Objective Cold coagulation, although less commonly used today, offers a less invasive alternative to excisional procedures for high-grade cervical intraepithelial neoplasia (CIN). This study evaluated post-treatment cytologic and virologic negativity rates among reproductive-age women with high-grade CIN. Methods This retrospective study analyzed the medical records of 151 reproductive-age women diagnosed with CIN2 or 3 who were treated with cold coagulation at a single tertiary referral hospital between January 2010 and April 2022. Efficacy was assessed using follow-up liquid-based cytology and human papillomavirus (HPV) tests performed 3 months to 3 years after treatment. Statistical analyses included odds ratios and a univariate Cox proportional hazards model to evaluate treatment outcomes and failure rates. Results At 6 months, cytologic negativity was achieved in 66.7% of patients and virologic negativity in 50.0%; these rates increased to 81.3% and 70.0%, respectively, by 3 years. Treatment failure occurred in 26.5% of patients. However, no significant differences in negative test rates were observed between CIN2 and CIN3 or between HPV16/18 and other high-risk HPV types. Persistent disease occurred in 25.8% of patients, whereas recurrence was observed in 2.6%. Minimal complications were reported and no cases of progression to cervical cancer were identified. Conclusion Cold coagulation demonstrated moderate post-treatment cytologic and virologic negativity rates with minimal immediate complications in this retrospective cohort. However, given the substantial rate of persistent disease and the nonstandard role of ablative treatment in settings where excision is available, these findings should be interpreted with caution.

Background/Objectives: Hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) has been reported to improve survival in patients with peritoneal carcinomatosis. This study aimed to investigate the morbidity and mortality rates of CRS with HIPEC in patients with ovarian cancers. Methods: We retrospectively reviewed the medical records of patients who underwent CRS with HIPEC for ovarian cancer from January 2013 to July 2021 at two tertiary institutions. The morbidities and mortalities that occurred within 30 days after HIPEC and the clinical and operative factors related to morbidities were investigated. Results: A total of 155 procedures in 151 patients were included in this study. The median age was 55 years and the median score of the peritoneal carcinomatosis index was eight points. Morbidities of grade ≥3 within 30 days of HIPEC occurred in 18 patients (11.6%). The most common severe morbidity was wound infection (3.2%), followed by pleural effusion (1.9%) and postoperative hemorrhage (1.9%). Within the 30-day postoperative period, there were no reported mortality cases. There were statistical differences in age, length of stay, peritoneal carcinomatosis index, bowel resection, operation time, and completeness of cytoreduction between the patients and severe morbidity. However, in the multivariate logistic analysis, none of the factors showed a statistically significant relationship with the occurrence of severe morbidity. Conclusions: The morbidity and mortality rates of CRS with HIPEC in gynecologic cancer patients were relatively low compared to those in previous reports. Further studies about the possible risk factors are needed.

OBJECTIVE:To evaluate upstaging, lymph node (LN) metastasis, and recurrence in patients with presumed stage I endometrial cancer using preoperative magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT). METHODS:Retrospective review of 422 patients with presumed clinical stage I endometrial cancer diagnosed via MRI and PET-CT (July 2014-June 2023). Surgical staging included pelvic lymph nodes (PLNs) and para-aortic lymph nodes (PALNs), classifying patients as low/intermediate- or high-risk groups. RESULTS:Post-operative upstaging rate was 14.5% (8.8% low/intermediate-risk vs. 22.8% high-risk, p<0.001). LN metastasis occurred in 5.5% of patients (2.0% low/intermediate-risk vs. 10.5% high-risk, p<0.001), with a dual imaging negative predictive value of 0.945. PLN metastasis was 4.5% (2.0% low/intermediate vs. 8.2% high-risk, p=0.003), and PALN metastasis was 2.6% (0.4% low/intermediate-risk vs. 5.8% high-risk, p=0.001). In low/intermediate-risk group: tumors ≤2cm had 1.1% LN metastasis rate, endometrium-limited 0.8%, and ≤2cm with endometrium-limited 0.9%. Deep myometrial invasion (odds ratio [OR]=4.4; 95% confidence intervals [CIs]=1.6-12.4) and tumor size >2 cm on MRI (OR=2.9; 95% CI=0.8-9.9) increased LN metastasis risk. Median 48.5-month follow-up showed an 8.1% overall recurrence rate (4.0% low/intermediate-risk vs. 14.0% high-risk, p<0.001), with 2.4% nodal recurrences (1.2% low/intermediate-risk vs. 4.1% high-risk). CONCLUSION:High-risk patients had significant upstaging, LN metastasis, and recurrence rates. Even in low/intermediate-risk groups, some patients exhibited LN metastasis and nodal recurrence, underscoring the importance of comprehensive surgical staging, including PALN evaluation, for precise diagnosis and treatment.

