Background: Recurrence poses a major challenge in epithelial ovarian cancer (EOC), often occurring despite optimal first-line therapy. Dormant cancer cells are believed to play a key role, yet the mechanisms driving their reactivation remain unclear. This study examined whether exosomes released by normal peritoneal mesothelial cells (PMCs) and fibroblasts (PFBs) undergoing iatrogenic senescence after carboplatin and paclitaxel exposure contribute to EOC recurrence. Methods and Results: Senescent PMCs and PFBs secreted markedly more exosomes, identified by CD9, CD63, and CD81, compared with young cells. Exosomes from both cell types more effectively reactivated dormant EOC cells (pEOCs, A2780, OVCAR-3, SKOV-3) than non-exosomal medium constituents. Importantly, senescent PMC-derived exosomes most strongly reactivated pEOCs and SKOV-3, whereas those from senescent PFBs exerted greater effects on pEOCs, OVCAR-3, and SKOV-3. Kinetic studies of exosome internalization revealed that this process was generally more efficient in the presence of exosomes derived from senescent cells compared with those from young donor cells. Compositional analysis revealed distinct profiles between young and senescent exosomes compared in two variants: young PMCs/senescent PMCs and young PFBs/senescent PFBS. Senescent PMC exosomes displayed reduced miR-210-3p, miR-409-3p, and miR-421, alongside elevated MMP1, MMP3, and VEGF, while senescent PFB exosomes showed increased amphiregulin and osteopontin but lower MMP1, MMP3, TIMP1, bFGF, VEGF, and HGF. Functionally, senescent PMC exosomes enhanced pEOC migration, invasion, and spheroid formation, and induced the expression of CCL11 and ABCB1. Senescent PFB exosomes promoted migration and upregulated CCL11, TGF-β1, BIRC5, and CHEK1. Conclusions: These findings suggest that therapy-induced senescence in peritoneal cells may contribute to EOC recurrence by reactivating dormant tumor cells through exosomal signaling.

Background/Objectives: Epithelial ovarian cancer (EOC) remains a gynecologic malignancy with a poor prognosis, with a 5-year survival of approximately 29% in advanced-stage disease. Despite cytoreductive surgery and platinum- and taxane-based chemotherapy, most patients relapse within 2 years. Major therapeutic barriers include chemoresistance, molecular heterogeneity, and an immunosuppressive peritoneal microenvironment. This review summarizes emerging therapeutic strategies for EOC, their mechanisms of action, and their potential to overcome treatment resistance. Methods: PubMed/MEDLINE was searched for preclinical studies, phase I-III clinical trials, systematic reviews, and meta-analyses addressing novel ovarian cancer therapies and resistance mechanisms. Results: The review covers molecularly targeted therapies, immunotherapies, metabolic and epigenetic approaches, cellular and gene therapies, targeted drug-delivery systems, and locoregional and physical modalities. Strategies include PARP inhibitors, antiangiogenic agents, antibody-drug conjugates, pathway inhibitors, immune checkpoint inhibitors, cancer vaccines, adoptive cell therapies, metabolic and epigenetic modulators, CAR-T, CAR-NK, CRISPR/Cas9, HIPEC, PIPAC, ablation, photodynamic therapy, and sonodynamic therapy. Conclusions: The clinical maturity of these approaches varies substantially. PARP inhibitors, antiangiogenic agents, selected antibody-drug conjugates, MAPK-directed therapy in LGSOC, and HIPEC in selected settings have the strongest clinical support. Most immune combinations, metabolic and epigenetic therapies, adoptive cell therapies, gene-editing approaches, and novel delivery or physical modalities remain early clinical or predominantly preclinical. Progress will depend on biomarker-guided patient selection, reassessment of evolving resistance mechanisms, and rational treatment sequencing and combinations.

