Turkish Journal of Obstetrics and Gynecology最新文献

{"title":"Prognostic determinants of survival in early-stage endometrial cancer: A retrospective analysis.","authors":"Nesibe Zeyveli Çelik, Rauf Melekoğlu, Ercan Yılmaz, Şeyma Yaşar","doi":"10.4274/tjod.galenos.2026.23934","DOIUrl":"10.4274/tjod.galenos.2026.23934","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate prognostic determinants of survival in early-stage endometrial cancer (EC), focusing on clinicopathological parameters including histologic grade, tumor stage, myometrial invasion, lymphovascular space invasion (LVSI), and preoperative CA-125, as well as the role of adjuvant therapies in disease-free survival (DFS) and overall survival (OS).</p><p><strong>Materials and methods: </strong>We retrospectively analyzed women treated surgically for International Federation of Gynecology and Obstetrics 2009 stage I-II EC at a tertiary center between January 2011 and January 2023. Demographic and pathological data were collected, including age, body mass index, reproductive history, menopausal status, comorbidities, tumor size, histologic subtype and grade, depth of myometrial invasion, LVSI, serum CA-125 levels, and surgical procedures. Adjuvant therapies-external beam radiotherapy, vaginal brachytherapy, and chemotherapy-were also documented. Associations between these variables and survival outcomes were assessed using Kaplan-Meier and Cox regression analyses.</p><p><strong>Results: </strong>A total of 241 women with early-stage EC were included. Median age was 57 years (range: 34-86 years). Of these, 181 (75.1%) were stage IA, 47 (19.5%) were stage IB, and 13 (5.4%) were stage II. Histologic grades were grade 1 in 44.8%, grade 2 in 39.0%, and grade 3 in 16.2%. During a median follow-up of 75 months, recurrence occurred in 4.6% of patients and mortality in 7.9% of patients. Univariate analysis showed that elevated CA-125, higher stage, and higher grade were associated with worse OS. Multivariate analysis identified histologic grade as an independent predictor of both OS and DFS. Neither adjuvant radiotherapy nor chemotherapy improved survival outcomes.</p><p><strong>Conclusion: </strong>Histologic grade was the strongest independent prognostic factor for OS and DFS in early-stage EC, surpassing tumor stage, myometrial invasion, and LVSI. These findings highlight the importance of comprehensive surgical staging, especially when high-grade tumors are detected intraoperatively, to ensure accurate risk stratification and appropriate use of adjuvant therapies.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"250-264"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of oxidative stress and angiogenic pathways by natural compounds in experimental preeclampsia: A narrative review focusing on MDA, sFlt-1, and PlGF.","authors":"Nopi Anggista Putri, Nita Parisa, Subandrate Subandrate, Debby Handayati Harahap","doi":"10.4274/tjod.galenos.2026.79068","DOIUrl":"10.4274/tjod.galenos.2026.79068","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize current evidence on the effects of natural compounds on oxidative stress and angiogenic biomarkers, particularly malondialdehyde (MDA), soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PlGF), in experimental models of preeclampsia.</p><p><strong>Materials and methods: </strong>A narrative review was conducted of studies retrieved from PubMed, Scopus, ScienceDirect, and Web of Science (2016-2026). Experimental animal studies that evaluated natural compounds and reported outcomes related to MDA, sFlt-1, PlGF, or angiogenic pathways were included. Study quality was assessed descriptively using the Joanna Briggs Institute framework.</p><p><strong>Results: </strong>Nine relevant experimental studies were included in the narrative synthesis. Interventions included Astragalus spp., pomegranate juice, young kopyor coconut water, soybean tempeh extract, <i>Cosmos caudatus</i> extract, <i>Nigella sativa, Puerariae lobatae</i> Radix, and olive leaf extract. Most interventions significantly reduced MDA and sFlt-1 levels, indicating reductions in oxidative stress and anti-angiogenic activity. Several compounds increased expression of PlGF and/or vascular endothelial growth factor, suggesting improved placental angiogenesis. Beneficial effects on placental morphology, blood pressure, proteinuria, and fetal outcomes were also reported.</p><p><strong>Conclusion: </strong>Natural compounds may ameliorate oxidative stress and angiogenic imbalance in experimental models of preeclampsia by reducing MDA and sFlt-1 levels and enhancing PlGF-mediated angiogenesis. These findings support their potential as adjunctive therapies for preeclampsia, although further mechanistic studies and clinical trials are needed to confirm their efficacy and safety. As this narrative review is based exclusively on findings from experimental animal models, these results should be interpreted with caution and not be directly extrapolated to clinical practice until they are confirmed by human studies.