Informed consent is a fundamental aspect of surgical care, designed to reinforce patient autonomy, promote shared decision-making, and potentially mitigate legal conflicts by ensuring the provision of comprehensive and consistent information in clinical practice. The Korean Society of Gynecologic Oncology (KSGO) previously published detailed informed consent documents for cervical, endometrial, and ovarian cancer surgery. However, standardized consent forms remain relatively lacking for laparoscopic-robotic hysterectomy performed for non-malignant indications, as well as for vulvar cancer surgery. Hence, the KSGO subcommittee collected, reviewed, and discussed consent forms from domestic medical institutions and subsequently developed informed consent for laparoscopic-robotic hysterectomy and vulvar cancer surgery, aiming to build patient trust and understanding.

Objective: We aimed to predict the risk of postoperative adjuvant therapy using preoperative variables in young patients with early stage cervical cancer. The predicted risk can guide whether ovarian transposition should be performed during surgery. Methods: In total, 886 patients with stage IB1-IIA cervical cancer aged 20-45 years who underwent modified radical or radical hysterectomy between January 2000 and December 2008 were included. Preoperative variables, preoperative laboratory findings, International Federation of Gynaecology and Obstetrics stage, tumor size, and pathological variables were collected. Patients with high risk factors or those who met the Sedlis criteria were considered adjuvant therapy risk (+); others were considered adjuvant therapy risk (-). A decision-tree model using preoperative variables was constructed to predict the risk of adjuvant therapy. Results: Of 886 patients, 362 were adjuvant therapy risk (+) (40.9%). The decision-tree model with four distinct adjuvant therapy risks using tumor size and age were generated. Specifically, patients with tumor size ≤2.45 cm had low risk (49/367; 13.4%), those with tumor size ≤3.85 cm and >2.45 cm had moderate risk (136/314; 43.3%), those with tumor size >3.85 cm and age ≤39.5 years had high risk (92/109; 84.4%), and those with tumor size >3.85 cm and age >39.5 years had the highest risk (85/96; 88.5%). Conclusion The risk of postoperative adjuvant therapy in young patients with early stage cervical cancer can be predicted using preoperative variables. We can decide whether ovarian transposition should be performed using the predicted risk.

BACKGROUND/AIMS: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model. METHODS: We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination. RESULTS: The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis. CONCLUSIONS: EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.
Abscess ; Animals ; Cicatrix ; Colon* ; Dogs ; Esophageal and Gastric Varices ; Fibrosis ; Follow-Up Studies ; Granulation Tissue ; Ligation* ; Needles ; Peritonitis ; Sepsis

Carcinosarcomas of the uterine cervix are extremely rare. Cervical carcinosarcoma can be characterized by having two different origins: the Mullerian ducts and the mesonephric duct remnants. A 53-year-old Korean woman was admitted to the hospital because of pelvic mass detected on computed tomography scan done at private clinic. A Radical hysterectomy with bilateral salpingooophorectomy and pelvic lymphadenectomy was carried out upon a diagnosis of stage IB2 cervical sarcoma. Immunohistochemically, the epithelial component was positive for pancytokeratin and estrogen receptor, but negative for CD 10 and carletinin. The mesenchymal component was positive for vimentin. The histopathologic diagnosis was a carcinosarcoma of the uterine cervix arising from Mullerian ducts. She underwent chemotherapy. She developed systemic recurrence seven months after operation and died of disease. The origin of cervical carcinosarcoma needs to be verified and immunohistochemical studies using mesonephric marker (CD 10, carletinin, and estrogen receptor) is helpful.
Breast Neoplasms ; Carcinosarcoma* ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Estrogens ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Middle Aged ; Mullerian Ducts* ; Recurrence ; Sarcoma ; Vimentin ; Wolffian Ducts

