Surgical Outcomes In Women Research Articles

PROMRIINE (PRe-operatory Magnetic Resonance Imaging is INEffective) Study: A Systematic Review and Meta-analysis of the Impact of Magnetic Resonance Imaging on Surgical Decisions and Clinical Outcomes in Women with Breast Cancer

BackgroundThe purpose of this study was to review and summarize the association between preoperative magnetic resonance imaging (MRI) and surgical outcomes in women with newly diagnosed invasive breast cancer from published randomized controlled trials (RCT).Materials and MethodsTwo independent researchers conducted a systematic review through a comprehensive search of electronic databases, including PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science. If there was disagreement between the two reviewers, a third reviewer assessed the manuscript to determine whether it should be included for data extraction. The quality of the papers was assessed using the risk of bias tool, and the evidence was analyzed using GRADE. Meta-analyses using a fixed-effects model were used to estimate the pooled risk ratio (RR) and 95% confidence interval (CI).ResultsInitially, 21 studies were identified, 15 of which were observational comparative studies. A total of five RCTs were included, and they suggested that preoperative MRI significantly reduced the rate of immediate breast-conserving surgery and increased the risk for mastectomy.ConclusionsFrom the RCT perspective, preoperative MRI for newly diagnosed invasive breast cancer did not improve surgical outcomes and may increase the risk of mastectomy.

Surgical outcomes in women diagnosed with deep endometriosis involving urological structures

IntroductionThe prevalence of endometriosis is estimated to be about 10% among women of reproductive age. In about 5–10% of these patients, involvement of urological structures will be developed due to deep endometriosis. Urologists should be familiar with the management of these patients, who will require multidisciplinary care with medical and surgical treatment. Material and MethodsRetrospective study of patients diagnosed with deep endometriosis involving urological structures who underwent surgery performed jointly with gynecology and colorectal surgery departments from June 2012 until June 2021 (60 cases). Urologic symptoms were grouped into 3 groupers for subsequent analysis (storage symptoms, voiding symptoms, and low back pain). ResultsStorage symptoms (frequency and urgency) are the most frequent urologic symptoms. Patients with storage symptoms and low back pain showed improvement after surgery. In contrast, patients with voiding symptoms did not improve with surgical treatment. ConclusionsThe prevalence of endometriosis and the likelihood of involving urologic structures require the urologic community to be aware of the pathology.Patients with storage symptoms will improve following excision of the endometriotic nodules. The need for Partial cystectomies with ureteral reimplantation can be safely performed by laparoscopic or robotic approach, even in previously operated patients, without compromising long-term function.

Abstract PO3-27-03: PROMISE Study: Pre-Operatory MRI is not Effective. A Systematic review of impact of magnetic resonance imaging on surgery-decision and clinical outcomes in women with breast cancer

Abstract Background: The use of magnetic resonance imaging (MRI) in patients with breast cancer before surgery has been a subject of ongoing debate and discussion. The role of MRI as a preoperative tool to guide surgical decision-making remains controversial. Some studies suggest that MRI may improve the detection of additional tumors or assess the extent of disease, while others discuss that it may lead to increased false-positive findings and unnecessary interventions. The potential benefits and potential harms of incorporating MRI into the preoperative assessment of breast cancer patients continue to be topics of research and clinical interest. Clarifying the impact of preoperative MRI on surgical outcomes is crucial to inform evidence-based practices and optimize patient care. Until present, there is no pooled analyses from randomized clinical trials perspective of the clinical impact regarding the routine use of MRI. Objectives: This study aims to conduct metanalysis of randomized controlled trials (RCT) to investigate the association between preoperative MRI and surgical outcomes in women with newly diagnosed invasive breast cancer, providing evidence-based recommendations for clinical practice. Methods: A comprehensive search of electronic databases including PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science was conducted by three independent researchers from inception to May 2023. The inclusion and exclusion criteria were based on Cochrane's principles. Relevant data from eligible studies were extracted. A systematic evaluation and meta-analysis were performed using the fixed-effects model to estimate the pooled risk ratio (RR) and 95% CI. Results: Out of 21 studies found, 6 were RCTs and 15 observational comparative studies. The results showed that in RCT preoperative MRI significantly reduce the rate of immediate breast conservative surgery (RR=0.94, 95%CI 0.91~0.96, I2=0%) and increase the mastectomy rate (RR=1.88, 95%CI 1.48~2.38, I2=86%). There wasn’t any change in reoperations rates (RR=0,87, 95%CI 0.71~1.07, I2=72%). Only 1 trial reported data on survival, showing no difference between groups. Conclusion: From RCT standpoint, the evidence suggests that preoperative MRI for newly diagnosed invasive breast cancer may not be beneficial to the patients by increasing rate of mastectomy with no survival benefit and that should be considered when offering as a routine practice to patients with breast cancer before surgery. Forest plot of mastectomy as an outcome Forest plot of re-operation as an outcome Citation Format: Andre Mattar, Andressa Amorim, Evandro Mateus, Fabio Bagnoli, Felipe Zerwes, Francisco Pimentel Cavalcante, Guilherme Novita, Lincon Mori, Marcelo Madeira, Marina Diogenes, Marcelo Antonini, Lucas Okumura. PROMISE Study: Pre-Operatory MRI is not Effective. A Systematic review of impact of magnetic resonance imaging on surgery-decision and clinical outcomes in women with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-03.

