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The Comprehensive Systematic Review of Impact of Early Mobilization on Long-term Outcomes in ICU Patients Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/7xkp5b59

Introduction: Early mobilization in intensive care unit (ICU) patients has been proposed to mitigate the deleterious effects of critical illness, yet its impact on long-term outcomes remains uncertain. This systematic review comprehensively evaluates the effects of early mobilization on long-term functional, cognitive, quality of life, and healthcare utilization outcomes in adult ICU patients. Methods: A systematic review was conducted following PRISMA guidelines. We included randomized controlled trials, controlled clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses involving adult ICU patients (≥18 years) who received early mobilization (initiated within 72 hours of ICU admission or mechanical ventilation) compared to standard care or delayed mobilization. Long-term outcomes were defined as those measured at least 30 days post-ICU or hospital discharge. Data were extracted on patient characteristics, mobilization protocols, long-term outcomes, safety, and study quality. Results: Sixty-eight studies were included, comprising over 30,000 patients. Early mobilization consistently improved short-term functional outcomes, including muscle strength (mean difference 4.47-8.62 points on MRC scale), reduced ICU-acquired weakness (OR 2.04-2.7 for independent functional status), and increased likelihood of walking independently at discharge (OR 2.13) (Patel et al., 2023; Tipping et al., 2017; Hu et al., 2019). However, large randomized controlled trials found no significant improvement in long-term mortality (Hodgson et al., 2022) or quality of life at 6-12 months (Higgins et al., 2025). Notably, one trial demonstrated reduced cognitive impairment at 1 year (24% vs 43%, p=0.0043) (Patel et al., 2023). Subgroup analyses revealed potential harm in diabetic patients receiving high-intensity mobilization (adjusted OR 3.47 for 180-day mortality) (Serpa Neto et al., 2024). Adverse event rates were low (<3%), though the TEAM trial reported more events in the intervention group (9.2% vs 4.1%, p=0.005) (Hodgson et al., 2022). Discussion: The evidence presents a complex picture where early mobilization yields clear short-term functional benefits that do not consistently translate into improved long-term survival or quality of life. Heterogeneity in protocols, patient populations, and outcome measures limits definitive conclusions. Conclusion: Early mobilization safely improves in-hospital functional outcomes and reduces healthcare utilization. However, long-term benefits beyond hospital discharge remain unproven, and high-intensity protocols may harm specific subgroups. Individualized, progressive mobilization strategies are recommended.

A Comprehensive Systematic Review of The Role of Vasopressors in Early Management of Hemorrhagic Shock Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/wf2brc56

Introduction: The role of vasopressors in the early management of hemorrhagic shock remains controversial, with conflicting evidence from observational studies and randomized controlled trials. This systematic review aims to evaluate the efficacy and safety of early vasopressor administration in adult patients with hemorrhagic shock. Methods: A systematic review was conducted screening studies based on predefined criteria: adult patients with hemorrhagic shock from any cause, evaluation of any vasopressor agent within the first 24 hours, comparative study designs reporting clinically relevant outcomes. Fifty-eight sources were identified including randomized controlled trials, observational studies, and systematic reviews. Data were extracted on patient populations, vasopressor interventions, mortality outcomes, hemodynamic effects, fluid requirements, and adverse events. Results: Randomized controlled trials demonstrated that low-dose norepinephrine (<0.3 µg/kg/min) concurrent with fluid resuscitation significantly reduced 24-hour mortality (3% vs 13%, p<0.05) and in-hospital mortality (9% vs 21%, p<0.05) (Mohamed et al., 2024). The AVERT-Shock trial found no mortality difference with low-dose vasopressin but showed reduced blood product requirements (1.4 L vs 2.9 L, p=0.01) (Sims et al., 2019). Observational studies consistently associated vasopressor use with increased mortality (Aoki et al., 2018; Plurad et al., 2011; Fisher et al., 2020), though propensity-score analyses attenuated this association (Gauss et al., 2018). Vasopressors consistently achieved hemodynamic stabilization with improved mean arterial pressure and reduced fluid requirements. Adverse event profiles were similar between groups, with vasopressin associated with fewer deep venous thromboses (Sims et al., 2019). Discussion: The apparent contradiction between observational and randomized evidence is explained by confounding by indication, where sicker patients preferentially receive vasopressors. Context-dependent effects, agent-specific considerations, and timing of administration significantly influence outcomes. Low-dose vasopressors appear safe when used as adjuncts to—not replacements for—hemorrhage control and volume resuscitation. Conclusion: Early low-dose vasopressor administration, particularly norepinephrine and vasopressin, may be beneficial in selected patients with hemorrhagic shock, improving hemodynamic stability and reducing transfusion requirements without increasing mortality. Further research is needed to optimize agent selection, dosing strategies, and timing of initiation.

