Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

We report a case of salvage lymphadenectomy for an isolated metastatic lesion in the para-aortic lymph node (LN) in a 49-year old woman with a history of cervical cancer, initially treated with radical hysterectomy and adjuvant radiotherapy. Preoperative 3-dimensional (3D) computed tomography (CT) angiography clearly revealed a huge retro-crural metastatic LN with distinct demarcation. A metastatic lesion, more than 10 cm in size, was located behind the vena cava, aorta, and left kidney, encompassing the left renal and lumbar arteries. The metastatic LN was excised along with the left kidney. On histologic examination, the tumor was found to have invaded the pelvis of the left kidney. Compared with conventional imaging techniques, 3D CT angiography can more clearly visualize such lesions. Thus, 3D CT angiography provides useful anatomical information, such as the exact size and location, and provides clear visualization and demarcation.
Angiography* ; Aorta ; Arteries ; Female ; Humans ; Hysterectomy ; Kidney ; Lymph Node Excision* ; Lymph Nodes ; Pelvis ; Radiotherapy, Adjuvant ; Recurrence ; Uterine Cervical Neoplasms*

Clinical practice guidelines for gynecologic cancers have been developed by many organizations. Although these guidelines have much in common in terms of the practice of standard of care for uterine corpus cancer, practice guidelines that reflect the characteristics of patients and healthcare and insurance systems are needed for each country. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to produce the third edition of the guidelines as an advanced form based on evidence-based medicine, considering up-to-date clinical trials and abundant qualified Korean data. These guidelines cover screening, surgery, adjuvant treatment, and advanced and recurrent disease with respect to endometrial carcinoma and uterine sarcoma. The committee members and many gynecologic oncologists derived key questions from the discussion, and a number of relevant scientific literatures were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, together with other details. The objective of these practice guidelines is to establish standard policies on issues in clinical areas related to the management of uterine corpus cancer based on the findings in published papers to date and the consensus of experts as a KSGO Consensus Statement.
Committee Membership ; Consensus* ; Delivery of Health Care ; Drug Therapy ; Endometrial Neoplasms ; Evidence-Based Medicine ; Female ; Humans ; Insurance ; Korea* ; Mass Screening ; Sarcoma ; Standard of Care

Ovarian dermoid cysts are one of the most common benign neoplasms in women. Rectal fistula formation due to an ovarian dermoid cyst, particularly a benign dermoid cyst, is extremely rare. A 17-year-old girl with symptoms of lower abdominal pain, passage of sebaceous materials in the stool, and hematochezia was found to have an 11-cm dermoid cyst complicated with a rectal fistula formation. Laparoscopic repair of the rectal fistula was performed successfully with bilateral ovarian cystectomies. This case presents the rare formation of a fistula between a benign dermoid cyst and the rectum and its treatment using laparoscopic repair without laparotomy.
Abdominal Pain ; Adolescent ; Cystectomy ; Dermoid Cyst* ; Female ; Fistula ; Gastrointestinal Hemorrhage ; Humans ; Laparoscopy ; Laparotomy ; Rectal Fistula* ; Rectum

Intrathoracic metastasis of ovarian cancer has poor prognosis regardless of treatment modality. Recent development of surgical techniques and the new concept of direct infusion of chemotherapeutic agents with hyperthermia could help with the treatment of disseminated diseases in ovarian cancer. Using video-assisted thoracoscopic surgery and intracavitary chemotherapy with hyperthermia, we tried hyperthermic intrathoracic chemotherapy for a case of stage IV high-grade serous ovarian cancer with pleural metastasis. There was no high-grade complication related to the procedure. The patient is alive without disease at 32 months after initial treatment.
Cisplatin* ; Drug Therapy* ; Fever ; Humans ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Prognosis ; Thoracic Surgery, Video-Assisted

Adult granulosa cell tumors (AGCTs) presenting with massive ascites and elevated serum CA-125 levels have rarely been described in the literature. An ovarian mass, massive ascites, and elevated serum CA-125 levels in postmenopausal women generally suggest a malignant ovarian tumor, particularly advanced epithelial ovarian cancer. AGCT has low 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography due to its low metabolic activity. In the present report, we describe a case of an AGCT with massive ascites, elevated serum CA-125 level, and low 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography.
Adult* ; Ascites* ; Electrons* ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Ovarian Neoplasms

The Yoon Soon (YS) knot is a laparoscopic extracorporeal slip knot that is easy to learn and apply. Our new technique, which uses the trocar as a knot pusher, is simpler, faster, and has more tension than conventional knot methods. The YS knot will help surgeons save operative time and perform tension-controlled knot-tying during laparoscopic surgery.
Laparoscopy ; Operative Time ; Surgical Instruments*

Indirect inguinal hernia containing an ovary is a rare condition, especially in adult women who do not have any other genital tract anomalies. In addition, inguinal hernia containing an ovary and endometriosis is exceedingly rare. In the present report, we describe a case of indirect inguinal hernia containing an ovary, fallopian tube, and endometriosis. Laparoscopic repair was performed successfully using polypropylene mesh for the treatment of the inguinal hernia.
Adult* ; Endometriosis* ; Fallopian Tubes* ; Female ; Hernia, Inguinal* ; Humans ; Ovary* ; Polypropylenes