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Chacon E, Chiva L. The art of bowel surgery in gynecologic cancer. Int J Gynecol Cancer 2024; 34:421-425. [PMID: 38438172 DOI: 10.1136/ijgc-2023-004595] [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] [Indexed: 03/06/2024] Open
Abstract
The field of gynecologic oncology has witnessed a profound transformation in the practice of bowel resection over the years. This evolution, driven by innovative techniques and expanded surgical skills, has redefined the role of the surgeon. This review article delves into the historical journey of bowel surgery, its contemporary importance in cytoreductive procedures for gynecologic cancers, and the general principles of digestive surgery. From pioneering surgeons such as Lane, Broca, and Billroth to the introduction of mechanical staplers, this narrative unfolds the remarkable advances in the field. It highlights the critical need for meticulous training, anatomic mastery, aseptic measures, vascular support, tension-free anastomoses, and precise surgical techniques. These principles underpin the success of bowel resection and anastomosis in the complex landscape of gynecologic oncology.
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Affiliation(s)
- Enrique Chacon
- Gynecology and Obstetrics, Clinica Universidad de Navarra, Pamplona, Spain
| | - Luis Chiva
- Gynecology and Obstetrics, Clinica Universidad de Navarra, Madrid, Spain
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Urologic Complication after Laparoscopic Hysterectomy in Gynecology Oncology: A Single-Center Analysis and Narrative Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121869. [PMID: 36557071 PMCID: PMC9782160 DOI: 10.3390/medicina58121869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Minimally invasive surgery (MIS) has recently increased its application in the treatment of gynecological malignancies. Despite technological and surgical advances, urologic complications (UC) are still the main concern in gynecology surgery. Current literature reports a wide range of urinary tract injuries, and consistent scientific evidence is still lacking or dated. This study aims to report a large single-center experience of urinary complications during laparoscopic hysterectomy for gynecologic oncologic disease. Materials and Methods: All patients who underwent laparoscopic hysterectomy for gynecologic malignancy at the Department of Medicine and Surgery of the University Hospital of Parma from 2017 to 2021 were retrospectively included. Women with endometrial cancer, cervical cancer, ovarian cancer, uterine sarcoma, or borderline ovarian tumors were included. Patients undergoing robotic surgery with incomplete anatomopathological data or patients lost during follow-up were excluded from the analysis. Intraoperative and postoperative UC were analyzed and ranked according to the Clavien-Dindo classification. Results: Two hundred-sixty patients were included in the study: 180 endometrial cancer, 18 cervical cancer, nine ovarian cancer, two uterine sarcomas, and 60 borderline ovarian tumors. Nine (3.5%) UCs were reported (five intraoperative and four postoperative complications). No anamnestic variables showed a statistical correlation with the surgical complication in the univariable analyses. C1 radical hysterectomy, a higher FIGO stage, and postoperative adjuvant treatment (p-value = 0.001, p-value = 0.046, and p-value = 0.046, respectively) were independent risk factors associated with the occurrence of UC. Conclusions: The urological complication rates in patients with oncological disease are relatively rare events in the expert hands of dedicated surgeons. Radical hysterectomy, FIGO stage, and adjuvant treatment are independent factors associated with urinary complications.
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Lanner M, Nikolova T, Gutic B, Nikolova N, Pletnev A, Selcuk I, Vlachos DE, Razumova Z, Bizzarri N, Theofanakis C, Lepka P, Kahramanoglu I, Han S, Nasser S, Molnar S, Hudry D, Montero-Macías R, de Lange N, Macuks R, Hasanov MF, Karimbayli R, Gagua I, Andrade C, Pardal C, Dotlic J, Alvarez RM, Hruda M, Fruhauf F, Ekdahl L, Antonsen SL, Sukhin V, Eriksson AGZ, Gliozheni E, Delic R, Satanova A, Kovacevic N, Gristsenko L, Babloyan S, Zalewski K, Bharathan R. Subspecialty training in Europe: a report by the European Network of Young Gynaecological Oncologists. Int J Gynecol Cancer 2020; 31:575-584. [PMID: 33361458 DOI: 10.1136/ijgc-2020-002176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND ESGO (European Society of Gynaecological Oncology) and partners are continually improving the developmental opportunities for gynaecological oncology fellows. The objectives of this survey were to evaluate the progress in the infrastructure of the training systems in Europe over the past decade. We also evaluated training and assessment techniques, the perceived relevance of ENYGO (European Network of Young Gynaecological Oncologists) initiatives, and unmet needs of trainees. METHODOLOGY National representatives of ENYGO from 39 countries were contacted with an electronic survey. A graduation in well/moderately/loosely-structured training systems was performed. Descriptive statistical analysis and frequency tables, as well as two-sided Fisher's exact test, were used. RESULTS National representatives from 33 countries answered our survey questionnaire, yielding a response rate of 85%. A national fellowship is offered in 22 countries (66.7%). A logbook to document progress during training is mandatory in 24 (72.7%) countries. A logbook of experience is only utilized in a minority of nations (18%) for assessment purposes. In 42.4% of countries, objective assessments are recognized. Trainees in most countries (22 (66.7%)) requested additional training in advanced laparoscopic surgery. 13 (39.4%) countries have a loosely-structured training system, 11 (33.3%) a moderately-structured training system, and 9 (27.3%) a well-structured training system. CONCLUSION Since the last publication in 2011, ENYGO was able to implement new activities, workshops, and online education to support training of gynaecological oncology fellows, which were all rated by the respondents as highly useful. This survey also reveals the limitations in establishing more accredited centers, centralized cancer care, and the lack of laparoscopic training.
