Management Of Gynecologic Cancers Research Articles

Optimising ovarian tumor classification using a novel CT sequence selection algorithm

Gynaecological cancers, especially ovarian cancer, remain a critical public health issue, particularly in regions like India, where there are challenges related to cancer awareness, variable pathology, and limited access to screening facilities. These challenges often lead to the diagnosis of cancer at advanced stages, resulting in poorer outcomes for patients. The goal of this study is to enhance the accuracy of classifying ovarian tumours, with a focus on distinguishing between malignant and early-stage cases, by applying advanced deep learning methods. In our approach, we utilized three pre-trained deep learning models—Xception, ResNet50V2, and ResNet50V2FPN—to classify ovarian tumors using publicly available Computed Tomography (CT) scan data. To further improve the model’s performance, we developed a novel CT Sequence Selection Algorithm, which optimises the use of CT images for a more precise classification of ovarian tumours. The models were trained and evaluated on selected TIFF images, comparing the performance of the ResNet50V2FPN model with and without the CT Sequence Selection Algorithm. Our experimental results show the Comparative evaluation against the ResNet50V2 FPN model, both with and without the CT Sequence Selection Algorithm, demonstrates the superiority of the proposed algorithm over existing state-of-the-art methods. This research presents a promising approach for improving the early detection and management of gynecological cancers, with potential benefits for patient outcomes, especially in areas with limited healthcare resources.

A comprehensive review on the potential of coumarin and related derivatives as multi-target therapeutic agents in the management of gynecological cancers.

Current treatments for gynecological cancers include surgery, radiotherapy, and chemotherapy. However, these treatments often have significant side effects. Phytochemicals, natural compounds derived from plants, offer promising anticancer properties. Coumarins, a class of benzopyrone compounds found in various plants like tonka beans, exhibit notable antitumor effects. These compounds induce cell apoptosis, target PI3K/Akt/mTOR signaling pathways, inhibit carbonic anhydrase, and disrupt microtubules. Additionally, they inhibit tumor multidrug resistance and angiogenesis and regulate reactive oxygen species. Specific coumarin derivatives, such as auraptene, praeruptorin, osthole, and scopoletin, show anti-invasive, anti-migratory, and antiproliferative activities by arresting the cell cycle and inducing apoptosis. They also inhibit metalloproteinases-2 and -9, reducing tumor cell migration, invasion, and metastasis. These compounds can sensitize tumor cells to radiotherapy and chemotherapy. Synthetic coumarin derivatives also demonstrate potent antitumor and anticancer activities with minimal side effects. Given their diverse mechanisms of action and minimal side effects, coumarin-class phytochemicals hold significant potential as therapeutic agents in gynecological cancers, potentially improving treatment outcomes and reducing side effects. This review will aid in the synthesis and development of novel coumarin-based drugs for these cancers.

Exploring the role of artificial intelligence, large language models: Comparing patient-focused information and clinical decision support capabilities to the gynecologic oncology guidelines.

Gynecologic cancer requires personalized care to improve outcomes. Large language models (LLMs) hold the potential to provide intelligent question-answering with reliable information about medical queries in clear and plain English, which can be understood by both healthcare providers and patients. We aimed to evaluate two freely available LLMs (ChatGPT and Google's Bard) in answering questions regarding the management of gynecologic cancer. The LLMs' performances were evaluated by developing a set questions that addressed common gynecologic oncologic findings from a patient's perspective and more complex questions to elicit recommendations from a clinician's perspective. Each question was presented to the LLM interface, and the responses generated by the artificial intelligence (AI) model were recorded. The responses were assessed based on the adherence to the National Comprehensive Cancer Network and European Society of Gynecological Oncology guidelines. This evaluation aimed to determine the accuracy and appropriateness of the information provided by LLMs. We showed that the models provided largely appropriate responses to questions regarding common cervical cancer screening tests and BRCA-related questions. Less useful answers were received to complex and controversial gynecologic oncology cases, as assessed by reviewing the common guidelines. ChatGPT and Bard lacked knowledge of regional guideline variations, However, it provided practical and multifaceted advice to patients and caregivers regarding the next steps of management and follow up. We conclude that LLMs may have a role as an adjunct informational tool to improve outcomes.

