Ovarian cancer (OC) remains one of the most challenging gynecological malignancies to cure, despite recent advances in treatment. Disparities in the diagnosis, management, and survival of OC exist worldwide and addressing them remains an ongoing challenge. The highest burden of OC is projected to be in women living in low- and middle-income countries, where mortality rates are also disproportionately higher. Maximal effort cytoreduction paired with maximal effort systemic therapy followed by maintenance therapies remain the cornerstones of treatment for OC. Disparities are twofold: first, due to challenges with systemic therapy; and second, due to variations in surgical care, especially for advanced disease. While the goals of surgery remain unchanged, the radicality of cytoreductive resections and variation in practices worldwide have increased. The provision of surgical care for OC patients faces numerous challenges broadly categorized into three main areas: health system barriers; patient-related barriers; and physician-related barriers. Health system challenges include the lack of centralized cancer care, scarcity of resources, and inadequate funding. Patient-related obstacles include disparities in patient education, comorbidities, socioeconomic factors, and underrepresentation of certain ethnicities in clinical trials. Physician-related barriers encompass suboptimal surgical training, limited access to educational resources, inconsistent adherence to guidelines, limited use of a multidisciplinary team and overall differences in philosophy, ethos, and surgical tradition. Addressing and overcoming these barriers is essential to ensure equitable access to high-quality surgical care for OC patients worldwide. The aim of the present review was to further explore these global challenges while also highlighting potential strategies to reduce disparities in women's health care.

OBJECTIVE:This study aimed to evaluate surgical outcomes of rectosigmoid resection versus rectosigmoid wall stripping for superficial tumor involvement during cytoreductive surgery for advanced ovarian cancer. METHODS:This retrospective study included patients with the International Federation of Gynecology and Obstetrics stage III to IV ovarian cancer who underwent rectosigmoid resection or rectosigmoid wall stripping during primary or interval cytoreductive surgery between January 2021 and January 2024. Inverse probability of treatment weighting was used to balance baseline characteristics. Perioperative and oncologic outcomes were compared using appropriate statistical tests, including χ2, Fisher exact, Wilcoxon rank-sum, and Z-tests. RESULTS:A total of 322 patients (rectosigmoid resection, n = 182; rectosigmoid wall stripping, n = 140) were included. A transition from rectosigmoid resection to rectosigmoid wall stripping began in mid-2022, resulting in an 83% reduction in rectosigmoid resection and a 900% increase in rectosigmoid wall stripping by late 2023. Rectosigmoid wall stripping was associated with shorter operation time (310 vs 400.8 minutes, p < .0001), lower blood loss (median, 489.4 vs 700 mL, p < .0001), fewer transfusions (31.3% vs 54.4%, p = .0002), shorter hospital stays (median, 11 vs 12 days, p = .0001), fewer thromboembolic events (6% vs 13.0%, p = .0356), and faster chemotherapy initiation (20 vs 22 days, p = .0002). Complete cytoreduction rates (72.6% vs 79.0%, p = .5152) and 6-month mortality (2.3% vs 1.7%, p = .6795) were similar. The rectosigmoid resection group showed a trend toward higher rates of bowel perforation (3.0% vs 0.8%) and fistula formation (2.0% vs 1.0%), although these differences were not statistically significant. CONCLUSIONS:For superficial and limited rectal serosal involvement, rectosigmoid wall stripping achieved macroscopic tumor clearance while reducing perioperative complications compared with rectosigmoid resection, which should be reserved for deeper or more extensive disease. Six-month follow-up showed comparable mortality rates between the 2 groups. Long-term and large-scale data are needed to ensure comparable oncologic safety.

(Abstracted from Int J Gynaecol Obstet 2025, doi: 10.1002/ijgo.70033) Ovarian cancer is the eighth most common cancer globally in women, and the annual incidence is 324,000 cases; annual cases are on the rise, with a predicted increase of 55% by 2050. The highest disease burden for ovarian cancer rests on women in low- and middle-income countries (LMICs), where mortality rates are high and access to care is limited.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This article has been retracted at the request of the Editors. After careful consideration, the Editorial Team has made the decision to retract the manuscript titled “Role of lymphadenectomy in advanced ovarian cancer—a subgroup analysis of the patients excluded from the LION trial (the Charité cohort)’". The decision is based on numerous discrepancies and substantial modifications introduced following the last formal review by the Editorial Team. While the Editors acknowledge that revisions are a natural and expected part of the editorial process, the extent and nature of these changes raised serious concerns regarding the consistency and reliability of the data presented. Maintaining the highest standards of scientific rigor and transparency is central to our journal's mission, and as such, we believe this retraction is necessary.