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"273-282"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant human papillomavirus vaccination after excisional treatment for cervical precancer.","authors":"Süleyman Özen, Eda Güner Özen, Gülin Özuyar Şimşek, İnci Başkır İşlek, Muzaffer Sancı","doi":"10.4274/tjod.galenos.2026.49475","DOIUrl":"10.4274/tjod.galenos.2026.49475","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether adjuvant 9-valent human papillomavirus vaccination improves viral clearance and reduces recurrence after excisional treatment for high-grade cervical intraepithelial neoplasia (CIN2+).</p><p><strong>Materials and methods: </strong>This retrospective cohort study included women aged 18 years and older who underwent loop electrosurgical excision procedure for histologically confirmed CIN2+ between December 2023 and January 2026. Women with pre-treatment human papillomavirus positivity, negative surgical margins, and available post-treatment follow-up data were included. Patients were stratified according to post-treatment vaccination status. The primary outcome was human papillomavirus clearance at 24 months. Secondary outcomes included clearance at 6 and 12 months, persistent infection, time to viral clearance, and CIN2+ recurrence. Multivariable logistic and Cox regression analyses were performed.</p><p><strong>Results: </strong>A total of 666 women were included, of whom 212 (31.8%) received adjuvant vaccination and 454 (68.2%) did not. Clearance of human papillomavirus was higher in vaccinated than in unvaccinated women at 6 months (60.8% vs. 46.3%), 12 months (78.3% vs. 58.8%), and 24 months (87.7% vs. 77.8%). Persistent infection at 24 months was lower in the vaccinated group (12.3% vs. 22.2%). CIN2+ recurrence occurred in 3.8% of vaccinated women and 11.9% of unvaccinated women. Adjuvant vaccination was independently associated with faster viral clearance (adjusted hazard ratio: 2.0, 95% confidence interval: 1.5-2.7, p<0.001).</p><p><strong>Conclusion: </strong>Adjuvant 9-valent human papillomavirus vaccination after excisional treatment was associated with higher viral clearance and lower CIN2+ recurrence.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"265-272"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pain after vNOTES versus laparoscopic hysterectomy: A procedure-specific comparative study.","authors":"Turan Şahin, Eda Adeviye Şahin, Buse Sahra Perkyürek, Gökan Güzeltaş, Arzu Bilge Tekin, Koray Gök, Hanifi Şahin","doi":"10.4274/tjod.galenos.2026.45928","DOIUrl":"10.4274/tjod.galenos.2026.45928","url":null,"abstract":"<p><strong>Objective: </strong>Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is associated with lower postoperative pain, reduced analgesic requirements, and faster early postoperative recovery compared with laparoscopy in patients undergoing hysterectomy for benign indications. To compare postoperative pain and early recovery outcomes between vNOTES and conventional laparoscopy in patients undergoing hysterectomy for benign gynecologic indications.</p><p><strong>Materials and methods: </strong>This single-center retrospective cohort study included 192 patients who underwent hysterectomy between March 2021 and September 2025. Patients were grouped according to surgical approach (vNOTES vs. laparoscopy). Postoperative pain was assessed using the visual analog scale at 6 and 24 hours. Primary outcomes were pain intensity and the requirement for additional analgesia. Secondary outcomes included operative time, change in hemoglobin, time to first flatus, and length of hospital stay. Multivariable logistic regression analysis was performed to identify predictors of analgesic requirement.</p><p><strong>Results: </strong>Of 192 patients, 75 (39.1%) underwent laparoscopy and 117 (60.9%) underwent vNOTES. Baseline characteristics were similar between groups. The vNOTES group had significantly lower pain scores at 6 and 24 hours (p=0.001) and a reduced need for additional analgesia (23.9% vs. 60.0%, p=0.001). Operative time was shorter and recovery outcomes, including time to first flatus and length of hospital stay, were significantly improved in the vNOTES group (p=0.001). Surgical approach, uterine weight, and operative time were independent predictors of analgesic requirement.</p><p><strong>Conclusion: </strong>In this retrospective cohort study, vNOTES was associated with lower postoperative pain scores, reduced analgesic requirement, and earlier recovery than conventional laparoscopy. These findings should be confirmed in prospective randomized studies.