To compare the perioperative outcomes of surgical staging performed using conventional laparotomy (LT) or the da Vinci SP robotic system (SP) in patients with endometrial cancer. We retrospectively analyzed 180 patients with stage I–III endometrial cancer who underwent surgical staging using LT (n = 126) or SP (n = 54) at the Yonsei Cancer Center between November 2018 and December 2022. Propensity score matching (PSM) was performed to mitigate potential confounding biases. Fifty-one pairs of patients were matched by PSM. SP required longer total operation time than LT (221 vs. 142 min in SP vs. LT, respectively, p < 0.001). However, estimated blood loss and postoperative hemoglobin change were lower in SP than in LT (30 vs. 100 mL, p < 0.001; 0.6 vs. 1.6 g/dL, p < 0.001 for SP vs. LT respectively). Furthermore, postoperative minor complications (13.7

IntroductionThe aim of this study was to investigate the prevalence of paraaortic lymph node (LN) metastasis in patients with endometrial cancer, whose preoperative clinical stage was assumed to be FIGO stage l.MethodsWe retrospectively analyzed the medical records of 462 patients who underwent surgical staging for endometrial cancer at Yonsei Cancer Center from July 2014 to April 2021. The study population consisted of patients with clinical presumed stage l endometrial cancer and who underwent nodal assessment, including both pelvic and paraaortic LNs.ResultsA total of 311 patients met the eligibility criteria for the study. They were classified into low/intermediate and high-risk groups based on histology and myometrial invasion. Of the total patients, 66.9% were classified as low/intermediate risk group, while 33.1% were classified as high-risk group. After surgical staging, 28 patients (9.0%) were upstaged, and 12 patients (3.9%) were found to have LN metastasis. The incidence of LN metastasis was higher in the high-risk group (6.8%) than in the low/intermediate risk group (2.9%). However, the pattern of LN metastasis did not differ between the two groups (pelvic and paraaortic LN metastasis: 16.7% vs. 14.3%; pelvic only: 50% vs. 57.1%; paraaortic only: 33.3% vs. 28.6%, in the low/intermediate vs. high-risk group, respectively).Conclusion/ImplicationsThe incidence of paraaortic LN metastasis in endometrial cancer patients presumed to be FIGO stage l by preoperative radiologic evaluation is low. However, our findings emphasize the importance of nodal assessment, particularly in high-risk groups, as a significant number of patients were upstaged and found to have LN metastasis.

The first-line treatment for early ovarian cancer typically involves primary debulking surgery aimed at maximal cytoreduction, alongside adjuvant chemotherapy if clinically indicated. Nodal assessment involving pelvic and para-aortic lymph node dissection is typically performed during the primary debulking surgery. However, the survival benefit of lymphadenectomy in patients with early ovarian cancer has not been well established, and the procedure is associated with longer operation time and higher perioperative complications. With the emergence of minimally invasive surgery as a potential alternative to laparotomy for early ovarian cancer, sentinel lymph node biopsy has been evaluated in this setting. In this review, we summarized the current literature regarding sentinel lymph node biopsy in patients with early ovarian cancer, focusing on the clinical relevance of this method, including its detection rate and diagnostic accuracy. Additionally, we discuss the current status of clinical trials investigating sentinel lymph node biopsy in early ovarian cancer cases.

Cervical and endometrial cancers are significant gynecologic malignancies, being the fourth and sixth most prevalent cancers in women in 2020, respectively. Gynecologic cancer staging, especially lymph node (LN) metastasis evaluation, profoundly affects patient treatment and prognosis. Although various modalities, including computed tomography, magnetic resonance imaging, and 18F-fluoro-2-deoxy-D-glucose positron emission tomography are available for LN metastasis assessment, their diagnostic accuracy is often insufficient, necessitating surgical LN evaluations. Traditional comprehensive lymph node dissection, once the standard, has now been replaced by sentinel lymph node (SLN) biopsy to minimize complications while maintaining accurate nodal staging. This review underscores the importance of near-infrared (NIR) imaging with indocyanine green (ICG) as an advanced method for SLN detection. NIR imaging, owing to its deep tissue penetration capabilities combined with ICG's unique properties, is comparable to former tracers for detecting SLNs, with minimal side effects and high diagnostic accuracy. Although challenges, such as difficulties in surgical skills and relatively high equipment costs, remain, this technique holds promise, demonstrating high detection rates and decreased morbidity, especially in early-stage cervical and endometrial cancers. This comprehensive review reinforces the growing relevance of NIR imaging with ICG in improving the diagnostic accuracy of SLN detection in gynecological cancers, thereby enhancing clinical decision-making and patient outcomes.