RA: Honoraria Novocure, EISAI/MSD, GSK, Roche, Astra Zeneca. CF: Honoraria received from Ethicon, GSK, Astra Zeneca/MSD, Roche, Oncoinvent. JS: Homoraria Novocure, EISAI/MSD, GSK, Roche, Astra Zeneca. Research data are not shared.

The management of gynecological cancer has evolved considerably over the past decades in almost every field of treatment. Surgery plays a major role in the treatment algorithm. However, these invasive interventions can have profound implications for the quality of life (QoL) of affected individuals. The routine implementation of QoL measurements in clinical trials has become common, reflecting a new research 'standard', despite the fact that all available QoL instruments were not designed nor validated prospectively for surgical trials. This review seeks to address whether patient reported outcomes and QoL measurements rightfully take center stage in current surgical trials, leading to direct implementation for the benefit of patient care, or are they simply more of a researcher's hope. We will also provide an 'action plan' to better implement QoL measurements in future surgical trials.

Although the incidence of cervical cancer in Europe is declining it remains a major public health problem, particularly in limited-resourced countries, with wide variations in regional and national management. Cervical cancer is still the leading cause of cancer-related death in women in eastern,

With growing knowledge about ovarian cancer over the last decades, diagnosis, evaluation and treatment of ovarian cancer patients have become highly specialized, and an individually adapted approach should be made in each woman by interdisciplinary cooperation. The present study aims to show the variety and extent of medical specialties involved at our institution according to the European Society of Gynecologic Oncology (ESGO) Quality indicators (QI). A woman, diagnosed with high-grade ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) class IVb was selected for a single case observational study. The observation period (total = 22d) comprised preoperative diagnostic procedures, including imaging, the in-patient stay for cytoreductive surgery, and the postoperative course and case discussion at our interdisciplinary tumor board. Data were obtained by self-reporting and by patient file review. Patient tracking demonstrated an interdisciplinary cooperation of 12 medical specialties [62 physicians (63

Objective To investigate the prognostic value of cancer antigen 125 (CA125) related variables on progression free survival and overall survival in primary and recurrent ovarian cancers. Method A comprehensive review of the Medline, Embase, and Cochrane Library databases was conducted to identify relevant literature on survival outcomes according to the ELIMination Rate Constant K (KELIM), Gynecologic Cancer InterGroup (GCIG) CA125 response criteria, CA125 half-life, and CA125 nadir levels during first line or later line chemotherapy. The search included articles published before February 2023. Cut-off values determining the favorable/unfavorable score of each study were extracted, and pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed using a random effects model to identify the relationship between survival outcomes of the favorable/unfavorable groups, which was determined by an individual model using CA125 kinetics. Results A total of 27 studies with 14 444 patients with epithelial ovarian cancer were included in this meta-analysis. In primary ovarian cancer, a favorable KELIM score, determined by individual modeled cut-off values, was associated with a significant progression free survival (HR 0.53, 95% CI 0.45 to 0.62) and overall survival (HR 0.51, 95% CI 0.43 to 0.62) benefit in the primary setting. The favorable KELIM scored group also correlated with a better progression free survival (HR 0.54, 95% CI 0.47 to 0.62) in relapsed disease. We failed to demonstrate a better prognostic value of the GCIG response criteria and the CA125 half-life for progression free survival and overall survival. Conclusion Novel chemotherapy response scores, such as KELIM, may be more clinically relevant than other prognostic models using CA125 kinetics, being directly associated with a more favorable survival in both the primary and relapsed setting in patients with epithelial ovarian cancer. Study registration The systemic review and meta-analysis were registered in PROSPERO (CRD42023385512).

