Surgery In Women Research Articles

Variability of Breast Surgery in Women Participating in Breast Cancer Screening Programs

IntroductionCurrently, variability in surgical practice is a problem to be solved. The aim of this study is to describe the variability in the surgical treatment of breast cancer and to analyze the factors associated with it. MethodsThe study population included 1057 women diagnosed with breast cancer and surgically treated. Our data were from the CaMISS retrospective cohort. ResultsThe mean age at diagnosis was 59.3±5 years. A total of 732 patients were diagnosed through screening mammograms and 325 patients as interval cancers. The mastectomy surgery was more frequent in the tumors detected between intervals (OR=2.5 [95%CI: 1.8–3.4]), although this effect disappeared when we adjusted for the rest of the variables.The most important factor associated with performing a mastectomy was TNM: tumors in stage III–IV had an OR of 7.4 [95%CI: 3.9–13.8], increasing in adjusted OR to 21.7 [95%CI: 11.4–41.8].Histologically, infiltrating lobular carcinoma maintains significance in adjusted OR (OR=2.5 [95%CI: 1.4–4.7]).According to the screening program, there were significant differences in surgical treatment. Program 3 presented an OR of non-conservative surgery of 4.0 [95%CI: 1.8–8.9]. This program coincided with the highest percentage of reconstruction (58.3%). ConclusionsThis study shows that, despite taking into account patient and tumor characteristics, there is great variability in the type of surgery depending on the place of diagnosis.

Women in Surgery: Changing Perspectives

Women in Surgery: Changing Perspectives

Ready, Aim, Fire: Ending Sexual Harassment of Women in Surgery.

Ready, Aim, Fire: Ending Sexual Harassment of Women in Surgery.

In Behalf of the Feminine Side of the Commercial Stage: The Institute of the Woman's Theatre and Stagestruck Girls

By Mabel Rowland's public accounting, the Institute of the Woman's Theatre helped hundreds of so-called stagestruck girls realize their ambitions by providing a safety net for the pitfalls of the commercial theatre. The organization, officially established in 1926 and in operation until roughly 1930, was said to have begun years earlier, “the outgrowth of a group which was formed in 1910 and used to meet in the Fitzgerald Building.” As president, Rowland—a press agent, well-known comedic monologist, and all-around theatre factotum—was supported by society women and a cadre of famous female writers and performers, including Florence Reed, who served as Vice President, and charter members Julia Arthur, Irene Castle, Rachel Crothers, Helen Hayes, Violet Heming, Elsie Janis, Anita Loos, Mary Pickford, and Mary Shaw, plus about a dozen more. At the time of its official founding, the institute announced that it would undertake three activities. First, it sought to establish aprofessionalBroadway theatre as exclusively a women's operation, employing female playwrights, designers, directors, managers, producers, box-office staff, and so forth: “The only men who will be connected with the enterprise … are the actors and stagehands.” Second and third, the institute would give “aid and advice to girls from out of town who think they have something to offer the theater, read scripts and give opinions thereon, and in other ways labor in behalf of the feminine side of the stage.” The institute's goal of a theatre in tandem with discovering talented women looked to create a meaningful shift in women's inclusion and power within commercial theatre.

Women in surgery: challenges and opportunities

Women have been involved in surgery throughout history. However, despite the fact that there are now as many female medical students compared with male students in universities, men still significantly outnumber women in a number of procedural specialties, most notably surgery. This article discusses the factors that can influence women’s choice of surgical career, and the challenges and discrimination that women can face as surgeons. There is a strong argument for substantive policy change at the individual, organizational, and governmental level to reduce gendered discrimination and gendered stereotypes in surgery. We call upon all organizations involved in surgery, and particularly in the emerging field of global surgery, to actively work toward equity.

Women in surgery: Is it really a Man’s world?

Women in surgery: Is it really a Man’s world?

THE FACTORS RELATED TO THE APPLICATION OF CONTRACEPTION METHOD OF WOMEN OPERATION (MOW)

Based on the data of Family Planning Field Officer in South Palu sub district in 2014, 10,138 women of childbearing age (WUS) were women aged ≥ 35 years old using women's method of contraception (MOW) as many as 439 women of childbearing age. The purpose of this study is to determine the factors associated with the use of contraceptive methods of women's surgery (MOW) in Kecamatan Palu Selatan. The design of this study is an analytical survey of cross sectional study approach. The population in this study were fertile couples aged ≥ 35 years amounted to 99 respondents. The analysis used in this research is univariate and bivariate analysis with chi-square test. The results of this study indicate that there is no correlation between knowledge with use of contraception method of operation of woman (MOW) with value p = 0,981 (p = 0,05), there is no correlation between education with use of contraception method operation woman (MOW) with value p = 0.604 (p = 0.05), there was a relationship between husband support and contraceptive use of female operation method (MOW) with p = 0,009 (p = 0,05). This research suggests that people can know and understand the usefulness in the use of contraceptive methods of women's surgery (MOW).Keywords : Contraception, application of contraception Mow, method of women operation

Risk-reducing Surgery in Women at Low Lifetime Risk of Developing Ovarian Carcinoma: Opportunistic Salpingectomy.