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Affiliation(s)
- Maximilian Lanner
- Department of Obstetrics and Gynaecology, Kardinal Schwarzenberg Klinikum, Schwarzach im Pongau, Austria
| | - Tanja Nikolova
- Klinikum Mittelbaden, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
| | - Bojana Gutic
- Gynaecology Department, Vojvodina Institute of Oncology, Sremska Kamenica, Serbia
| | - Natasha Nikolova
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Andrei Pletnev
- Department of Gynaecological Oncology, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | - Ilker Selcuk
- Gynaecological Oncology, Maternity Hospital, Ankara City Hospital, Ankara, Turkey
| | - Dimitrios-Efthymios Vlachos
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoia Razumova
- Department of Women's and Children's Health, Division of Neonatology, Obstetrics and Gynaecology, Karolinska Institute, Stockholm, Sweden
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Charlampos Theofanakis
- Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Attica, Greece
| | - Piotr Lepka
- Department of Oncology, Gynaecological Oncology Clinic, Wroclaw Medical University and 2nd Lower Silesian Oncology Centre, Wroclaw, Poland
| | - Ilker Kahramanoglu
- Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, Istanbul University Cerrrahpasa Medical Faculty, Istanbul, Turkey
| | - Sileny Han
- Gynaecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Sara Nasser
- Department of Gynaecological Oncology, Gynaecology Clinic with Oncologic Surgery Centre, Charité Comprehensive Cancer Centre, Campus Virchow Klinikum, Berlin, Germany
| | - Szabolcs Molnar
- Department of Obstetrics and Gynaecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Delphine Hudry
- Department of Gynaecological Oncology, Centre Oscar Lambret, Lille, France
| | - Rosa Montero-Macías
- Gynaecologic and Breast Oncologic Surgery Department, European Hospital Group Georges-Pompidou, Paris, France
| | - Natascha de Lange
- Department of Gynaecological Oncology, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Ronalds Macuks
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia
| | - Mir Fuad Hasanov
- Department of Obstetrics and Gynaecology, Medical Center-University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Ramina Karimbayli
- Department of Oncogynaecology, The National Centre of Oncology, Baku, Azerbaijan
| | - Irina Gagua
- Department of Gynaecology, Research Institute of Clinical Medicine, Todua Clinic, Tbilisi, Georgia
| | - Claudia Andrade
- Department of Gynaecology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Catarina Pardal
- Department of Obstetrics and Gynaecology, Hospital de Braga, Braga, Portugal
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynaecology, Clinical Centre of Serbia, University of Belgrade, Beograd, Serbia
| | - Rosa Maria Alvarez
- Department of Gynaecological Oncology and Breast Cancer, Santa Cristina University Hospital, Madrid, Spain
| | - Martin Hruda
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Filip Fruhauf
- Department of Obstetrics and Gynaecology, General University Hospital, Charles University, Prague, Czech Republic
| | - Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital Lund, Lund, Sweden
| | - Sofie Leisby Antonsen
- Gynaecological Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Vladyslav Sukhin
- Department for Gynaecological Oncology, Grigoriev Institute for medical Radiology and Oncology NAMS, Kharkov, Ukraine
| | - Ane Gerda Zahl Eriksson
- Department of Gynaecological Oncology, Division of Cancer Medicine, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Elko Gliozheni
- Department of Obstetrics and Gynaecology, Maternity Koco Gliozheni Hospital, Tirana, Albania
| | - Ratko Delic
- Department of Obstetrics and Gynaecology, General Hospital Celje, Celje, Slovenia
| | - Alima Satanova
- Department of Gynaecological Oncology, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Nina Kovacevic
- Department of Gynaecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Liidia Gristsenko
- Department of Obstetrics and Gynaecology, The North Estonian Medical Centre, Tallinn, Estonia
| | - Suzanna Babloyan
- Department of Obstetrics and Gynaecology, Yerevan State Medical University, Yerevan, Armenia
| | - Kamil Zalewski
- Gynaecological Oncology, Świętokrzyskie Cancer Centre, Kielce, Poland
| | - Rasiah Bharathan
- Department of Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
