Women Surgeons: Barriers and Solutions

OBJECTIVE

Underrepresentation and undertreatment of women in surgery continues to be highly prevalent, with major barriers to improvement. The aim of the study was to review the current state of women surgeons in Poland.

METHODS

Information from the various Polish databases on women surgeons in nine medical universities in general, oncological, vascular, thoracic, and cardiac surgery was retrospectively evaluated. Demographics of residents and staff surgeons, academic ranks and leadership positions at universities, in surgical societies and on scientific journals editorial boards were analyzed. Descriptive statistics were used.

RESULTS

In 2020, 61 % of 3668 graduates of Polish medical universities were women. In five surgical specialties 11.9% (1,243 of 10,411) of the surgeons were women, with the lowest numbers in cardiac (5.6%) and in vascular surgery (6.4%); 40.4% of general surgery residents were women, less in vascular (18.4%) and thoracic surgery (24%), more in oncological surgery (28.7%). In 35 surgical departments of nine universities all department chairs were men, all full professors were men; 7 % of associate professors, 16% of assistant professors were women. Rectors of all universities were men, 27% of the vice-rectors were women. In the senates and university councils, 39% and 35%, respectively, were women. Presidents, vice presidents, and secretaries of surgical societies and Editor-in-Chief of four surgical journals were all men.

CONCLUSIONS

Polish women surgeons face major difficulties with representation in surgery, in departmental, institutional, and societal leadership, and on scientific journal editorial boards. A multi-faceted approach to correct these serious inequalities is urgently needed.

Tissue self-organization underlies morphogenesis of the notochord

The notochord is a conserved axial structure that in vertebrates serves as a hydrostatic scaffold for embryonic axis elongation and, later on, for proper spine assembly. It consists of a core of large fluid-filled vacuolated cells surrounded by an epithelial sheath that is encased in extracellular matrix. During morphogenesis, the vacuolated cells inflate their vacuole and arrange in a stereotypical staircase pattern. We investigated the origin of this pattern and found that it can be achieved purely by simple physical principles. We are able to model the arrangement of vacuolated cells within the zebrafish notochord using a physical model composed of silicone tubes and water-absorbing polymer beads. The biological structure and the physical model can be accurately described by the theory developed for the packing of spheres and foams in cylinders. Our experiments with physical models and numerical simulations generated several predictions on key features of notochord organization that we documented and tested experimentally in zebrafish. Altogether, our data reveal that the organization of the vertebrate notochord is governed by the density of the osmotically swelling vacuolated cells and the aspect ratio of the notochord rod. We therefore conclude that self-organization underlies morphogenesis of the vertebrate notochord.This article is part of the Theo Murphy meeting issue on 'Mechanics of development'.

Preoperative or postoperative therapy for resectable gallbladder cancer? A retrospective analysis of patients treated at a single institution

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Background: Gallbladder cancer (GBC) is the most common malignancy of the biliary tract. Less than 30% present at an early stage where surgical resection is curative. We examine a cohort of patients with GBC toward determining if preoperative and postoperative treatment of locally advanced GBC demonstrate any differing results in complications or survival.

Methods: A retrospective review of patients seen at FCCC with GBC from Jan 1991 to Nov 2008 was performed. Demographics, clinical stage, surgical procedure, AJCC 7th stage, details of neoadjuvant and adjuvant treatment and complications of surgery were analyzed.

Results: Fifty-one patients with GBC were identified. Of these, 66% had their GBC found incidentally, 77% had stage 2 or greater cancers, and 35 patients needed liver resection with portal lymphadenectomy. 13 patients had an extrahepatic bile duct resection. 10 patients had extended resections including pancreatoduodenectomy (5) or colectomy (5), while 6 had cholecystectomy alone. 25% (n=13) of the population had preoperative chemoradiation only, 30 % (n=15) had postoperative chemoradiation only, while 15% (n=8) received maintenance chemotherapy only. 10% (n=5) had preoperative and postoperative therapy, while twenty percent of the group (n=10) had surgery only. 49% had recurrences (n=25), with 48% percent of these being local-regional. Median survival was 30 months for the whole group, with 54.6 month median survival for the 41 patients without extended resection. No significant difference in survival was seen comparing preoperative therapy versus postoperative treatment (p=0.13). Five-year survival is 47% for those with minor hepatic resection compared to 25% for those with combined hepatic and colon or pancreatic resection.

Conclusions: We present a retrospective view of patients treated in our center, the majority of whom received either preoperative or postoperative adjuvant therapy, both of which had good median survival and acceptable morbidity and mortality. Given the poor survival and high recurrence rate for stage II and greater cancers, we suggest that preoperative or postoperative adjuvant therapy for these cases may be equally effective.

No significant financial relationships to disclose.