ePoster -Ovarian cancerderived from the cohort of the current trial (ClinicalTrials.govIdentifier: NCT01091636).The incremental cost-effectiveness ratio (ICER) was evaluated by dividing the incremental costs by incremental quality-adjusted life-years (QALYs) with a time horizon of 10 years.Costs were calculated from a Korean healthcare perspective, and health utility values were extracted from published sources.Results: Based on data from the trial, the mean QALY in the ICS group was 7.16 compared to 10.8 in ICS followed by the HIPEC group.With an incremental QALY of 3.64, ICS followed by HIPEC was estimated to obtain an ICER of KRW 875,944 (USD 649) per QALY.Conclusion: This economic evaluation found that ICS followed by HIPEC is cost-effective with a significant gain in QALYs.These results may support the current reimbursement of HIPEC from Korean insurance services and the management of longterm conditions.

The number of studies comparing robotic systems in endometrial cancer staging is limited. This retrospective study analyzed the medical records of 42 consecutive endometrial cancer patients, who underwent robotic staging using the da Vinci SP (SP) system, and 126 propensity score-matched patients who underwent staging using the da Vinci Xi (Xi) system. Median console and total operation times were longer in the SP group than those in the Xi group (125 vs. 77 min, p < 0.001; 225 vs. 154.5 min, p < 0.001, respectively). Notably, the median console time of the first 10 cases using SP was 184 min; it subsequently decreased to 99.5 min in the fourth 10 cases. SP had lesser postoperative hemoglobin (Hb) change (0.6 ± 0.7 g/dL vs. 1.8 ± 0.9 g/dL in Xi, p < 0.001) and lower median pain score at 6 h after surgery (2 vs. 3 in Xi, p = 0.046). Moreover, median postoperative hospital stay was shorter in the SP group (2 days) than that in the Xi group (6 days) (p < 0.001). Although SP was correlated with lower postoperative Hb change, shorter postoperative hospital stay, and lower pain score than those in Xi, it required longer operation times. Further prospective randomized studies are needed to validate the benefits of SP compared to other robotic platforms.

Objective:To analyze the survival outcome of cervical cancer patients who underwent treatments in Korea Institute of Radiological and Medical Sciences (KIRAMS) and Dongnam Institute of Radiological and Medical Sciences (DIRAMS) since 2010.Methods: We recruited the data from medical records and analyzed survival outcome with SPSS v24.This study was approved by KIRAMS Institutional Review Board.Results: Total number of patients who underwent treatments in KIRAMS or DIRAMS were 478 and 64 each.We focused on not only survival outcome but also any difference of outcome between pre-bevacizumab era and post-bevacizumab era, which was introduced from 2014 as Gynecologic Oncology Group 240 trial was published on the New England Journal of Medicine.The details will be presented by oral presentation in Korean Society of Gynecologic Oncology 2023. Conclusion:Bevacizumab was promising when used with paclitaxel-cisplatin for recurrent cervical cancer patients.Recently 'paclitaxel-cisplatin-pembrolizumab with or without bevacizumab' regimen is being recommended as a treatment of choice for recurrent cervical cancer patients.We need to clarify which regimen is best for patients by evidence of recent clinical trials.

CA 19-9 were 19.7 U/mL and 69.2 U/mL, respectively. Robot-assisted surgical staging including total hysterectomy, bilateral salpingo-oophorectomy, and retroperitoneal pelvic and paraaortic SLN biopsy was planned. Diluted ICG (1.25 mg/ mL, Dongindang Pharmaceuticals, Siheung, Korea) was prepared with an injection needle (0.7 mm needle tip, 330 mm working length, 5 mm diameter, 20 mm needle length; RZ Mediz-intechnik GmbH, Tuttlingen, Germany). Fluorescent lymphatic channels were visualized using Firefly imaging system (Intuitive Surgical, Sunnyvale, CA, USA). In this video, we described the procedure in 10 steps: (1) Exploration of abdominal cavity; (2) Peritoneal cytology; (3) Bilateral tubal ligation at fimbria; (4) ICG injection on the bilateral uterine cornus; (5) Paraaortic SLN; (6) ICG injection on the uterine cervix; (7) Pelvic SLN biopsy; (8) Total hysterectomy with bilateral salpingo-oophorectomy; (9) Saline irrigation of pelvic cavity; (10) Vaginal vault closure. Paraaortic SLNs were identified 15 minutes after ICG in - jection on the uterine cornus. After the paraaortic SLN biopsy, ICG was injected on the uterine cervix. Bilateral pelvic