IntroductionThe results of the prospective randomized phase-III LION-trial failed to demonstrate a therapeutic benefit from LND in tumor-free operated advanced OC patients with macroscopically normal appearing LN. Patients were randomized intraoperatively with exclusion of those thought by the surgeon not to be fully operable or with suspicious/bulky LN by inspection or palpation. We wished to address the surgical and survival outcomes of this excluded group in a single center.MethodsThis is a monocentric analysis in a tertiary ESGO-accredited center of excellence for OC. A total of 202 patients were screened for the original study; 120 were excluded, and 82 included in the final LION analysis. Excluded cases were retrospectively analyzed according to the same endpoints (PFS and OS) of the LION-trial with a subsequent comparison analysis.ResultsOverall, 195 patients were included in the present analysis. Rate of CR was with 45% significantly lower in the intraoperatively excluded patients vs the tumor-free operated patients of the original LION analysis. This had a significantly negative impact on OS and PFS. Only 60% of the screening failed patients had histologically positive LN in final pathology. There was no significant difference in PFS or OS between the tumor-free operated screening failed patients versus those randomized, regardless of their histological LN-status and whether an LND was performed.Conclusion/ImplicationsOur findings confirm the lack of therapeutic LND in advanced OC even in patients with suspicious LN. Non-tumor-free operated patients had worse outcome. We demonstrated that intraoperative LN evaluation by the surgeon is subjective and inaccurate.

Research Question What are the growth patterns of uterine myomas in untreated premenopausal women? Which factors influence the growth rate of uterine myomas in premenopausal women? Method All premenopausal women who presented to the outpatient myoma consultation clinic between January 2005 and March 2022 at least twice were screened. Exclusion criteria were hormonal therapy, pregnancy, and postmenopausal status. Results A total of 189 patients were included in our study which focused on the respective largest uterine myoma of each woman. An ideal linear growth over time was assumed. Most myomas ( 82%) increased in size. The mean annual growth of these myomas was 68.42 cm(3). The most important prognostic factor for growth was the initial size of themyoma. The absolute annual growth of myomas measuring > 50 cm(3) at first presentation was higher compared to smaller myomas (p < 0.001). The relative annual growth rate was highest for myomas measuring between 20 and 50 cm(3) at the initial presentation (p = 0.003). The relative annual growth rate in women older than 40 years was significantly lower than that in women below the age of 40 years (p = 0.003). Conclusion Overall, it is difficult to make an individual prognosis about the growth pattern of a uterine myoma in a specific patient. It should be noted especially in asymptomatic patients that spontaneous regression of myoma size can also occur in premenopausal women.

OBJECTIVES:Benign leiomyomas are the most common uterine tumors. In contrast, uterine leiomyosarcomas are malignancies with a poor prognosis due to difficulties in early diagnosis and inappropriate surgical treatment. Most often they are diagnosed incidentally after surgery performed for treatment of leiomyoma. As the appropriate surgical treatment is crucial for survival of the patient, there is a high demand to predict leiomyosarcoma pre-operatively. Available scoring systems to discriminate leiomyoma from leiomyosarcoma are based on retrospective studies with limited numbers of patients and are not implemented in routine clinical practice. METHODS:The aim of our study was to evaluate a recently published score-the pre-operative leiomyosarcoma (pLMS) score-to determine whether it would have been predictive of leiomyosarcoma in 177 patients from the NOGGO-REGSA study, a German register of histologically proven gynecological sarcoma detected during routine clinical investigation. RESULTS:The threshold of the pLMS score for 'leiomyosarcoma not probable' (< -3) failed for 7.5% of the patients and the threshold 'indicator for leiomyosarcoma' (>+1) was true for 39.1% of the patients. 53.4% of the patients were attributed to the group 'additional investigations are recommended' (-3 to +1). The most relevant parameters in our analysis were suspicious sonography and rapid growth, but neither have been quantitatively defined. CONCLUSION:In our validation cohort, the pLMS score seems not to be a reliable tool to predict leiomyosarcoma and therefore we do not recommend its clinical implementation to identify leiomyosarcoma.

Lymphedema is a frequent complication after surgical treatment in gynecological oncology with substantial impact on patients´ Quality of Life (QoL). Little is known about screening instruments and prevention. Primary objective was to develop and validate the German version of a 13 items screening questionnaire (SQ) developed by Yost et al. to provide a valid instrument for early diagnosis of lower extremity lymphedema (LEL). After translation the SQ was used in pt. with cervical or endometrial cancer who underwent pelvic/paraaortic Lymphadenectomy. Sensitivity and specifity were analysed regarding possible prediction and influencing factors of LEL. 67 pt. had LEL (N = 128). Nearly 50% of women in each group (38 in LEL + e 30 in LEL − ) had a body mass index (BMI) > 30 kg/m2. Number of removed lymphnodes, radiotherapy and were significantly associated with development of LEL. Translated Mayo Clinic questionnaire can be used with reliable specifity and sensitivity. Four additional questions improved the diagnostic accuracy of the SQ. The translated SQ is a valuable and predictive tool for screening and early detection of LEL in Gynecological cancer surgery and can even improved by adding simple questions.