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Publications Update # 16

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Publications Update # 16
Chelsea Milling Company (Jiffy Mix) Photographer: Shitanshu Uppal

Non-Medical Article of the Week

I nearly overlooked this TED Talk that was first broadcasted in 2018 B.C. However, thanks to the TED Radio Hour, I recently discovered it during their March 2023 A.C. radio broadcast. It seems that many of us struggle to recall the timelines of our lives before the COVID-19 pandemic.

Here is a remarkable five-minute poetry talk that I particularly enjoy, as it highlights the essence of creativity: observing and being curious. Sarah, the speaker, has captured this concept perfectly.

If you're interested in exploring the elusive concept of creativity, I recommend starting with this excellent article that outlines four different types of creativity.

Cultivating the Four Kinds of Creativity
In the decades to come, creativity will be key to doing most jobs well. In this article the authors offer a new typology that breaks creative thinking into four types: integration, or showing that two things that appear different are the same; splitting, or seeing how things that look the same are m…
Harvard Business ReviewGabriella Rosen Kellerman

Tl;dr

The article argues that creativity is not just a matter of talent. It is also a skill that can be learned and developed. By understanding the four types of creativity and how to cultivate them, we can all become more creative thinkers and innovators.

Endometrial Cancer

Two great articles on fertility-sparing management of endometrial cancer.

Fertility-sparing hormonal treatment in patients with stage I endometrial cancer of grade 2 without myometrial invasion and grade 1-2 with superficial myometrial invasion: Gynecologic Oncology Research Investigators coLLaborAtion study (GORILLA-2001) - PubMed
The overall response rate to FST was promising, however, the PD rate was significant during the first 12 months of FST. Therefore, performing thorough endometrial biopsy and imaging studies is essential to strictly evaluate the extent of the disease every 3 months from FST initiation.
PubMedA Jin Lee

Patients Included in the Study

  • Stage I endometrial cancer (EC) without deep (<50%) myometrial invasion
  • Grade 1 or 2
  • Aged <45 years with a desire to preserve fertility
  • No suspicious or metastatic disease on imaging studies

Intervention:

  • Oral progestins, such as MPA 500 mg qd or MA 40 mg qd. LNG-IUDs were used at the physician's discretion (57% got it). Treatment response was assessed every three months using D&C, hysteroscopy with TV-US, and serum CA-125.

FINAL COHORT

  • 44 patients (81%) with Stage 1 Grade 2 with no invasion
  • 8 patients (14.8%) with Stage 1 Grade 1 with < 50% invasion
  • 2 patients (3.7%) with Stage 1 Grade 2 with < 50% invasion

 Summary Points

  • The complete response rate was 72%
  • Of 39 patients who attempted pregnancy, the pregnancy rate was 46.7%( 7/15), and the live birth rate was 71.4% (5/7).
  • Tumors > 2 cm had the lowest response rates.
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Based on these results, it's reasonable to consider fertility preservation with Stage 1 Grade 2 patients with NO invasion. Given the low number of patients with invasion in this study (~18%), I would be hesitant to offer fertility preservation to patients with invasion regardless of the grade.
Comparison of the effect of levonorgestrel-intrauterine system with or without oral megestrol acetate on fertility-preserving treatment in patients with atypical endometrial hyperplasia: A prospective, open-label, randomized controlled phase II study - PubMed
gov/ct2/show/NCT03241888?term=NCT03241888&draw=2&rank=1.
PubMedZhiying Xu

Summary Points:

  • Levonorgestrel IUD performed on par with systemic treatments and achieved remission faster with less side effects (not SS).
  • A prior retrospective study has shown similar results
Progestin therapy for obese women with complex atypical hyperplasia: levonorgestrel-releasing intrauterine device vs systemic therapy - PubMed
Our study suggests that local therapy with the levonorgestrel-releasing intrauterine device may be more effective than systemic therapy for women with complex atypical hyperplasia who opt for nonsurgical treatment, particularly in morbidly obese women. Shifts in treatment paradigm during the study p…
PubMedRachel S Mandelbaum

Finally, real-world utilization seems to support this trend. IUD use is now increasing for this patient population.

Systemic Progestins and Progestin-Releasing Intrauterine Device Therapy for Premenopausal Patients With Endometrial Intraepithelial Neoplasia - PubMed
The rate of conservative treatment with progestins in premenopausal individuals with endometrial intraepithelial neoplasia has increased over time, and among progestin users, progestin-releasing IUD use is increasing. Progestin-releasing IUD use may be associated with a lower rate of hysterectomy an…
PubMedYukio Suzuki

GYOEDU lecture on Fertility Preservation in CAH/Endometrial cancer

Surgical Video

Functional Ileocecal Side to End Anastomosis

Difference between side-to-side and end-to-side anastomosis

Lin SY, Liang Buan BJ, Sim W, Jain SR, Ying Chang HS, Lee KC, Chong CS. Side-to-side versus end-to-side ileocolic anastomosis in right-sided colectomies: A cohort control study. J Minim Access Surg. 2022 Jul-Sep;18(3):408-414. doi: 10.4103/jmas.jmas_161_21. PMID: 35046183; PMCID: PMC9306133.

Video (Watch online)

Functional End-to-Side Ileocecal Anastomosis
Technique for making an end-to-side anastomosis post ileocecal anastomosis
GYOEDU PlusShitanshu Uppal

Data supporting Functional End-to-side Anastomosis

Ileocolonic anastomosis after right hemicolectomy for colon cancer: functional end-to-end or end-to-side? - PubMed
An FEEA after right hemicolectomy for colon cancer is a safe and reliable anastomotic technique, resulting in a favorable outcome in selected patients with the right colon cancer.
PubMedZheng Liu

That's it for this week.