Pelvic exenteration: a retrospective study in a tertiary referral cancer center in the UK.

Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years. This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period. The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively). The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Visceral Adipose Tissue Percentage Compared to Body Mass Index as Better Indicator of Surgical Outcomes in Women With Obesity and Endometrial Cancer

Study ObjectiveTo assess the impact visceral adipose tissue percentage (VAT%) on surgical outcomes during minimally invasive surgery in obese women with endometrial cancer. DesignRetrospective observational cohort study. SettingMie University Hospital, Japan. PatientsOf the 73 women (body mass index [BMI] >30 kg/m2) with obesity and primary endometrial cancer, 52 underwent robotic surgery, while 21 underwent laparoscopic surgery between April 2014 and December 2022. InterventionsWe investigated the correlation between surgical outcomes (operative time and blood loss) and obesity (BMI and visceral adipose tissue percentage [VAT%]). Measurements and Main ResultsAbdominal fat-related parameters were measured at the level of the umbilicus using preoperative computed tomography. A weak negative correlation was found between BMI and VAT% (CC = −0.313, p = .001). Multivariate analysis showed that VAT% had a stronger correlation to total and practical operative time than BMI (β = 0.338 vs 0.267, β = 0.311 vs 0.209, respectively) and was an independent predictor of blood loss. VAT% was an independent predictive marker prolonged for operative time and increased blood loss during lymphadenectomy. ConclusionVAT% could be an indicator of surgical outcomes for patients with obesity and endometrial cancer.

OC18.05: Surgical outcome in women with advanced stage of pelvic organ prolapse: levator ani muscle avulsion and mesh application

OC18.05: Surgical outcome in women with advanced stage of pelvic organ prolapse: levator ani muscle avulsion and mesh application

Examining the relationship between severe persistent mental illness and surgical outcomes in women undergoing mastectomy for breast cancer

BackgroundSevere persistent mental illness (SPMI) is associated with worse outcomes in cancer patients. Less is known about the relationship between SPMI and surgical outcomes after mastectomy for breast cancer. MethodsWe selected patients with breast cancer and SPMI from the National Inpatient Sample (2016–2018) and used propensity score matching. We then used multivariate analysis, Kruskal-Wallis tests, and conditional logistic regression to compare demographics and outcomes. ResultsThe study sample consisted of 670 patients: 536 without SPMI and 134 with SPMI. SPMI was associated with bilateral mastectomy (bilateral: 53% vs. unilateral: 42.7%, p = 0.033) and decreased frequency of breast reconstruction (p < 0.001). SPMI was associated with more extended hospitalization (4 days vs. 2 days, p < 0.001) and increased risk of developing post-procedural infection and sepsis (OR 2.909). ConclusionsSPMI is associated with bilateral mastectomy, more extended hospitalization, and increased risk for post-procedural infection and sepsis – suggesting the need for increased use of standardized screening tools to identify SPMI in patients and inform perioperative management correctly.

