implemented to motivate and educate institutions to decrease the incidence of SSI, among other complications. In the current study, the authors undertake an evaluation of SSIs occurring in patients undergoing EC staging via MIS or laparotomy over 10 years. Their thoughtful analysis includes a breakdown of risk factors into risks that can be preventable and those that are unavoidable such as the need for bowel resection or the need for transfusion at the time of surgery. They conclude that patients would be better served if some of these risk factors such as preoperative smoking and hy- perglycemia could be brought under control. Although their database did not permit this, it would be interesting to determine a metric for ‘‘good control.’’ Would that be hemoglobin A 1c ? Preoperative levels of nicotine metabolite? It would also be interesting to know more about antibiotic prophylaxis. There was no difference between the groups; however, the period of evaluation included a nonYSurgical Care Im- provement Project era (pre-2006), and previous to that time, the decision to give antibiotics and choice of drug might have been variable. Lastly, the findings support MIS approach; a 15-fold decrease in SSIs was observed when staging was performed via MIS compared with laparotomy. There are many reasons to offer an MIS approach, and luckily we are well into the era of MIS. While the Gynecologic Oncology Group Lap 2 trial showed no difference between laparotomy and laparoscopy/MIS approach in regard to SSI, more recent articles support the finding that SSI is much decreased with an MIS approach, thus decreasing cost and patient mor- bidity. Surgical-site infections are important post- operative complications, and whereas some are not serious, many can be. This is an area worth paying attention to especially because we as surgeons can intervene at so many levels to de- crease the incidence of SSIs.VLVL) Prophylactic Use of Levonorgestrel-Releasing Intrauterine System in Women With Breast Cancer Treated With Tamoxifen: A Randomized Controlled Trial Alice W. Y. Wong, Symphorosa S. C. Chan, Winnie Yeo, Mei-Yung Yu, and Wing-Hung Tam Departments of Obstetrics and Gynaecology, Clinical Oncology, and Anatomical and Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Obstet Gynecol 2013;121:943Y950 ABSTRACT The use of tamoxifen has contributed to the decline of breast cancer mortality in the Western world. Although a 5-year course of treatment reduces the annual recurrence rate of this cancer by almost half and the mortality rate by one third, tamoxifen also increases the incidence of endometrial polyps and doubles the risk of endometrial cancer. Previous studies have shown that the levonorgestrel-releasing intrauterine system (LNG-IUS) provides endometrial protection for women with a uterus receiving estrogen replacement therapy and induces regression of endometrial hyperplasia. The prophylactic benefits of this system in women with breast cancer treated with tamoxifen are unclear. Only 2 ran- domized controlled trials have examined the endometrial protective effects of LNG-IUS in women with breast cancer treated with tamoxifen. Short-term follow-up data (2 years at most) from both trials showed that the system provided endometrial protection against tamoxifen. 568 Obstetrical and Gynecological Survey Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.