Introduction: Uterine penetrating wounds in pregnant women are rare. Usually, they are caused by traffic accidents, but sometimes they are an effect of violence, accidental injuries, or deliberate self-harm. Case Report: We present a case of a stab wound to the uterus in a 25-year-old woman in the 37th week of pregnancy, which was the result of a knife attack. Emergency splenectomy and cesarean section were performed less than an hour after the attack. The child required resuscitation and long-term intensive therapy. Both the woman and the newborn survived; however, the newborn’s condition remained poor. The child died a few months later, according to community-acquired pneumonia. Discussion: Cases of wounds penetrating the uterus have been described for many years around the world. They are often the result of violence, most often from the partner. Statistically, pregnant women are more likely to be victims of violence. Sometimes, the wounds penetrating the uterus are accidental and arise, for example, as a result of a fall. A rare but not isolated case is self-mutilation to terminate a pregnancy. Women often inflict such injuries on themselves using sharp tools, sometimes firearms. There are also cases of another person helping to terminate a pregnancy in this way. Conclusions: Violence against women, including pregnant women, remains a significant social problem in all regions of the world and poses a challenge to uniformed services, medical professions, and social services. Regardless of the mechanism of injury, in the event of an imminent threat to the life of the mother and fetus, it is crucial to make quick decisions aimed at saving lives.

Background/Objectives: Peritoneal carcinomatosis is the leading cause of death in advanced ovarian cancer (AOC). Mesothelial cells lining the peritoneum modulate tumor implantation, yet the role of their apoptosis in metastasis development remains unclear. This study investigated the relationship between mesothelial cell apoptosis and metastatic spread in ovarian cancer (OC). Methods: The study included 26 patients with AOC, 11 with early-stage OC (EOC), and 13 healthy controls. Apoptotic activity in parietal peritoneal wall and omental mesothelial cells was assessed using the TUNEL technique. Metastases were classified as pushing or infiltrating. Associations with the peritoneal cancer index (PCI), BRCA mutation, and homologous recombination deficiency (HRD) status were analyzed. Results: Mesothelial cells adjacent to AOC metastases exhibited significantly higher apoptotic activity compared to controls (p < 0.05). Apoptosis was greater near infiltrating metastases than near pushing ones in both parietal (p < 0.01) and omental (p = 0.04) sites. The infiltration pattern was consistent between omental and parietal metastases (R = 0.588, p < 0.01). No significant differences in apoptosis were found between EOC and healthy controls, or in tumor and stromal cells between invasion types. Mesothelial apoptosis was independent of PCI, BRCA mutation, and HRD status. Conclusions: Our study suggests that mesothelial cell apoptosis may be associated with peritoneal spread in OC. Mesothelial cell apoptosis is more pronounced near infiltrative-type lesions, independent of BRCA/HRD status. These findings highlight mesothelial apoptosis as a relevant process in peritoneal dissemination. Further studies are needed to clarify its role in ovarian cancer progression.

Introduction.The treatment of pregnant women with placenta accreta spectrum (PAS) remains both an organizational and therapeutic challenge. In recent years, the number of caesarean sections has increased, and caesarean section, alongside placenta previa, is one of the main risk factors for placental invasion. The PAS is no longer rare, with placenta percreta (invasive placenta) accounting for 5% of cases — these being the most severe in terms of treatment comple­xity. The currently recommended approach involves an elective classical caesarean section with leaving the placenta in utero and performing simultaneous peripartum hysterectomy. Alternatively, conservative management with leaving the placenta in situ and possible delayed hysterectomy is an option. Hemorrhage and other severe complications can occur in up to half of PAS cases, with an even higher incidence in conservative management. Therefore, the technique of hysterectomy and the surgical expertise of the operator play a crucial role in minimizing the risk of hemorrhage and urinary tract injury. Peripartum hysterectomy for placenta percreta falls into the category of multiorgan resections, incorporating a modified radical hysterectomy. Technically very similar procedures are commonly performed by gy­necologic oncologists in the treatment of advanced ovarian malignancies. The preferred technique in such cases is often the Hudson operation, a modification of the classical Wertheim procedure. In order to properly perform such an operation, it is necessary to dissect the avascular spaces within the operative field, which helps prevent hemorrhage and reduces the number of other complications. Material and methods.A multicenter retrospective comparative study included 166 patients. Clinical and organi­zational parameters characterizing the course of surgical treatment were analyzed in the following patient groups: those operated on for placenta percreta and ovarian cancer. The reference group consisted of patients who underwent surgery for cervical cancer. Results.The risk of hemorrhage in modified radical hysterectomy was highest in procedures performed for placenta percreta. In these cases, statistically more units of packed red blood cells (pRBC) and fresh frozen plasma (FFP) were transfused, although the procedure itself did not take significantly longer. Blood loss was lower when more avascular spaces were dissected. The highest number of avascular spaces were prepared in radical hysterectomy for cervical cancer, while the lowest number was associated with surgeries for placenta percreta. Conclusions.The dissection of avascular spaces is one of the methods to reduce the risk of uncontrolled blood loss during radical hysterectomy.

