J. Yazbek

Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer.

To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer.

Psychological Issues Associated With Absolute Uterine Factor Infertility and Attitudes of Patients Toward Uterine Transplantation

Context: Uterine transplantation (UTx). Objective: To explore patients’ knowledge of and attitudes toward UTx before and after a short educational intervention via a video and question and answer (Q&A) session. Design: Large, in-depth survey investigating patients’ motivations, aims, and beliefs on UTx. Setting: Imperial College London. Participants: Women diagnosed with absolute uterine factor infertility (AUFI) who were seeking information on UTx and had already volunteered to participate in the study. Intervention: A semistructured interview involving a brief baseline questionnaire before a Q&A session and a 20-minute video exploring the main risks and benefits for UTx. Main outcome measures: Attitudes of self-referred patients with AUFI toward UTx before and after education focusing on UTx. Rank order of importance of key UTx-related issues. Results: Forty women were interviewed. Following the video presentation and Q&A session, 97.5% (n = 39) would undergo UTx ahead of surrogacy and adoption in full knowledge that the latter 2 options would be ultimately safer for their own well-being and the fact that the graft could fail even prior to conception. All felt that UTx should take place, and 92.5% saw UTx as achievable. Conclusion: The study demonstrates a keen interest in UTx, partly because other options seem difficult to access. It is worth noting that people appear to be distancing themselves from the risk. This requires careful assessment in any clinical program. This study is the first to demonstrate a qualitative relationship between patients with AUFI and their curiosity and desire for UTx. It paves the way for forming the introduction into the psychological assessment of a potential patient.

Uterine transplantation: past, present and future.

Absolute uterine factor infertility (AUFI) is a term used to describe women who cannot carry a pregnancy because of the absence of a uterus or the presence of an anatomically or physiologically non-functioning uterus. Causes of AUFI can be categorised into congenital, such as Mayer–Rokitansky–Kuster–Hauser syndrome and acquired, due to Asherman syndrome or following hysterectomy to treat postpartum haemorrhage, benign gynaecological disease or gynaecological cancer. AUFI affects one in 500 women of childbearing age. The present options to acquire motherhood include adoption or surrogacy, both of which are associated with moral and ethical difficulties in addition to complex legal, financial and religious factors. The fact that surrogacy is prohibited in many countries, including Italy, Germany, Pakistan and Saudi Arabia, epitomises the difficulties that such women experience to have children. Uterine transplantation (UTx) may overcome many of these difficulties and could become a realistic future treatment option for AUFI.

A case of pregnancy following a modified Strassman procedure applied to treat a placental site trophoblastic tumour

Please cite this paper as: Saso S, Chatterjee J, Yazbek J, Thum Y, Keefe K, Abdallah Y, Naji O, Lindsay I, Savage P, Seckl M, Smith J. A case of pregnancy following a modified Strassman procedure applied to treat a placental site trophoblastic tumour. BJOG 2012; DOI: 10.1111/j.1471‐0528.2012.03501.x.

Ultrasound-guided laparoscopic ovarian preserving surgery to treat anti-NMDA receptor encephalitis.

preserving surgery to treat anti-NMDA receptor encephalitis BP Jones, R Rees, S Saso, C Stalder, JR Smith, J Yazbek a West London Gynaecological Cancer Centre, Queen Charlotte’s & Chelsea Hospital, Imperial College NHS Trust, London, UK b Department of Surgery and Cancer, Imperial College London, London, UK c Department of Neurology, Charing Cross Hospital, Imperial College NHS Trust, London, UK Correspondence: BP Jones, Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK. Email benjamin.jones@nhs.net

Surgery for Recurrent Uterine Cancer: Surgical Outcomes and Implications for Survival—A Case Series

Objective The purpose of this study was to describe the patterns of relapse in uterine cancer (UC) and the role of surgery in the recurrent setting. Methods We describe surgical and clinical outcomes of all patients who underwent surgery for recurrent UC in a gynecological oncology tertiary referral center between May 1, 2013, and April 30, 2016. Progression-free survival and overall survival were estimated using Kaplan-Meier methods with the surgery at relapse being the starting point. Results We evaluated 15 patients with a median age of 66 years. The predominant histology was the endometrioid variant (n = 11; 73.3%). The median interval between the end of previous treatment and relapse surgery was 24 months (range, 8–164). Locoregional pelvic recurrences were the most common type of recurrence (n = 13; 86.7%) with the para-aortic lymph node space being the most commonly affected extrapelvic site (13%). Patients predominantly presented with a multifocal pattern of relapse (n = 10; 66.7%) requiring multivisceral resections such as bowel (n = 7; 46.6%) and/or bladder/ureteric resections (n = 8; 53.3%) to achieve complete tumor clearance. All patients were operated tumor free with a 30-day major morbidity and mortality rate of 6.7% and 0%, respectively. Five patients (33.3%) received postoperative chemotherapy or radiotherapy. Five patients (33.3%) relapsed, and 3 died within a mean follow-up of 12.4 months (95% confidence interval [CI], 6.5–18.2). Two of those patients had a sarcoma. Mean progression-free survival and overall survival for the entire cohort postrelapse surgery was 21.7 months (95%CI, 13.9–29.5) and 26.0 months (95%CI, 18.4–33.7), respectively. Survival was significantly worse in patients with nonendometrioid histology (P < 0.0001). Conclusions Surgery for UC relapse seems feasible with acceptable morbidity and high complete resection rates despite the multifocal patterns of relapse in a selected group of patients in a reference center for gynecological cancers. Larger scale studies are warranted to establish the value of surgery at relapse for UC.