Purpose: To report preliminary experience of single-port robotic surgery using the da Vinci SP surgical system in gynecologic tumors. Materials and Methods: This was a retrospective study on 100 consecutive patients who underwent da Vinci SP single-port robotic surgery between November 2018 and January 2021. All procedures were performed by an experienced gynecologic surgeon using a single 2.5-cm umbilical incision. Results: Of the 100 cases, the procedures included myomectomy (n=76), hysterectomy (n=2), endometrial cancer surgical staging (n=14), radical hysterectomy (n=3), radical trachelectomy (n=3), and ovarian cystectomy (n=2). None of the cases was converted to robotic multiport or open surgery. The median docking time was 5.0 minutes [interquartile range (IQR), 3.0-7.0], the median console time was 107.5 minutes (IQR, 78.7-155.8), and the median total operation time was 250.0 minutes (IQR, 215.0-310.0). The median estimated blood loss was 50.0 mL (IQR, 30.0-100.0), and the median change in hemoglobin level was 0.8 g/dL (IQR, 0.3-1.3). The median pain scores rated on a numerical rating scale immediately after and at 6, 12, and 24 hours after surgery were 5, 2, 2, and 2, respectively. The mean duration of postoperative hospitalization was 2.8 days. Conclusion: Da Vinci SP single-port robotic surgery was successfully performed in various gynecologic tumors without significant complications. Therefore, this surgical system could be applied in patients who want precise gynecologic surgery while minimizing surgical incision.

To evaluate the additive effects of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval debulking surgery (IDS) in patients with advanced-stage ovarian cancer. From January 2015 to February 2019, 123 patients with stages IIIC-IV ovarian cancer were treated with neoadjuvant chemotherapy (NAC) followed by IDS with optimal cytoreduction. Forty-three patients received IDS with HIPEC and 80 patients had IDS without HIPEC. The median follow-up period was 34.4 months. No differences in baseline characteristics in patients were found between the two groups. The IDS with HIPEC group had fewer median cycles of chemotherapy (P = 0.002) than the IDS group. The IDS with HIPEC group had a higher rate of high surgical complexity score (P = 0.032) and higher rate of complete resection (P = 0.041) compared to the IDS group. The times to start adjuvant chemotherapy were longer in the IDS with HIPEC group compared to the IDS group (P < 0.001). Postoperative grade 3 or 4 complications were similar in the two groups (P = 0.237). Kaplan-Meier analysis showed that HIPEC with the IDS group had better progression-free survival (PFS) (P = 0.010), while there was no difference in overall survival between the two groups (P = 0.142). In the multivariate analysis, HIPEC was significantly associated with better PFS (HR, 0.60; 95% CI, 0.39 - 0.93). The addition of HIPEC to IDS resulted in longer PFS than IDS without HIPEC not affecting the safety profile. Further research is needed to evaluate the true place of HIPEC in the era of targeted treatments.

Objectives We aimed to compare perioperative surgical outcomes of endometrial cancer surgical staging using da Vinci Xi and SP system. Methods In this study, 42 consecutive patients who underwent endometrial cancer surgical staging with da Vinci SP system (SP) since 2018 and propensity score-matched 124 patients who underwent surgery with da Vinci Xi system (Xi) were included. We compared operation time, postoperative complications and postoperative hospital stay of each group. Considering learning curve of SP robotic surgery, we also compared Xi group with each 10 cases of SP group respectively. Results The console time and total operation time were shorter in Xi group than SP group (83.7 ± 37.3 minutes vs. 133.4 ± 56.3 min; and 178.5 ± 58.7 min vs. 245.9 ± 80.5 min, respectively). Total console time of the first 10 cases of SP group was 195.2 ± 63.3 min and it decreased to 110.8 ± 47.4 min in the 4th 10 SP cases. Postoperative hemoglobin change was 0.64 ± 0.69 g/dL in SP group and 1.79 ± 0.87 g/dL in Xi group (P < 0.001). The overall postoperative complication rate was not different in two groups (10.5% in Xi and 11.9% in SP group). The median postoperative hospital stay was shorter in SP group (2 days) compared to Xi group (5 days). The median number of harvested lymph nodes were 12 (IQR: 6–20) in SP group and 6 (IQR: 3–11) in Xi group. Conclusions Robotic endometrial cancer staging using da Vinci SP system was feasible and comparable to Xi system.