The increasing shift toward outpatient surgical care represents a major developmentin healthcare systems and is driven by both medical advances and economic as wellas health policy considerations. This article provides an evidence-based assessment ofambulatory surgery, with a particular focus on structural requirements and the currentGerman S3 guideline on benign uterine diseases. International data demonstrate thathigh rates of outpatient surgery can only be safely achieved within clearly definedstructural frameworks and standardized decision-making processes. The availableevidence comparing outpatient and inpatient care is heterogeneous and limited bya substantial risk of bias, preventing any general conclusion regarding the superiorityof either setting. Instead, outcomes largely depend on patient selection, individualrisk profiles, and the organization of care. Using minimally invasive hysterectomyas an example, outpatient treatment is shown to be feasible but requires careful,individualized risk assessment. A generalized shift toward outpatient care is thereforenot appropriate. Decisions regarding the treatment setting should remain physician-led and be based on shared decision-making with the patient, rather than beingprimarily driven by economic considerations.

Die zunehmende Ambulantisierung operativer Eingriffe stellt eine zentrale Entwicklung im Gesundheitswesen dar und wird sowohl durch medizinischen Fortschritt als auch durch ökonomische und gesundheitspolitische Faktoren vorangetrieben. Ziel dieser Arbeit ist eine evidenzbasierte Einordnung der Ambulantisierung unter besonderer Berücksichtigung struktureller Voraussetzungen und der aktuellen S3-Leitlinie „Benigne Erkrankungen des Uterus“. Internationale Vergleiche zeigen, dass eine hohe Ambulantisierungsquote nur unter klar definierten strukturellen Rahmenbedingungen und standardisierten Entscheidungsprozessen sicher umgesetzt werden kann. Die vorhandene Evidenz zur Qualität ambulanter im Vergleich zu stationären Behandlungen ist heterogen und durch ein relevantes Bias-Risiko limitiert, sodass keine generelle Überlegenheit eines Versorgungssettings abgeleitet werden kann. Entscheidend sind vielmehr Patientinnenselektion, Risikoprofil und Versorgungsstrukturen. Am Beispiel der minimal-invasiven Hysterektomie wird deutlich, dass eine ambulante Durchführung zwar möglich ist, sie jedoch eine individuelle, risikoadaptierte Indikationsstellung erfordert. Eine pauschale Ambulantisierung ist nicht gerechtfertigt. Die Entscheidung über das Versorgungssetting muss ärztlich und im Rahmen einer gemeinsamen Entscheidungsfindung mit der Patientin erfolgen und darf nicht primär durch ökonomische Steuerungsmechanismen bestimmt werden.

Endometrioid ovarian carcinoma accounts for approximately 10% of epithelial ovarian carcinomas. The majority of tumors are classified as low-grade and have a significantly better prognosis than the most common subtype of high-grade serous ovarian carcinoma. The current data also suggest that there is a different response to therapy, but due to the small number of cases and therefore limited data, primary therapy is carried out in the same way as for high-grade serous carcinoma. If the disease recurs under standard therapy, however, individual treatment approaches should also be considered [1, 2, 3].

Wir stellen den Fall einer Patientin mit endometrioidem low grade Ovarialkarzinom vor, die bei Auftreten eines Rezidivs 9 Monate nach Erstlinientherapie und Nicht-Ansprechen des Tumorrezidivs auf insgesamt 6 medikamentöse Therapielinien, erstmals ein Therapieansprechen auf eine off-label Therapie mit Pembrolizumab und Lenvatinib zeigte. Nachdem diese Therapie nach zwei Jahren auf Grund von Nebenwirkungen und bei tendenziell minimalem Progress beendet werden musste, erfolgte eine erneute off-label Therapie mit Palbociclib und Letrozol, worunter sich nun ebenfalls ein Tumorregress im Staging zeigt. Dieser Fall soll die Wichtigkeit individueller Therapieansätze bei Nicht-Ansprechen der Standardtherapien in dem kleinen Kollektiv der endometrioiden low grade Ovarialkarzinome verdeutlichen und auch die Notwendigkeit weiterer Studien bezüglich eines abweichenden Vorgehens bereits in der Erstlinientherapie betonen.

Urinary incontinence is commonly encountered in everyday clinical practice, affecting an estimated 25-45% of women and about 10 mio. people in Germany. Formerly believed to be a condition affecting the aging population only, we have come to realise that younger female patients can be affected by various forms of urinary incontinence as well - more so after higher degree birth injuries or during participation in high impact sports. Although not life threatening, urinary incontinence can have detrimental effects on the patient's quality of life. As such it is our responsibility to recognise the symptoms and initiate adequate diagnostics and treatment early and refer patients as necessary. Most symptoms can be addressed, diagnostic measures and conservative treatments initiated during an outpatient visit already. This article aims to provide a concise summary of the current national guidelines.

