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The objective of the present study was to define and validate an anastomotic leak prognostic score based on previously described and reported anastomotic leak risk factors (OVA-LEAK: https://n9.cl/ova-leakscore) and to establish if the use of OVA-LEAK score is better than clinical criteria (surgeon's choice) selecting anastomosis to be protected with a diverting ileostomy.This is a retrospective, multicentre cohort study that included patients who underwent cytoreductive surgery for primary advanced or relapsed ovarian cancer with colorectal resection and anastomosis between January 2011 and June 2021. Data from patients already included in the previous predictive model were not considered in the present analysis. To validate the performance of our logistic regression model, we used the OVA-LEAK formula (Annex I: https://n9.cl/ova-leakscore) for estimating leakage probabilities in a new independent cohort. Then, receiver operating characteristic (ROC) analysis was performed and area under the curve (AUC) was used to measure the performance of the model. Additionally, the Brier score was also estimated. 95% confidence intervals (CI) for each of the estimated performance measures were also calculated.848 out of 1159 recruited patients were finally included in the multivariable logistic regression model validation. The AUC of the new cohort was 0.63 for predicting anastomotic leak. Considering a cut-off point of 22.1% to be 'positive' (to get a leak) this would provide a sensitivity of 0.45, specificity of 0.80, positive predictive value of 0.09 and negative predictive value of 0.97 for anastomotic leak. If we consider this cut-off point to select patients at risk of leak for bowel diversion, up to 22.5% of the sampled patients would undergo a diverting ileostomy and 47% (18/40) of the anastomotic leaks would be 'protected' with the stoma. Nevertheless, if we consider only the 'clinical criteria' for performing or not a diverting ileostomy, only 12.5% (5/40) of the leaks would be 'protected' with a stoma, with a rate of diverting ileostomy of up to 24.3%.Compared with subjective clinical criteria, the use of a predictive model for anastomotic leak improves the selection of patients who would benefit from a diverting ileostomy without increasing the rate of stoma use.

The purpose of this document is to present preliminary design procedures for bridge superstructures that are made partially or completely of precast concrete. This document deals with continuous and simply supported superstructures, used in integral or nonintegral bridges. The document is intended for engineers with limited experience who will find it an instructive detailed guide to carry out conceptual design of superstructures of these types. Additionally, it is intended for experienced engineers who are interested in learning how different countries solve similar conceptual design problems. Finally, it is intended to enrich the knowledge of precasters everywhere, to be able to enhance their own designs with ideas and methods from many different countries.

The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study. 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1-mm portion of each lymph node was subjected to semi-serial sectioning at 200-μm intervals and examined by hematoxylin-eosin and immunohistochemistry with CK19; the remaining tissue was analysed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/μl), the sensitivity of the OSNA assay was 92%; specificity was 82%; diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis.

The primary objective was to evaluate the response rate of conservative treatment for endometrial cancer, and the secondary objective was to assess oncological, fertility and obstetric outcomes in patients who underwent fertility preservation treatment.This multicentre, observational, retrospective study evaluated endometrial cancer patients who underwent fertility-sparing treatment in Spanish centres between January 2010 and January 2020. Seventy-three patients with stage IA endometrioid adenocarcinoma of the uterus were included in the study.The levonorgestrel intrauterine device (LNG-IUD) was the most common fertility-sparing treatment (53.4%), followed by megestrol acetate (20.5%) and medroxyprogesterone acetate (16.4%). During the 24-month follow-up period, the rate of complete response to fertility-sparing management was 74% (n = 54), and 8.2% (n = 6) of patients presented a partial response. Additionally, 13 (17.8%) patients presented with persistent disease and six (8.2%) relapsed after response. The LNG-IUD was associated with a higher complete response rate than the other methods (87.2 vs. 58.8%; p = 0.01). Surgical treatment (at least hysterectomy) was performed in 44 (60.3%) patients as the end of fertility-sparing treatment. Four (5.5%) patients presented relapse after surgery, associated with final FIGO stage III (p = 0.036), myometrial invasion 50% (p = 0.018) and final tumour grade 2-3 (p = 0.018). The mean follow-up period was 57.8 (range 6-159) months. The 5-year relapse-free survival and overall survival rates were 92.6% [95% CI (81.3, 97.2)] and 93.5% [95% CI (80.7, 97.9)], respectively. During follow-up, three patients (4.1%) died of the disease after completion of surgical treatment. Up to 50.7% of patients included in the study attempted to get pregnant. Of these, the rate of pregnancy was 81.1% (n = 30/37), and reproductive techniques were used for this purpose in 78.4% of cases.Fertility-sparing management presented a high response rate in patients with endometrial cancer. LNG-IUD was associated with a better response rate compared to the other treatment options. Moreover, in patients using this management method, pregnancy could be achieved using reproductive techniques.

