1.1. Objective: To show the results of complementary and rescue surgeries in patients with Locally Advanced Cervical Cancer (LACC), Squamous Cell Carcinoma (SCC) and Adenocar-Cinoma (ADC), with confirmation orsuspicion of tumor persistence to treatment with Chemo-Radio Therapy (CRT) with or without Intra-Cavitary Brachy Therapy (ICBT). 1.2. Material and Methods: Retrospective study of patients treated in the Oncology Service of the General Hospital of Mexico (GHM) in the period from 2008 to 2015, who had a diagnosis of Persistent Cervical Cancer (PCC) and were laparotomized in order to perform complementary or rescue surgeries. 1.3. Results: We performed 100 surgeries, 61 Complementary Hysterectomies (CH) with or without lymphadenectomy, 24 Pelvic Exenterations (PE) and 15 laparotomies because the neoplasm was unresectable. Major Complications (MC) occurred in 11/65 (16.9%) Page -01 World Journal of Medical Oncology Open Access patients treated with CRT and ICBT, and 1/20 (5.0%) of patients in the CRT group without ICBT (p = 0.2290). There was no postoperative mortality. Disease Free Survival (DFS) was 30.5 months in 66/90 (73.3%) of all patients; by surgery 51/56 (91.0%) CH and 15/19 (78.9%) PE; by histopatology, 35/56 (62.5%) with SCC and 31/34 (91.1%) with ADC (p = 0.003); and for stage II the main clinical stage with 58 patients: 22/36 (61.1%) for SCC and 20/22 (90.9%) for ADC (p = 0.0145). 1.4. Conclusions: Adyuvant surgery has a place in the management of LACC with tumor persistence or suspicion of this after conventional treatment with CRT. External Beam Radiation Therapy (EBRT) plus Chemo-Therapy (QT) plus surgery can be considered for the treatment of ADC from CS IB3.

Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.

Giant juvenile fibroadenoma (GJF) represents 0.5% of fibroadenomas and the usual age range of occurrence is 10 to 18. GJF definition describes a benign tumor that measures more than 5 cm, weighs more than 500 grams or occupies more than 80% of the mammary gland. In this report, we present the case of a 14-year-old patient's GJF with six months of evolution. The examination proved skin and the Nipple-Areola Complex (NAC) involve, resulting in the identification of a smooth, firm and mobile tumor of 20 cm with negative local lymph nodes. The diagnosis used Mammography (MG), Ultrasound (US), and Magnetic Resonance Imaging (MRI). In addition, Breast Conservative Surgery (BCS) required making an incision in the breast groove, resulting in good aesthetic results. To the best of our knowledge, there is no standard surgical approach. In practice, the treatment options for BCS are enucleation, Wide Local Excision (WLE) and oncoplastic techniques, and Simple Mastectomy (SM) considering or excluding reconstruction. This case challenged medicine itself since human skin gained elasticity after six months, it did not reach full breast development, and hormonal action exposition was present all time, which can generate recurrences, for instance, pregnancy or psychological factors. Whilst GJF is a pathology that requires Therapeutic Board (TB) criteria for adequate BCS, it needs a multidisciplinary team including a Gynecology Oncologist specialist, Plastic and Reconstructive Surgery (PRS) specialist, and a psychologist, where the aesthetic result of the patient should always be priority. This case shows the importance of making adequate differential diagnosis (DD) and respecting oncological principles. In a year of follow-up, skin retraction improved due to normal breast development suggesting effectiveness of the technique.

To draw attention to the increase in the frequency of endometrial cancer (CE) in recent decades and its association with overweight and obesity in a highly specialized institution. Retrospective study of patients with EC treated in the Oncology Service (OS) General Hospital of Mexico (GHM), in the years 2000 to 2017, obtaining information related to some risk factors and their classification. The data were compared with a previous study from the years 1966-1993. Of the record of 1,045 EC treated during the studied time of 44 years, 785 corresponded to the period 2000-2017 and 260 to the previous report, which meant an increase of 200% for this disease. Of gynecological cancers, the EC figures increased from 17.9% in 2010-2011 to 29.4% in 2016-2017 (p=0.0001). Overweight and obesity were in 572/785 (72.8%) of the current series vs. 120/260 (46.1%) of the previous series (p<0.05). An increase of 19% to 28% was found in women younger than 48 years when comparing the periods 2000 -2009 vs. 2010-2017 (p=0.011); 119/389 classified as stage I, (30.5%) had risk factors for tumor recurrence and 378/898 (42.0%) had advanced malignancies. An increase in CE reported in this series and its association with overweight and obesity, may highlight the public health problem that this association represents in our country.

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