Lack of success in ovarian cancer control through screening or advances in treatment in the general population has prompted exploration in new avenues of prevention. "Opportunistic" salpingectomy describes a surgical procedure or risk-reducing intent in women at low-risk/general population risk for developing ovarian cancer who are undergoing pelvic/abdominal surgery for other indications. This chapter reviews the uptake, safety, and anticipated impact of this prevention initiative.

Outcomes in Pelvic Organ Prolapse Surgery in Women Using Chronic Antithrombotic Therapy.

Chronic antithrombotic therapy is common among patients requiring surgery for pelvic organ prolapse because of age and comorbidities. The impact of chronic anticoagulation on postoperative complications in pelvic organ prolapse surgery has not been investigated. This study aims to determine if patients on chronic antithrombotic therapy are at increased risk for postoperative complications. This retrospective cohort study included women having prolapse surgery from 2012 to 2015, identified by Current Procedural Terminology codes, excluding patients undergoing concomitant major nonurogynecologic procedures. Baseline characteristics were compared and all procedures performed, operative duration, estimated blood loss, and length of hospitalization. Complications (blood transfusion, intensive care unit admission, reoperation, readmission, hematoma, thromboembolic event, and infection) were compared in women on chronic antithrombotic therapy and controls. Logistic regression determined odds ratio (OR) for complications in patients on chronic antithrombotics. Complications were graded by the Clavien-Dindo classification. A total of 388 charts were reviewed, and 386 patients met inclusion criteria. Twenty-one of the 386 patients were on chronic antithrombotic therapy. Chronic antithrombotic therapy increased overall complications (OR, 6.8; P < 0.0005), blood transfusion (OR, 165; P < 0.001), intensive care unit admission (OR, 19.10; P < 0.004), hospital readmission (OR, 20.7; P < 0.0005), vaginal hematoma (OR, 554.1; P < 0.001), infection (OR, 22.44; P < 0.004), and complications that required specific additional follow-up (OR, 9.42; P < 0.0005). There were no thromboembolic events. Antithrombotic therapy did not significantly increase reoperation rates (OR, 3.8; P = 0.275). Findings were maintained when adjusting for covariates of age and body mass index. Postoperative surgical complications after prolapse repair procedures are increased in patients who use chronic antithrombotic medication, the majority of cases are successfully managed conservatively.

64 - Endometriosis of the Appendix: Prevalence and Correlation with Gross Pathological Findings at Time of Minimally Invasive Excision Surgery in Women with Chronic Pelvic Pain

64 - Endometriosis of the Appendix: Prevalence and Correlation with Gross Pathological Findings at Time of Minimally Invasive Excision Surgery in Women with Chronic Pelvic Pain

Surgical Specialty Choice: Perceptions about Choosing Surgical Specialties for Women in Surgery

Price, Kristie; Altieri, Maria S. MD; Obeid, Nabeel R. MD; Sbayi, Samer MD; Bates, Andrew MD; Docimo, Salvatore DO; Spaniolas, Konstantinos MD; Talamini, Mark A. MD, FACS, MD, FACS; Pryor, Aurora D. MD, FACS Author Information

Women in surgery: A longer term follow-up

BackgroundThere are an increasing number of women in surgery. Previously, many questions focused upon their ability to complete surgical training and contribute fully to the surgical workforce. More meaningful information lies in identifying the long-term follow-up of where, and in what specialty, women residents eventually practice. MethodsAll residents entering general surgery training at the University of Louisville between 1996 and 2009 were studied. Comparison between men and women was performed for program completion, length of residency training, and eventual specialty practice. ResultsOne hundred and eight residents entered general surgery residency. Twenty-three (21%) did not complete training. There was no difference in attrition rates between men or women (22% vs. 19%, p = 0.77). Women completing residency were just as likely to practice general surgery (either private or academic practice) as their male counterparts (67% vs. 67% p = 0.96). ConclusionsWomen are a valuable resource in surgery and are able to complete a vigorous residency. Long-term follow-up is crucial and permits us to evaluate this important group of trainees practicing surgery today.

Minimally Invasive Staging Surgery in Women with Early-Stage Endometrial Cancer: Analysis of the National Cancer Data Base.

