Gynecologic Oncology Research Articles

Innovative 3D Imaging in Pre-Operative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: A Pilot Study.

The efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While 3D imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modeling in SCS preparation. A retrospective analysis was undertaken at a university affiliated tertiary medical center, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into two cohorts: those with pre-operative CT-based 3D imaging (Group A) and those without (Group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. Among the 76 identified patients, 18 were deemed suitable for surgery, with 7 in Group A undergoing preoperative 3D modeling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in Group B. Although operative metrics and collaborative endeavors exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in Group A (100%) compared to Group B (54%), with a significance level of P = 0.05. CT-based 3D modeling in the preoperative phase of secondary cytoreductive surgery for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate impact.

Patient-Reported Goals of Care in the Preoperative Clinic: Barriers to and Facilitators of Patient Values Elicitation and Documentation.

Infrequent preoperative goals of care (GOC) documentation leads to challenges in medical decision-making when patients experience postoperative complications. We evaluated the feasibility of enhancing GOC documentation through a patient portal-based values questionnaire. A patient values questionnaire (PVQ) was distributed to patients before their Gynecologic Surgical Oncology clinic appointments via an electronic health record (EHR)-based portal from June to October 2023. Surgeons and advanced practice providers were encouraged to address PVQ responses during clinic appointments. Patient acceptability surveys were sent to PVQ respondents and clinicians were interviewed to assess feasibility and acceptability. PVQ response rate was 225/383 (59%); 29% of all patients had an established cancer diagnosis. Clinicians deemed preoperative GOC documentation important and the PVQ valuable to prepare for unexpected postoperative complications. Accessing questionnaire responses through the EHR was a technical barrier. Clinicians agreed that GOC should be addressed after diagnosis and treatment discussions, but before surgery. Ninety percent of patients felt comfortable discussing GOC at their first clinic appointment. Patient portals facilitate preoperative GOC documentation, however, clarifying and integrating values into care require ongoing discussions between clinicians and patients. Optimal timing of GOC elicitation is posttreatment planning and before surgery when the patient is most informed.

Ultrasound assessment of lymph nodes for staging of gynecological cancer: consensus opinion on terminology and examination technique.

The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Gynaecologic oncology referrals to specialist palliative care in a tertiary referral centre: population, characteristics and outcomes

BackgroundThe early integration of a specialist palliative care team is demonstrated to have numerous benefits for patients. These extend beyond end-of-life care to include reducing depressive symptoms, improving quality of...

Ultrasound assessment of the pelvic sidewall: methodological consensus opinion.

A standardized methodology for the ultrasound evaluation of the pelvic sidewall has not been proposed to date. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for the ultrasonographic evaluation of structures within the pelvic sidewall. Five categories of anatomical structures are described (muscles, vessels, lymph nodes, nerves and ureters). A step-by-step transvaginal ultrasound (or, when this is not feasible, transrectal ultrasound) approach is outlined for the evaluation of each anatomical landmark within these categories. Accurate assessment of the pelvic sidewall using a standardized approach improves the detection and diagnosis of non-gynecological pathologies that may mimic gynecological tumors, reducing the risk of unnecessary and even harmful intervention. Furthermore, it plays an important role in completing the staging of malignant gynecological conditions. Transvaginal or transrectal ultrasound therefore represents a viable alternative to magnetic resonance imaging in the preoperative evaluation of lesions affecting the pelvic sidewall, if performed by an expert sonographer. A series of videoclips showing normal and abnormal findings within each respective category illustrates how establishing a universally applicable approach for evaluating this crucial region will be helpful for assessing both benign and malignant conditions affecting the pelvic sidewall. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Suture Materials in relation to Wound Care in Women Undergoing Gynecological Oncology Operations

Suture Materials in relation to Wound Care in Women Undergoing Gynecological Oncology Operations

Endometrial cancer tumor genetic testing practice patterns among gynecologic oncologists

Endometrial cancer tumor genetic testing practice patterns among gynecologic oncologists

Shifting trends and sicker patients: Reassessing benign hysterectomies performed by gynecologic oncologists

Shifting trends and sicker patients: Reassessing benign hysterectomies performed by gynecologic oncologists

Gynecologic oncologist in cesarean hysterectomy for placenta accreta spectrum in the United States: A surgeon specialty-specific assessment

Gynecologic oncologist in cesarean hysterectomy for placenta accreta spectrum in the United States: A surgeon specialty-specific assessment

Mental health in gynecologic oncologists: Unmet needs, barriers to care, and possibilities for improvement

Mental health in gynecologic oncologists: Unmet needs, barriers to care, and possibilities for improvement

Trends in benign hysterectomies performed by gynecologic oncologists, 2015–2021: A National Surgical Quality Improvement Program (NSQIP) analysis

Trends in benign hysterectomies performed by gynecologic oncologists, 2015–2021: A National Surgical Quality Improvement Program (NSQIP) analysis

Informed consent in gynecological oncology: a JAGO/NOGGO survey on real-world practices in daily clinical routine.