The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study, and 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1 mm portion of each lymph node was subjected to semi-serial sectioning at 200 μm intervals and examined by hematoxylin–eosin and immunohistochemistry with CK19; the remaining tissue was analyzed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/μL), the sensitivity of the OSNA assay was 92%, specificity was 82%, diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis., El objetivo de este estudio fue evaluar la eficacia de la amplificación de ácido nucleico en un solo paso (OSNA) para la detección de metástasis en el ganglio linfático centinela (GC) en comparación con la ultraestadificación patológica estándar en pacientes con cáncer de endometrio (CE) en estadio temprano. Se incluyeron en el estudio un total de 526 SLN de 191 pacientes con EC, y 379 SLN (147 pacientes) fueron evaluados por ambos métodos, OSNA y ultraestadificación patológica estándar. La porción central de 1 mm de cada ganglio linfático se sometió a un seccionamiento semiserie a intervalos de 200 μm y se examinó mediante hematoxilina-eosina e inmunohistoquímica con CK19; el tejido restante fue analizado por OSNA para ARNm de CK19. El ensayo OSNA detectó metástasis en el 19,7 % de los pacientes (14,9 % micrometástasis y 4,8 % macrometástasis), mientras que la ultraestadificación patológica detectó metástasis en el 8,8 % de los pacientes (3. 4% micrometástasis y 5,4% macrometástasis). Usando el valor de corte establecido para detectar metástasis SLN por OSNA en EC (250 copias/μL), la sensibilidad del ensayo OSNA fue del 92 %, la especificidad fue del 82 %, la precisión diagnóstica fue del 83 % y el valor predictivo negativo fue del 99 % Se registraron resultados discordantes entre ambos métodos en 20 pacientes (13,6%). OSNA resultó en una sobreestadificación en 12 pacientes (8,2%). OSNA podría ayudar en la identificación de pacientes que requieren tratamiento adyuvante en el momento del diagnóstico. Se registraron resultados discordantes entre ambos métodos en 20 pacientes (13,6%). OSNA resultó en una sobreestadificación en 12 pacientes (8,2%). OSNA podría ayudar en la identificación de pacientes que requieren tratamiento adyuvante en el momento del diagnóstico. Se registraron resultados discordantes entre ambos métodos en 20 pacientes (13,6%). OSNA resultó en una sobreestadificación en 12 pacientes (8,2%). OSNA podría ayudar en la identificación de pacientes que requieren tratamiento adyuvante en el momento del diagnóstico.

The uterine manipulator is a device commonly used in minimally invasive hysterectomy procedures for benign disease to facilitate uterus mobilization during surgery, generate tension on the main supporting elements of the uterus (broad ligament, uterine vessels, and uterosacral ligaments) to improve

Fistula repair in the perineal region represents a major challenge for surgeons. It is important for the medical community to facilitate and disclose these techniques. The aim of this article was to show a stepwise approach for a direct repair and use of a Martius flap for a vesicovaginal fistula. We show a single case performed in a patient who presented with a vesicovaginal fistula diagnosed after surgery, which did not respond to conservative management. The procedure consists of the following steps: intraoperative cystoscopy, anatomical direct repair of the fistulous tract between the bladder and vagina, and modified Martius flap. Martius flap is a repair technique used for complex fistula in the perineal region. It is a simple, safe, and reproducible procedure with good long-term functional and esthetic results.