Health literacy of patients consulting in an expert gynecological tertiary center: A pilot study

BackgroundPrevious studies have highlighted patients with chronic conditions seek for medical knowledge and therapeutics on their own. So far, no data exist on the health literacy of patients with gynecological conditions and especially those suffering from endometriosis, whose symptoms’ have a major impact on their daily lives. MethodThe objective was to evaluate the health literacy of patients consulting in a referral expert center for the management of endometriosis and gynecological cancers. The secondary objective was to compare the health literacy of patients with endometriosis to patients without. We conducted an observational, prospective, monocentric study in the gynecological department of Tenon Hospital (Paris, France) between July 6, 2022 to January 3, 2023. All patients fulfilled the validated French version of HLS-EU-Q16 questionnaire. ResultsOne hundred and ten patients were included. The two following questions were identified as the most difficult among patients with endometriosis: “Find information about treatments for their disease” and “know when it would be helpful to have another doctor's opinion”. Compared to patients consulting for other conditions, it was more difficult for patients with endometriosis to respectively “find information about treatments for diseases” and “use information given by the doctor to take decisions about the illness” (p = 0.003). Compared to patients consulting for cancer, it was more difficult for patient with endometriosis to “find information about treatments for diseases” (p = 0.02). ConclusionProgresses in the capacity of the health care to better inform the patients would be highly beneficial, especially for those suffering from endometriosis.

Controversies in the Surgical Management of Gynecologic Cancer: Balancing the Decision to Operate or Hesitate.

Cancer outcomes are largely measured in terms of disease-free survival or overall survival, which is highly dependent on timely diagnosis and access to treatment methods available within the country's existing health care system. Although cancer survival rates have markedly led in the past few decades, any improvement in the 5-year survival of gynecologic cancers has been modest, as in the case of ovarian and cervical cancers, or has declined, as in the case of endometrial cancer. The lack of effective screening options contributes to many women presenting with advanced-stage disease and the need for radical approaches to treatment. Although treatment for early-stage disease can lead to a cure, advanced-stage disease is fraught with a high potential for morbidity and mortality, and recent clinical trials have aimed to assess the noninferiority of minimally invasive options versus aggressive surgical approaches. Of particular interest is fertility-sparing treatments for endometrial and cervical cancers, which have recently been on the rise among younger women. Balancing morbidity with the risk of mortality, and loss of fertility and quality of life requires a targeted patient-centered approach to treatment. This is an ongoing area of intense research and sometimes may challenge current treatment paradigms. In this two-part review, we present an overview of current approaches to gynecologic cancer treatment and the need to de-escalate radical surgical approaches and preserve fertility. We also review the intricacies of ovarian and advanced endometrial cancer treatment, exploring the nuances in surgical debulking timing and its impact on outcomes.

Metabolic dysregulation in obese women and the carcinogenesis of gynecological tumors: A review.

Obesity is a significant health issue associated with increased cancer risks, including gynecological malignancies. The worldwide rise in obesity rates is significantly impacting both cancer development and treatment outcomes. Adipose tissue plays a crucial role in metabolism, secreting various substances that can influence cancer formation. In obese individuals, dysfunctional adipose tissue can contribute to cancer development through inflammation, insulin resistance, hormonal changes, and abnormal cholesterol metabolism. Studies have shown a strong correlation between obesity and gynecological cancers, particularly endometrial and breast cancers. Obesity not only increases the risk of developing these cancers but is also associated with poorer outcomes. Additionally, obesity affects the perioperative management of gynecological cancers, requiring specialized care due to increased complications and resistance to therapy. Treatment strategies for managing metabolic dysregulation in patients with gynecological cancers include weight management, statin therapy, and insulin-sensitizing medications. Emerging studies suggest that interventions like intermittent fasting and caloric restriction may enhance the effectiveness of cancer treatments. Furthermore, targeting cholesterol metabolism, such as with statins or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, shows potential in cancer therapy. In conclusion, addressing metabolic issues, particularly obesity, is crucial in preventing and treating gynecological malignancies. Personalized approaches focusing on weight management and metabolic reprogramming may improve outcomes in these patients.