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"234-241"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful placental removal guided by MRI-based mapping in advanced abdominal pregnancy: A case report and literature review.","authors":"Mehmet Bülbül, Polat Dursun, Gökçe Kaan Ataç","doi":"10.4274/tjod.galenos.2026.83903","DOIUrl":"10.4274/tjod.galenos.2026.83903","url":null,"abstract":"<p><p>Advanced abdominal pregnancy is a rare but life-threatening condition associated with substantial maternal and fetal morbidity and mortality, particularly when diagnosis is delayed beyond the first trimester. Owing to its rarity, there is still no consensus regarding its optimal diagnostic approach or management. We present a case of advanced abdominal pregnancy in a woman who first sought medical care at 24 weeks' gestation. She reported five months of amenorrhea accompanied by progressively worsening abdominal pain, constipation, and dyspareunia. Ultrasonography demonstrated a gestational sac outside the uterine cavity. Magnetic resonance imaging was subsequently performed to define the placental location and its relationship to adjacent structures and to confirm the diagnosis of advanced abdominal pregnancy. Because the patient had persistent severe abdominal pain and clinical findings concerning for an acute abdomen, immediate surgical management was undertaken after counseling and preoperative planning. Laparotomy was performed through a midline abdominal incision. Intraoperatively, the omentum, uterus, adnexa, and bladder were densely adherent to the gestational sac, creating the appearance of a frozen pelvis. The placenta invaded the peritoneum overlying the sigmoid colon and left iliac region, although no major vascular involvement was identified. Organ-sparing surgery was successfully performed, and the placenta was carefully dissected and removed without complications. The postoperative course was uneventful, and the patient was discharged in good condition. Advanced abdominal pregnancy should be considered in the differential diagnosis of pregnant patients presenting with abdominal pain and atypical imaging findings. In symptomatic patients with an acute abdomen, immediate surgery may be preferred over expectant management. Although placental management remains controversial, detailed preoperative imaging is crucial for surgical planning. In selected cases without major vascular invasion, placental removal may be feasible with organ preservation.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"283-290"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal diagnosis of hemoglobinopathies by chorionic villus sampling: A large single-center experience.","authors":"Serdar Aykut, Fatma Tuncay Özgünen, İsmail Cüneyt Evrüke, Süleyman Cansun Demir, Emre Yalçın, Özge Keleş Bayer","doi":"10.4274/tjod.galenos.2026.78137","DOIUrl":"10.4274/tjod.galenos.2026.78137","url":null,"abstract":"<p><strong>Objective: </strong>Hemoglobinopathies are among the most common inherited disorders worldwide. Given the high prevalence and carrier rates in our region, this study aimed to evaluate the obstetric, genetic, and procedure-related outcomes of pregnancies undergoing chorionic villus sampling (CVS) for prenatal diagnosis.</p><p><strong>Materials and methods: </strong>This retrospective observational study included 1,330 pregnant women referred for hemoglobinopathy screening between January 2008 and December 2012. Data regarding gestational age, indication for CVS, placental location, number of insertions, complications, and genetic results were analyzed. Transabdominal CVS was primarily performed between 10 and 14 weeks of gestation.</p><p><strong>Results: </strong>The mean gestational age at CVS was 12.4±1.03 weeks. Late referral (≥14 weeks) was observed in 8.8% of cases. Adequate sampling was achieved with a single insertion in 88.3% of procedures. The overall complication rate was 2.6%, with a fetal loss rate of 1.8% and an incidence of chorioamnionitis of 0.07%. Multiple insertions (p=0.036) and posterior placental location (odds ratio: 2.21; 95% confidence interval: 1.11-4.38; p=0.033) were significantly associated with an increased risk of complications. Genotype analysis showed that 50.2% of fetuses were carriers, 25.4% were normal, and 21% were affected. Pregnancy termination was performed in most of the affected cases (n=266), while 11 cases resulted in live births. Hemoglobin S (HbS) was the most frequent variant (31%), followed by HbD and HbE. The most common β-thalassemia mutation was IVS-I-110 (G>A), and the most frequent α-thalassemia mutation was -α^3.7 deletion.</p><p><strong>Conclusion: </strong>CVS is a reliable and effective method for early prenatal diagnosis of hemoglobinopathies. Procedure-related risks are influenced by technical factors, such as the number of insertions and placental location. Standardization of techniques and operator experience may reduce complications. In high-prevalence regions, the integration of carrier screening and early prenatal diagnosis is essential to reduce the disease burden.