, p < 0.001) and HPV 18 (73.9% vs. 18.5%, p = 0.017), was also significantly more frequent among treated women. Cytological normalization occurred more often in the treatment group (88.4% vs. 60.4%, p < 0.001). Multivariable analysis identified use of the vaginal gel as the strongest independent factor associated with HPV clearance (adjusted odds ratio [aOR] = 10.19; 95% confidence interval [CI]: 3.52-29.47; p < 0.001). Conclusions: Treatment with a Coriolus versicolor-based vaginal gel was associated with significantly higher rates of high-risk HPV clearance and cervical cytological normalization. These findings suggest that this therapy may represent an effective adjunct in the conservative management of HPV infection; however, randomized controlled trials are warranted to confirm these results.

Severe obesity raises endometrial cancer (EC) risk and worsens outcomes. Combining metabolic bariatric surgery (MBS) with minimally invasive hysterectomy in a single encounter may streamline care. Following PRISMA 2020, we searched Scopus, Web of Science, and PubMed (final search January 2026) with a deliberately broad search strategy to identify all reports of concomitant MBS and gynecologic oncologic surgery in adult women with severe obesity and either EC or endometrial intraepithelial neoplasia (EIN). Five studies (n = 19) met eligibility. All procedures were minimally invasive. Operative time was longer than for hysterectomy alone, without increased major morbidity or hospital stay. Six-month excess weight loss ranged 42–72

Objective: To demonstrate the robotic-assisted Davydov technique for neovaginal creation in Mayer-Rokitansky-Kuster-Hauser syndrome. Design: Stepwise demonstration of the technique with narrated video. Subjects: A 27-year-old patient has been diagnosed with Mayer-Rokitansky-Kuster-Hauser syndrome since the age of 18 years. Three months ago, vaginal dilation was attempted at another medical center but was unsuccessful because of intolerance. Pelvic examination revealed a shallow vaginal dimple. Exposure: After identification of the anatomical structures, the rectovaginal and vesicovaginal spaces were dissected, creating a space for the neovaginal canal and forming anterior and posterior peritoneal flaps. After complete dissection of the rectum from the posterior pelvic peritoneum, the vaginal remnant was bluntly dissected externally under guidance of a blunt-tipped curette handle and connected adequately to the introitus. Subsequently, the created anterior and posterior flaps were individually interrupted with sutures to form the neovaginal entrance. After the neovaginal entrance was established, the robot was used again to continuously suture the uterine remnants to create the anterior neovaginal wall. The uterine remnants, rectal serosa, and internal portions of the flaps were then joined together to form the neovaginal vault. Main Outcome Measures: Demonstration of the steps for the robotic management of neovaginal creation in Mayer-RokitanskyKuster-Hauser syndrome. Results: The patient was discharged on postoperative day 1 with a soft mold in the vagina. On postoperative day 3, the soft mold was replaced with a medium-sized rigid mold. By postoperative day 6, the patient could insert a full-size rigid mold. The patient achieved full penetration and engaged in sexual activity within 1 month, with no postoperative complications observed. At the 8-month follow-up, the neovaginal cavity measured 13.4 cm in depth and 4.7 cm in diameter. Conclusion: Creating a neovagina using the robotic-assisted Davydov technique in patients with Mayer-Rokitansky-Kuster-Hauser syndrome is a safe, feasible, beneficial, and highly effective method. Although the superiority of robotic systems over laparoscopy has not yet been fully established through extensive publications, the advantages provided by high-image quality, magnification, and maneuverability are highlighted in this study. Robotic technology could be particularly beneficial for patients with obesity or those with complex pelvic anatomy because of prior surgeries.

Objective:This study aimed to assess the likelihood of detecting cancer in final pathology and evaluate the accuracy of intraoperative frozen-section assessment in cases of endometrioid intraepithelial neoplasia (EIN). Material and methods:We included patients diagnosed with EIN at Hacettepe University Hospital who subsequently underwent hysterectomy at the same center between January 2011 and March 2023. EIN diagnoses made at other institutions were re-evaluated and confirmed by co-author gynecopathologists. Results:A total of 354 patients diagnosed with EIN underwent hysterectomy. The majority of patients (68.5%) had a final diagnosis of EIN. Endometrial cancer (EC) was identified in 11.3% (n = 40) of patients in the final pathology. Advanced age (≥50 years) (OR = 2.52; 95% CI: [1.27-4.96]; p = 0.006) and menopausal status (OR = 2.62; 95% CI: [1.34-5.11]; p = 0.004) were significantly associated with an increased risk of EC. Among 263 patients who underwent intraoperative frozen-section assessment, EC was detected in 12.9% (n = 34). The sensitivity and specificity of frozen-section assessment for EC detection were 41.1% and 100%, respectively. The frozen-section assessment failed to identify only one of the seven patients who required staging surgery. Conclusion:Our study demonstrates that a preoperative EIN diagnosis carries an 11.3% risk of concurrent EC. Additionally, the likelihood of EC is significantly higher in older and postmenopausal patients. The majority of patients requiring staging surgery were identified by frozen-section assessment. Our findings indicate that frozen-section assessment provides the necessary information for adequate surgical treatment in EIN cases.