Objective To demonstrate the feasibility of a protective maneuver to avoid tumor exposure during laparoscopic radical hysterectomy. Design This video illustrates the vaginal cuff closure technique in cervical cancer surgery. Setting The Oncologic Gynecology Department at the University Hospital La Fe. Interventions After the Laparoscopic Approach to Cervical Cancer trial [1] , the laparoscopic approach to the surgical treatment of cervical cancer has been questioned: laparotomic surgery has been associated with a better cancer outcome. This publication has changed the current approach recommendation for performing radical hysterectomy from minimally invasive surgery to open surgery. There are some theories that might justify these findings. In minimally invasive surgery, the use of a uterine manipulator can condition the spread owing to erosion and friction caused on the tumor, even leading to the perforation of the tumor. In addition, intraperitoneal colpotomy can lead to pelvic peritoneum contamination by the tumor. To close the gap between laparoscopy and laparotomy, some protective maneuvers, such as vaginal cuff closure, have been proposed [ 2 , 3 ]. These strategies aim to reduce the possibility of manipulation or exposure of the tumor to the pelvis during colpotomy in laparoscopic radical hysterectomy. These protective maneuvers have been shown to decrease the relapse rate in retrospective studies [4] . However, prospective trials are needed to elucidate and confirm these findings. In this video, we explain step-by-step the technique of vaginal cuff closure before a radical hysterectomy performance for uterine cervical cancer. First, the nodal status is established by laparoscopic sentinel lymph node dissection and frozen section study. Bilateral pelvic lymphadenectomy is completed according to the size of the tumor. In the case of negative nodal status, the vaginal cuff is closed: Approximately 2 to 3 cm from the tumor (depending on its size), a circumferential incision of the vaginal mucosa is performed, followed by the dissection of the vaginal wall, which should be sufficient to allow a tension-free vaginal closure. The vaginal cuff is then closed with a running suture. A laparoscopic radical hysterectomy is then completed, and the surgical specimen is removed without any manipulation of the tumor. Conclusion Avoiding manipulation of the tumor during cancer surgery is crucial. A vaginal cuff closure technique appears to be an easy protective maneuver that prevents tumor exposure and manipulation during laparoscopic radical hysterectomy.

Objective. To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. Methods. We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. Results. The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p

ObjectiveEarly-stage ovarian cancer might represent an ideal disease scenario for sentinel lymph node application. Nevertheless, the published experience seems to be limited. Our objective was to assess the feasibility and safety concerns of sentinel lymph node biopsy in patients with clinical stage I–II ovarian cancer.MethodsWe conducted a prospective cohort study of 20 patients with histologically confirmed ovarian cancer. 99mTc and indocyanine green were injected into both the utero-ovarian and infundibulopelvic ligament stump, if they were present, during surgical staging. An intraoperative gamma probe and near-infrared fluorescence imaging were used to detect the sentinel lymph nodes. Inclusion criteria included: >18 years of age, suspicious adnexal mass (unilateral or bilateral) at ultrasound and CT imaging or confirmed ovarian tumor after previous surgery (unilateral or bilateral salpingo-oophorectomy with or without hysterectomy). Adverse events were recorded through postoperative day 30. The primary trial end point was to report adverse events related to the technique, including the use of 99mTc and ICG intraperitoneally, as well as the feasibility of the technique.ResultsA total of 20 patients were included in the analysis. Sentinel lymph nodes were detected in 14/15 (93%) pelvic and all 20 (100%) para-aortic regions. Five patients did not have utero-ovarian injection because of prior hysterectomy. The mean time from injection to sentinel lymph node resection was 53±15 min (range; 30–80). The mean number of harvested sentinel lymph nodes was 2.2±1.5 (range; 0–5) lymph nodes in the pelvis and 3.3±1.8 (range; 1–7) lymph nodes in the para-aortic region. There were no adverse intraoperative events, nor any within the 30 days of follow-up related with the technique.ConclusionSentinel lymph node mapping in early-stage ovarian cancer is feasible without major intraoperative or < 30 days safety concerns. (NCT03452982).Trial registration numberClinicalTrials.gov, NCT03452982.