Chronological age does not correlate precisely with physiological age, nor is age alone a predictor for the risk of poor recovery from surgery. Instead, it is necessary to determine patient frailty, defined as an ability to maintain homeostasis after stressors linked to the applied therapy, including extensive surgery. The clinical usefulness of the frailty assessment prior to surgery has been correlated with long-term outcomes in ovarian cancer patients and with the proposed modification of the Frailty Index as the Memorial Sloan Kettering-Frailty Index (MSK-FI) that includes both functional assessment and comorbidity. The aim of this study was the assessment of the frailty status of 114 patients based on the MSK-FI relative to the rates of 5-year overall survival in a group of older patients more than 70 years old treated surgically due to ovarian cancer. In our group of older patients operated on due to ovarian cancer, we have observed statistically significantly longer OS when the frailty status index as measured by the MSK-FI was less than 3. Notably, the patients from the high-risk group (MSK-FI ≥ 3) had statistically significant lower rates of complete resections. As the frailty status of the patient is a useful predictor of perioperative morbidity, it should be precisely determined prior to beginning treatment. The MSK-FI helps to support this process.

Background/Objectives: The primary aim of this systematic review was to evaluate fertility outcomes and the oncological safety of different surgical techniques of radical trachelectomy (RT). Methods: The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search on PubMed, Embase, and Google Scholar was performed between 1 November 2023 and 31 March 2024 with no limits for the time of publication. Results: In total, 56 studies met the inclusion criteria: 22 for abdominal RT (1712 patients), 14 for endoscopic RT (445 patients), and 22 for vaginal RT (1158 patients). Data regarding certain steps of the procedure (uterine artery preservation, autonomous nerve-sparing, abdominal cerclage, types of sutures used for the cerclage, uterine dilatation during cerclage placement, prolongation of uterine catheterization, type of uterovaginal anastomosis, antibiotic prophylaxis, and suppression of menstruation) were extracted and analyzed with regard to the obstetrical and oncological outcomes. Endoscopic RT was associated with a significantly higher pregnancy rate and a lower rate of preterm deliveries. Uterine artery preservation was associated with a higher live birth rate. Nerve-sparing RT resulted in a higher pregnancy rate, but no differences in the attempt for pregnancy and live birth rates were observed. Conclusions: Taking into account the obstetrical outcomes, it seems that the preferred option for radical RT is an endoscopic procedure with preservation of the uterine artery and the pelvic autonomic nerves. However, the safety of the endoscopic approach should be evaluated in prospective trials.