What is The Effectiveness of Intravenous Magnesium Supplementation Compared to Standard Care on Clinical Outcomes in Critically Ill Patients with Hypomagnesemia? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 34 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/fvm8m476

Introduction: Hypomagnesemia is common in critically ill patients and is associated with adverse outcomes. However, the effectiveness of intravenous (IV) magnesium supplementation remains controversial. Methods: This systematic review screened 80 studies including RCTs, etc across general ICUs, cardiac surgery, sepsis, neurological conditions, and other critical illnesses. Outcomes assessed included mortality, arrhythmias, neurological recovery, length of stay, and adverse events. Results: In post-cardiac surgery, IV magnesium significantly reduced supraventricular arrhythmias (RR 0.77; 95% CI: 0.63–0.93) and ventricular arrhythmias (RR 0.52; 95% CI: 0.31–0.87) [1,2]. In sepsis, magnesium improved lactate clearance and reduced ICU stay from 15 to 8 days (p<0.01) [3], with a network meta-analysis showing reduced short-term mortality (RR 0.33; 95% CI: 0.14–0.79) [4]. In AKI on CRRT, magnesium was associated with significantly lower 90-day mortality (aHR 0.38; 95% CI: 0.18–0.83) [5]. In aneurysmal SAH, magnesium reduced vasospasm (OR 0.61; 95% CI: 0.37–0.99) and delayed cerebral ischemia (OR 0.57; 95% CI: 0.37–0.88) but did not improve overall neurological outcome [6,7]. In TBI, the largest RCT showed no benefit and potential harm [8]. In general ICU patients with borderline hypomagnesemia, routine supplementation did not improve 24-hour clinical outcomes [9]. Extended infusion strategies improved magnesium retention compared to rapid boluses [11,12]. Adverse events were generally mild, though higher doses in TBI increased mortality [8]. Discussion: The effectiveness of IV magnesium is highly context-dependent. Strongest evidence supports arrhythmia prevention post-cardiac surgery. Sepsis and AKI on CRRT show promising signals for mortality and organ function, but evidence certainty is low. Neurological benefits are limited to intermediate events without improving final outcomes. Routine supplementation for mild hypomagnesemia in general ICU is not supported. Conclusion: IV magnesium supplementation is recommended for arrhythmia prophylaxis in post-cardiac surgery. Its role in sepsis and AKI on CRRT requires further high-quality RCTs. Magnesium should not be routinely administered for mild hypomagnesemia in general ICU or for neuroprotection in TBI.