7369 Conventional Vaginal Hysterectomy vs vNOTES Hysterectomy: A Retrospective Cohort Analysis of Two Techniques

<h3>Study Objective</h3> The aim of this study was to compare the surgical outcomes in women undergoing a vaginal hysterectomy for abnormal uterine bleeding through a conventional vaginal hysterectomy (TVHH) vs. hysterectomy using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) method. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> Tertiary academic center. <h3>Patients or Participants</h3> Seventy-eight patients with the diagnosis of abnormal uterine bleeding underwent a hysterectomy. Forty-five of them had a TVH and thirty-three of them had a hysterectomy via the vNOTES approach. <h3>Interventions</h3> A group of surgeons trained in conventional vaginal hysterectomy and vNOTES hysterectomy performed the surgeries from July 2017 to December 2021. <h3>Measurements and Main Results</h3> Our primary surgical outcomes were surgical time, rate of surgical complication, and blood loss. Average age for patients who underwent TVH was 41 years old and 41.2 for vNOTES; however, the average BMI for TVH was 31.7 and 30.8 for the vNOTES. 17% of the TVH group had a prior cesarean delivery (n=8) and 42.4% of them had a prior cesarean (n=14). The complications in the vNOTES group included three patients that required blood transfusions and one was readmitted within 30 days. All four of these patients had uteri weighing more than 100 g (102-840g) and one had a previous cesarean delivery. For the conventional group, nine cases resulted in complications including three blood transfusions, four patients with postoperative fever, one with a vaginal laceration and one ureteral injury. Three patients had a previous cesarean delivery and only two of them had a uterine larger than 100 g. <h3>Conclusion</h3> Overall vNOTES hysterectomies were faster and had lower complications compared to conventional vaginal hysterectomy; however, our analysis did not reach statistical significance. Patients in the vNOTES group had a higher proportion of prior cesareans and overall larger uteri, although less complications were noted. Randomized clinical trials are required to better characterize the findings of our study.

Impact of Preoperative Magnetic Resonance Imaging on Surgical Outcomes in Women with Invasive Breast Cancer: A Systematic Review and Meta-Analysis

Background Currently, whether magnetic resonance imaging (MRI) should be routinely applied to patients with breast cancer before surgery remains controversial. A pooled analysis of the association between preoperative MRI and surgical outcomes in female patients with newly diagnosed invasive breast cancer was conducted to provide evidence-based medicine for clinical practice. Methods Three independent researchers searched the following databases: PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science from inception to April 2022. Literature was included and excluded according to Cochrane's principles. The basic information from eligible documents was extracted. Systematic evaluation and meta-analysis were performed, and the odds ratio (OR) was analyzed by the random-effect model. The quality of the literature was assessed using the modified Jadad scale and the Newcastle-Ottawa (NOS) mean scale. Results A total of 19 studies were included, including 4 randomized controlled trials and 15 observational comparative studies. Among them, most studies were not limited to a specific pathological type, with the exception of 3 that were limited to invasive lobular carcinoma. The results showed that preoperative MRI examination would significantly reduce the reoperation rate (OR = 0.77, P=0.02) and increase the mastectomy rate (OR = 1.36, P=0.001). In comparison, preoperative MRI did not significantly affect the rate of secondary mastectomy (OR = 0.77, P=0.02), the rate of positive margin (OR = 1.08, P=0.66), the rate of mastectomy (OR = 1.00, P < 0.05), and reoperations (OR = 0.65, P=0.19) in the subgroup analysis of patients with invasive lobular carcinoma. Conclusion Available evidence suggests that preoperative MRI examination increases the rate of mastectomy and reduces the rate of reoperations. The results indicate that preoperative MRI examination has the potential to benefit patients with breast cancer, but more high-quality studies are needed for confirmation.

Estrogen-Associated Headaches Can Be Treated by Surgery: A Multicenter Retrospective Cohort Study.