Use of perioperative therapy in gastric cancer: A retrospective comparison of ECF and chemoradiation

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Background: Gastric Cancer (GC) remains a major cause of cancer related morbidity and mortality in Western Countries with five year survival rates between 30%-40%. Preoperative therapy has been championed by groups extrapolating data from the Intergroup 0116 and the MAGIC trials, with a view to enhancing completion of therapy and improving survival in locally advanced tumors.

Methods: Patients with preoperative treatment of GC were reviewed from our tumor registry. Stages were assigned by AJCC 7th edition. A comparison between the ECF regimen and non-ECF chemoradiation regimens was performed to view patterns of pathologic complete response (pCR), recurrence, toxicity and overall survival.

Results: Forty-two patients were identified and stratified into two groups; Group 1 ECF treatment arm (n = 16) compared to group 2 non-ECF chemo-radiation arm (n = 26). No statistical difference was noted in age, ethnicity or stage stratification. All of Group 1 received their chemotherapy regimen after 2005. In contrast, 60% of Group 2 patients received their treatment pre-2005. Only 56% the ECF group completed their treatment course (19% received other postoperative therapy). Seventy percent of group 2 received adjuvant chemotherapy. A grade 2 or higher toxicity was noted in 16% of Group 1 compared to 60% in Group 2 (p = 0.035). Seven complications were noted in the group 1 compared to 10 in group 2 (p = NS). The differentiation of tumor between groups was not significant (p = 0.97). Length of stay was significant (Group 1:9 days, Group 2:12 days, p = 0.02). More nodes were retrieved from group 1 versus group 2 (20.2 versus 15.2, p = 0.03). Group 1 had 3 recurrences (19%) while Group 2 had 11 recurrences (42%, p = 0.94). In both groups 80% of recurrences were distant. Group 1 had a 19% pCR versus 23% in group 2 (p = 0.79). Two-year survival was 70% in both groups, with a median survival of 51 months for group 2. Median survival was not reached for group 1.

Conclusions: No difference was noted in pCR, recurrences, or survival between these two regimens. If this can be confirmed in larger, prospective, randomized trials, use of radiation and its potential morbidity may be avoided.

No significant financial relationships to disclose.

Abstract P1-14-05: Predicting Brain Metastasis in Breast Cancer Patients: Who Is at Highest Risk?

Background: The development of brain metastases (BrM) in women with breast cancer is associated with more advanced stage at presentation (Atahan 2008), although predicting who is at greatest risk remains difficult. This study aims to determine the characteristics of those at highest risk for BrM, and characterize treatment prior to their development. Methods: A prospective database containing 4,169 breast cancer patients (pts) was retrospectively reviewed for those developing BrM between 1997 and 2007. Demographic and prognostic variables were reviewed. Controls without BrM were matched for T stage, N stage and ER status, with 2 matched controls for 44 BrM pts.

Results: Forty-nine patients (1.2%) developed BrM, among whom 6 were evident at initial presentation. BrM pts overall were diagnosed at a median age of 57 y with pathologic stages I and II accounting for 33% of cases at initial presentation. Pts developed BrM at a median of 19.7 mos after diagnosis. T1/T2 tumors were present in 65% of overall cases. 21 (43%) were ER/PR negative. Among 24 sites of distant disease evident prior to BrM were 16 (66%) bone and 6 (25%) lung metastases. Univariate BrM predictors included evidence of prior non-brain metastases (p=0.0004), high nuclear grade (p=0.002), PR-negativity (p=0.005), and inflammatory breast cancer (IBC, p=0.04). Family history of breast cancer approached significance (p=0.053). On multivariable analysis for predictors, prior non-brain metastases (p=0.001), high nuclear grade (p=0.006), and IBC (p=0.01) remained significant predictors. Despite adjustment for T and N stage, univariate treatments associated with, but given prior to BrM development, were use of radiotherapy (p=0.002), chemotherapy (p=0.009), and mastectomy (vs lumpectomy, p=0.03; vs no operation, p=0.0016). The sole treatment associated on multivariable analysis was chemotherapy use (p=0.02). After BrM diagnosis, 94% had whole brain radiotherapy, 22% had chemotherapy, and 8% underwent neurosurgery. BrM pts’ median survival was 38.6 mos, while matched controls did not reach median survival in 100 mos of mean follow up. Median time from BrM diagnosis to death was 10.8 mos, with a 5 y survival of 25.6%. Conclusion: The development of BrM is associated with shorter survival in patients with breast cancer. Several clinico-pathologic factors may identify patients at greatest risk of developing BrM, even in the face of more aggressive primary therapy. Such risk factors should be considered when developing early diagnostic and therapeutic interventions for BrM, and when validating any such intervention prospectively.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-14-05.