What are The Most Effective Management Strategies for Obstetric Emergencies in ICU Settings, and How do They Impact Maternal and Neonatal Mortality Rates? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 34 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/z43b0823

Background: Obstetric emergencies requiring intensive care unit (ICU) admission contribute significantly to maternal and neonatal mortality worldwide, yet optimal management strategies remain heterogenous across settings. Methods: This systematic review synthesized 80 studies (1990-2025) examining management strategies for obstetric emergencies in ICUs. Outcomes included maternal mortality, neonatal mortality, and effectiveness of interventions. Results: Hypertensive disorders (42.96% in Africa) and hemorrhage (24.15%) were the leading admission causes. Multidisciplinary team approaches, early intervention (<6 hours for hemorrhage), and protocolized care consistently improved outcomes. Whole blood transfusion reduced transfusion volumes versus component therapy (2,607 mL vs. 4,683 mL, p=0.03) with zero maternal deaths. The non-pneumatic antishock garment combined with balloon tamponade eliminated hemorrhage-related mortality (0% vs. 3 deaths). Continuous renal replacement therapy reduced sepsis mortality by 35%. Skills training for postpartum hemorrhage reduced maternal mortality from 75% to 0%. Maternal mortality ranged from 0%-41.2%, with African centers reporting 30.69% versus 3.03% in dedicated obstetric ICUs. Neonatal mortality ranged 4.2%-52%. Critical timing factors included ICU admission <24 hours from symptom onset and delivery before critical deterioration. Discussion: Effective management requires condition-specific, early, multidisciplinary approaches. Resource disparities explain much outcome variation, with unbooked status and delayed referral as key modifiable risk factors. Standardized protocols, early warning systems, and uterine-conserving techniques show strongest evidence. Conclusion: Early, protocol-driven, multidisciplinary ICU management significantly reduces maternal and neonatal mortality in obstetric emergencies. System strengthening and skills training are as crucial as technological interventions.

Is there a relationship between fasting blood glucose levels and the incidence of polyhydramnios in pregnant women with gestational diabetes? : A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/vehvp648

Introduction: Gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, including polyhydramnios. However, the direct relationship between fasting blood glucose levels and the incidence of polyhydramnios in GDM populations remains debated. This systematic review aimed to evaluate the association between fasting glucose levels and polyhydramnios occurrence in pregnant women with GDM. Methods: A systematic review of observational studies examining the relationship between glucose parameters and polyhydramnios in GDM pregnancies was conducted. Thirty-five studies published to 2026 were identified,. Data extraction focused on study characteristics, GDM populations, glucose measurements, polyhydramnios occurrence, and statistical associations. Results: Polyhydramnios rates among GDM women ranged from 8.3% to 56.8%. Direct evidence from Dashe et al. and Xu et al. demonstrated significant positive correlations between amniotic fluid glucose concentration and amniotic fluid index (AFI) in diabetic populations (r=0.32, p=0.04; r=0.330, p=0.002). Xu et al. further showed strong correlation between amniotic fluid glucose and maternal fasting glucose (r=0.589, p<0.01). Critically, well-controlled GDM demonstrated significantly lower AFI (13.9±4.2 cm) compared to uncontrolled GDM (16.4±4.4 cm, p<0.05). Bartha et al. showed early GDM screening reduced hydramnios rates from 12.7% to 2.1% (p<0.0001). Late-onset GDM was identified in 4.8-11.8% of women with third-trimester polyhydramnios and prior negative screening. Discussion: The evidence supports an osmotic mechanism whereby maternal hyperglycemia leads to elevated amniotic fluid glucose, increasing amniotic fluid volume. The glucose-polyhydramnios relationship is modifiable through glycemic control, explaining apparent contradictions between studies. Studies failing to detect associations typically examined narrow glycemic ranges in normoglycemic populations. Conclusion: Fasting blood glucose levels are positively associated with polyhydramnios in GDM, mediated through amniotic fluid glucose concentration. Early detection and strict glycemic control significantly reduce polyhydramnios incidence and severity.