Informed consent is a quintessential element of contemporary medicine, reflecting the fundamental right of patients to participate in decision-making regarding their health. Despite its critical importance, there is a lack of data on real-world practices regarding patient informed consent in the context of modern, high-pressure medical environments. Weconducted a multinational multicentric survey from February 24, 2022, to September 14, 2022, investigating the practices and challenges surrounding informed consent in hospitals across Germany, Austria, and Switzerland with the use of a specifically developed questionnaire. Drawing on over 200 responses from gynecologists, the survey shows a critical need for structured training in conducting informed consent discussions with over 80% of participants expressing interest in courses addressing this aspect. Notably, a considerable portion of the physicians (59.9%) reported conducting discussions on procedures they had never personally witnessed. Significant disparities between types of hospitals and professional groups were observed in the frequency of informed consent discussions, with limitations arising from factors such as time constraints, language barriers, and insufficient resources for patient education. Moreover, the psychological burden experienced by physicians after informed-consent discussions underscores the need for systemic changes to alleviate concerns regarding patient safety, legal repercussions, and patient satisfaction. This study serves as a call to action, emphasizing the need of enhancing resources and support for medical professionals to uphold the principles of empathic and comprehensive patient information and shared decision-making. DRKS00028295, 25.07.2024.

Predicting clinical trial availability in gynecological oncology [PENTAGON]

Predicting clinical trial availability in gynecological oncology [PENTAGON]

Artificial intelligence powered insights: Assessment of ChatGPT's treatment recommendations in gynecologic oncology

Artificial intelligence powered insights: Assessment of ChatGPT's treatment recommendations in gynecologic oncology

Ridesharing as transportation assistance in gynecologic oncology: A pilot study

Ridesharing as transportation assistance in gynecologic oncology: A pilot study

Gynecologic oncology robot-assisted surgery in octogenarians: Impact of age on hospital stay.

To compare postoperative stay in octogenarians and younger patients undergoing gynecologic oncology robot-assisted surgery. A retrospective review of robot-assisted surgery in Gynecological Oncology division during 2019-2022. We included all consecutive cases. Octogenarians (age ≥80 years) and younger patients were investigated by univariable analysis for characteristics and outcome. A total of 816 robot-assisted surgeries were performed, 426 (52.2%) endometrial cancer, 159 (19.5%) ovarian cancer, 27 (3.3%) cervical cancer, 35 (4.3%) endometrial intraepithelial neoplasia, and in 169 (20.7%) the final pathology was benign. There were 60 (7.4%) octogenarians and 756 (92.6%) younger patients. The proportion of patients with an American Society of Anesthesiology score greater than 2 was higher among octogenarians (66.7% vs 32.0%, P < 0.001). The median console time, surgical time, and total operation theater time were similar between groups (P = 0.303, P = 0.643 and P = 0.688, respectively). Conversion rate did not differ between groups (0.4% among younger patients vs 0% in octogenarians, P > 0.99). The median length of stay in the recovery room was similar in both groups (median 170 min, interquartile range [IQR] 125-225 min vs 170 min, IQR 128-240 min in octogenarians, P = 0.731). Length of hospital stay was similar in both age groups; median 1 day (IQR 1-1) among octogenarians versus 1 (0-1) in younger patients (P = 0.136). Octogenarians undergoing robotic surgery have no increased risk of length of stay or conversion to laparotomy compared with younger patients.

Patient perspective on virtual pre-chemotherapy visits in gynecologic oncology

Patient perspective on virtual pre-chemotherapy visits in gynecologic oncology

Implementation of automated social determinants of health screening in gynecologic oncology: A pilot study

Implementation of automated social determinants of health screening in gynecologic oncology: A pilot study

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

The Doc versus the Bot: A pilot study to assess the quality and accuracy of physician and chatbot responses to clinical questions in gynecologic oncology

The Doc versus the Bot: A pilot study to assess the quality and accuracy of physician and chatbot responses to clinical questions in gynecologic oncology