INTRODUCTION: Nodal status is a major factor influencing the survival rates of cervical cancer patients. According tothe 2018 International Federation of Gynecology and Obstetrics (FIGO) classification system, the presence of lymphnode metastases is a criterion for stage IIIC cervical cancer. In contrast to merely indicating the presence or absenceof lymph node metastases, calculating the lymph node ratio LNR [number of positive lymph nodes (LNs)/number of harvestedLNs] can provide additional clinical information about nodal status. In a group of node-positive patients whohad early-stage cervical cancer followed by surgical treatment, high LNR was associated with poor patient survival. MATERIAL AND METHODS: In the present retrospective study, 5-year and 10-year overall survival rates for 310 patientsdiagnosed with stage IB–IIA cervical cancer were analyzed based on the 2009 FIGO classification system. Of thesepatients, 72 had lymph node metastases. We evaluated the number of metastatic LN and calculated the LNR. We thenassessed the 5-year and 10-year overall survival (OS) in relation to the LNR. RESULTS: The multivariant survival analysis of a group of 72 patients with pelvic lymph node metastases revealed that0.25 was the optimal LNR cutoff value for differentiating between short-term and long-term survivors. CONCLUSIONS: Lymph node ratio may be used to stratify a high-risk population of patients with cervical cancer and maybe crucial for identifying those patients who might benefit from adjuvant therapy.

Carboplatin (CPT) and paclitaxel (PCT) are the optimal non-surgical treatment of epithelial ovarian cancer (EOC). Although their growth-restricting influence on EOC cells is well known, their impact on normal peritoneal cells, including mesothelium (PMCs) and fibroblasts (PFBs), is poorly understood. Here, we investigated whether, and if so, by what mechanism, CPT and PCT induce senescence of omental PMCs and PFBs. In addition, we tested whether PMC and PFB exposure to the drugs promotes the development of a pro-cancerogenic phenotype. The results showed that CPT and PCT induce G2/M growth arrest-associated senescence of normal peritoneal cells and that the strongest induction occurs when the drugs act together. PMCs senesce telomere-independently with an elevated p16 level and via activation of AKT and STAT3. In PFBs, telomeres shorten along with an induction of p21 and p53, and their senescence proceeds via the activation of ERK1/2. Oxidative stress in CPT + PCT-treated PMCs and PFBs is extensive and contributes causatively to their premature senescence. Both PMCs and PFBs exposed to CPT + PCT fuel the proliferation, migration, and invasion of established (A2780, OVCAR-3, SKOV-3) and primary EOCs, and this activity is linked with an overproduction of multiple cytokines altering the cancer cell transcriptome and controlled by p38 MAPK, NF-κB, STAT3, Notch1, and JAK1. Collectively, our findings indicate that CPT and PCT lead to iatrogenic senescence of normal peritoneal cells, which paradoxically and opposing therapeutic needs alters their phenotype towards pro-cancerogenic. It cannot be excluded that these adverse outcomes of chemotherapy may contribute to EOC relapse in the case of incomplete tumor eradication and residual disease initiation. © 2023 The Pathological Society of Great Britain and Ireland.

This comprehensive review encompasses studies examining changes in the cervical and cervico-vaginal microbiota (CM and CVM) in relation to human papillomavirus (HPV) using next-generation sequencing (NGS) technology. HPV infection remains a prominent global health concern, with a spectrum of manifestations, from benign lesions to life-threatening cervical cancers. The CM and CVM, a unique collection of microorganisms inhabiting the cervix/vagina, has emerged as a critical player in cervical health. Recent research has indicated that disruptions in the CM and CVM, characterized by a decrease in Lactobacillus and the overgrowth of other bacteria, might increase the risk of HPV persistence and the progression of cervical abnormalities. This alteration in the CM or CVM has been linked to a higher likelihood of HPV infection and cervical dysplasia. NGS technology has revolutionized the study of the cervical microbiome, providing insights into microbial diversity, dynamics, and taxonomic classifications. Bacterial 16S rRNA gene sequencing, has proven invaluable in characterizing the cervical microbiome, shedding light on its role in HPV infections and paving the way for more tailored strategies to combat cervical diseases. NGS-based studies offer personalized insights into an individual's cervical microbiome. This knowledge holds promise for the development of novel diagnostic tools, targeted therapies, and preventive interventions for cervix-related conditions, including cervical cancer.

