The impact on obstetric outcomes following complete amputation of the cervix uteri in fertility preservation surgery for cervical neoplasm.

OBJECTIVES: Radical trachelectomy is offered to women with early-stage cervical neoplasia who desire fertility. The presence of isthmic glands within histological specimens suggests complete cervical amputation and as such, we examined if the presence of these glands in surgical specimens adversely affects obstetric outcomes. STUDY DESIGN: The study cohort comprises 43 consecutive cases of early-stage cervical neoplasia. The presence of isthmic glands in pathological specimens was correlated with obstetric outcomes. Univariate and multivariate analyses were constructed to identify clinicopathological factors associated with adverse obstetric outcomes. RESULTS: 43 patients underwent fertility sparing surgery; radical (30; 69.8 %) or simple trachelectomy (13; 30.2 %). Of these, 26 (60.5 %) had isthmic glands within the surgical specimen. Isthmic gland presence was not influenced by surgery radicality, disease stage, histological diagnosis, or surgical approach. Obstetric outcomes were available for 36 patients, with 27 attempting conception post-trachelectomy and 15 (55.6 %) achieving at least one pregnancy. Of 21 total pregnancies, the miscarriage and live birth rates were 7.4 % and 85.0 %, respectively. The presence of isthmic glands did not influence the overall conception rate, with 53.8 % of women with complete cervical amputation conceiving compared to 57.1 % of those without (p = 0.8632). Complete removal of the cervix did not increase premature deliveries <37 weeks gestation (p = 0.2521). CONCLUSIONS: The presence of isthmic glands in trachelectomy specimens provides a reliable surrogate marker for complete cervical amputation. In cases where complete cervical amputation is required to achieve maximum oncological outcomes, patients may be assured that there is little evident impact on fertility and obstetric outcomes.

Maintaining surgical care delivery during the COVID-19 pandemic: A comparative cohort study at a tertiary gynecological cancer centre.

BACKGROUND: Surgery is the cornerstone of gynecological cancer management, but inpatient treatment may expose both patients and healthcare staff to COVID-19 infections. Plans to mitigate the impact of the COVID-19 pandemic have been implemented widely, but few studies have evaluated the effectiveness of these plans in maintaining safe surgical care delivery. AIM: To evaluate the effects of mitigating plans implemented on the delivery of gynecological cancer surgery during the COVID-19 pandemic. METHODS: A comparative cohort study of patients treated in a high-volume tertiary gyneoncological centre in the United Kingdom. Prospectively-recorded consecutive operations performed and early peri-operative outcomes during the same calendar periods (January-August) in 2019 and 2020 were compared. RESULTS: In total, 585 operations were performed (296 in 2019; 289 in 2020). There was no significant difference in patient demographics. Types of surgery performed were different (p = 0.034), with fewer cytoreductive surgeries for ovarian cancer and laparoscopic procedures (p = 0.002) in 2020. There was no difference in intra-operative complication rates, critical care admission rates or length of stay. One patient had confirmed COVID-19 infection (0.4%). The 30-day post-operative complication rates were significantly higher in 2020 than in 2019 (58 [20.1%] versus 32 [10.8%]; p = 0.002) for both minor and major complications. This increase, primarily from March 2020 onwards, coincided with the first peak of the COVID-19 pandemic in the UK. CONCLUSIONS: Maintaining surgical throughput with meticulous and timely planning is feasible during the COVID-19 pandemic but this was associated with an increase in post-operative complications due to a multitude of reasons.

Patient-Reported Outcomes After Extensive (Ultraradical) Surgery for Ovarian Cancer: Results From a Prospective Longitudinal Feasibility Study.

BACKGROUND: Extensive (ultraradical) surgery may facilitate complete cytoreduction in ovarian cancer with potential survival benefit but with greater morbidity. Currently, patient-reported outcomes (PROs) from such surgery are unknown. We conducted the Surgery in Ovarian Cancer Quality of life Evaluation Research study (SOCQER 1), a prospective study investigating the feasibility of collection of serial PROs in patients who had extensive surgery and standard surgery for ovarian cancer. METHODS: Ninety-three patients were recruited for 33 months to complete serial PRO assessments using the validated EORTC QLQ-C30 and the ovarian cancer-specific QLQ-OV28 questionnaires preoperatively, at 6 weeks, and at 3, 6, and 9 months postoperatively. Aletti Surgical Complexity Score of 3 or lower was considered standard surgery; a Surgical Complexity Score of 4 or higher was considered extensive surgery. Prospective data collection was obtained from the hospital electronic database, including patient demographics, American Society of Anaesthesiologists grade, preoperative serum CA125 and albumin levels, chemotherapy regimen, and surgical morbidity. RESULTS: Three cohorts of patients--32 benign, 32 undergoing standard surgery, and 24 undergoing extensive surgery--completed the questionnaires. Median questionnaire completion rate in this study was 64%, demonstrating the feasibility of longitudinal quality of life (QoL) assessment after surgery. Patient-reported outcomes revealed a falling trend in QoL in the short-term (6 weeks-3 months) after surgery, which gradually returned to baseline at 6 to 9 months; this trend was more marked after extensive surgery. CONCLUSIONS: This study provides useful insight into the impact of extensive surgery on patients. Further multicenter studies are needed to evaluate the impact of extensive surgery on patient's QoL and survival.