Ultrasound-Guided Laparoscopic Ovarian Wedge Resection in Recurrent Serous Borderline Ovarian Tumours.

Objective The aim of this study was to demonstrate the use of intraoperative ultrasound-guided ovarian wedge resection in the treatment of recurrent serous borderline ovarian tumors (sBOTs) that are too small to be visualized laparoscopically. Methods This was a prospective analysis of all women with recurrent sBOTs that were not visible laparoscopically, who underwent intraoperative ultrasound-guided ovarian wedge resection between January 2015 and December 2016 at the West London Gynaecological Cancer Centre, Imperial College NHS Trust, London, United Kingdom. Results We evaluated 7 patients, with a median age of 35 years (range, 28–39 years). Six women were nulliparous, whereas 1 woman had a single child. Previous surgical intervention left 5 women with a single ovary, whereas the remaining 2 had previous ovarian-sparing surgery. The median size of recurrence was 18 mm (range, 12–37 mm). All women underwent uncomplicated intraoperative guided ovarian wedge resections. Histological assessment confirmed sBOT in all 7 cases. Six of the women remain disease-free. One woman recurred postoperatively with her third recurrence, who previously had bilateral disease and noninvasive implants with microinvasive disease and micropapillary pattern. No cases progressed to invasive disease. The median follow-up time was 12 months (range, 1–20 months). One pregnancy has been achieved postoperatively but resulted in miscarriage. Conclusions Continuous intraoperative ultrasound can be used to facilitate complete tumor excision in recurrent sBOT while minimizing the removal of ovarian tissue in women with recurrent sBOT. It is essential that surgical techniques evolve simultaneously with diagnostic imaging modalities to enable surgeons to treat such pathology.

Methylation of MYLK3 gene promoter region: a biomarker to stratify surgical care in ovarian cancer in a multicentre study

Background:Survival benefit from surgical debulking of ovarian cancer (OC) is well established, but some women, despite total macroscopic clearance of disease, still have poor prognosis. We aimed to identify biomarkers to predict benefit from conventional surgery.Methods:Clinical data from women debulked for high-stage OC were analysed (Hammersmith Hospital, London, UK; 2001–2014). Infinium’s HumanMethylation27 array interrogated tumour DNA for differentially methylated CpG sites, correlated to survival, in patients with the least residual disease (RD; Hammersmith Array). Validation was performed using bisulphite pyrosequencing (Charité Hospital, Berlin, Germany cohort) and The Cancer Genome Atlas’ (TCGA) methylation data set. Kaplan–Meier curves and Cox models tested survival.Results:Altogether 803 women with serous OC were studied. No RD was associated with significantly improved overall survival (OS; hazard ratio (HR) 1.25, 95% CI 1.06–1.47; P=0.0076) and progression-free survival (PFS; HR 1.23, 95% CI 1.05–1.43; P=0.012; Hammersmith database n=430). Differentially methylated loci within FGF4, FGF21, MYLK2, MYLK3, MYL7, and ITGAE associated with survival. Patients with the least RD had significantly better OS with higher methylation of MYLK3 (Hammersmith (HR 0.51, 95% CI 0.31–0.84; P=0.01), Charité (HR 0.46, 95% CI 0.21–1.01; P=0.05), and TCGA (HR 0.64, 95% CI 0.44–0.93; P=0.02)).Conclusions:MYLK3 methylation is associated with improved OS in patients with the least RD, which could potentially be used to determine response to surgery.

OC04.05: Management of ovarian masses during pregnancy in a London university hospital: a cohort study

Methods: This is a retrospective study in a tertiary referral centre. Patients who presented at the Department of O&G at Singapore General Hospital in a 3-year period between 2014 and 2017 with suspected ovarian pathology were evaluated using IOTA LR2 model and designated as benign (likelihood ratio of malignancy less than 10%) or malignant (likelihood ratio of malignancy greater than 10%). LR2 scores were correlated with histopathological findings. Collected data was statistically analysed using chi-square test. Results: Of the 1110 patients who were assigned an IOTA LR2 score, 745 (67.7%) were managed conservatively or declined surgery. Of the 355 (32.3%) patients who underwent surgery, 150 (42%) had ovarian masses classified as malignant (LR2 greater than 10%). Of these 150 patients, 21 received a benign diagnosis with histopathological confirmation. All of the remaining 205 patients with masses assigned a likelihood score of LR2 less than 10% were confirmed to benign. The sensitivity for the detection of malignancy using the IOTA LR2 model was 100% and the specificity was 90.7%, with a positive predictive value of 86% and accuracy of 94%. Conclusions: IOTA ultrasound-based logistic regression models were highly sensitive and specific in predicting ovarian malignancy preoperatively yet being reproducible, easy to train and use.

Use of biomedical photonics in gynecological surgery: a uterine transplantation model

Aim: Uterine transplantation (UTx) has been proposed as a treatment for permanent absolute uterine factor infertility. The study aims were to compare pulse oximetry and multispectral imaging (MSI), for intraoperative tracking of uterine oxygen saturation in animal UTx models (rabbit and sheep). Results/methodology: Imaging results confirmed the re-establishment of adequate perfusion in the transplanted organ after surgery. Comparison of oxygen saturation values between the pre-UTx donor and post-UTx recipient, and pre-UTx and post-UTx recipient reveals a statistically significant decrease in saturation levels post-UTx. Conclusion: The use of MSI is the first case in gynecology and has demonstrated promise of possible future human use. MSI technique has advantages over pulse oximetry – it provides spatial information in a real-time, noncontact manner.