Endometrial cancer (EC) poses a significant health issue among women, and its incidence has been rising for a couple of decades. Surgery remains its principal treatment method and may have a curative, staging, or palliative aim. The type and extent of surgery depends on many factors, and the risks and benefits should be carefully weighed. While simple hysterectomy might be sufficient in early stage EC, modified-radical hysterectomy is sometimes indicated. In advanced disease, the evidence suggests that, similarly to ovarian cancer, optimal cytoreduction improves survival rate. The role of lymphadenectomy in EC patients has long been a controversial issue. The rationale for systematic lymphadenectomy and the procedure of the sentinel lymph node biopsy are thoroughly discussed. Finally, the impact of the molecular classification and new International Federation of Gynecology and Obstetrics (FIGO) staging system on EC treatment is outlined. Due to the increasing knowledge on the pathology and molecular features of EC, as well as the new advances in the adjuvant therapies, the surgical management of EC has become more complex. In the modern approach, it is essential to adjust the extent of the surgery to a specific patient, ensuring an optimal, made-to-measure personalized surgery. This narrative review focuses on the intricacies of surgical management of EC and aims at summarizing the available literature on the subject, providing an up-to-date clinical guide.

OBJECTIVES:The aim of the study was to evaluate the B7-H4 expression in endometrial cancer cells and to investigate its relationship with patient prognosis and clinicopathological features of the disease.MATERIAL AND METHODS:We performed a single-center, retrospective cohort study that included endometrial cancer patients treated between 2012 and 2019. B7-H4 expression in specimens obtained from 63 patients was examined by immunohistochemical staining. The evaluation of B7H4 immunoreactivity was assessed using Immunoreactivity Scoring (IRS) system.RESULTS:B7-H4 reactivity was observed in all, except one, endometrial cancer patients (98%). Staining intensity: no reaction in one case, weak in 16 (24%) patients, moderate in 25 (37%), and strong in 22 (35%). Twenty-nine (46%) patients showed B7-H4 immunoreactivity in more than 60% of cells, while, in 18 (29%) cases and 16 (25%) patients, the percentages were 30-60% and < 30% respectively. Median IRS was 2 (range 0-6). We found a significantly worse overall survival (OS) rate for patients with high versus low B7-H4 IRS (p = 0.03), however, in multivariate analysis, the difference in patient survival was close to the significance level (p = 0.052). B7-H4 expression was not related to histopathological type of the tumor, tumor grade, lymph node metastases, or the FIGO stage of the disease.CONCLUSIONS:Our result suggests that B7-H4 expression might be a useful prognostic factor in endometrial cancer.

OBJECTIVES:The prognosis of ovarian cancer (OC), among other factors, depends on residual disease after primary debulking surgery (PDS) and initial disease advancement. The main aim of our study was to evaluate the survival benefits of splenectomy and diaphragmatic surgery in OC patients, when the procedures result in resection to no macroscopic residual disease or minimal residual disease [tumor nodules below 2.5 mm according to Sugarbaker's completeness of cytoreduction score (CC) = 1]. MATERIAL AND METHODS:The study included 25 OC patients after splenectomy procedures, 28 patients after diaphragmatic surgery and 17 patients who had undergone both splenectomy and diaphragmatic surgery. Patients' overall survival (OS) was compared with residual disease-matched controls (47 patients) who had upper abdomen involvement but no requirement for splenectomy and/or diaphragmatic surgery. RESULTS:Overall survival of patients after splenectomy was not significantly different from OS of patients who did not required splenectomy (36.1 vs 31.6 months; p = 0.85). No differences in OS were observed between patients who did and did not require diaphragmatic surgery (31.3 vs 41.8; p = 0.33). Similarly, we found no differences in OS between patients who underwent both splenectomy and diaphragmatic surgery and those patients who did not require either procedure (20.1 vs 31.6 months; p = 0.45). Splenectomies and diaphragmatic surgeries were associated with prolonged hospitalization and length of surgery, however, no specific morbidity related to the procedures was observed. CONCLUSIONS:In the cases of advanced OC, diaphragm and spleen involvement do not hamper patient prognosis when adequately resected.