Introduction/Background Female sexuality is a complex phenomenon with important repercussions on their overall quality of life. In the case of women who have undergone gynecological interventions, their quality of sexual life may be diminished. Methodology Women survivors of gynecological cancers usually have important sequelae derived from the treatment. The radicality of the surgery and / or adjuvant radiotherapy treatments are sometimes unavoidable and they involve reconstructive surgery to restore the anatomical defect (vaginal stenosis) and, in this way, the woman can recover her sexual life and body self-perception as before. Results The role of reconstructive surgery for the anatomo-functional sequelae and body self-perception of the onco-gynecological patient has already been evaluated in previous studies (Hawighorst-Knapstein 2004, Chen 2015) with promising results since women who underwent reconstructive techniques such as Vaginoplasty with autologous peritoneal tissue (Chen 2015) improved sexual functioning and quality of life. Similar results were obtained in non-oncological patients with vaginal aplasia using the technique of vaginoplasty modified by Creatsas in which up to 95.5% of women reported feeling satisfied in their sexual life (Creatsas 2007). The surgical video is presented. With the goal of visualization this technique in the treatment of vaginal stenosis after pelvic radiotherapy for gynecological cancer. Conclusion Reconstructive surgery such as vaginoplasty modified by Creatsas, can help to restore the anatomical defect and, ultimately, improve the patient´s body perception and quality of sexual life. Disclosure Nothing to disclose

Introduction/Background There is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the video is to show the standardized sentinel lymph node technique in early ovarian cancer Methodology In the case of malignancy, the sentinel lymph node technique was performed. We subperitoneally injected 0.2 mL of saline solution containing 37 mBq of 99mTc nanocolloid (Albu-res, Pharmaceutical Nycomed Amersham, Braunschweig, Germany). At the same time, 0.5 mL of indocyanine green (concentration 1.25 mg/mL) was injected. We used a 27 G needle at each injection point Results The sentinel lymph nodes were checked with an intra-operative mobile gamma camera (Sentinellatm, Oncovision) for descriptive purposes only. Thirty minutes after the injection, the SLN procedure was started regardless of probe migration with the IMGC. Guided by the acoustic signal of a gamma probe (Wprobe wireless gamma probe STD and LAP, Oncovision), we performed a minimum dissection looking for the hottest sentinel lymph node(s) in the pelvic/para-aortic region. We simultaneously used the Imagen1 HUB-OPAL1 (NIR/ICG system) (Karl Storz Endoscopy, GmbH, Mittelstrasse, Tuttlingen, Germany) to detect the sentinel lymph node(s) dyed with indocyanine green. Any lymph node with a remarkably higher count than the background was considered a sentinel lymph node and was harvested separately. Conclusion In light of the findings of SENTOV clinical trial, the sentinel lymph node technique appears to be applicable in early-stage ovarian cancer Disclosure Nothing to disclose

Introduction/Background In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. Methodology To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. Results He anastomotic leak rate was 6.6% (46/695; range 1.7%–12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013–1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407–0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228–10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777–39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726–0.971, p = 0.018). Conclusion Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided. Disclosure Nothing to disclose.

Introduction/Background There is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study and clinical trial is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm and the use of 99mTc and indocyanine green for its detection. Methodology Patients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection. Results The sentinel lymph node technique was performed in 10 patients in the pilot study and in 20 patients in the clinical trial with a detection rate in the pelvic and/or para-aortic region of 100%. Conclusion The sentinel lymph node technique appears to be applicable in early-stage ovarian cancer with excellent detection rate. further studies are needed to establish the negative predictive value of the technique. Disclosure Nothing to disclose.