Introduction: Gene expression assays, such as the MammaPrint® (Agendia, Amsterdam, the Netherlands) 70-gene signature, are increasingly used by oncologists to understand breast cancer biology and improve treatment planning. This study assesses the utility of MammaPrint genomic risk in predicting treatment outcomes for women with breast cancer in a retrospective German cohort with a 10-year follow-up, treated based on clinicopathological features alone. Methods: The sample set of 117 tumours from the ‘Patients Tumour Bank of Hope’ (PATH) biobank with 10-year follow-up were classified using MammaPrint into high or low risk of distant metastasis. Patients were previously treated according to St. Gallen and Adjuvant! Online high- or low-risk criteria. Statistical analyses compared overall survival (OS) and treatment outcomes between clinical and genomic risk groups. Results: Among the 78 patients with clinically high-risk tumours, 50% (39) were reclassified as MammaPrint low risk. In total, 57.3% (67/117) patients with MammaPrint low-risk tumours demonstrated a significantly higher 10-year OS of 93.4%, irrespective of nodal status, compared to patients with MammaPrint high-risk tumours (71.2%; p=0.001). Chemotherapy improved OS in patients with MammaPrint high-risk tumours by 29.4%, but not for patients with MammaPrint low-risk tumours (p=0.016). Discussion: The findings confirm the prognostic utility of MammaPrint for identifying genomically low-risk patients who may safely omit chemotherapy while suggesting genomically high-risk cases may benefit from chemotherapy. By providing a more precise assessment of cancer risk than traditional clinicopathological methods alone, MammaPrint may help reduce unnecessary treatments and improve long-term quality of life for patients diagnosed with early-stage breast cancer.

In many cases, outpatient surgical treatment of benign diseases of the uterus has advantages over inpatient care. This has been demonstrated by the healthcare situation in other countries. However, the prerequisite for the provision of outpatient services is that this does not lead to any impairment in the quality of care or of patient safety. The ultimate goal should not be to reduce costs but rather to maintain and, ideally, improve the quality of care. This requires that services are not just defined by the surgical procedure but also by the entire treatment chain, including, for example, psychosocial support, and are remunerated accordingly. It is particularly worrying that the final decision as to whether an outpatient operation is possible is not the responsibility of the operating unit, but of the "Medizinischer Dienst," with the corresponding options and threats of sanctions. This situation is unique internationally and requires a paradigm shift. Furthermore, structural prerequisites must be maintained which currently only exist inadequately in Germany. Since a substantial proportion of planned outpatient operations require immediate or secondary inpatient treatment, there must be a barrier-free transition between the outpatient and inpatient sectors. This will require the creation of networks between outpatient service providers and one or more hospitals that are equipped and competent to manage even complex complications. It is important to create structures that, with intensive involvement of the operating unit, include adequate preoperative evaluation and patient education as well as needs-oriented postoperative care at home. The current separation of sectors is a significant hinderance. Moreover, when expanding and promoting outpatient surgery, the aspect of training and further education of specialist staff must be taken into account, as well as cross-sectoral quality assurance. Based on a review of the international literature, this article presents 13 recommendations for adequate structures when providing outpatient services which should serve as a prerequisite for the greatest possible guarantee of patient safety.

Die Harninkontinenz ist in der Gynäkologie ein Krankheitsbild mit einer hohen Prävalenz (etwa 30

MammaPrint (MP) is a 70-gene signature, which has been validated in multiple studies and has proven to be a powerful predictor of risk of recurrence in patients with breast cancer (BC). In a German validation study using samples from the Patients Tumor Bank of Hope (PATH), the degree of concordance between MP and clinical risk classifications valid at that time has been determined retrospectively. MP use was shown to be feasible in a German study population revealing a change in treatment recommendation in 40% of patients (Gevensleben H et al. Int J Mol Med 2010;26:837-843). In this analysis, we present the prognostic value of MP at 10 years of follow-up. Tumor samples from 140 German patients were classified by MP as low risk (LR) or high risk (HR) of recurrence and compared to the then-current adjuvant treatment guidelines. The patients were treated based on the clinical risk assessment. We collected 10-year data from 117 patients and compared overall survival (OS) between subgroups based on MP. In the cohort of 117 patients MP identified 57.3% (n=67) LR, and 42.7% (n=50) HR patients. The 10-year overall survival (OS) in patients with LR and HR was 93.4% and 71.2%, respectively. The OS in the lymph-node positive population was 93.3% for the LR group (n=20%) and 40.4% for the HR group (n=18), respectively. Treatment received and overall survival stratified per treatment are presented in Table.Table: 162P10-year OS and treatment received in patients from the German PATH cohort stratified by MammaPrintMP LR n = 67MP HR n = 50Treatment received, n (%)CT+ET29 (43)14 (28)CT only0 (0)10 (20)ET only29 (43)13 (26)No AST-(-)1 (2)Unknown9 (13)12 (24)10-year OS (%)Overall93.471.2CT96.39.9no CT92.561.5 Open table in a new tab AST, adjuvant systemic therapy; CT, chemotherapy; ET, endocrine therapy; MP LR, MammaPrint Low Risk; MP HR, MammaPrint High Risk; OS, overall survival. Patients with a MP LR had an excellent OS at 10 years, regardless of lymph node status and treatment, thus confirming its prognostic value. In a cohort treated based on clinical risk assessments only, about a third of patients received a treatment not in line with their MP results, possibly affecting their quality of life and outcomes.

