BackgroundWhen determining adjuvant treatment for endometrial cancer, the decision typically relies on factors such as cancer stage, histologic grade, subtype, and a few histopathologic markers. The Cancer Genome Atlas revealed molecular subtyping of endometrial cancer, which can provide more accurate prognostic information and guide personalized treatment plans.ObjectiveTo summarize the expression and molecular basis of the main biomarkers of endometrial cancer.Search StrategyPubMed was searched from January 2000 to March 2023.Selection CriteriaStudies evaluating molecular subtypes of endometrial cancer and implications for adjuvant treatment strategies.Data Collection and AnalysisThree authors independently performed a comprehensive literature search, collected and extracted data, and assessed the methodological quality of the included studies.Main ResultsWe summarized the molecular subtyping of endometrial cancer, including mismatch repair deficient, high microsatellite instability, polymerase epsilon (POLE) exonuclease domain mutated, TP53 gene mutation, and non‐specific molecular spectrum. We also summarized planned and ongoing clinical trials and common therapy methods in endometrial cancer. POLE mutated endometrial cancer consistently exhibits favorable patient outcomes, regardless of adjuvant therapy. Genomic similarities between p53 abnormality endometrial cancer and high‐grade serous ovarian cancer suggested possible overlapping treatment strategies. High levels of immune checkpoint molecules, such as programmed cell death 1 and programmed cell death 1 ligand 1 can counterbalance mismatch repair deficient endometrial cancer immune phenotype. Hormonal treatment is an appealing option for high‐risk non‐specific molecular spectrum endometrial cancers, which are typically endometrioid and hormone receptor positive. Combining clinical and pathologic characteristics to guide treatment decisions for patients, including concurrent radiochemotherapy, chemotherapy, inhibitor therapy, endocrine therapy, and immunotherapy, might improve the management of endometrial cancer and provide more effective treatment options for patients.ConclusionsWe have characterized the molecular subtypes of endometrial cancer and discuss their value in terms of a patient‐tailored therapy in order to prevent significant under‐ or overtreatment.
Objectives. The standardized residency training (SRT) program in China is an important link for continuing education and clinical work training for graduate students. The purpose of our study was to enable educators to maintain the effectiveness of hysteroscopy teaching techniques and make the standardized residency training students well experienced in surgery, thus demonstrating that higher efficiency of teaching can lead to better proficiency for surgery. Methods. We generated resident-as-teacher teaching round and tutor guided hysteroscopic surgery as well as a questionnaire based on the mastery degree of the basic theoretical knowledge and operational skills of hysteroscopy among seven junior residents and five senior residents of the Obstetrics and Gynecology Department, including four attending gynecologic surgeons of a hysteroscopy teaching program. Results. Senior residents felt confident to teach, while junior residents learned effectively through the teaching round. There were statistically significant differences in the whole operation time and the volume of distension fluid used between junior and senior residents (p<0.05). Conclusions. This study acknowledges the need for new approaches to medical education for better characterization of the link between the use of teaching rounds through problem-based learning (PBL) discussion dominated by the residents themselves and overall surgical skills of teaching and learning.
Background: Few previous studies have introduced general techniques to overcome the “chopstick effect” in laparoendoscopic single-site surgery (LESS). We aim to investigate and highlight the key ergonomic methodologies for gynaecologic LESS based on the surgeon's hands-on performance. Methods: The first author surgeon A reviewed and analyzed the LESS procedures performed by herself and how she taught surgeon A B, from January 2021 to April 2022. The procedures were classified based on technical difficulty and learning periods, and the hands-on technical skills of the surgeons during the LESS module were evaluated. Results: Surgeon A conducted 580 LESS procedures, which were divided into the novice (n=48) and intermediate (n=33) periods, and the remaining cases were included in the routine period. We took ergonomic aspects into account and formed a special ergonomic LESS operating methodology: 1 Maintain good LESS laparoscopic spatial sensation, keep hand-eye coordination, well cooperation between the main surgeon and the assistant; 2 Improve basic LESS technique: grasp, lift, transfer and place objects, and proficient in blunt separating, coagulation, cutting and handling produce. 3 Coordination location, orientation, movements, functions, and flexion or extension of shoulders, arms, elbow, wrist and finger joints; 4 Maintain strength, tension, ambidexterity, depth perception, continuous postures and repetition with joint and muscular efforts to control instruments. 5 Experienced multiport laparoscopy surgery (MPS) skills on basic surgical proceduresand familiarity with anatomical structures were also determining elements. Surgeon B learned the above experiences by performing 39 LESS procedures under the guidance of surgeon A. Conclusion: This educational research sheds light on the common challenges faced in LESS and presents the importance of ergonomic hands-on performance skills in improving surgical outcomes. The findings could serve as a guide for future training and education in LESS.
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