In apparent early stage ovarian cancer, complete surgical staging surgery including systematic lymphadenectomy is recommended at the time of diagnosis. Although minimally invasive surgery can be carried out for re-staging, laparotomy is the standard surgical approach recommendation to treat and

Study Objective To demonstrate the feasibility of laparoscopic sentinel lymph node technique in presumed early-stage ovarian cancer. Design Video illustrating the laparoscopic performance of the sentinel lymph node technique in ovarian cancer. Setting The Oncologic Gynecology Department at the University Hospital La Fe. Patients Candidates for the technique presented an apparent early stage ovarian cancer. The technique was performed in the context of a clinical trial called SENTOV (NCT03452982). Interventions To date, lymphadenectomy is recommended after the diagnosis of apparent early-stage ovarian cancer as part of the surgical staging. Minimally invasive surgery can be considered for the purpose of restaging [1] . Up to 14% of the patients are upstaged because of positive lymph nodes after pelvic and para-aortic lymphadenectomy [2] . Regarding low-grade tumors, a lower rate of lymph node involvement has been reported [3] . Sentinel lymph node technique has been reported to be feasible in a recent pilot study [4] . Two clinical trials (Sentinel Lymph Node in Early Ovarian Cancer and Sentine Lymph Node in Early Ovarian Cancer) are currently ongoing to clarify the use of sentinel lymph node technique in early ovarian cancer. The injection points were at the infundibulopelvic and ovarian ligament stumps. Two hundred microliters of saline solution containing 37 MBq of technetium-99m nanocolloid followed by 0.5 mL of indocyanine green (ICG) was injected subperitoneally. We used a 27 G needle at each injection point. Immediately after injection and also at 15 and 30 minutes after injection, the operative field was checked guided by the acoustic signal of the gamma probe and the near-infrared camera. We performed a minimum dissection looking for the sentinel lymph node or nodes in the pelvic and para-aortic region. Any lymph node with a remarkable radioactivity count as high as 10 times the background and/or dyed with ICG was considered a sentinel lymph node and was harvested separately. A systematic surgical staging was performed after the sentinel lymph node procedure was completed. Because of its small size, the ICG molecule is not caught in the lymph node valve system and keeps migrating when performing lymphography. An exhaustive direct view of the dye path is required to avoid misleading detection of the real sentinel lymph node. This theoretical problem is resolved by the use of the 99mTC-nanocolloid. This tracer gets trapped into the lymph node valve system because of its molecular size and does not keep migrating as does ICG. As such, a combination of both methods is proposed. Conclusion Laparoscopic performance of sentinel lymph node technique in ovarian cancer seems to achievable. Between 2017 and 2019, this procedure was performed in 30 patients (13 laparoscopic), in the context of our pilot experience [4] and the Sentinel Lymph Node in Early Ovarian Cancer clinical trial (NCT03452982).

Cervical cancer is the fourth most frequent cancer in women worldwide and the ninth cause of death in women between 30 and 49 years of age. Increase in early detection and diagnosis has allowed the implementation of more conservative management strategies. The radical trachelectomy (RT) is considered the treatment of choice for patients with early stage cervical cancer that desire fertility preservation, without compromising oncologic outcomes. The published data regarding reproductive and obstetric outcomes after RT reports decreased fertility, and increased abortion rates, prematurity and obstetric complications. On the other hand, data on oncologic outcomes has not shown higher rates of residual disease compared to radical hysterectomy. Data on obstetric outcomes following RT is scarce, generating controversy. We present the case of a patient diagnosed with stage IB1 cervical cancer managed with a vaginal radical trachelectomy (VRT), who subsequently had two successful gestations that resulted in premature deliveries with associated neonatal morbidity.