OBJECTIVES:Growing data suggest a role of Treg cells in placentation. The aim of the study was to evaluate Treg cells (FOXP3-positive cells) placental bed infiltration in patients with placenta accrete syndrome (PAS) and patients who experienced placental abruption. MATERIAL AND METHODS:The study group included 13 patients with PAS and the control group consisted of 66 women who had caesarean (CD) delivery of whom, 44 patients with elective caesarean (EC) delivery, and 22 patients with urgent caesarean (UC) delivery due to placental abruption. FOXP3 cell infiltration was assessed by means of immunohistochemistry in placental chorionic villous (CV) and in the decidua (D) and cumulatively in the placental bed (PB). RESULTS:We observed significant difference in the degree of FOXP3-positive cell CV infiltration between studied groups (p = 0.04). FOXP3-positive cells were the most commonly observed in PAS patients, while, they were the least frequently presented in patients after UC. The immunoreactivity for FOXP3-positive cells in CV were as follows: PAS 5 (38%), urgent CS 1 (5%) and elective CS 8 (18%) subjects. We found no difference in the presence of FOXP3-positive cells in the D (p = 0.35) and in the PB (p = 0.23) of analyzed groups. FOXP3-cell infiltration was not related with patient age, BMI, gestational age and neonatal birth weight. CONCLUSIONS:Our study provides further evidence that abnormal invasive placentation is an associated disturbance of the maternal immune response. Accordingly, we have theorized that alteration of the FOXP3-positive Treg cell infiltration into the placental bed allows trophoblast cell invasion.

Cancer stem cells (CSCs) may contribute to an increased risk of recurrence in ovarian cancer (OC). Further research is needed to identify associations between CSC markers and OC patients’ clinical outcomes with greater certainty. If they prove to be correct, in the future, the CSC markers can be used to help predict survival and indicate new therapeutic targets. This study aimed to determine the CSC markers at mRNA and protein levels and their association with clinical presentation, outcome, and risk of recurrence in HGSOC (High-Grade Serous Ovarian Cancer). TCGA (The Cancer Genome Atlas) database with 558 ovarian cancer tumor samples was used for the evaluation of 13 CSC markers (ALDH1A1, CD44, EPCAM, KIT, LGR5, NES, NOTCH3, POU5F1, PROM1, PTTG1, ROR1, SOX9, and THY1). Data on mRNA and protein levels assessed by microarray and mass spectrometry were retrieved from TCGA. Models to predict chemotherapy response and survival were built using multiple variables, including epidemiological data, expression levels, and machine learning methodology. ALDH1A1 and LGR5 mRNA expressions indicated a higher platinum sensitivity (p = 3.50 × 10−3; p = 0.01, respectively). POU5F1 mRNA expression marked platinum-resistant tumors (p = 9.43 × 10−3). CD44 and EPCAM mRNA expression correlated with longer overall survival (OS) (p = 0.043; p = 0.039, respectively). THY1 mRNA and protein levels were associated with worse OS (p = 0.019; p = 0.015, respectively). Disease-free survival (DFS) was positively affected by EPCAM (p = 0.004), LGR5 (p = 0.018), and CD44 (p = 0.012). In the multivariate model based on CSC marker expression, the high-risk group had 9.1 months longer median overall survival than the low-risk group (p < 0.001). ALDH1A1, CD44, EPCAM, LGR5, POU5F1, and THY1 levels in OC may be used as prognostic factors for the primary outcome and help predict the treatment response.