The objective of the present study was to examine how intermediate-risk factors affect the oncological outcomes of patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB2 cervical cancer who do not undergo any adjuvant treatment. A multicentric retrospective study that involved 612 patients who were diagnosed with stage IA-IB2 cervical cancer at seven tertiary gynaecological oncology centres between 1993 and 2023 was conducted. A total of 232 patients were classified as FIGO 2018 stage IB2. Patients who had received neoadjuvant chemotherapy, parametrial or surgical border involvement, received adjuvant therapy and synchronous tumours were excluded from the present cohort. Therefore, the present study cohort consisted of 120 patients who had undergone radical hysterectomy and lymphadenectomy. Among the 120 patients, 89 (74.2%) had squamous cell cancer, 18 (15%) had adenocarcinoma, 2 (1.7%) had a mixed type tumour consisting of squamous cell cancer and adenocarcinoma and 11 (9.1%) had other types of tumours (adenosquamous cancer and glassy cell cancer). Deep cervical stromal invasion was found in 68 (56.7%) patients. The duration of patient follow-up varied from 1 to 246 months, with a median of 36 months. Overall, 6 patients (5%) experienced recurrence and 1 patient (0.8%) succumbed to the disease. The 3-year disease-free survival (DFS) rate was 94%, whereas the 3-year overall survival rate was 99%. The presence of deep cervical stromal invasion had a statistically significant impact on DFS (P=0.038). Deep cervical stromal invasion was found to be associated with recurrence in patients with stage IB2 cervical cancer. Hence, the present study demonstrated that the presence of deep cervical stromal invasion may be considered a key parameter in determining whether adjuvant treatment should be applied in patients with stage IB2 cervical cancer.

OBJECTIVE:To evaluate the incidence of lymphocyst formation in patients undergoing pelvic and/or para-aortic lymphadenectomy for gynecologic malignancies and identify associated factors. METHODS:A retrospective analysis was performed on 614 patients who underwent lymphadenectomy for primary endometrial, ovarian, or cervical cancer at Hacettepe University between 2014 and 2019. RESULTS:Of the 614 patients, 276 (45%) had endometrial cancer, 262 (42.6%) had ovarian cancer, and 76 (12.4%) had cervical cancer. Postoperative lymphocyst formation occurred in 187 patients (30.5%), predominantly in the pelvic region (91.4%). Lymphocyst incidence was not significantly influenced by primary cancer type. Factors such as age, menopausal status, the extent of surgery and the use of pelvic drains or absorbable hemostats did not significantly affect lymphocyst formation. However, para-aortic lymphadenectomy, neoadjuvant therapy, adjuvant therapy, and the number of lymph nodes removed were identified as significant factors contributing to the development of lymphocysts. In multivariate analysis, only para-aortic lymphadenectomy (OR 2.17, 95% CI: 1.26-3.73) and neoadjuvant therapy (OR 2.31, 95% CI: 1.28-4.19) were found to be independent parameters associated with lymphocyst development. Symptomatic or complicated lymphocysts requiring intervention occurred in 16 patients (8.6%), representing 2.6% of the total patient cohort. The most common reason for intervention was infection within the lymphocyst. CONCLUSION:Lymphocyst formation is a frequent complication following gynecologic cancer surgery, often remaining asymptomatic and detected incidentally during routine follow-ups. Lymphocysts are generally not a cause for concern, but they can lead to complications like infection, which requires intervention.