Nerve decompression surgery has been successful in treating headaches refractory to traditional medical therapies. Nevertheless, a subset of patients remains unresponsive to surgical treatment. The authors conducted a retrospective chart review of the two senior authors' (J.E.J. and W.G.A.) patient data from 2007 to 2020 to investigate differences in surgical outcomes in women reporting estrogen-associated headaches (headaches associated with menstrual period, oral contraceptives, pregnancy, or other hormonal drugs) compared with those who did not. For these two groups, the authors used the migraine headache index as the metric for headache severity and compared the mean percent change in migraine headache index score at 3 months and 1 year. Of the 99 female patients who underwent nerve decompression surgery and met inclusion criteria, 50 reported estrogen-associated headaches and were found to have significantly earlier age of onset ( p = 0.017) and initial presentation to clinic ( p = 0.046). At 1 year postoperatively, migraine headache index score had improved more than 80 percent in the majority of patients (67 percent), but there was a subset of patients whose score improved less than 5 percent (12.5 percent). The authors did not find a significant difference in percent change in postoperative migraine headache index score between women with estrogen-associated headaches and those without such headaches. Women with estrogen-associated headaches have surgical outcomes comparable to those of women without this association. Nerve decompression surgery should be offered to women experiencing estrogen-associated headaches as an option for treatment. Risk, II.

Long-Term Outcomes Following Nonoperative Treatment of Prearthritic or Extra-Articular Hip Pain in Women.

Introduction:There is an abundance of literature focusing on morphological and surgical outcomes in women with arthritic and prearthritic hip pain. However, no studies have evaluated conservative treatment outcomes, such as physical therapy (PT) and injections, in women with prearthritic or extra-articular hip pain. The purpose of this study is to assess changes in long-term patient-reported outcome measures after nonoperative treatments in women with prearthritic or extra-articular hip pain.Methods:Twenty-nine female patients (35–65 years old) who presented to a single provider between December 1, 2012 and September 1, 2017 for prearthritic or extra-articular hip pain (Tonnis 1 or less) and had baseline patient-reported outcome data (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS] activities of daily living [ADL] and sport scores, International Hip Outcome Tool-33 [iHOT-33]) available from the institutional hip registry were included. Patients underwent nonoperative treatments for intra-articular or extra-articular hip pain. A follow-up questionnaire was prospectively administered at 3–5 years after the baseline visit.Results:Most patients underwent targeted PT (n = 27; 93%) to treat intra-articular or extra-articular hip pain. Targeted PT can be defined as primarily exercise-based therapy focusing on hip and lumbar stability. Twelve patients (41%) received injections; of these, 11 were also treated with PT. Overall, significant improvements in mHHS, HOS-ADL, and iHOT-33 scores were observed (p = 0.006, 0.022, and <0.001, respectively). HOS-ADL and iHOT-33 scores improved by a median of 10.3 and 18.0 points, respectively, and were clinically significant. HOS-sport scores also improved but were not statistically significant. There were no differences in patient-reported outcomes between patients who received both PT and injections versus those who received PT, injections, or other treatments.Conclusions:Nonoperative treatments for prearthritic or extra-articular hip pain in women, specifically PT and/or injections, were associated with sustained improvements in patient-reported outcomes at 3–5 years postbaseline.

Long-term development of surgical outcome of laparoscopic sacrohysteropexy with anterior and posterior mesh extension.

Long-term durability and functional outcome of laparoscopic sacrohysteropexy (LSH) remains to be confirmed. We set out to assess the development of surgical outcome in women with increasing minimal follow-up. All women after LSH with anterior and posterior mesh extension operated for advanced apical uterine prolapse at Geoffroy Saint-Hilaire clinic from July 2005 to June 2020 were enrolled in this retrospective study. Last known follow-up information was used for the analysis and allocation into groups. The surgical success was defined as no prolapse beyond hymen, no symptomatic recurrence or no retreatment. Functional outcome was evaluated from validated questionnaires and presence of pelvic floor disorders. The outcomes were compared with preoperative state using chi-square and Fisher's test; p < 0.05 was considered significant. In total, 270 patients after LSH with a follow-up of up to 14.5years were enrolled and divided into groups according to their last follow-up length: ≥ 1 year 242, ≥ 3 years 112, ≥ 5years 76, ≥ 7years 45 and ≥ 10 years 18 women. Increase of minimal follow-up was associated with gradual decrease in surgical success. Rates of stress urinary incontinence were unchanged by the surgery, while anal incontinence and constipation rates decreased significantly; 14.5% of women were operated on for SUI in the follow-up. The PFDI-20, PFIQ-7 and VAS bother scores decreased significantly regardless of minimal follow-up length. LSH with anterior and posterior mesh extension is a safe, effective and durable surgery with a positive long-term effect on quality of life. Although the surgical success gradually decreases, LSH remains a surgical success in most women.