Recurrent disease and treatment-associated chemoresistance are the two main factors accounting for poor clinical outcomes of ovarian cancer (OC) patients. Both can be associated with cancer stem cells (CSCs), which contribute to cancer formation, progression, chemoresistance, and recurrence. Hence, this study investigated whether the expression of known CSC-associated markers ALDH1A, CD44, and CD133 may predict OC patient prognosis. We analyzed their expression in primary epithelial ovarian cancer (EOC) patients using immunohistochemistry and related them to clinicopathological data, including overall survival (OS) and progression-free survival (PFS). Expression of ALDH1A1 was detected in 32%, CD133 in 28%, and CD44 in 33% of cases. While Kaplan–Meier analysis revealed no association of the expression of CD133 and CD44 with PFS and OS, ALDH1A1-positive patients were characterized with both significantly shorter OS (p = 0.00022) and PFS (p = 0.027). Multivariate analysis demonstrated that the expression of ALDH1A1, FIGO stage III–IV, and residual disease after suboptimal debulking or neoadjuvant chemotherapy correlated with shorter OS. The results of this study identify ALDH1A1 as a potential independent prognostic factor of shorter OS and PFS in EOC patients. Therefore, targeting ALDH1A1-positive cancer cells may be a promising therapeutic strategy to influence the disease course and treatment response.

Introduction: The primary aim of our study was to analyse the impact of the lymph node ratio (LNR) and extracapsular involvement (ECI) on the prognosis of endometrial cancer (EC) patients. Material and methods: We carried out a retrospective analysis of 886 patients surgically treated for EC between 2000 and 2015. In the subgroup of patients with lymph node metastases (LNM), we evaluated the impact of the number and localization of the LNM, LNR, and ECI on patients' overall survival (OS). Results: In the group of patients with LNM, 0.3 was the optimal LNR cut-off for differentiating between short and long-term survivors [HR = 2.94 (95% CI: 1.49-5.80)]. Patients with a LNR >= 0.3 had a significantly shorter OS period (35.0 months, range 0.2-175 months) compared to patients with a LNR < 0.3 [median OS - mOS, was 143, range 15-169 months; (p = 0.003]. We observed significant differences in the mOS of EC patients without LNM compared to patients with LNM, as well as those with both LNM and ECI (p < 0.0001). In the group of patients with LNM, we also found that a poorer prognosis depended on the extension of the primary tumour. Conclusions: Our results suggest that when LNM are found, the long-term outcomes of EC patients are worse in those who have a LNR >= 0.3, the presence of ECI, and a more advanced extension of the primary tumour.

2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland Department of Chemotherapy, The Franciszek Lukaszczyk Oncological Center, 85-796 Bydgoszcz, Poland Department of Brachytherapy, The Franciszek Lukaszczyk Oncological Center, 85-796 Bydgoszcz, Poland Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland Department of Radiotherapy and Gynaecological Oncology, Greater Poland Cancer Centre, Poznan, Poland, 61-866 Poznan, Poland Faculty and Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland

Objective: We analysed microbiological results of early and late infectious complications following total pelvic exenteration (TPE) due to cervical cancer recurrence and evaluated the significance of infections in patient survival. Methods: A retrospective study was conducted on 13 out of 31 patients who had undergone TPE due to cervical cancer, from February 2013 to January 2018. Results: Early and late infections occurred in 7 (53.8%) patients and 6 (46.1%) patients, respectively. Superficial and deep surgical site infections (SSIs) were the only ones that appeared as early infections. Late infections, besides SSIs (4/13; 30.8%), also included urinary infections (2/13; 15.4%). The most frequently isolated microorganisms were Enterococcus spp. (9/28; 32.1%) and Escherichia coli (6/28; 21.4%). There was no resistance to vancomycin, teicoplanin and linezolid among Enterocccus spp. Among gram-negative rods, there was no resistance to meropenem and imipenem. We found three ESBL (extended-spectrum beta-lactamase) producers. Patients diagnosed with early deep SSIs had a shortened median overall survival (5.0 months vs. 11.5 months, P = 0.03). Patient survival was neither related to the occurrence of early superficial infections nor to late infections. Conclusions: Our results suggest that early, especially early deep, SSI may worse the prognosis of patients after TPE. The time of infection management after the operation should be especially intensified within 1 month after TPE.