Introduction PATH Foundation operates a biobank under uniform SOPs. Fresh-frozen tissue samples are collected alongside with blood serum and FFPE specimens. Research groups from academia and industry can obtain samples. In 2016 scientists joined forces to form the Horizon2020 funded MESI-STRAT consortium to address unmet needs of women with ER-positive breast cancer. PATH is a co-coordinator within MESI-STRAT.

Diseases and functional disorders of the female pelvic floor are continuously gaining in importance due to the demographic developments with the increasing life expectations of women and the demands on the preservation of the quality of life at all ages. In a Swedish study the prevalence of genital prolapse in a subgroup of women between 20 and 59 years old was given as 31% and the prevalence in women between 50 and 79 years old increased up to 41%. In recent years the German working group for urogynecology and plastic surgical pelvic floor reconstruction (AGUB) together with colleagues from Austria and Switzerland has developed high-quality guidelines for all relevant diseases and for all German-speaking regions in Europe. The principal steps of the diagnostics as well as the conservative and surgical treatment are presented. Special emphasis is placed on the various vaginal, abdominal and minimally invasive access routes by laparoscopy as well as uterus-preserving surgical procedures. Finally, an assessment of alloplastic mesh materials is carried out as reflected in the currently available literature.

Skizziert werden Geschichte und Entwicklung der im Jahr 1970 gegründeten Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion (AGUB), eine der größten AGs in der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Zu ihren Aufgaben gehört besonders die Aktualisierung und Fortentwicklung der Leitlinien sowie die Umsetzung qualitätsgesicherter, an den Leitlinien ausgerichtete Diagnostik- und Therapieverfahren in die klinische Praxis. Perspektivisch anzustreben ist – analog zur Versorgung von Brustkrebspatientinnen in zertifizierten Brustkrebszentren – eine ganzheitliche Betreuung von Frauen mit Beckenbodenproblemen in zertifizierten, interdisziplinären Beckenbodenzentren. Dargestellt werden Meilensteine der Subspezialität Urogynäkologie, etwa TVT(„tension-free vaginal tape“)-Systeme, intravaginale Lasertherapien oder der β3-Adrenorezeptoragonist Mirabegron. Auch aufgrund demographischer Entwicklungen wird der Bedarf für urogynäkologische Interventionen steigen. Daher sind Aus- und Weiterbildung des Nachwuchses und die Harmonisierung mit europäischen Vorgaben (EBCOG) von hoher Relevanz.

Zusammenfassung Die Harninkontinenz der Frau ist ein bedeutendes, jedoch immer noch durch starke Tabuisierung gekennzeichnetes Thema in unserer Gesellschaft. Für die betroffenen Frauen geht dies oft mit einem hohen Leidensdruck und Einschränkungen der Lebensqualität einher. Personen, die an Inkontinenz leiden, schweigen über ihre Erkrankung, weil Inkontinenz immer noch als unabwendbare Folge des natürlichen Alterungsprozesses und als nicht heilbare Krankheit angesehen wird. Etwa 28 % der Frauen über 20 Jahre leiden an Harninkontinenz. Doch in etwa 90 % der Fälle kann durch sorgfältige Diagnostik und Einleitung einer suffizienten Therapie den betroffenen Frauen zufriedenstellend geholfen werden.

Die Harninkontinenz der Frau ist ein bedeutendes, jedoch immer noch durch starke Tabuisierung gekennzeichnetes Thema in unserer Gesellschaft. Für die betroffenen Frauen geht dies oft mit einem hohen Leidensdruck und Einschränkungen der Lebensqualität einher. Personen, die an Inkontinenz leiden, schweigen über ihre Erkrankung, weil Inkontinenz immer noch als unabwendbare Folge des natürlichen Alterungsprozesses und als nicht heilbare Krankheit angesehen wird. Etwa 28 % der Frauen über 20 Jahre leiden an Harninkontinenz. Doch in etwa 90 % der Fälle kann durch sorgfältige Diagnostik und Einleitung einer suffizienten Therapie den betroffenen Frauen zufriedenstellend geholfen werden.