Absorbable versus Permanent Suture for Vaginal Uterosacral Ligament Suspension for Treatment of Apical Prolapse

The aim of this study was to compare surgical outcomes in women undergoing vaginal uterosacral ligament suspension using permanent as opposed to absorbable sutures. We also aimed to assess for specific risk factors for suture complications. Retrospective cohort study. Female pelvic medicine and reconstructive surgery unit at a university-affiliated tertiary medical center. Women with apical prolapse who underwent vaginal hysterectomy with uterosacral ligament suspension during the study period. none. A total of 197 women were included in the study. Of them, 118 (59.9%) underwent the procedure using a permanent suture and 79 (40.1%) using an absorbable suture. Women in the permanent suture group were less sexually active and had less prolapse of point C on pre-operative exam. With regard to intra-operative and postoperative data, women in the permanent suture group had increased frequency of concomitant procedures, regional anesthesia, surgical time, duration of hospital stay, and change in hemoglobin. Clinical, anatomical, and composite success did not differ between groups. Patient satisfaction recorded using the Patient Global of Improvement Questionnaire was similar as well. Women in the permanent suture group had a higher frequency of suture exposure compared with the absorbable suture group (9.3% vs 0.0%, p=.006). In order to assess for risk factors leading to suture complications, a comparison was performed between women who had suture exposure or granulation tissue and those who did not. Increasing parity by 1 increased the odds of having suture exposure or granulation tissue by a factor of approximately 1.2 (adjusted odds ratio=1.24; Confidence interval, 1.05-1.47). Women with stage IV prolapse had 3.4 times the odds of suture complication compared with women with stage III prolapse (adjusted odds ratio=3.4; Confidence interval, 1.1-10.6). Use of an absorbable suture affords comparable success and lower frequency of suture exposure compared with permanent sutures in women undergoing vaginal uterosacral ligament suspension for treatment of apical prolapse.

Effect of Age on Complications Rate and Surgical Outcomes in Women Undergoing Laparoscopic Sacrohysteropexy and Sacrocolpopexy

Study ObjectiveTo compare perioperative and long-term outcomes of laparoscopic sacrohysteropexy/sacrocolpopexy in different groups of age. DesignThis was a retrospective cohort study. Patients were evaluated preoperatively and postoperatively (starting from 1 month after surgery and then annually). SettingThe department of functional pelvic surgery and oncology, a tertiary care center. PatientsAll patients who underwent laparoscopic sacrohysteropexy/sacrocolpopexy, between July 2005 and December 2019. InterventionsLaparoscopic sacrohysteropexy/sacrocolpopexy. Measurements and Main ResultsThe study population was divided into 3 groups, according to age at the time of surgery: group 1, <65 years; group 2, between 65 and 75 years, and group 3, >75 years. The primary outcome was the rate of perioperative complications. The secondary outcome was the comparison of long-term results among the groups. A total of 330 patients were included: in group 1, 183 patients (mean age 53.4 ± 8.2), in group 2, 92 patients (mean age 69.2 ± 2.9), and in group 3, 55 patients (mean age 79.3 ± 3.5). The overall perioperative complications rate (up to 30 days after surgery) was 5.7%. No differences among the groups in operative details and rates of perioperative complications were observed. During the follow-up period, 37 patients (11.2%) presented with prolapse recurrence (objective and/or subjective); the rates of prolapse recurrence and long-term complications were similar among the groups. Similarly, the groups did not differ in postoperative functional results except for postoperative stress urinary incontinence. A surgery for stress urinary incontinence was more common among patients in group 3 (group 1, 13.4%; group 2, 11.9%; group 3, 31.3%; p = .008). ConclusionLaparoscopic sacrohysteropexy/sacrocolpopexy is associated with low rates of perioperative and long-term complications. We did not find a difference in rates of complications and/or long-term outcomes, between different age groups.