OBJECTIVE: To evaluate the histopathological findings of patients with high-risk human papillomavirus (hr-HPV) positivity. STUDY DESIGN: This retrospective cohort study included 814 women aged 30–65 years who underwent colposcopic evaluation following a positive hr-HPV DNA result detected using the Hybrid Capture 2 test (Qiagen, Hilden, Germany). HPV genotyping and concurrent cervical cytology were performed for all participants. RESULTS: Among the cohort, 495 women were positive for HPV 16 and/or 18, while 319 had non-16/18 hr-HPV types with negative cervical cytology. Colposcopic biopsy was performed in 515 cases. The prevalence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was significantly higher in women with HPV 16/18 and negative cytology (23.3%) compared to those with non-16/18 hr-HPV and negative cytology (3.8%) (p=0.001). In the subgroup with HPV 16/18 positivity, CIN2+ lesions were detected in 42.6% of women with LSIL and 21.2% of those with ASCUS cytology (p=0.043). Among patients with ASCUS cytology, CIN2+ was identified in 40% of those with HPV 31 and only 6.3% of those infected with other non-16/18/31 hr-HPV types (p=0.021). Among patients with non-16/18 HPV DNA types, regardless of cytology, there was no statistically significant difference in terms of CIN2+ lesions between those with HPV type 31 and those with other high-risk types (excluding HPV 16, 18, and 31). CONCLUSIONS: HPV 16/18 remains the highest-risk group regardless of cytology. Among non-16/18 HPV patients, no significant difference in CIN2+ risk was found between HPV 31 and other types overall. However, HPV 31 poses a higher risk in patients with ASCUS cytology, indicating the need for closer management in this subgroup. Therefore, a more individualized evaluation is recommended for non-16/18 HPV infections.

Background: To identify prognostic factors related to survival in patients with early-stage cervical cancer treated with radical surgery in six high-volume gynecologic oncology centers in Turkey. Methods: This retrospective analysis examined a cohort of 612 patients diagnosed with cervical cancer who underwent type II/III radical hysterectomy and pelvic lymphadenectomy, with or without para-aortic lymphadenectomy at six gynecologic oncology centers. A total of 537 patients between 1993 and 2023 were included. According to the 2009 FIGO staging system, 411 patients (76.5%) were stage IB1, 76 (14.2%) were stage IB2, 40 (4.7%) were stage IIA1, and 10 (1.9%) were stage IIA2. Patients underwent either type II or type III radical hysterectomy with pelvic lymphadenectomy, with para-aortic lymphadenectomy performed in 93.1% of cases. Among the 537 patients, 258 (48%) underwent type II radical hysterectomy and 279 (52%) underwent type III. Univariate and multivariate analyses of 5-year overall survival (OS) and 5-year disease-free survival (DFS) were performed. Results: In the entire cohort, 258 (48%) patients underwent radical surgery alone, while 279 (52%) patients underwent radical surgery followed by adjuvant therapy. The 5-year DFS and 5-year OS rates were 85.3% and 98.4%, respectively. In the multivariate logistic analysis, lymph node metastasis was identified as an independent prognostic factor for DFS and OS. Conclusions: Lymph node metastasis was the most important prognostic factor for survival in this large multicenter Turkish cohort. These findings highlight the prognostic value of nodal status, stromal invasion, margin status, and LVSI, while underscoring the importance of tailored adjuvant treatment strategies.

Objective:Within the International Federation of Gynecology and Obstetrics (FIGO) 2023 staging framework, stage IC endometrial carcinoma denotes tumors with aggressive histology confined to the endometrium, without myometrial invasion. This study evaluated treatment outcomes and survival following adjuvant radiotherapy (RT). Materials and Methods:Twenty-eight patients diagnosed with FIGO 2023 stage IC endometrial carcinoma who were treated with adjuvant RT were retrospectively analyzed. Results:The most common histologic subtype was serous carcinoma (39%), followed by clear cell carcinoma (25%), high-grade endometrioid carcinoma (25%), carcinosarcoma (7%), and undifferentiated carcinoma (4%). Half of the patients received RT alone, while the remainder received combined RT and chemotherapy. Vaginal brachytherapy was the predominant adjuvant RT technique (86%). The median duration of observation was 59 months. The 2-and 5-year overall survival (OS) rates were 96% and 87; locoregional recurrence-free survival (LRRFS) rates were 96% and 82; and distant metastasis-free survival (DMFS) rates were 92% and 80%, respectively. The presence of malignant peritoneal cytology during surgical staging predicted significantly poorer 5-year OS (93% vs. 33%), LRRFS (86% vs. 33%), and DMFS (90% vs. 0%). Within this limited cohort, the addition of chemotherapy to adjuvant RT did not confer a clear survival advantage. No severe treatment-related toxicities were observed. Conclusion:While patients with FIGO 2023 stage IC endometrial carcinoma typically achieve favorable outcomes after adjuvant RT, malignant peritoneal cytology remains an adverse prognostic factor. In this subgroup, escalation of adjuvant therapy, such as combination chemotherapy, may be appropriate.