ObjectiveAnastomotic leak remains the main concern after colorectal anastomosis in ovarian cancer. Our objective was to compare the use of three different management approaches after colorectal resection and anastomosis in patients with ovarian cancer.MethodsBetween January 2010 and June 2018, a total of 133 patients with International Federation of Gynecology and Obstetrics (FIGO) stage II–IV ovarian cancer who underwent colorectal resection and anastomosis were included. According to the approach followed after colorectal anastomosis and during the post-operative period, patients were stratified into three groups: conservative management and observation, diverting ileostomy, or ghost ileostomy technique. Univariate analyses were performed for quantitative variables by applying Student’s t test or Mann-Whitney U test and for qualitative variables by using the χ2 test (or Fisher’s test according to the sample size).ResultsA total of 145 patients underwent colorectal resection during cytoreduction for FIGO stage II–IV ovarian cancer. Twelve patients were excluded because a colostomy was required. Thus, 133 patients were included in the final analysis. Modified posterior pelvic exenteration was performed in 121 (91%) patients and recto-sigmoid resection in 12 (9%) patients with relapse. The approach after anastomosis was wait-and-see in 72 patients (54.1%), diverting ileostomy in 19 patients (14.4%), and ghost ileostomy in 42 patients (31.5%). There were no differences in diagnosis, age, body mass index, ECOG (Eastern Cooperative Oncology Group), histology, tumor grade, FIGO stage, or type of surgery between the groups. No differences were found regarding the anastomosis leak related factors or the rate of anastomotic leak between the three groups (5.6% vs 5.3% vs 4.8%; p=0.98). Two patients died because of the anastomotic leak in the wait-and-see group, and none died in the diverting ileostomy or ghost ileostomy group. In the diverting ileostomy group, a higher number of patients had complications compared with the ghost ileostomy group (78.9% vs 7.1%; p1500 mL) causing electrolyte imbalance in the diverting ileostomy group, and one patient (2.4%) in the ghost ileostomy group (p=0.03). The stoma reversal rate was 73.7% for the diverting ileostomy group and 100% for the ghost ileostomy group.ConclusionsThere were no differences found in the rate of anastomotic leak among the three groups of patients. The use of ghost ileostomy avoids the drawbacks of diverting ileostomy and seems to have advantages over routine diverting ileostomy and wait-and-see approaches for ovarian cancer patients undergoing colorectal anastomosis. Rates of stoma reversal are lower after diverting ileostomy when compared with ghost ileostomy.

Objective. To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. Background. In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. Methods. Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. Results. The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). Conclusions. Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided. Crown Copyright (C) 2019 Published by Elsevier Inc. All rights reserved.

Female sexuality is a complex phenomenon with important repercussions on patients' quality of life. Women survivors of gynecological malignancy might have sexual dysfunction after cancer treatment. Surgical radicality and radiation therapy might cause scar tissue in the vagina, being a common long

Introduction Pelvic exenteration (PE) is indicated in cases of unresponsive, recurrent pelvic cancer or for palliative intent. Despite the fact that the surgery is associated with a high rate of morbidity, it is currently the only real option that can effect a cure. Material and methods Patients who underwent PE between January 2011 and July 2017 in our centre were retrospectively reviewed. Data related to surgery, complications and outcomes were recorded. Results Twenty-three patients were included. PE was performed due to recurrent gynaecological cancer, persistence of disease and after first diagnosis in 19 (82%), 2 (9%) and 2 patients (9%), respectively. Total PE was performed in 15 cases (65%), followed by anterior PE in 5 cases (22%) and posterior PE in 3 cases (13%). Early grade II, III and IV complications occurred in 15 (65%), 5 (22%) and 2 patients (9%), respectively. No mortality was observed within 30 days. Medium-late grade II, III, IV and V complications occurred in 15 (65%), 11 (48%), 3 (13%) and 2 cases (9%), respectively. Two patients died after > 30-day period from surgery-related complications. The overall survival (OS) and disease-free survival (DFS) at 48 months after PE was 41.6% and 30.8% respectively. Conclusions PE provides about a 40% 4-year survival chance in a selected group of patients. The early-complications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II–V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE.

Urinary and fecal diversion is needed to restore normal function after total pelvic exenteration because of gynecological cancer.[1][1] In these patients, the Bricker procedure and end colostomy are often used for this purpose. Nevertheless, their use may lead to complications in patients with

ObjectiveDiverting ileostomy (DI) has been proposed to reduce the incidence and consequences anastomotic leakage after bowel resection. In colorectal cancer treatment, ghost ileostomy (GI) has been proposed as an alternative to DI. Our objective was to report the results of GI associated with colorectal resection in the treatment of ovarian cancer.Materials and MethodsThis is an observational pilot study performed in a single institution. The main objective sought was to report the results of GI associated with colorectal resection in the treatment of ovarian cancer: 26 patients were included.ResultsModified posterior exenteration was performed in 24 cases (92.3%) and rectum resection in the 2 cases of relapse (7.7%). After the main procedure GI was created, to check up the anastomosis status, a sequential postoperative rectoscopy was performed on postoperative day 5 ± 1 (range, 4–7). Serum levels were monitored in first and third postoperative days just with a descriptive intention to establish its relationship with the rectoscopy findings. In 2 cases, rectoscopy demonstrated a leakage. During postoperative course, no other complication related with the GI or DI was observed. No case of clinical anastomotic leakage was found.ConclusionsTo the extent of our knowledge, this is the first study in which GI has been performed for the treatment of patients with ovarian cancer. Ghost ileostomy represents a real option that may reduce the number of ileostomies performed in ovarian cancer without increasing the morbimortality. Ghost ileostomy presents the advantages of DI while avoiding its drawbacks. It also seems to be a safe, feasible, and reproducible technique that does not add significant costs to the surgery.