Is a sedentary lifestyle associated with a decrease in semen quality in adult men aged 18-50 years? A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/njxa1z45

Introduction: Global declines in semen quality over recent decades have raised concerns about the impact of modern lifestyles on male fertility. Sedentary behavior, increasingly prevalent in occupational and leisure settings, has been hypothesized as a potential contributing factor. This systematic review aims to evaluate whether a sedentary lifestyle is associated with decreased semen quality in healthy adult men aged 18-50 years. Methods: A systematic review was conducted following predefined screening criteria. Sixteen studies were included randomized controlled trial, etc. Studies were required to assess sedentary behavior (directly or indirectly), evaluate semen quality parameters (concentration, motility, morphology, volume, DNA fragmentation), and include healthy adult men aged 18-50 years. Data were extracted on study characteristics, sedentary behavior definitions, semen parameters, association findings, confounding factors, and limitations. Results: Direct evidence from two studies specifically measuring sedentary behavior showed inconsistent findings. Sterpi et al. (2024) reported mixed results across 13,509 men: three studies found declines in sperm concentration with high sedentary time, but most studies showed no significant associations with concentration, motility, or morphology. Eisenberg et al. (2015) found no association between occupational prolonged sitting and any semen parameter after adjustment for confounders. Indirect evidence from physical activity studies suggested that moderate physical activity benefits semen quality, while intense exercise may be detrimental (Montano et al., 2021; Nesello et al., 2020; Zańko et al., 2022). Obesity, strongly correlated with sedentary behavior, consistently predicted impaired semen quality (Magoutas et al., 2025; Venishetty et al., 2024; Бобков et al., 2020). Discussion: The available evidence does not demonstrate a robust independent association between sedentary behavior and decreased semen quality. Methodological limitations include heterogeneous definitions of sedentary behavior, reliance on self-report measures, inadequate adjustment for confounders (particularly BMI/obesity), and selection bias across study populations. The pathway linking sedentary behavior to semen quality appears mediated primarily through metabolic consequences (obesity, hormonal imbalances) rather than direct effects. Conclusion: Current evidence is insufficient to establish a causal relationship between sedentary lifestyle and decreased semen quality in healthy adult men aged 18-50 years. High-quality prospective studies using objective sedentary behavior measures (accelerometry) with adequate adjustment for adiposity and confounders are needed. Future research should distinguish between sedentary behavior's independent effects and those mediated through obesity.

Is Multiple Gestation Associated with an Increased Risk of Placenta Previa ? : A Systematic Review Carina Rhamadhanis; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 45 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/6wg4jy65

Background: Placenta previa is a major cause of antepartum hemorrhage, preterm delivery, and maternal morbidity. Multiple gestation is frequently listed as a risk factor in clinical guidelines, yet direct comparative evidence remains sparse and inconsistent. This systematic review evaluates whether multiple gestation independently increases the risk of placenta previa after accounting for key confounders, particularly assisted reproductive technology (ART) and prior cesarean delivery. Methods: We systematically screened RCT, etc that compared multiple gestations (twins or higher-order) with singleton gestations and reported placenta previa as an outcome. Studies were required to provide sufficient data for calculating measures of association (OR, RR, or incidence proportions). Data extraction focused on study design, population characteristics, multiple gestation details, placenta previa definition, association results, confounder adjustment, and sample sizes. Only studies with statistically significant positive findings were emphasized for the primary analysis. Results: Among 80 identified studies, only four provided direct quantitative comparisons between multiple and singleton gestations for placenta previa. In a cohort of 14,583 cesarean deliveries (Guo et al., 2022), placenta previa incidence was significantly lower in multiple gestations (2.4%) than singletons (3.9%; p=0.012)—a counterintuitive finding. Among placenta accreta spectrum (PAS) cases, twins had significantly lower previa rates (38.1% vs. 71.9%; p<0.001) and fewer prior cesareans (median 0 vs. 2) (Shamshirsaz et al., 2020). ART-conceived dichorionic twins had a nearly threefold higher risk of placenta previa compared with naturally conceived twins (RR=2.99; 95% CI 1.51–5.92; p=0.002; I²=0%) (Qin et al., 2016). The ART-associated previa risk was significantly lower in twins (OR=1.50) than in singletons (OR=2.67) (Karami et al., 2018). After adjusting for multiple gestations, the crude ART–previa association attenuated from OR=4.6 to aOR=1.8 (Johnston et al., 2015). Discussion: The apparent clinical association between multiple gestation and placenta previa is largely explained by confounding. ART increases both twinning and previa risk, while prior cesarean—a dominant previa risk factor—is less common in multiples. The lower crude previa rate in multiples is explained by their lower burden of uterine scarring. Mechanistically, ART alters endometrial receptivity and trophoblast invasion independently of plurality. In PAS, multiples exhibit a distinct risk profile (higher ART, lower previa, fewer prior cesareans). Conclusion: Multiple gestation is not an independent risk factor for placenta previa. The observed association is driven by ART and obstetric history. Future population-based studies must adjust for mode of conception, prior cesarean details, parity, and chorionicity.