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"201-209"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined triple screening and BMI models for gestational diabetes prediction.","authors":"Naziye Gürkan, Sakine Merve Aydın, Mevlüde Alpaslan, Kübra Geyik Şengül, Neşet Gümüşburun","doi":"10.4274/tjod.galenos.2026.42203","DOIUrl":"10.4274/tjod.galenos.2026.42203","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated whether routinely used second-trimester triple screening markers (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) could help identify pregnancies at increased risk of gestational diabetes mellitus. In addition, several hematological inflammation indices were evaluated as potential adjunctive predictors.</p><p><strong>Materials and methods: </strong>Medical records of 405 singleton pregnancies were retrospectively reviewed. All participants underwent triple screening during gestational weeks 15-20 and subsequently underwent oral glucose tolerance testing during gestational weeks 24-28. Patients were categorized, according to oral glucose tolerance test findings, as either having gestational diabetes or as normoglycemic controls. Receiver operating characteristic analyses were performed to assess both the isolated and combined predictive capacities of measurements of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol. The impact of maternal body mass index on model performance was also analyzed.</p><p><strong>Results: </strong>Alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels showed poor discriminatory ability for identifying pregnancies complicated by gestational diabetes, both individually and in combined models. However, adding maternal body mass index to the combined biomarker model substantially improved predictive accuracy (area under the curve=0.809; p<0.001). None of the evaluated inflammatory indices demonstrated significant predictive performance for gestational diabetes mellitus.</p><p><strong>Conclusion: </strong>Routine second-trimester triple screening markers appear to have limited standalone value for predicting gestational diabetes. Nevertheless, incorporating maternal body mass index considerably enhances model performance and may improve clinical risk stratification.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"218-223"},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thiol-disulfide homeostasis in ovarian cancer: comparative analysis with benign neoplasia and healthy women.","authors":"Alaattin Karabulut, Muzaffer Sancı, Volkan Karataşlı, Sercan Kantarcı, Ayça Aydın Uysal, Özcan Erel, Salim Neşelioğlu, Alper İleri","doi":"10.4274/tjod.galenos.2026.55257","DOIUrl":"10.4274/tjod.galenos.2026.55257","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate thiol-disulfide (DS) homeostasis in women with ovarian cancer and to assess its ability to distinguish malignant ovarian tumors from benign ovarian neoplasia and healthy women.</p><p><strong>Materials and methods: </strong>This prospective comparative study included 39 women with histopathologically confirmed ovarian cancer, 30 with benign ovarian neoplasia, and 46 age- and body mass index-matched healthy women. Serum native thiol (NT), total thiol (TT), DS, and ischemia-modified albumin (IMA) levels were measured. Thiol-DS indices were calculated as DS/NT (DNT), DS/TT (DTT), and NT/TT (NTT). Data were analyzed statistically. The study was registered at ClinicalTrials.gov (NCT05011539).</p><p><strong>Results: </strong>Compared with healthy women, the ovarian cancer group exhibited lower NT, TT, and NTT values, along with higher DS, DNT, and DTT values. When malignant and benign ovarian neoplasms were compared, NT and NTT values were lower, whereas DNT and DTT ratios were higher. IMA levels did not differ between groups. Serum CA-125 levels were positively correlated with DNT and DTT, and negatively correlated with NT, TT, and NTT.</p><p><strong>Conclusion: </strong>Thiol-DS imbalance is more pronounced in ovarian cancer than in benign ovarian neoplasia and in healthy women, suggesting that these markers may be useful adjuncts in the preoperative evaluation of adnexal masses.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"160-166"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the new FIGO 2023 staging system on stage distribution and adjuvant therapies in endometrial cancer: A retrospective cohort study.","authors":"Ali Deniz Erkmen, Kevser Arkan","doi":"10.4274/tjod.galenos.2026.68523","DOIUrl":"10.4274/tjod.galenos.2026.68523","url":null,"abstract":"<p><strong>Objective: </strong>The 2023 update of the International Federation of Gynecology and Obstetrics (FIGO) staging system introduced significant changes in the classification of endometrial cancer by incorporating key pathological and molecular features. This study aimed to evaluate the impact of the revised FIGO 2023 staging system on stage distribution and adjuvant treatment decisions in patients undergoing surgical management of this malignancy.