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Wang CC, Foley OW, Blank SV, Huh WK, Barber EL. Shifting trends and sicker patients: Reassessing hysterectomy performed for benign indications by gynecologic oncologists. Gynecol Oncol 2024; 184:43-50. [PMID: 38277920 DOI: 10.1016/j.ygyno.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To assess trends and differences in patient characteristics, complications, and distributions of hysterectomy for benign indications by benign gynecologists (BG) and gynecologic oncologists (GO). METHODS This retrospective cohort study identified patients undergoing hysterectomy for benign indications using the National Surgical Quality Improvement Program data from 2014 to 2021. Exclusions were made for gynecologic or disseminated cancers, ascites, non-gynecologic surgeons, and cesarean hysterectomies. Primary outcome was major (≥Grade 3) 30-day complications, categorized into any complications, wound, cardiovascular and pulmonary, renal, infectious, andthromboembolic complications. Thirty-day readmissions, reoperations, and mortality were also analyzed. Propensity score matching was performed in a 1:1 match of GO to BG patients and was compared. Linear regressions assessed trends. RESULTS Among 198,767 patients, 18% (n = 37,707) underwent hysterectomy for benign indications with GO. GO patients exhibited more risk factors for complications and differed significantly from BG patients in comorbidities and perioperative characteristics. Overall, GO patients had higher major complication rates (3.1% vs 2.2%, p < 0.001) and for several other composite complications. After matching, compared to BG, GO-performed hysterectomies had similar rates of major complications (3.0% vs 3.0%, p = 0.55) and no differences in other composite complications, except fewer reoperations (1.2 % vs 1.5%, p < 0.01) and wound complications (0.4% vs 0.5%, p = 0.02) in GO patients. Over the eight years, the percentage of GO-performed hysterectomy (β = 0.41, R2 = 0.71,p < 0.01) increased significantly whereas BG-performed surgeries decreased by the same magnitude. BG had a significant decrease in frail patients (β = -0.47, R2 = 0.90, p < 0.01), but GO did not (β = -0.36, R2 = 0.38, p = 0.10). CONCLUSIONS GO are performing more hysterectomies for benign indications on higher-risk patients. However, on a matched cohort, risks of major complications were similar between GO and BG.
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Affiliation(s)
- Connor C Wang
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA.
| | - Olivia W Foley
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Stephanie V Blank
- Icahn School of Medicine at Mount Sinai, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, New York, NY, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Birmingham, AL, USA
| | - Emma L Barber
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
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Foley OW, Vega B, Roque D, Hinchcliff E, Marcus J, Tanner EJ, Barber EL. Characterization of pre-operative anemia in patients undergoing surgery by a gynecologic oncologist and association with post-operative complications. Int J Gynecol Cancer 2023; 33:1778-1785. [PMID: 37423639 PMCID: PMC10774452 DOI: 10.1136/ijgc-2023-004539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE Anemia is prevalent in patients with gynecologic cancers and is associated with increased peri-operative morbidity. We aimed to characterize risk factors for pre-operative anemia and describe outcomes among patients undergoing surgery by a gynecologic oncologist to identify potential areas for impactful intervention. METHODS We analyzed major surgical cases performed by a gynecologic oncologist in the National Surgical Quality Improvement Program (NSQIP) database from 2014 to 2019. Anemia was defined as hematocrit <36%. Demographic characteristics and peri-operative variables for patients with and without anemia were compared using bivariable tests. Odds of peri-operative complications in patients stratified by pre-operative anemia were calculated using logistic regression models. RESULTS Among 60 017 patients undergoing surgery by a gynecologic oncologist, 23.1% had pre-operative anemia. Women with ovarian cancer had the highest rate of pre-operative anemia at 39.7%. Patients with advanced-stage cancer had a higher risk of anemia than early-stage disease (42.0% vs 16.3%, p≤0.001). In a logistic regression model adjusting for potential demographic, cancer-related, and surgical confounders, patients with pre-operative anemia had increased odds of infectious complications (odds ratio (OR) 1.16, 95% CI 1.07 to 1.26), thromboembolic complications (OR 1.39, 95% CI 1.15 to 1.68), and blood transfusion (OR 5.78, 95% CI 5.34 to 6.26). CONCLUSIONS There is a high rate of anemia in patients undergoing surgery by a gynecologic oncologist, particularly those with ovarian cancer and/or advanced malignancy. Pre-operative anemia is associated with increased odds of peri-operative complications. Interventions designed to screen for and treat anemia in this population have the potential for significant impact on surgical outcomes.