Does the Presence of Adenomyosis Affect the Results of DEEP Infiltrating Endometriosis Surgery?

<h3>Study Objective</h3> To evaluate the impact of adenomyosis on surgical outcomes in women with deep infiltrating endometriosis (DIE) undergoing laparoscopic surgery. <h3>Design</h3> Retrospective study including women undergoing DIE surgery during a 3-year period. <h3>Setting</h3> Referral tertiary university hospital. <h3>Patients or Participants</h3> 157 women with DIE undergoing surgery. <h3>Interventions</h3> Two expert sonographers preoperatively diagnosed DIE and adenomyosis. DIE was defined according to the criteria of the International Deep Endometriosis Analysis group, and adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DIE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien-Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. <h3>Measurements and Main Results</h3> 157 DIE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. There were no differences between groups regarding demographic characteristics, current treatment, symptoms, r-ASRM classification or type of surgery. The mean operating time was higher in the A group (237min±98.4) compared to noA group (188min±79.3) (p=0.017). The mean hospital stay was also higher in the A group compared to noA group (3.62±4.3 vs 2.55±1.79 days, p<0.05). Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.5% (noA group) (p<0.001). There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p<0.001). <h3>Conclusion</h3> Adenomyosis seems to play a detrimental role in DIE surgical procedures. It increases the risk of presenting complications in DIE surgery after controlling for demographic, clinical and surgical factors. Adenomyosis should be considered an independent preoperative risk factor of surgical complications.

Retrospective, Multicenter Analysis Comparing Conventional with Oncoplastic Breast Conserving Surgery: Oncological and Surgical Outcomes in Women with High-Risk Breast Cancer from the OPBC-01/iTOP2 Study

IntroductionRecent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4).MethodsData from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed.ResultsA total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups.ConclusionsLarge resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.

Is bladder outlet obstruction responsible for a successful surgical outcome in women with complicated stress urinary incontinence? Urodynamic results before and after a Remeex® readjustable sling.

To describe the changes in urodynamic parameters after Remeex® placement in women with recurrent stress urinary incontinence (rSUI) or intrinsic sphincteric deficiency (ISD) and to analyze a potential relationship between postoperative bladder outlet obstruction and a successful surgical outcome. Retrospective analysis of those women who had undergone Remeex® placement due to rSUI or ISD in our department between 2000 and 2017. All patients underwent urodynamic evaluation before and after the surgery. If tension readjustment was required, postoperative urodynamics was performed after the last regulation, once the final continence status had been achieved. The female Bladder Outlet Obstruction Index (BOOIf) was calculated for all patients postoperatively. Obstruction was considered present if BOOIf was >18. Pre- and postoperative urodynamic variables were compared. Postoperative urodynamic changes were also compared between cured and noncured patients. A total of 205 women were included. After a follow-up of 89 ± 36 months, 165 women (80.5%) were continent. A significant impairment in the majority of the urodynamic parameters was observed. Mean postoperative BOOIf was -11.8 ± 21.5 in cured patients and -15.3 ± 23.1 in noncured patients (p = 0.365);15 (9.1%) patients in the cured group had a postoperative BOOIf >18, whereas all (100%) patients in the noncured group had a postoperative BOOIf <18. Most urodynamic parameters may worsen after the Remeex® system placement. Postoperative urodynamic parameters may not differ substantially between cured and noncured patients, although a certain grade of bladder outlet obstruction could be related to postoperative continence status in some patients.

P134 - Retrospective multicenter analysis comparing conventional with oncoplastic breast conservation: oncologic and surgical outcome in women with high risk breast cancer from the OPBC-01/iTOP2 study

P134 - Retrospective multicenter analysis comparing conventional with oncoplastic breast conservation: oncologic and surgical outcome in women with high risk breast cancer from the OPBC-01/iTOP2 study

Value of first-trimester ultrasound in prediction of third-trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome.