Serum Tumor Markers and Outcomes in Patients With Appendiceal Adenocarcinoma

Serum tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125) have been useful in the management of gastrointestinal and gynecological cancers; however, there is limited information regarding their utility in patients with appendiceal adenocarcinoma. To assess the association of serum tumor markers (CEA, CA19-9, and CA125) with clinical outcomes and pathologic and molecular features in patients with appendiceal adenocarcinoma. This is a retrospective cohort study at a single tertiary care comprehensive cancer center. The median (IQR) follow-up time was 52 (21-101) months. Software was used to query the MD Anderson internal patient database to identify patients with a diagnosis of appendiceal adenocarcinoma and at least 1 tumor marker measured at MD Anderson between March 2016 and May 2023. Data were analyzed from January to December 2023. Association of serum tumor markers with survival in patients with appendiceal adenocarcinoma. Cox proportional hazards regression analyses were also performed to assess associations between clinical factors (serum tumor marker levels, demographics, and patient and disease characteristics) and patient outcomes (overall survival). A total of 1338 patients with appendiceal adenocarcinoma were included, with a median (range) age at diagnosis of 56.5 (22.3-89.6) years. The majority of the patients had metastatic disease (1080 patients [80.7%]). CEA was elevated in 742 of the patients tested (56%), while CA19-9 and CA125 were elevated in 381 patients (34%) and 312 patients (27%), respectively. Individually, elevation of CEA, CA19-9, or CA125 were associated with worse 5-year survival; elevated vs normal was 81% vs 95% for CEA (hazard ratio [HR], 4.0; 95% CI, 2.9-5.6), 84% vs 92% for CA19-9 (HR, 2.2; 95% CI, 1.4-3.4), and 69% vs 93% for CA125 (HR, 4.6; 95% CI, 2.7-7.8) (P < .001 for all). Quantitative evaluation of tumor markers was associated with outcomes. Patients with highly elevated (top 10th percentile) CEA, CA19-9, or CA125 had markedly worse survival, with 5-year survival rates of 59% for CEA (HR, 9.8; 95% CI, 5.3-18.0), 64% for CA19-9 (HR, 6.0; 95% CI, 3.0-11.7), and 57% for CA125 (HR, 7.6; 95% CI, 3.5-16.5) (P < .001 for all). Although metastatic tumors had higher levels of all tumor markers, when restricting survival analysis to 1080 patients with metastatic disease, elevated CEA, CA19-9, or CA125 were all still associated worse survival (HR for CEA, 3.4; 95% CI, 2.5-4.8; P < .001; HR for CA19-9, 1.8; 95% CI, 1.2-2.7; P = .002; and HR for CA125, 3.9; 95% CI, 2.4-6.4; P < .001). Interestingly, tumor grade was not associated with CEA or CA19-9 level, while CA-125 was slightly higher in high-grade tumors relative to low-grade tumors (mean value, 18.3 vs 15.0; difference, 3.3; 95% CI, 0.9-3.7; P < .001). Multivariable analysis identified an incremental increase in the risk of death with an increase in the number of elevated tumor markers, with an 11-fold increased risk of death in patients with all 3 tumor markers elevated relative to those with none elevated. Somatic mutations in KRAS and GNAS were associated with significantly higher levels of CEA and CA19-9. In this retrospective study of serum tumor markers in patients with appendiceal adenocarcinoma, CEA, CA19-9, and CA125 were associated with overall survival in appendiceal adenocarcinoma. Given their value, all 3 biomarkers should be included in the initial workup of patients with a diagnosis of appendiceal adenocarcinoma.