What are The Rates of Mortality, Major Morbidity, and Hospital Readmission Within 30 Days Following Elective Gynecological Procedures in Patients Over 80 Years? : A Systematic Review Melati Ganeza; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 48 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/gj4gt527

Introduction: The global population is aging, and more women over 80 years are considered for elective gynecological surgery. However, evidence on short-term postoperative outcomes in this specific age group remains scarce. Methods: We conducted a systematic review following PRISMA guidelines, searching multiple databases for studies reporting 30-day mortality, major morbidity, or hospital readmission after elective gynecological procedures in patients ≥80 years. Observational studies, RCTs, etc were included. Results: The pooled 30-day mortality was 0–1% (Friedman et al., 2006; Fitzgerald et al., 2008). Major morbidity was elevated in elderly patients, particularly medical complications (UTI, respiratory failure, sepsis) (Friedman et al., 2006; Bourgin et al., 2016). No study reported 30-day readmission rates specifically for patients over 80. Length of stay was consistently longer in older patients (Friedman et al., 2006; Gultekin et al., 2015). Minimally invasive and obliterative procedures (e.g., colpocleisis) were associated with better outcomes (Raffone et al., 2021; Sadeh et al., 2022). Discussion: There is a profound evidence gap regarding perioperative outcomes in women over 80 undergoing elective gynecological surgery. Available data suggest low mortality but increased morbidity compared to younger patients. Readmission remains unmeasured. Frailty, hypoalbuminemia, and open surgical approach are key risk factors. Conclusion: Elective gynecological surgery in selected patients over 80 is feasible with low mortality, but major morbidity is higher. No readmission data exist. Future research must include this age group, report geriatric-specific outcomes, and evaluate ERAS protocols.

How Does Telemedicine-Based Postoperative Monitoring Affect Recovery Outcomes and Healthcare Costs for Women Undergoing Gynecological Procedures? : A Systematic Review Melati Ganeza; Yahya Nurlianto; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 39 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/75y50z88

