Time intervals from the first symptom to surgery of ovarian malignancies in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.</p><p style="text-align: justify;"><strong>Methods.</strong> Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.</p><p style="text-align: justify;"><strong>Results.</strong> The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments' clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage</p>

Oncological outcomes of the fertility-sparing surgery for the gynecologic malignancies / 中国实用妇科与产科杂志

Cervical cancer,ovarian cancer and endometrial carcinoma are most common maligancies in gynecology.More and more women suffer from gynecologic malignancies at a younger age.For these young women with hoping to preserve fertility,the fertilitysparing surgery without increasing the rise of tumor has been paid much attention.How are the oncological outcomes of these patients after the fertility-sparing surgeries ? We try to discuss this in the article.

Deep Common Iliac Region Lymphadenectomy by Laparoscopic Surgery and Its Clinical Value in Uterine Malignancy / 中山大学学报(医学科学版)

[Objective]To investigate the value of deep common iliac region lymphadenectomy in treatment of uterine malignancies.[Methods]88 patients with deep common iliac region lymphadenectomy in Third affiliated hospital of sun yat-sen university from March 2016 to June 2017 were enrolled in this study. The number of removed lymph nodes、metastatic lymph nodes、operative complication and so on were analyzed.[Results]The number of pelvic lymph nodes resection is from 18 to 52,the average is 26;the number of deep common iliac region lymph nodes resection is from 2 to 16,the average is 5. The number of pelvic lymph node metastasis is 11 and the rate is 12.5%;the number of deep common iliac region lymph node metastasis is 3,accounting for 27.3% of the total number of pelvic lymph node metasta-sis,which alone deep common iliac region lymph node positive in 1 case,9.0% of the total number of pelvic lymph node metastasis.The average operation time of single pelvic lymph node resection was 43 min and that of single deep common iliac region lymph nodes was 10 min.There was no severe complication.[Conclusion]Deep common iliac region lymphad-enectomy is feasibility and safety,27%of patients with pelvic lymph node metastasis has positive deep common iliac region lymph nodes,and we believe that the promotion and application of deep common iliac region lymphadenectomy can further improve the therapeutic effect of uterine malignancy.

Qualitative research in mental conditions of pregnant patients with gynecologic malignancies during chemotherapy after parturition / 现代临床护理

Objective To understand the actual psychological conditions of pregnant patients with gynecologic malignancies during chemotherapy so as to instruct the nurses to provide individualized psychological care to the patients and their relatives. Method The in-depth interviews were conducted to 7 patients by implementing the phenomenological approach of qualitative study. The acquired data were analyzed. Result The patients experienced four psychological conditions: pessimism about prognosis, anxiety to know more about the chemotherapy and guilty to their family and hope for treatment effect. Conclusion Nurses should pay attention to the psychological conditions of pregnant patients with gynecologic malignancies and help them successfully live through the treatment.

The impact of robotic surgery on gynecologic oncology / 부인종양

The objective of this article was to review the published scientific literature pertaining to robotic surgery and its applications in gynecologic malignancies and to summarize the impact of robotic surgery on the field of gynecologic oncology. Summarizing data from different gynecologic disease-sites, robotic-assisted surgery is safe, feasible, and demonstrates equivalent histopathologic and oncologic outcomes. In general, benefits to robotic surgery include decreased blood loss, fewer perioperative complications and decreased length of hospital stay. Disadvantages include accessibility to robot surgical systems, decreased haptic sensation and fixed cost as well as cost of disposable equipment. As robotic surgery becomes readily available it will be imperative to develop standardized training modalities. Further research is needed to validate the role of robotic surgery in the treatment of gynecologic malignancies.

