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A straightforward algorithm based mainly on contrast agent swallow for patients with small-bowel obstructions enabled a timely and very accurate differentiation between patients qualifying for conservative and operative treatment.

Highlights Left-sided diaphragm hernias are rare after extensive upper abdominal debulking surgery in advanced stage ovarian cancer. A left-sided diaphragm hernia can easily be misdiagnosed because patients may present with a variety of different symptoms. After peritonectomy of the diaphragm, the diaphragm should be carefully checked for defects; any defect must be repaired.

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Background BRCA1/2 mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the BRCA1/2 mutation(s) based on the checklist score (CLS). Methods A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a BRCA1/2 genetic analysis result and a CLS was available. Out of 545 cases with a BRCA1/2 result (cohort A), 453 cases additionally had an extended gene panel result (cohort B). Results A BRCA1/2 mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non-BRCA1/2 genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a BRCA1 (n = 92) or BRCA2 (n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a BRCA1/2 mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. Conclusions The BRCA1/2 mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a BRCA1/2 mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.

An ongoing question in the field of gynecologic oncology has been whether or not secondary cytoreductive surgery (SCS) followed by platinum-based chemotherapy increases overall survival (OS) in patients with platinum-sensitive recurrent ovarian cancer. Several retrospective studies have been published on this topic. Bristow et al. published a metaanalysis showing that complete cytoreductive surgery is the strongest independent factor for survival, demonstrating that with every 10% increase in complete cytoreduction, there was an associated 3 months' increase in median survival [1]. To this end, three large, multicenter, randomized, phase 3 trials-the DESKTOP III (NCT01166737), GOG-0213 (NCT00565851) and the SOC-1 trial (NCT01611766)-were designed to evaluate SCS followed by platinumbased chemotherapy in these patients.Findings from the DESKTOP III trial were recently presented and demonstrated an improved median OS benefit of 7.5 months in the SCS followed by chemotherapy group compared with the chemotherapy-alone group (53.7 vs. 46.2 months, respectively). Looking further into the data, complete macroscopic resection resulted in a median OS benefit of approximately 15 months (60.7 vs. 46.2 months, respectively) [2]. On the other hand, data from the GOG-0213 study did not show an improvement in median OS with SCS followed by chemotherapy compared with chemotherapy alone (50.6 vs. 64.7 months, respectively) [3]. Even when comparing only patients who achieved complete gross resection (CGR) to those who did not undergo SCS, there was still no median OS advantage (56.0 vs. 64.7 months, respectively) [3]. Both the GOG-0213 and DESKTOP III trials, however, did show a progression-free survival (PFS) benefit in the surgery versus no-surgery arms (18.9 versus 16.2 months in GOG-0213 and 18.4 versus 14.0 months in DESKTOP III, respectively) [2,3]. Median OS data from the SOC-1 trial are still immature; however, median PFS was 17.4 months in the surgery arm and 11.9 months in the no-surgery arm [4].These findings have left gynecologic oncologists wondering why the data from GOG-0213 did not show an OS benefit with SCS, as they did with DESKTOP III. We looked at similarities and differences in trial design and reported outcomes to address this question. Median platinum-free interval, which is a well-established, important prognostic factor for patients with recurrent disease, was similar between the 2 studies (20.4 months in GOG-0213 and 21.1 months in DESKTOP III) [2,3]. Patients in the SOC-1 trial, however, had a median platinum-free interval of 16 months, suggesting the trial enrolled more higher-risk

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