Introduction The use of laparoscopy in the treatment and management of advanced ovarian cancer is increasing among the gynaecologic oncologists. The development of port site metastases after laparoscopy is a concern and a matter of debate due to theoretical iatrogenic disease spread. Port site resection (PSR) has been proposed as an option to avoid this scenario. Material and methods One hundred and twenty-three patients with advanced ovarian cancer (FIGO III-IV) and with diagnostic laparoscopy were included and after cytoreductive surgery were classified into two groups: no port site resection (No-PSR) and port site resection (PSR). Based on the pathological results of all port site specimens, PSR was classified as positive port site metastasis (PSM+) and negative port site metastasis (PSM-). Results In 82 cases, the laparoscopic port site access was resected in the debulking surgery. At the final specimen examination, 49% presented as PSM+. No statistical differences regarding survival were found, either between the No-PSR and PSR groups (p = 0.28) or between the PSM+ and PSM - groups (p = 0.92). A higher wound complication rate was found in the PSR group (17% vs. 34%; p = 0.047). The RR (Relative Risk) of wound events for PSR was 2.42 (95% CI 1.09–5.35; p = 0.0296). Conclusions To date, not only there is no data supporting PSR after laparoscopy in advanced ovarian cancer, but the role of PSM+ in prognosis also remains unclear. In patients in which laparoscopy is performed prior to the debulking procedure, the PSR may not be recommended in those cases of no macroscopic port site metastasis.

IntroductionThere is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm.MethodsPatients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection.ResultsThe sentinel lymph node technique was performed in ten patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively.ConclusionThe detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.

In order to reach cytoreduction in advanced ovarian cancer, peritonectomy and diaphragmatic stripping are procedures required to remove the disease in the upper abdomen. Diaphragm involvement is estimated in up to 40% of cases. Nevertheless, in some of these patients, the tumour volume may constitute a limitation of the technique due to the association with abdominal wall involvement, bulky tumour at the Morrison's pouch or liver infiltration. Extensive upper abdominal procedures should represent a basic resource for the gynaecologic oncologist in order to reach an optimal cytoreduction. A radical peritonectomy with en bloc resection for treating advanced ovarian cancer with extensive widespread diaphragmatic peritoneal carcinomatosis is showed in this surgical film.

In order to reach cytoreduction in advanced ovarian cancer, peritonectomy and diaphragmatic stripping are procedures required to remove the disease in the upper abdomen. Diaphragm involvement is estimated in up to 40% of cases. Nevertheless, in some of these patients, the tumour volume may constitute a limitation of the technique due to the association with abdominal wall involvement, bulky tumour at the Morrison’s pouch or liver infiltration. Extensive upper abdominal procedures should represent a basic resource for the gynaecologic oncologist in order to reach an optimal cytoreduction. A radical peritonectomy with en bloc resection for treating advanced ovarian cancer with extensive widespread diaphragmatic peritoneal carcinomatosis is showed in this surgical film.