Anti-cancer activity of capsaicin and its analogs in gynecological cancers.

Capsaicin is the hot and pungent ingredient of chili peppers. It is a potent pain-relieving agent and is often present in over-the-counter analgesic lotions and creams. Several convergent studies reveal that capsaicin displays growth-suppressive activity in human cancers in vitro and in vivo. Apart from its growth-suppressive activity (as a single agent), capsaicin has been found to sensitize human cancer cells to the pro-apoptotic effects of chemotherapy and radiation. The first part of this book chapter discusses the anti-cancer activity of capsaicin in gynecological cancers in cell culture experiments and mouse models. Out of all gynecological cancers, the anti-cancer activity of capsaicin (and its analogs) has only been investigated in cervical cancers and ovarian cancers. The clinical development of capsaicin as a viable anti-cancer drug has remained challenging due to its poor bioavailability and aqueous solubility properties. In addition, the administration of capsaicin is associated with adverse side effects like gastrointestinal cramps, stomach pain, irritation in the gut, nausea diarrhea and vomiting. Two strategies have been investigated to overcome these drawbacks of capsaicin. The first is to encapsulate capsaicin in sustained release drug delivery systems. The second strategy is to design non-pungent capsaicin analogs which will retain the anti-tumor activity of capsaicin. The second part of this chapter provides an overview of the anti-neoplastic (and chemosensitization activity) of capsaicin analogs and capsaicin-based sustained release formulations in cervical and ovarian cancers. The design of selective non-pungent capsaicin analogs and capsaicin-based polymeric drug delivery systems may foster the hope of novel strategies for the treatment and management of gynecological cancers.

Antibody-Drug Conjugates in Gynecologic Cancers.

Antibody-drug conjugates (ADCs) are a novel class of targeted cancer therapies with the ability to selectively deliver a cytotoxic drug to a tumor cell using a monoclonal antibody linked to a cytotoxic payload. The technology of ADCs allows for tumor-specificity, improved efficacy, and decreased toxicity compared to standard chemotherapy. Common toxicities associated with ADC use include ocular, pulmonary, hematologic, and neurologic toxicities. Several ADCs have been approved by the United States Food and Drug Administration (FDA) for the management of patients with recurrent or metastatic gynecologic cancers, a population with poor outcomes and limited effective treatment options. The first FDA-approved ADC for recurrent or metastatic cervical cancer was tisotumab vedotin, a tissue factor-targeting agent, after demonstrating response in the innovaTV 204 trial. Mirvetuximab soravtansine targets folate receptor alpha and is approved for use in patients with folate receptor alpha-positive, platinum-resistant, epithelial ovarian cancer based on results from the SORAYA trial. While there are no FDA-approved ADCs for the treatment of uterine cancer, trastuzumab deruxtecan, an anti-human epidermal growth factor receptor 2 (HER2) agent, is actively being investigated. In this review, we will describe the structure and mechanism of action of ADCs, discuss their toxicity profiles, review ADCs both approved and under investigation for the management of gynecologic cancers, and discuss mechanisms of ADC resistance.

Vulvar cancer management and wrangling recurrent disease: A report from the society of gynecologic oncology journal club

The Society of Gynecologic Oncology (SGO) Journal Club webinar series is an open forum that invites national experts to discuss the literature pertaining to important topics in the management of gynecologic cancers. On August 14th, 2023, SGO hosted a journal club focused on the management of upfront and recurrent vulvar cancer. Our discussants included Dr. Brian M Slomovitz from Mount Sinai Medical Center in Miami Beach, Dr. Emi Yoshida from the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, and Dr. Lilian Gien from the University of Toronto Sunnybrook Odette Cancer Center. During the discussion,we reviewed the progression of vulvar cancer surgery from en bloc resection of the vulva and groins, to partial radical vulvectomy and sentinel lymph nodes. We also reviewed the management of node positive vulvar cancer including published and accruing Groningen International Study on Sentinel Nodes in Vulvar Cancer (GROINSS) trials and other sentinel trials from the Gynecologic Oncology Group (GOG). Here we will also review the literature on the management of recurrent vulvar cancer, highlighting current treatment options and ongoing clinical trials. The following is a report of the journal club presentation.

Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review.

Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.

Telemedicine consultation between providers managing gynecologic cancers.

556 Background: Gynecologic cancers are among the most prevalent cancers in women, yet many patients do not receive guideline-concordant care, in part due to lack of geographic access to gynecologic oncologists (Gyn Onc). Telemedical technology allows patients’ local physicians to consult with subspecialist Gyn Oncs, without burdening patients with unnecessary in-person visits. Providers’ acceptance of provider-to-provider telemedicine consultation for the management of gynecologic cancers is unknown. We aimed to gather feedback about experiences with referrals, communication, and openness to telemedical consultation between Gyn Oncs, gynecologists (Gyn) and medical oncologists (Med Onc). Methods: Gyn Onc, Gyn, and Med Onc physicians were recruited from practices serving rural patient populations to participate in semi-structured interviews. As implementation of telemedicine interventions is influenced by factors at multiple levels, the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) guided the interview. Questions focused on barriers and facilitators to provider-to-provider telemedicine consultation stemming from inner/outer settings and individual experiences. Interviews were conducted via WebEx, recorded, and transcribed. Two coders established analytic reliability with two transcripts and independently coded remaining interviews using a combined CFIR-TDF framework. Codes were analyzed and combined into salient themes. Results: We conducted 11 interviews (6 Gyn Onc, 3 Gyn, 2 Med Onc). We identified six themes (Table 1). Themes included hesitancy to adopt new methods of communication, frustration with existing methods, and potential gaps that could be filled by a cloud-based asynchronous platform. Conclusions: Providers experience burnout from communication and are hesitant to adopt a new platform. Providers note referrals with providers using different EHR systems is difficult, as they cannot share patient records easily and securely. Providers are open to adopting provider-to-provider telemedicine consultation if the system can be streamlined to share patient records easily.[Table: see text]

Management of gynecological cancers in the emergency department: Impact of precariousness and prognostic factors

ObjectiveThe primary objective was to determine the profile of patients consulting in an emergency department and diagnosed with a pelvic cancer. Our secondary objective was to assess the potential impact on this diagnostic trajectory on survival. MethodA single-center retrospective study including patients managed for a pelvic cancer between January 2018 and November 2020 in the center Hospitalier Intercommunal de Creteil was conducted. Patients’ characteristics were compared based on their diagnostic trajectory (emergency or referred to consultation). Precariousness was assessed using Pascal's tool based on 4 characteristics: being a beneficiary of the former Couverture Maladie Universelle (CMU) or Aide Medicale d'Etat (AME), not having complementary health insurance, being job seeking for more than 6 months and being beneficiary of allowances. A patient was defined as precarious if the Pascal tool was ‘TRUE’, i.e., at least one positive item. The main socio-demographic and cancer associated factors were analyzed as prognostic factors. ResultsOver the inclusion period, among the 283 eligible patients, 37.3 % (87/233) had a diagnosis of cancer following an emergency department visit. There was a significant association between precariousness, rupture of gynecological follow-up, lack of participation in national screening campaigns and the risk of being diagnosed through the emergency pathway for all cancers studied (p = 0.001). There was no difference in terms of stage at diagnostic, management (according to current guidelines), prognostic and overall survival between the two groups. ConclusionPatients in a situation of precariousness are more likely to be diagnosed with cancer in an emergency department. Our study underlines the importance of precariousness as a factor determining the type of diagnostic management of gynecological cancer. Efforts should be made toward improving frail patients to primary care.

18F-FDG PET/MRI and 18F-FDG PET/CT for the Management of Gynecological Malignancies: A Comprehensive Review of the Literature.

Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) or magnetic resonance imaging (18F-FDG PET/MRI) has emerged as a promising tool for managing various types of cancer. This review study was conducted to investigate the role of 18F- FDG PET/CT and FDG PET/MRI in the management of gynecological malignancies. We searched for relevant articles in the three databases PubMed/MEDLINE, Scopus, and Web of Science. All studies reporting data on the FDG PET/CT and FDG PET MRI in the management of gynecological cancer, performed anywhere in the world and published exclusively in the English language, were included in the present study. We used the EndNote software (EndNote X8.1, Thomson Reuters) to list the studies and screen them on the basis of the inclusion criteria. Data, including first author, publication year, sample size, clinical application, imaging type, and main result, were extracted and tabulated in Excel. The sensitivity, specificity, and diagnostic accuracy of the modalities were extracted and summarized. After screening 988 records, 166 studies published between 2004 and 2022 were included, covering various methodologies. Studies were divided into the following five categories: the role of FDG PET/CT and FDG-PET/MRI in the management of: (a) endometrial cancer (n = 30); (b) ovarian cancer (n = 60); (c) cervical cancer (n = 50); (d) vulvar and vagina cancers (n = 12); and (e) gynecological cancers (n = 14). FDG PET/CT and FDG PET/MRI have demonstrated potential as non-invasive imaging tools for enhancing the management of gynecological malignancies. Nevertheless, certain associated challenges warrant attention.

Adoption of cytoreductive surgery in the management of peritoneal malignancies-Global trends.

Cytoreductive surgery (CRS) has now been accepted as an integral component in the management of gastrointestinal and gynecological cancers with peritoneal metastases. Since the adoption of CRS is influenced by access to advanced medical facilities, trained multidisciplinary teams, and funding, there is wide variability in incorporation of CRS into routine clinical practice between high- versus low- and middle-income countries. This review highlights the global trends in the adoption of CRS for peritoneal malignancies with a specific focus on the establishment of CRS programs and barriers to incorporate CRS into routine clinical care in low- and middle-income countries.

Artificial Intelligence in Gynaecological Malignancies: Perspectives of a Clinical Oncologist.

Gynecological malignancies are treated with a multi-disciplinary approach. There are two important factors, the stage and Karnofsky performance status scale (KPS) of patients, which guide the treatment strategy by single or multiple modalities in terms of surgery, radiotherapy, or chemotherapy. Various aspects are included in the workflow of gynecological malignancies, like screening, diagnosis in each individual, treatment modalities, and finally, follow-up to see for outcomes leading to the development of new research protocols. The quality data plays an important role in every step. Artificial Intelligence (AI) will play an important role if it is developed in the above-mentioned steps. AI is already established partially in every aspect of the management of gynecological cancer. It needs to be strengthened and incorporated further in a more robust form. This needs an association between clinicians, software engineers, and stakeholders. This article reviews the role of AI in various steps of the workflow of gynecological malignancies and discusses a few clinical aspects that may be researched to find solutions by AI.

Impact of the Covid-19 pandemic on the management of gynecologic cancer: a Spanish survey. Observational, multicenter study

BackgroundThe SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic changed the distribution of healthcare resources, leading in many cases to the suspension of all non-essential treatments and procedures and representing a challenge for medical professionals. The objective of this study was to evaluate whether clinical protocols in gynecologic oncology care were modified as a result of the pandemic and to assess surgeons’ perceptions regarding the management of gynecologic cancers".MethodsData were collected through an anonymous and voluntary survey sent via email to healthcare professionals in the field of gynecologic oncology in Spain.ResultsA total of 75 gynecologic oncologists completed the online survey. Of these, 93.2% (69) reported working in public hospitals and 62.5% (45) in tertiary care hospitals. 97.3% (71) were affiliated with hospitals treating patients infected with SARS-CoV-2. 85.1% (63) of the respondents expressed concern about the SARS-CoV-2 pandemic and 52.1% (38) indicated that the pandemic impacted the diagnostic and therapeutic quality of care for oncology patients. SARS-CoV-2 nasopharyngeal swab PCR (Polymerase Chain Reaction) testing was always performed before surgical interventions by 97.3% (71), being considered a best practice in triage by 94.4% (68). 87.5% (63) reported no change in the type of surgical approach during the pandemic. 62.5% (45) experienced limitations in accessing special personal protective equipment for SARS-CoV-2. An impact on the follow-up of patients with gynecologic cancers due to the pandemic was reported by 70.4% (50).ConclusionsMost of the Spanish gynecologic oncologists who responded to our survey reported that the SARS-CoV-2 pandemic had affected their clinical practice. The primary measures implemented were an increase in telemedicine, restricting outpatient visits to high-risk or symptomatic patients and the use of SARS-CoV-2 screening prior to surgery. No major changes in the surgical approach or management of the treatment of ovarian, endometrial or cervical cancer during the pandemic were reported.