OBJECTIVES: To evaluate the effects of 3-year hormone therapy, raloxifene and alendronate on lipid profile and body mass index (BMI) in Korean postmenopausal women. METHODS: We studied 107 postmenopausal women who had visited the Department of Obstetrics and Gynecology of Inje University Sanggye Paik Hospital between January 2000 and June 2010. These patients were divided into alendronate (n=21), raloxifene (n=18), estrogen therapy (ET) (n=35), estrogen-progesterone therapy (EPT) (n=33) group. Serum lipid profile was measured at baseline and 1, 2, 3-year after treatment. BMI were also assessed at baseline and 3-year after treatment. RESULTS: Total cholesterol level was decreased significantly after 3 years of treatment in EPT group by 5.0% and raloxifene group by 8.7%. Triglyceride level was decreased significantly after 3 years in alendronate group by 12%. HDL-cholesterol level was increased significantly after 2 years in ET group by 12% and EPT group by 6.0%. LDL-cholesterol level was decreased significantly after 1 year in ET group by 7.0% and EPT group by 13%. In raloxifene group, LDL-cholesterol level was decreased significantly after 3 years by 7%. BMI was not changed significantly after 3 years in all four groups. CONCLUSIONS: In postmenopausal women, the treatment with hormone therapy or raloxifene has a beneficial effect on lipid profiles. BMI was not changed.
Alendronate ; Body Mass Index ; Cholesterol ; Estrogens ; Female ; Gynecology ; Humans ; Obstetrics ; Raloxifene Hydrochloride

OBJECTIVES: Breast density is an independent risk factor for the development of invasive breast cancer. We conducted this study to evaluate the effects of 3 years of hormone therapy, raloxifene, and alendronate on mammographic breast density in postmenopausal Korean women. METHODS: We studied 127 postmenopausal women who had visited the Department of Obstetrics and Gynecology of Inje University Sanggye Paik Hospital between January 2000 and June 2010. These patients were divided into the following 5 groups: alendronate (n = 26); raloxifene (n = 18); estrogen therapy (ET; n = 43); continuous estrogen-progesterone therapy (EPT; n = 20); and cyclic EPT (n = 20). The Breast Image Reporting and Data System (BI-RADS) composition grade 1, 2, and 3 years after treatment was compared with the BI-RADS composition grade at baseline. RESULTS: The BI-RADS grade decreased significantly in the raloxifene group at 1 year (P = 0.04). The BI-RADS grade increased significantly in the ET group at 3 years (P = 0.03), in the continuous EPT at 1, 2, and 3 years (P = 0.01, < 0.001, < 0.001, respectively), and in the cyclic EPT group at 2 and 3 years (P = 0.04 and 0.02, respectively). Although not statistically significant, a decrease in the BI-RADS grade occurred in the alendronate group at 1, 2, and 3 years (P = 0.08, 0.1, and 0.1, respectively). CONCLUSION: This study showed that there was significant decrease in mammographic breast density at 1 year in the raloxifene group and a decreasing trend in the alendronate group, whereas there was significant increase in the ET and EPT groups. To determine the effect of raloxifene and alendronate on breast density, larger prospective studies are needed.
Alendronate ; Breast ; Breast Neoplasms ; Estrogens ; Female ; Gynecology ; Humans ; Information Systems ; Menopause ; Obstetrics ; Raloxifene Hydrochloride ; Risk Factors

OBJECTIVES: The aim of this study was to assess atrophic symptoms, the vaginal maturation index (VMI), and vaginal pH in postmenopausal women after use of estriol vaginal tablets for the treatment of vaginal atrophy. METHODS: In a randomized prospective study, 67 postmenopausal women were treated with 500microg estriol tablets 3 times a week for 1 week in the 1-week treatment group (n = 40) and for 2 weeks in the 2-week treatment group (n = 27). The primary endpoints were changes in the VMI, vaginal pH, and improvement in participant-reported most bothersome symptom (MBS; vaginal dryness, irritation/itching, or dyspareunia). We compared three endpoints before and after treatment in each group and between the two treatment groups. The correlation between the vaginal pH and maturation value (MV) was assessed. RESULTS: A statistically significant increase in the MV, decrease in pH, and improvement in the MBS occurred for women treated with estriol vaginal tablets in the 1- (P = 0.000, P = 0.002, and P = 0.000, respectively) and 2-week treatment groups (P = 0.000, P = 0.000, and P = 0.000, respectively). There were no significant differences between the 1- and 2-week treatment groups with respect to improvement in the VMI, vaginal pH, or MBS. The correlation between the vaginal pH and MV showed a negative linear correlation at 0, 1, and 2 weeks (P = 0.000, P = 0.000, and P = 0.011, respectively). CONCLUSION: Treatment with 500microg estriol vaginal tablets thrice-weekly for 1 week was effective in improving. It is thought that the three primary endpoints (VMI, vaginal pH, and MBS) improved at the same time during treatment.
Estriol ; Estrogens ; Female ; Humans ; Hydrogen-Ion Concentration ; Prospective Studies ; Tablets ; Vaginal Creams, Foams, and Jellies