To explore whether early first-trimester ultrasound can predict the third-trimester sonographic stage of placenta accreta spectrum (PAS) disorder and to elucidate whether combining first-trimester ultrasound findings with the sonographic stage of PAS disorder can stratify the risk of adverse surgical outcome in women at risk for PAS disorder. This was a retrospective analysis of prospectively collected data from women with placenta previa, and at least one previous Cesarean delivery (CD) or uterine surgery, for whom early first-trimester (5-7 weeks' gestation) ultrasound images could be retrieved. The relationship between the position of the gestational sac and the prior CD scar was assessed using three sonographic markers for first-trimester assessment of Cesarean scar (CS) pregnancy, reported by Calí et al. (crossover sign (COS)), Kaelin Agten et al. (implantation of the gestational sac on the scar vs in the niche of the CS) and Timor-Tritsch et al. (position of the center of the gestational sac below vs above the midline of the uterus), by two different examiners blinded to the final diagnosis and clinical outcome. The primary aim of the study was to explore the association between first-trimester ultrasound findings and the stage of PAS disorder on third-trimester ultrasound. Our secondary aim was to elucidate whether the combination of first-trimester ultrasound findings and sonographic stage of PAS disorder can predict surgical outcome. Logistic regression analysis and area under the receiver-operating-characteristics curve (AUC) were used to analyze the data. One hundred and eighty-seven women with vasa previa were included. In this cohort, 79.6% (95% CI, 67.1-88.2%) of women classified as COS-1, 94.4% (95% CI, 84.9-98.1%) of those with gestational-sac implantation in the niche of the prior CS and 100% (95% CI, 93.4-100%) of those with gestational sac located below the uterine midline, on first-trimester ultrasound, were affected by the severest form of PAS disorder (PAS3) on third-trimester ultrasound. On multivariate logistic regression analysis, COS-1 (odds ratio (OR), 7.9 (95% CI, 4.0-15.5); P < 0.001), implantation of the gestational sac in the niche (OR, 29.1 (95% CI, 8.1-104); P < 0.001) and location of the gestational sac below the midline of the uterus (OR, 38.1 (95% CI, 12.0-121); P < 0.001) were associated independently with PAS3, whereas parity (P = 0.4) and the number of prior CDs (P = 0.5) were not. When translating these figures into diagnostic models, first-trimester diagnosis of COS-1 (AUC, 0.94 (95% CI, 0.91-0.97)), pregnancy implantation in the niche (AUC, 0.92 (95% CI, 0.89-0.96)) and gestational sac below the uterine midline (AUC, 0.92 (95% CI, 0.88-0.96)) had a high predictive accuracy for PAS3. There was an adverse surgical outcome in 22/187 pregnancies and it was more common in women with, compared to those without, COS-1 (P < 0.001), gestational-sac implantation in the niche (P < 0.001) and gestational-sac position below the uterine midline (P < 0.001). On multivariate logistic regression analysis, third-trimester ultrasound diagnosis of PAS3 (OR, 4.3 (95% CI, 2.1-17.3)) and first-trimester diagnosis of COS-1 (OR, 7.9 (95% CI, 4.0-15.5); P < 0.001), pregnancy implantation in the niche (OR, 29.1 (95% CI, 8.1-79.0); P < 0.001) and position of the sac below the uterine midline (OR, 6.6 (95% CI, 3.9-16.2); P < 0.001) were associated independently with adverse surgical outcome. When combining the sonographic coordinates of the three first-trimester imaging markers, we identified an area we call high-risk-for-PAS triangle, which may enable an easy visual perception and application of the three methods to prognosticate the risk for CS pregnancy and PAS disorder, although it requires validation in large prospective studies. Early first-trimester sonographic assessment of pregnancies with previous CD can predict reliably ultrasound stage of PAS disorder. Combination of findings on first-trimester ultrasound with second- and third-trimester ultrasound examination can stratify the surgical risk in women affected by a PAS disorder. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Charlson Comorbidity Index as Predictor of Poor Surgical Outcomes in Patients Undergoing Minimally Invasive Hysterectomy by Gynecologic Oncologists

OBJECTIVES: To determine whether the validated Charlson comorbidity index (CCI) and other preoperative assessments are predictive of poor surgical outcomes in women undergoing minimally invasive hysterectomy by gynecologic oncologists.