Robot-Assisted Surgery in the Treatment of Gynecological Carcinoma and Malignancies: Introduction to the da Vinci Robotic Surgery System.

Robotic surgery is a surgical intervention that was developed from traditional manual surgeries because of the intrusive procedures it uses.It is now accomplished in hospitals worldwide, and comprehensive programs for the application of technology in the management of gynecological cancer are being developed. Robotic surgery should be straightforwardly compared with manual and traditional laparoscopy to see if the higher indirect costs are justified by some improvements in patient studies. This paper aims to evaluate the procedure of robotic surgery and its implementation in gynecologicalcancer to verify its safeness, practicability, and effectiveness. A higher chance of infections is usually in classicalsurgery,particularly in comparison to laparoscopic or robotic surgery. Surgical and hospital stay are much less with any of these new technologies than the aforementioned; however, the drawbacks are the scarcity of robot systems, theirhigh price, and the realization that it is only appropriate in learning institutions with infrastructure and highly skilled surgeons. In conclusion, tissue engineering constitutesa significant discovery and approach for treating gynecologicalcancer with improved methods than some other types of traditional surgery, and it will likely become dominant technology shortly.

Utilisation of Hospital-Based Specialist Palliative Care in Patients With Gynaecological Cancer: Temporal Trends, Predictors and Association With High-Intensity End-of-Life Care

ABSTRACT Although chemotherapy and short-course radiotherapy play important roles in the palliative management of gynecological cancers, these may be associated with significant discomfort and minimal symptom control in advanced disease. Terminally ill patients approaching death may have complex palliative care needs that cannot be resolved in general care practices and require multidisciplinary specialist palliative care services (SPC). Timely access to SPCs is associated with improved quality of life and reduced high-intensity care during the end-of-life phase; however, the role of palliative care on high-intensity interventions at the end of life in patients with gynecological cancers has not been examined in large-scale studies. This nationwide registry-based study aimed to examine the temporal trends, predictors of use, and relationship with high-intensity treatments in hospital-based SPC utilization among patients with gynecological malignancies. All adults in Denmark who died of gynecological cancer between 2010 and 2016 were included. Demographic, financial, and oncological data were obtained for each patient. Utilization of SPC included care provided during hospital admissions, in outpatient clinics, or in the patients' own home. High-intensity end of life care included invasive treatments (chemotherapy, surgery, and radiation), use of services such as emergency department visits, intensive care unit admissions, or more than 1 hospital admission within 30 days, as well as no hospice admissions in the prior year or a patient death in the hospital. Binary regression was used to estimate the chance of receiving hospital-based SPC and the adjusted relative risk of high-intensity end of life care by potential predictors including cancer type, age at death, comorbidity score, region of residence, marital status, income level, migrant status, and FIGO cancer stage. A total of 4502 patients with cervical cancer (n = 708), ovarian cancer (n = 2595), and endometrial cancer (n = 1199) were identified, of whom 179 (40.0%) accessed SPC. The proportion of patients dying of gynecological cancer and receiving SPC increased from 24.2% in 2010 to 50.7% in 2016. Each potential predictor studied was associated with receiving SPC at the end of life, with the strongest associations after adjustment for year of death between 2014 and 2016, younger age, 3 or more comorbidities, residence in Danish regions other than the Capital region, and being an immigrant or descendant. Patients aged 60 to 69 had a 24% decreased chance of receiving SPC compared with those aged 18 to 59 (adjusted relative risk [aRR], 0.76; 95% confidence interval [CI], 0.69–0.83), and as age increased, the proportion of those that received SPC decreased further. Those with 3 or more comorbidities had a 23% higher chance of receiving SPC (aRR 1.23; 95% CI, 1.13–1.34). Compared with nonimmigrants, immigrants and descendants were 29% more likely to receive SPC (aRR, 1.29; 95% CI, 1.14–1.96). Hospital-based SPC, particularly when accessed &gt;30 days before death, was associated with lower utilization of all high-intensity end of life care including a 25% lower risk of dying during a hospital admission (aRR, 0.75; 95% CI, 0.68–0.84). The results of this study demonstrate that the proportion of patients dying of gynecological cancers and receiving hospital-based SPC increased significantly between 2010 and 2016, and these patients received fewer high-intensity end of life interventions and were less likely to die during a hospital admission.

Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort

IntroductionThe proximity of the urinary tract to the female genital tract explains its possible involvement in pelvic gynaecological cancer or deep endometriosis. Surgical treatment is aimed at improving overall survival and recurrence-free survival of patients, as well as restoring normal anatomy and functional integrity depending on the pathology. These operations are accompanied by significant post-operative complications. Thus, the urological procedures performed must be rigorously justified, and the different resection and reconstruction techniques adapted to the pathology and the level of infiltration. ObjectiveTo describe the activity profile, over the last ten years, of a gynaecological surgery department in terms of urological procedures in the management of patients with deep endometriosis and pelvic carcinology. Study designThis is a monocentric retrospective observational study, including all patients who underwent a urological procedure by a gynaecological surgeon only, as part of the management of pelvic gynaecological cancers or deep endometriosis, at the University Hospital Centre (CHU) of Strasbourg, between January 1st 2010 and April 31st 2021. The variables studied were early postoperative complications, the rate of surgical reintervention, operating time, length of hospital stay, the need for peri-operative drainage or transfusion, and post-operative functional disorders. ResultsA total of 86 patients were included, 27 in the pelvic gynaecological cancer group and 59 in the deep endometriosis group. 61.6% of patients received uretero-vesical catheterization, 60.5% partial cystectomy, 10.5% psoic bladder ureteral reimplantation, and 3.5% trans-ileal Bricker skin ureterostomy. The mean operating time was 316 min in the pelvic gynaecological cancer group and 198.9 min in the deep endometriosis group. The average hospital stay was 11.5 days, 22.3 days for patients treated for pelvic cancer and 6.3 days for those treated for endometriosis. The rate of minor post-operative complications was 8.2% of cases, and major post-operative complications 17.4% of cases, the majority of which were in the gynecological cancer group. There were no cases of intra- or early post-operative death. Early postoperative urinary complications affected 14.0% of the total patients, mostly in the gynaecological cancer group with 33.3% of patients, but only 5.1% of patients in the deep endometriosis group. The total reoperation rate within 60 days postoperatively was 15.1%, 40.7% for patients treated for gynaecological cancer and 3.4% for those treated for deep pelvic endometriosis. The rate of reoperations for urinary complications was 11.6% of total patients, or 76.9% of total reoperations. 15 patients received labile blood products intra- or postoperatively, 11 in the pelvic gynaecological cancer group and 4 in the endometriosis group. ConclusionOur overall results appear comparable to those reported in the literature and are particularly satisfactory in terms of post-operative complications after partial cystectomy in the management of deep endometriosis compared to other gynaecological departments. This work encourages us to continue and improve the training of gynaecological surgeons in terms of multidisciplinary surgical procedures, including urological ones, to obtain a global vision of the pathology and to allow an optimal quality of care for the patients.