The viaduct over River Ulla is located in the Atlantic High Speed Railway Line between A Coruña and Pontevedra, in the northwest of Spain. Its location, close to the firth of Ulla, in a landscape of outstanding natural beauty and strong environmental constraints, was the object of a tender among the most renowned Spanish structural specialists. The solution chosen was a 1620 m long viaduct, with three main spans of 225 + 240 + 225 m and several approaching spans of 120 m length each, which meant a main span being about 20% longer than the Nantenbach bridge in Germany, the current world record in High Speed Railway composite steel and concrete truss girder beam bridges. The main spans have been designed with a double composite steel and concrete truss deck, with double composite action in hogging zones, and a total depth ranging from 9,15 m at the midspan section to 17,90 m at the section over the piers. The adjacent spans that give access to the depth-varying main ones have been designed with constant depth. This article describes the structural conception of the bridge and the three different constructive processes that had to be used due to the access and the environmental restrictions. 0.414 JCR (2014) Q4, 51/59 Construction and building technology, 105/124 Engineering, civil UEM

Over the years, low resistivity pay has become recognized as a worldwide phenomenon, unfortunately only a few of these reservoirs are successfully identified and evaluated using standard logging data. This is especially true in the Cretaceous clastic reservoirs of the Orinoco Oil Belt. The primary goals of this investigation were to understand the causes of low resistivity in the pay zones, the nature of the gamma ray response, and to investigate the potential of whole-rock elemental data for characterizing these reservoirs. It is well known that improvements in missed pay identification must include integration of geological, petrophysical, and reservoir engineering data. The first step was to characterize the composition of the Creataceous formation in well-constrained core samples from an older vertical well, X-23. Thin section and X-ray diffraction (XRD) analyses showed the samples to contain significant amounts of detrital clay, most of which is kaolinite. Some authigenic kaolinite may also be present, but is minor. The source of low resistivity in the X-23 reservoir section can be logically interpreted to be formation water present in microporosity associated with the bundant clay minerals. For the second step, a test was performed on cuttings samples from the Cretaceous reservoir in the recently-drilled X-272 horizontal well. No core was available from this well. Whole-rock elemental data was obtained for 50 elements from 29 washed cuttings samples, using combined WD-XRF (Wavelength-Dispersive X-ray Fluorescence spectroscopy) and ICP-MS (Inductively Coupled Plasma - Mass Spectrometry). Three of these samples were also analyzed for mineralogy by XRD. Results of the combined analyses indicated the samples contained little clay (about 2%), virtually no plagioclase, significant K-feldspar (5-11%), small amounts of carbonate (2-8%), and moderate amounts of heavy minerals. The heavy minerals, as inferred from elemental data (TiO2, Zr, Nb, Th, U and rare earth element (REE)), are likely to be ilmenite, rutile, titanite, zircon, and apatite; monazite, xenotime, garnet, micas, and Th-oxides may be present as well. The low Al2O3 and XRD clay values preclude these elements being primarily associated with clays. The third step was to assess the gamma and resistivity responses of the logs. In the X-272 horizontal well, the gamma and resistivity responses could not be adequately explained by the composition inferred by the combined mineralogical and elemental analyses. It is therefore suspected that there was significant detrital clay present in the original oil-saturated cuttings samples, but almost all was removed during cleaning of cuttings at wellsite, leaving the sand fraction as a residual sample. Despite the difficulties in obtaining representative samples from washed cuttings, the elemental data from the sand fraction of the X-272 samples alone shows potential for the definition and chemostratigraphic correlation of distinctive stratigraphic units for the purpose of wellbore positioning. In addition, the utility of the elemental data has provided motivation to develop an improved method of sample cleaning for oil-sands cuttings at wellsite.

The Viaduct over River Ulla is located in the Atlantic High Speed Railway Line between A Coruña and Pontevedra, in the north west of Spain. Its location, close to the firth of Ulla, in a landscape of outstanding natural beauty and strong environmental constraints, was the object of a tender among the most renowned Spanish structural specialists. The solution that was finally chosen is a viaduct 1620 m long, with three main spans of 225+240+ 225 m and several approaching spans 120 m long each, which mean a main span about 20% longer than the Nantenbach bridge in Germany, current world record in H.S.R. composite steel and concrete truss girder beam bridges. The main spans are designed with a double composite steel and concrete truss deck, with double composite action in hogging zones, and a total depth ranging from 9,15 m at the midspan section to 17,90 m at the section over the piers. The adjacent spans that give access to the depth-varying main ones, have been designed with constant depth. The article describes the structural conception of the bridge and the three different constructive process, that had to be used due to the access and the environmental restrictions.