Introduction: Postoperative care following gynecological surgery traditionally relies on in-person visits, which impose burdens on patients and healthcare systems. Telemedicine offers a potential alternative, but its impact on recovery outcomes and costs specifically for gynecological procedures requires systematic evaluation. Methods: This systematic review followed structured screening and data extraction procedures. We included randomized controlled trials, etc involving adult women (≥18 years) undergoing routine gynecological procedures. Studies examined telemedicine-based postoperative monitoring (remote technologies, virtual consultations, mobile apps, telehealth platforms) compared to standard care. Outcomes included recovery measures (complications, readmissions, patient satisfaction, quality of life, return to activities) and healthcare costs. Sixteen studies met inclusion criteria for final analysis. Results: Patient satisfaction was noninferior or superior to standard care across 10 studies (Lee et al., 2020; Wherley et al., 2025; Robin et al., 2025). Functional recovery improved significantly with comprehensive eHealth programs combining activity tracking and personalized advice, reducing return-to-normal-activities by 13 days (den Bakker et al., 2023). Simple telephone follow-up showed no benefit on quality of life or pain in enhanced recovery settings (Kassymova et al., 2020; Kassymova et al., 2022). Telemedicine was safe across all studies, with no increased complications or readmissions. Cost-effectiveness was demonstrated for internet-based programs (Bouwsma et al., 2018) and automated low-cost interventions (Sajnani et al., 2020; Robin et al., 2025), while nurse-led telephone models doubled costs without clinical benefit (Kassymova et al., 2025). Discussion: Intervention complexity predicts functional recovery benefits; personalized, interactive eHealth platforms outperform passive monitoring. Enhanced recovery after surgery (ERAS) contexts may attenuate marginal benefits of simple telephone follow-up. Satisfaction is universally preserved across all telemedicine modalities. Telemedicine does not increase low-acuity healthcare contacts and may reduce them through structured coaching. Cost-effectiveness depends on mechanism of savings—technology-mediated scalable interventions are superior to staffing-intensive models. Patient age, technological literacy, and psychological factors influence uptake and outcomes. Conclusion: Telemedicine-based postoperative monitoring for gynecological procedures is safe and achieves patient satisfaction equivalent or superior to standard care. Functional recovery benefits require comprehensive, personalized interventions with active patient engagement rather than simple follow-up. Cost-effectiveness favors automated or internet-based programs over labor-intensive telephone models. Future implementation should match intervention complexity to clinical context, target specific care gaps (activity guidance, expectation management), and consider patient digital literacy and psychological needs.

What are The Optimal Surgical Staging Procedures for Fallopian Tube Cancer in Terms of Diagnostic Accuracy, Morbidity, and Long-Term Patient Outcomes? : A Systematic Review Melati Ganeza; Yahya Nurlianto; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 39 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/nsxw3t27

Introduction: Primary fallopian tube cancer (PFTC) is a rare gynecologic malignancy that shares clinical and histological features with epithelial ovarian cancer. The optimal surgical staging procedures for PFTC and its precursor, serous tubal intraepithelial carcinoma (STIC), remain incompletely defined due to limited prospective data. Methods: This systematic review synthesized evidence from 16 studies, including RCT, etc. Data were extracted on diagnostic accuracy (upstaging rates), surgical morbidity, long-term outcomes (survival, recurrence), and comparative effectiveness of staging approaches (laparoscopy vs. laparotomy, complete vs. incomplete staging, extraperitoneal vs. transperitoneal lymphadenectomy). Results: For PFTC, comprehensive surgical staging (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy, peritoneal cytology/biopsies) improved 5-year survival from 33.3% to 65.4% (p=0.043) (Yu et al., 2007). Optimal cytoreduction significantly improved survival (68.4% vs. 41.7%, p=0.044) (Yu et al., 2007). Upstaging rates for apparent early-stage adnexal cancers were 23% (Brockbank et al., 2013). For STIC, upstaging varied from 0% in BRCA carriers undergoing risk-reducing surgery (Hoeven et al., 2018) to 43% in incidental STIC in low-risk women (Chay et al., 2015). Minimally invasive staging reduced blood loss, hospital stay, and lymphatic ascites (p<0.05) compared to laparotomy (Nezhat et al., 2010; Pérez-Medina et al., 2015; Kerbage et al., 2020). Extraperitoneal para-aortic lymphadenectomy had fewer intraoperative complications (OR 0.40, p=0.001) but more lymphoceles (OR 4.12) than transperitoneal approach (Li et al., 2021). Discussion: The evidence supports complete surgical staging and optimal cytoreduction for PFTC. For STIC, staging is most clearly indicated when incidentally found in non-BRCA patients. Minimally invasive approaches are preferred due to lower morbidity, provided tumor rupture is avoided. The independent prognostic value of lymphadenectomy remains debated, while omentectomy shows consistent survival benefit. Conclusion: Optimal surgical staging for fallopian tube cancer should include systematic lymphadenectomy, omentectomy, peritoneal biopsies, and cytology, aiming for no residual disease. Laparoscopic staging is safe and effective for early-stage and selected advanced cases. STIC management should be individualized based on BRCA status and clinical context.

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