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Affiliation(s)
- Olivia W Foley
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brenda Vega
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dario Roque
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily Hinchcliff
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jenna Marcus
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward J Tanner
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma L Barber
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Temkin SM, Terplan M. Levels of Gynecologic Care: A Task Force Consensus Statement. Obstet Gynecol 2023; 142:993-994. [PMID: 37734102 DOI: 10.1097/aog.0000000000005363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
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Blank SV, Huh WK, Bell M, Dilley S, Hardesty M, Hoskins ER, Lachance J, Musa F, Prendergast E, Rimel BJ, Shahin M, Valea F. Doubling down on the future of gynecologic oncology: The SGO future of the profession summit report. Gynecol Oncol 2023; 171:76-82. [PMID: 36827841 DOI: 10.1016/j.ygyno.2023.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
The original vision of the field of gynecologic oncology was to establish a multidisciplinary approach to the management of patients with gynecologic cancers. Fifty years later, scientific advances have markedly changed the overall practice of gynecologic oncology, but the profession continues to struggle to define its value-financial and otherwise. These issues were examined in full at the Society of Gynecologic Oncology (SGO) Future of the Profession Summit and the purpose of this document is to summarize the discussion, share the group's perceived strengths, weaknesses, opportunities, and threats (SWOT) for gynecologic oncologists, further educate members and others within the patient care team about the unique role of gynecologic oncologists, and plan future steps in the short- and long- term to preserve the subspecialty's critical mission of providing comprehensive, longitudinal care for people with gynecologic cancers.
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Affiliation(s)
- Stephanie V Blank
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Warner K Huh
- University of Alabama Birmingham, Birmingham, AL, United States of America
| | - Maria Bell
- MBA Sanford Women's Health, Sioux Falls, SD, United States of America
| | - Sarah Dilley
- Emory Healthcare, Atlanta, GA, United States of America
| | - Melissa Hardesty
- Alaska Women's Cancer Care, Anchorage, AK, United States of America
| | - Ebony R Hoskins
- Medstar Washington Hospital Center, Washington, D.C, United States of America
| | - Jason Lachance
- Maine Medical Partners, Scarborough, ME, United States of America
| | - Fernanda Musa
- Swedish Cancer Institute, Seattle, WA, United States of America
| | | | - B J Rimel
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Mark Shahin
- Abington Hospital, Jefferson Health, Willow Grove, PA, United States of America
| | - Fidel Valea
- Northwell Health, Zucker School of Medicine, New Hyde Park, NY, United States of America
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Kumar S, Tatarian T, Palazzo F. A surgeon's framework for the unplanned intraoperative consultation. Langenbecks Arch Surg 2023; 408:42. [PMID: 36656401 DOI: 10.1007/s00423-022-02733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Surgeons will likely be called to assist with or offer advice regarding an unanticipated intraoperative event or finding many times during their careers. Yet, there is no practical framework of how to respond to these consults nor is there any formal training in this area. The review of the limited literature and expert senior opinions can help explain the ethical components involved but does not address some of the practical aspects that the consulting surgeon may need to confront when responding to an unplanned intraoperative consultation. METHODS We reviewed the existing surgical literature on intraoperative consultation across surgical disciplines and interpreted it in light of our own experiences and the advice of senior surgical colleagues. RESULTS We present a framework for the minimum professional expectations of a surgeon responding to an intraoperative consultation. CONCLUSION In this manuscript, we present a selected review of the available literature on the topic, establish some of the guiding ethical principles, and offer an actionable and detailed framework that can support trainees and practicing surgeons dealing with these increasingly common and stressful unplanned circumstances.
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Affiliation(s)
- Sunjay Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Martin A, Wells A, Anderson ML, Chern JY, Rutherford TJ, Shahzad MM, Wenham RM, Hoffman MS. Trends in ureteral surgery on an academic gynecologic oncology service. Gynecol Oncol 2021; 163:552-556. [PMID: 34674890 DOI: 10.1016/j.ygyno.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the incidence, complications, and trends associated with ureteral surgeries on a gynecologic oncology service in the context of a fellowship training program over a 24-year period. METHODS We conducted a retrospective cohort analysis of ureteral surgeries by gynecologic oncologists at either Moffitt Cancer Center or Tampa General Hospital from 1997 to 2020. Patient characteristics, predisposing factors, location and type of injury, repair method, postoperative management and complications were abstracted from the medical record. The recent cohort (2005-2020) was compared to our prior series (1997-2004). RESULTS Eighty-eight cases were included. The average number of ureteral surgeries per year decreased from 5.75 (1997-2004) to 2.63 (2005-2020). Of 46 iatrogenic injuries, 45 were recognized and repaired intraoperatively. Ureteral transection was the most common type (85% [39 of 46]) and the distal 5 cm was the most common location of injury (63% [29 of 46]). Ureteroneocystostomy was the most common method of repair (83% [73 of 88]). Postoperative management, including stenting and imaging, has not changed significantly. Length of urinary catheter usage decreased in the recent cohort without associated complications. Five patients had major postoperative complications and 4 involved the urinary tract. Of those with follow-up, 96% (66 of 69) of ureteroneocystostomies and 75% (9 of 12) of ureteroureterostomies had radiologically normal urinary tracts. CONCLUSIONS Ureteral surgery is necessary in the case of injury or involvement with invasive disease. There has been a decrease in number of procedures. Ureteroneocystostomy has remained the most common method of reconstruction for both injury and resection with acceptable postoperative complication rates.