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Hall M, Savvatis K, Nixon K, Kyrgiou M, Hariharan K, Padwick M, Owens O, Cunnea P, Campbell J, Farthing A, Stumpfle R, Vazquez I, Watson N, Krell J, Gabra H, Rustin G, Fotopoulou C. Maximal-Effort Cytoreductive Surgery for Ovarian Cancer Patients with a High Tumor Burden: Variations in Practice and Impact on Outcome. Ann Surg Oncol 2019; 26:2943-2951. [PMID: 31243666 PMCID: PMC6682567 DOI: 10.1245/s10434-019-07516-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to compare the outcomes of two distinct patient populations treated within two neighboring UK cancer centers (A and B) for advanced epithelial ovarian cancer (EOC). METHODS A retrospective analysis of all new stages 3 and 4 EOC patients treated between January 2013 and December 2014 was performed. The Mayo Clinic surgical complexity score (SCS) was applied. Cox regression analysis identified the impact of treatment methods on survival. RESULTS The study identified 249 patients (127 at center A and 122 in centre B) without significant differences in International Federation of Gynecology and Obstetrics (FIGO) stage (FIGO 4, 29.7% at centers A and B), Eastern Cooperative Oncology Group (ECOG) performance status (ECOG < 2, 89.9% at centers A and B), or histology (serous type in 84.1% at centers A and B). The patients at center A were more likely to undergo surgery (87% vs 59.8%; p < 0.001). The types of chemotherapy and the patients receiving palliative treatment alone were equivalent between the two centers (3.6%). The median SCS was significantly higher at center A (9 vs 2; p < 0.001) with greater tumor burden (9 vs 6 abdominal fields involved; p < 0.001), longer median operation times (285 vs 155 min; p < 0.001), and longer hospital stays (9 vs 6 days; p < 0.001), but surgical morbidity and mortality were equivalent. The independent predictors of reduced overall survival (OS) were non-serous histology (hazard ratio [HR], 1.6; 95% confidence interval [CI] 1.04-2.61), ECOG higher than 2 (HR, 1.9; 95% CI 1.15-3.13), and palliation alone (HR, 3.43; 95% CI 1.51-7.81). Cytoreduction, of any timing, had an independent protective impact on OS compared with chemotherapy alone (HR, 0.31 for interval surgery and 0.39 for primary surgery), even after adjustment for other prognostic factors. CONCLUSIONS Incorporating surgery into the initial EOC management, even for those patients with a greater tumor burden and more disseminated disease, may require more complex procedures and more resources in terms of theater time and hospital stay, but seems to be associated with a significant prolongation of the patients overall survival compared with chemotherapy alone.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/surgery
- Cytoreduction Surgical Procedures/mortality
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Practice Patterns, Physicians'/standards
- Prognosis
- Retrospective Studies
- Survival Rate
- Tumor Burden
- Young Adult
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Affiliation(s)
- Marcia Hall
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Konstantinos Savvatis
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, London, UK
- William Harvey Research Institute, Queen Mary University, London, UK
| | - Katherine Nixon
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK
| | - Maria Kyrgiou
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK
| | | | - Malcolm Padwick
- West Hertfordshire Gynaecological Cancer Centre, WHH NHS Trust, Watford, UK
| | - Owen Owens
- West Hertfordshire Gynaecological Cancer Centre, WHH NHS Trust, Watford, UK
| | - Paula Cunnea
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK
| | - Jeremy Campbell
- Department of Anaesthetics, Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Ham House, Hammersmith Hospital, London, UK
| | - Alan Farthing
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK
| | - Richard Stumpfle
- Department of Anaesthetics, Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Ham House, Hammersmith Hospital, London, UK
| | | | - Neale Watson
- Department of Gynaecology, Hillingdon Hospital, Pield Heath Road, Uxbridge, UK
| | - Jonathan Krell
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK
| | - Hani Gabra
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK
- Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Gordon Rustin
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Imperial College London and West London Gynecological Cancer Centre, Imperial College NHS Trust, London, UK.
- Department of Anaesthetics, Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Ham House, Hammersmith Hospital, London, UK.
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