Gynecologic Oncology Research Articles

Optimization of Timing for Risk-Reducing Salpingectomy and Oophorectomy

Most cases of ovarian cancer are diagnosed at an advanced stage, and long-term survival rates are low. Because no effective ovarian cancer screening has yet been developed, the primary focus to reduce ovarian cancer mortality is surgical prevention. For individuals with a significantly increased risk of ovarian cancer, risk-reducing bilateral salpingo-oophorectomy is highly effective, but uptake at the recommended age is suboptimal, likely because of concerns about premature menopause. Evidence suggests that many “ovarian” cancers originate in the distal fallopian tube, thus making bilateral salpingectomy after completion of childbearing with delayed oophorectomy an attractive but still unproven risk-reduction option for those who decline or are not yet ready for risk-reducing bilateral salpingo-oophorectomy. Two clinical trials (SOROCk [A Non-randomized Prospective Clinical Trial Comparing the Non-inferiority of Salpingectomy to Salpingo-oophorectomy to Reduce the Risk of Ovarian Cancer Among BRCA1 Carriers], NCT04251052; and TUBA-WISP2 [Tubectomy With Delayed Oophorectomy as an Alternative to Risk-Reducing Salpingo-oophorectomy in High-Risk Women to Assess the Safety of Prevention]; NCT04294927) are ongoing to determine whether bilateral salpingectomy with delayed oophorectomy is as effective as risk-reducing bilateral salpingo-oophorectomy to prevent ovarian cancer. The SOROCk trial is a national, prospective nonrandomized trial powered to test the hypothesis that bilateral salpingectomy with delayed oophorectomy is noninferior to risk-reducing bilateral salpingo-oophorectomy to reduce the incidence of ovarian cancer among people with deleterious germline BRCA1 mutations. Gynecologists and gynecologic oncologists in both community-based and academic practices may perform risk-reducing surgeries and have their patients participate in the SOROCk trial. We review key aspects of the SOROCk clinical trial and discuss how surgeons can partner with SOROCk clinical trial sites and facilitate their patients' participation to help answer this important clinical question. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04251052.

Ultrasound assessment of the pelvic sidewall: methodological consensus opinion.

A standardized methodology for the ultrasound evaluation of the pelvic sidewall has not been proposed to date. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for the ultrasonographic evaluation of structures within the pelvic sidewall. Five categories of anatomical structures are described (muscles, vessels, lymph nodes, nerves and ureters). A step-by-step transvaginal ultrasound (or, when this is not feasible, transrectal ultrasound) approach is outlined for the evaluation of each anatomical landmark within these categories. Accurate assessment of the pelvic sidewall using a standardized approach improves the detection and diagnosis of non-gynecological pathologies that may mimic gynecological tumors, reducing the risk of unnecessary and even harmful intervention. Furthermore, it plays an important role in completing the staging of malignant gynecological conditions. Transvaginal or transrectal ultrasound therefore represents a viable alternative to magnetic resonance imaging in the preoperative evaluation of lesions affecting the pelvic sidewall, if performed by an expert sonographer. A series of videoclips showing normal and abnormal findings within each respective category illustrates how establishing a universally applicable approach for evaluating this crucial region will be helpful for assessing both benign and malignant conditions affecting the pelvic sidewall. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Endometrial cancer tumor genetic testing practice patterns among gynecologic oncologists

Endometrial cancer tumor genetic testing practice patterns among gynecologic oncologists

Shifting trends and sicker patients: Reassessing benign hysterectomies performed by gynecologic oncologists

Shifting trends and sicker patients: Reassessing benign hysterectomies performed by gynecologic oncologists

Gynecologic oncologist in cesarean hysterectomy for placenta accreta spectrum in the United States: A surgeon specialty-specific assessment

Gynecologic oncologist in cesarean hysterectomy for placenta accreta spectrum in the United States: A surgeon specialty-specific assessment

Mental health in gynecologic oncologists: Unmet needs, barriers to care, and possibilities for improvement

Mental health in gynecologic oncologists: Unmet needs, barriers to care, and possibilities for improvement

Trends in benign hysterectomies performed by gynecologic oncologists, 2015–2021: A National Surgical Quality Improvement Program (NSQIP) analysis

Trends in benign hysterectomies performed by gynecologic oncologists, 2015–2021: A National Surgical Quality Improvement Program (NSQIP) analysis

Informed consent in gynecological oncology: a JAGO/NOGGO survey on real-world practices in daily clinical routine.