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Affiliation(s)
- Alexandra Martin
- Department of Clinical Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, United States of America.
| | - Ali Wells
- Department of Obstetrics & Gynecology, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Matthew L Anderson
- Division of Gynecologic Oncology, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Jing-Yi Chern
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| | - Thomas J Rutherford
- Division of Gynecologic Oncology, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Mian M Shahzad
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| | - Robert M Wenham
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
| | - Mitchel S Hoffman
- H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America
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Connect the Dots—August 2019. Obstet Gynecol 2019; 134:416-417. [DOI: 10.1097/aog.0000000000003388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benign hysterectomy performed by gynecologic oncologists: Is selection bias altering our ability to measure surgical quality? Gynecol Oncol 2018; 151:141-144. [DOI: 10.1016/j.ygyno.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 01/10/2023]
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Abstract
OBJECTIVE The objective of this study was to assess the scope of intestinal surgery training across gynecologic oncology fellowships in the United States and identify factors associated with perceived preparedness to perform intestinal surgery independently. MATERIALS/METHODS An institutional review board-approved survey was distributed to Society of Gynecologic Oncology fellows and candidate members within the first 3 years of practice. Questions addressed demographics, operative experience, preparedness and plans for performing intestinal surgery, and attitudes toward gynecologic oncologists (GOs) performing intestinal surgery. Responses were analyzed using descriptive statistics as well as univariate and multivariate analyses. RESULTS Of 374 Society of Gynecologic Oncology members invited, 108 (29%) responded, including 38 fellows (35%) and 53 recent graduates (49%). Fifteen (14%) reported more than 3 years of practice and were excluded. Most participants (96%) received intestinal surgery training from GOs, and 64% reported that all faculty routinely performed intestinal surgery. Most participants (81%) believed GOs should perform intestinal procedures, whereas only 58% felt prepared and 59% planned to perform intestinal procedures independently. Fellows who performed more than 10 intestinal diversion procedures, participated directed in intestine-related intraoperative consultations, or reported that all faculty performed intestinal surgery were more likely to feel prepared to perform intestinal surgery independently. Sex, training region, intended practice environment, and fellowship curriculum were not associated with preparedness to perform intestinal surgery. CONCLUSIONS Almost half of gynecologic oncology fellows and recent graduates in the United States do not feel prepared to perform intestinal procedures independently after fellowship. Increased volume and direct involvement of fellows in intestinal surgery may improve preparedness for performing intestinal surgery after fellowship.
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Primary Placement of Incisional Negative Pressure Wound Therapy at Time of Laparotomy for Gynecologic Malignancies. Int J Gynecol Cancer 2018; 26:1525-9. [PMID: 27488215 DOI: 10.1097/igc.0000000000000792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Wound complications are an important cause of postoperative morbidity amongst patient with gynecologic malignancies. We evaluated whether the placement of prophylactic negative pressure wound therapy (NPWT) at the time of laparotomy for gynecologic cancer surgery reduces wound complication rates. METHODS A retrospective analysis of patients undergoing laparotomy with primary wound closure performed by a gynecologic oncologist at a single academic institution over a 5-year study period was performed. Patients who had placement of prophylactic NPWT dressing were compared with patients with a standard closure. Postoperative outcomes were examined. RESULTS A total of 230 patients were identified: 208 women received standard wound care, 22 received NPWT. Groups were similar in age, prevalence of diabetes, tobacco use, and number of previous abdominal procedures. Intraoperative factors including length of procedure and transfusion requirements were similar. Body mass index for patients receiving standard treatment was 30.67 compared with 41.29 for NPWT group (P < 0.001). Incidence of all wound complications was 19.7% for those receiving standard treatment versus 27.3% for NPWT group (P = 0.40). Length of hospital stay was similar between the 2 groups (5.25 vs 6.22 days, P = 0.20). There were 3 hospital readmissions for wound complications-none occurred in women with a prophylactic NPWT dressing. CONCLUSIONS Despite significantly higher obesity rates, patients with prophylactic NPWT dressing placement had similar rates of wound complications. Our findings suggest a potential therapeutic benefit in the use of prophylactic NPWT for the reduction of wound complications in this high-risk gynecologic oncology patient population.