</p><p><strong>Materials and methods: </strong>This retrospective study included 220 patients who underwent surgical staging for endometrial cancer between January 2018 and December 2025. All patients were initially staged using the FIGO 2009 classification. Cases were subsequently reclassified according to the FIGO 2023 staging criteria, using the algorithm proposed for settings in which routine molecular classification is unavailable. The McNemar test was used to compare stage categories between the two staging systems, and the Wilcoxon signed-rank test was applied to evaluate the impact of stage migration on adjuvant treatment recommendations.</p><p><strong>Results: </strong>Stage migration occurred in 12.7% of patients (28/220) following the application of the FIGO 2023 criteria, predominantly due to upstaging. The most common factor associated with stage reclassification was substantial lymphovascular space invasion (LVSI). The proportion of patients managed with observation alone significantly decreased from 44.5% to 32.7% (p<0.001), while the use of pelvic radiotherapy increased from 19.1% to 28.2% (p=0.004). Similarly, the proportion of patients receiving combined chemoradiotherapy significantly increased from 11.8% to 17.3% (p=0.012).</p><p><strong>Conclusion: </strong>The implementation of the FIGO 2023 staging system has resulted in clinically meaningful stage migration and significantly impacted adjuvant treatment strategies. In particular, the recognition of substantial LVSI as a defining feature of stage IIC disease has led to more intensive adjuvant therapy in a subset of patients previously categorized as low risk.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":"23 2","pages":"167-173"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroperitoneal anatomy and avascular spaces for pelvic surgery: Cadaveric dissection atlas.","authors":"İlker Selçuk, Özhan Özdemir, Necdet Kocabıyık, Mehmet Ali Güner, Melike Doğanay","doi":"10.4274/tjod.galenos.2026.57142","DOIUrl":"10.4274/tjod.galenos.2026.57142","url":null,"abstract":"<p><p>This paper presents a comprehensive cadaveric dissection atlas detailing the retroperitoneal anatomy essential to advanced pelvic surgery. Developed by a multidisciplinary team of anatomists, gynecologists, and gynecologic oncologists, the study provides a systematic, layer-by-layer guide for navigating the pelvic avascular spaces. It details five critical surgical corridors: the presacral (retrorectal) space, the pararectal space (divided into the Latzko and Okabayashi compartments), the paravesical space (medial and lateral compartments), the prevesical (retropubic/Retzius) space, and the medial psoas space (laterovascular plane). This atlas emphasizes the use of reliable landmarks, such as the sacral promontory, the obliterated umbilical artery, and the ureter, to define anatomical boundaries and ensure safe surgical practice. The primary objective is to maintain adequate exposure after retroperitoneal entry and to perform layer-by-layer surgical dissection to identify critical anatomical structures. The superior hypogastric plexus; hypogastric nerve; pelvic splanchnic nerves; inferior hypogastric plexus with its vesical and rectal branches; the internal iliac artery with its posterior and anterior trunk branches (including the superior gluteal, iliolumbar, lateral sacral, uterine, inferior gluteal, pudendal, obturator, middle rectal, and inferior and superior vesical arteries, and the obliterated umbilical artery); the external iliac artery; and the corresponding internal and external iliac veins were discussed. Additionally, the somatic nerves, obturator nerve, lumbosacral trunk, sacral nerves, sciatic nerve, genitofemoral nerve, and femoral nerve were reviewed. The parietal fascial planes, pubocervical fascial structure, and visceral compartments were evaluated as part of the whole. Respecting fascial planes-particularly the presacral fascia-is mandatory to avoid catastrophic hemorrhage and autonomic nerve injury. These spaces serve as the \"neurovascular roadmap\" for complex procedures, including radical hysterectomy, nerve-sparing pelvic surgery, pelvic lymphadenectomy, and hemorrhage control. Mastery of these interconnected retroperitoneal compartments facilitates a transition from organ-based to space-oriented surgery, significantly reducing morbidity while maintaining oncologic radicality.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"174-189"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}