Informed consent is a quintessential element of contemporary medicine, reflecting the fundamental right of patients to participate in decision-making regarding their health. Despite its critical importance, there is a lack of data on real-world practices regarding patient informed consent in the context of modern, high-pressure medical environments. Weconducted a multinational multicentric survey from February 24, 2022, to September 14, 2022, investigating the practices and challenges surrounding informed consent in hospitals across Germany, Austria, and Switzerland with the use of a specifically developed questionnaire. Drawing on over 200 responses from gynecologists, the survey shows a critical need for structured training in conducting informed consent discussions with over 80% of participants expressing interest in courses addressing this aspect. Notably, a considerable portion of the physicians (59.9%) reported conducting discussions on procedures they had never personally witnessed. Significant disparities between types of hospitals and professional groups were observed in the frequency of informed consent discussions, with limitations arising from factors such as time constraints, language barriers, and insufficient resources for patient education. Moreover, the psychological burden experienced by physicians after informed-consent discussions underscores the need for systemic changes to alleviate concerns regarding patient safety, legal repercussions, and patient satisfaction. This study serves as a call to action, emphasizing the need of enhancing resources and support for medical professionals to uphold the principles of empathic and comprehensive patient information and shared decision-making. DRKS00028295, 25.07.2024.

Predicting clinical trial availability in gynecological oncology [PENTAGON]

Predicting clinical trial availability in gynecological oncology [PENTAGON]

Artificial intelligence powered insights: Assessment of ChatGPT's treatment recommendations in gynecologic oncology

Artificial intelligence powered insights: Assessment of ChatGPT's treatment recommendations in gynecologic oncology

Ridesharing as transportation assistance in gynecologic oncology: A pilot study

Ridesharing as transportation assistance in gynecologic oncology: A pilot study

Gynecologic oncology robot-assisted surgery in octogenarians: Impact of age on hospital stay.

To compare postoperative stay in octogenarians and younger patients undergoing gynecologic oncology robot-assisted surgery. A retrospective review of robot-assisted surgery in Gynecological Oncology division during 2019-2022. We included all consecutive cases. Octogenarians (age ≥80 years) and younger patients were investigated by univariable analysis for characteristics and outcome. A total of 816 robot-assisted surgeries were performed, 426 (52.2%) endometrial cancer, 159 (19.5%) ovarian cancer, 27 (3.3%) cervical cancer, 35 (4.3%) endometrial intraepithelial neoplasia, and in 169 (20.7%) the final pathology was benign. There were 60 (7.4%) octogenarians and 756 (92.6%) younger patients. The proportion of patients with an American Society of Anesthesiology score greater than 2 was higher among octogenarians (66.7% vs 32.0%, P < 0.001). The median console time, surgical time, and total operation theater time were similar between groups (P = 0.303, P = 0.643 and P = 0.688, respectively). Conversion rate did not differ between groups (0.4% among younger patients vs 0% in octogenarians, P > 0.99). The median length of stay in the recovery room was similar in both groups (median 170 min, interquartile range [IQR] 125-225 min vs 170 min, IQR 128-240 min in octogenarians, P = 0.731). Length of hospital stay was similar in both age groups; median 1 day (IQR 1-1) among octogenarians versus 1 (0-1) in younger patients (P = 0.136). Octogenarians undergoing robotic surgery have no increased risk of length of stay or conversion to laparotomy compared with younger patients.

Patient perspective on virtual pre-chemotherapy visits in gynecologic oncology

Patient perspective on virtual pre-chemotherapy visits in gynecologic oncology

Implementation of automated social determinants of health screening in gynecologic oncology: A pilot study

Implementation of automated social determinants of health screening in gynecologic oncology: A pilot study

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

The Doc versus the Bot: A pilot study to assess the quality and accuracy of physician and chatbot responses to clinical questions in gynecologic oncology

The Doc versus the Bot: A pilot study to assess the quality and accuracy of physician and chatbot responses to clinical questions in gynecologic oncology

Financial toxicity in gynecologic oncology and its impact on medication access, debt, and food insecurity

Financial toxicity in gynecologic oncology and its impact on medication access, debt, and food insecurity

The significance of gynecologic oncologist presence in a community-based obstetric and gynecology residency program

The significance of gynecologic oncologist presence in a community-based obstetric and gynecology residency program

Yes, it's true: Benign hysterectomy trends for gynecologic oncologists in the United States from 2015 to 2021

Yes, it's true: Benign hysterectomy trends for gynecologic oncologists in the United States from 2015 to 2021

Molecular testing by gynecologic oncologists versus medical oncologists: Is there a difference?

Molecular testing by gynecologic oncologists versus medical oncologists: Is there a difference?