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Fujii T. Changing state of gynecologic oncologist specialty in Japan. J Obstet Gynaecol Res 2016; 42:481-8. [PMID: 26988808 DOI: 10.1111/jog.12970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/24/2015] [Accepted: 01/10/2016] [Indexed: 11/29/2022]
Abstract
Gynecologic oncologists must have extensive knowledge regarding the methods of treating a diverse range of gynecologic cancers as well as the ability to perform cutting-edge multidisciplinary treatments that frequently involve surgery. Given that coordination with other medical departments is vital for treatment, a high level of interpersonal and technical skills needs to be demonstrated to form the axis for medical treatment. One objective of the specialist certification system is the grooming of leaders as gynecologic oncologists while instructing trainees. The most distinguishing feature of Japanese gynecologic oncologists is that they need experience in more than 150 invasive cancer treatments, including more than 100 operations within the last 3-5 years. As for performance of surgery, at least 30 operations, including 15 radical hysterectomies, are required. Since surgical methods, including laparoscopic surgery, are undergoing a radical change, and increasing numbers of patients are undergoing radiotherapy for invasive cervical cancer, a review of the necessary requirements is critical. It is important to foster new leaders who are research-oriented. Now is the time for marked reform with the new specialist certification system being introduced by the Japanese Medical Specialty Board. Japan has the advantage of offering medical services at a much lower cost because of its national health insurance system. However, specialists are currently not receiving clear benefits befitting their efforts, and the question of how to maintain their motivation is an issue for the future. For these purposes, I believe securing incentives is a critical issue for specialists.
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Affiliation(s)
- Takuma Fujii
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, Aichi, Japan
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Davidovic-Grigoraki M, Thomakos N, Haidopoulos D, Vlahos G, Rodolakis A. Do critical care units play a role in the management of gynaecological oncology patients? The contribution of gynaecologic oncologist in running critical care units. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26805516 DOI: 10.1111/ecc.12438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Abstract
Routine post-operative care in high dependency unit (HDU), surgical intensive care unit (SICU) and intensive care unit (ICU) after high-risk gynaecological oncology surgical procedures may allow for greater recognition and correct management of post-operative complications, thereby reducing long-term morbidity and mortality. On the other hand, unnecessary admissions to these units lead to increased morbidity - nosocomial infections, increased length of hospital stay and higher hospital costs. Gynaecological oncology surgeons continue to look after their patient in the HDU/SICU and have the final role in decision-making on day-to-day basis, making it important to be well versed in critical care management and ensure the best care for their patients. Post-operative monitoring and the presence of comorbid illnesses are the most common reasons for admission to the HDU/SICU. Elderly and malnutritioned patients, as well as, bowel resection, blood loss or greater fluid resuscitation during the surgery have prolonged HDU/SICU stay. Patients with ovarian cancer have a worse survival outcome than the patients with other types of gynaecological cancer. Dependency care is a part of surgical management and it should be incorporated formally into gynaecologic oncology training programme.
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Affiliation(s)
- Miona Davidovic-Grigoraki
- 1st Department of Obstetrics and Gynecology, Gynecological Oncology Unit, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - Nikolaos Thomakos
- 1st Department of Obstetrics and Gynecology, Gynecological Oncology Unit, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - Dimitrios Haidopoulos
- 1st Department of Obstetrics and Gynecology, Gynecological Oncology Unit, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - Giorgos Vlahos
- 1st Department of Obstetrics and Gynecology, Gynecological Oncology Unit, "Alexandra" Hospital, University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Gynecological Oncology Unit, "Alexandra" Hospital, University of Athens, Athens, Greece
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Minig L, Padilla-Iserte P, Zorrero C. The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer. Front Oncol 2016; 5:308. [PMID: 26835417 PMCID: PMC4712269 DOI: 10.3389/fonc.2015.00308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/25/2015] [Indexed: 12/29/2022] Open
Abstract
Gynecologic oncologists have an essential role to treat women with gynecological cancer. It has been demonstrated that specialized physicians who work in multidisciplinary teams to treat women with gynecological cancers are able to obtain the best clinical and oncological outcomes. However, the access to gynecologic oncologists for women with suspected gynecological cancer is scarce. Therefore, this review analyzes the importance of specialized care of women with ovarian, cervical, and endometrial cancer. In addition, the role of gynecologic oncologists who offer fertility-sparing treatment as well as their role in assisting general gynecologists and obstetricians is also reviewed.
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Affiliation(s)
- Lucas Minig
- Gynecology Department, Valencian Institute of Oncology (IVO) , Valencia , Spain
| | | | - Cristina Zorrero
- Gynecology Department, Valencian Institute of Oncology (IVO) , Valencia , Spain
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