Revised International Federation of Gynecology and Obstetrics (FIGO) staging systems in gynecologic malignancies / 대한산부인과학회지

The International Federation of Gynecology and Obstetrics (FIGO) has reported annually for the development and changes of gynecologic cancer classification and staging since 1958. FIGO staging systems in gynecologic malignancies has been reflected on prognostic factors in predicting patients' outcomes and organized patients into several groups. The aim of the FIGO staging system is to afford a classification of gynecologic cancer and to share treatment methods with others. The FIGO staging systems have been updated several times every 3 years according to the latest data, which is responsive and adaptive to scientific development including imaging and treatment modalities. In 2008, the FIGO staging system for carcinoma of the cervix, endometrium, vulva, and uterine sarcomas was revised. After applying the revised staging system in clinical setting, it is need to consider and review problems. As a result, we must make up for the weak points in staging systems continuously.

Assessment of gynecologic malignancies: A multi-center study in Tehran (1995-2005).

Objective: The observed differences in cancer incidence are mainly due to different individuals and social risk factors. This study aims to demonstrate the characteristics of female genital malignancies according to the pathological records in Tehran, Iran. Materials and Methods: In this cross-sectional study, all records of pathological specimens categorized as ovarian, uterine corpus or uterine cervix cancers from 1995 to 2005, in five teaching hospitals in Tehran, were studied. Age, marriage, parity, menopausal status, smoking, oral contraceptive usage, pathological staging, and histological grading were reviewed by a trained general practitioner. SPSS 14 was used for statistical analysis. Result: Mean age (SD) at the time of diagnosis was 50 (15). Fifty-nine percent of ovarian, 33.9 and 47.7% of uterine corpus and uterine cervix malignant patients were premenopausal. About 90% of all were nonsmokers and 82.7% were multiparae. Various types of gynecologic malignancies included ovarian (55.5%), uterine corpus (24.9%), and uterine cervical cancers (19.6%) were diagnosed. In tumors of the uterine corpus and uterus cervix, the most frequent stage of diagnosis was stage IIA. Conclusion: Ovarian cancer was the most frequently occurring gynecologic tumor. Although distribution of age in ovarian cancer was similar to that mentioned in the literature, occurrence of the cancer was more frequent in the premenopausal state.

The role of positron emission tomography in the diagnosis and management of gynecologic malignancies / 대한산부인과학회지

The utility of positron emission tomography (PET) in gynecologic malignancy has been increased rapidly in recent years. PET scans are mostly performed using 18-fluorodeoxyglucose (FDG-PET). It is valuable for primary staging of untreated advanced cervical cancer, for evaluating unexplained tumor marker elevation after treatment and for restaging of potentially curable recurrent cervical cancer. Its value in early-stage cervical cancer is limited. In ovarian cancer, sequential imaging predicts both response to neoadjuvant chemotherapy and survival. It also provides benefits when serum CA-125 was elevated or computed tomography/magnetic resonance imaging defined recurrence is noted but biopsy deemed infeasible. A few studies have shown that FDG-PET may facilitate optimal management of endometrial cancer, especially for post-therapy surveillance and after salvage therapy. FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by monitoring response and localizing viable tumors after chemotherapy. Scanty studies have been reported in vulvar and vaginal cancer. The methodology and prospects of using integrated PET/computed tomography (PET-CT) in the management of gynecological cancer are discussed. The role of PET or PET-CT has evolved from a diagnostic tool into a potential indicator of both response to treatment and prognosis. Evaluating this tool by clinical impact is an attractive end point.

Surgical approaches for gynecologic malignancies causing peritoneal dissemination / 대한산부인과학회지

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.

Expression of interleukin 2,interleukin 6,interleukin 2 receptor and Change of T cell in peripheral blood of patients with gynecologic malignancy before and after cord blood transfusion / 中国输血杂志

Objective To study the immune function of gynecologic malignant tumor patients with chemotherapy and the influence of cord blood transfusion.Methods Thirty cases of gynecologic malignant tumor patients with chemotherapy and 30 of healthy women were divided into three groups,MTT colorimetry and flow cytometry was used to determine the change of immune function.Results ①The number of CD4 + T cell in patients was lower than that in healthy women and CD8 + was much higher.The ratio of CD4 +/CD8 + was inverted( t=2.56,P