The aim of this study was to determine factors associated with the adoption of minimally invasive surgery (MIS) compared with laparotomy in the treatment of endometrial cancer and to compare surgical outcomes and survival between these two surgical modalities. We utilized the National Cancer Data Base (NCDB) to identify women diagnosed with presumed early-stage endometrial cancer between 2010 and 2012. We also identified factors associated with the performance of MIS and utilized propensity score matching to create a matched cohort of women who underwent minimally invasive staging surgery or laparotomy for surgical staging. Overall, 20,346 women were eligible for inclusion in the study; 12,604 (61.9%) had MIS, while 7742 (38.1%) had a laparotomy. African American race (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.49-0.60], Hispanic ethnicity (OR 0.70, 95% CI 0.61-0.80), Charlson score >2 (OR 0.79, 95% CI 0.69-0.91), high-grade histology (OR 0.63, 95% CI 0.59-0.68), presumed clinical stage II disease (OR 0.53, 95% CI 0.46-0.60), and surgery at a community cancer program (OR 0.46, 95% CI 0.39-0.55) or in the Midwest region (OR 0.70, 95% CI 0.64-0.76) were associated with a decreased likelihood of having MIS, while private insurance (OR 1.69, 95% CI 1.45-1.97) and highest quartile median household income (OR 1.13, 95% CI 1.03-1.24) were associated with an increased likelihood of having MIS. After propensity score matching, there was no association between minimally invasive staging surgery and 3-year overall survival (hazard ratio 1.03, 95% CI 0.92-1.16). There are notable racial, ethnic, socioeconomic, and geographic variations in the utilization of MIS for endometrial cancer staging in the US. After controlling for the aforementioned factors, MIS had a similar 3-year survival compared with laparotomy in women undergoing staging surgery for endometrial cancer.

Long-Term Cause-Specific Mortality After Surgery for Women With Breast Cancer: A 20-Year Follow-Up Study From Surveillance, Epidemiology, and End Results Cancer Registries.

BACKGROUNDResearch into long-term cause-specific mortality of women diagnosed with breast cancer is important because it allows for the splitting of the population into patients who eventually die from breast cancer and from other causes. The adoption of this approach helps to identify patients with an elevated risk of eventual death from breast cancer.OBJECTIVEThe primary aim of this study was to examine the associations between both sociodemographic and clinicopathologic characteristics and the underlying risks of death from breast cancer and from other causes for women diagnosed with breast cancer. A second aim was to propose a predictive biomarker of cause-specific mortality in terms of treatment and several important characteristics of a patient.METHODSA cohort of 16 511 female patients diagnosed with breast cancer in 1990 was obtained from the Surveillance, Epidemiology, and End Results cancer registries and followed for 20 years. A mixture model for the regression analysis of competing risks was used to identify factors and confounders that affected either the eventual cause-specific mortality or conditional cause-specific hazard rates, or both. Missing data were handled with multiple imputation.RESULTSCurvilinear relationships of age at diagnosis along with race, marital status, breast cancer type, tumor size, estrogen receptor status, extension, lymph node status, type of surgery, and radiotherapy status were significant risk factors for the cause-specific mortality, with extension and lymph node status appearing to be confounded with the effects of both type of surgery and radiotherapy status. The score obtained from combining a set of predictors showed to be an accurate predictive biomarker.CONCLUSIONSIn cause-specific mortality of women diagnosed breast cancer, prognosis appears to depend on both sociodemographic and clinicopathologic factors. The predictive biomarker proposed in this study may help identifying the level of seriousness of the disease earlier than traditional methods, potentially guiding future allocation of resources for better patient care and management strategies.

Dry Eye Following Cataract Surgery in Women Over 50 Years Old

Dry Eye Following Cataract Surgery in Women Over 50 Years Old

Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer

Uncertainty remains about the relative benefits of primary cytoreductive surgery (PCS) vs neoadjuvant chemotherapy (NACT) for advanced-stage epithelial ovarian cancer (EOC). To compare overall survival of PCS vs NACT in a large national population of women with advanced-stage EOC. Retrospective cohort study of women with stage IIIC and IV EOC diagnosed between 2003 and 2011 treated at hospitals across the United States reporting to the National Cancer Data Base. We focused on patients 70 years or younger with a Charlson comorbidity index of 0 who were likely candidates for either treatment. Initial treatment approach of PCS vs NACT, examined using an intent-to-treat analysis. Overall survival, defined as months from cancer diagnosis to death or date of the last contact. We used propensity score matching to compare similar women who underwent PCS and NACT. The association of treatment approach with overall survival was assessed using the Kaplan-Meier method and the log-rank test. We assessed whether the findings were influenced by differences in the prevalence of an unobserved confounder, such as limited performance status (Eastern Cooperative Oncology Group 1-2), preoperative disease burden, and BRCA status. Among 22 962 patients (mean [SD] age, 56.12 [9.38] years), 19 836 (86.4%) received PCS and 3126 (13.6%) underwent NACT. We matched 2935 patients treated with NACT with similar patients who received PCS. The median follow-up was 56.5 (95% CI, 54.5-59.2) months in the PCS group and 56.3 (95% CI, 54.5-59.8) months in the NACT group in the propensity-matched cohort. Among propensity score-matched groups, the median overall survival was 37.3 (95% CI, 35.2-38.7) months in the PCS group and 32.1 (95% CI, 30.8-34.1) months in the NACT group (P < .001). However, if the NACT group had a higher proportion of women with performance statuses of 1 to 2 compared with those who underwent PCS (60% vs 50%), the association of PCS and improved survival would not be statistically significant. Primary cytoreductive surgery was associated with improved survival compared with NACT in otherwise healthy women with advanced-stage epithelial ovarian cancer aged 70 years or younger. The lower survival in women who received NACT could be explained by a higher prevalence of limited performance status in women undergoing NACT.

Bariatric Surgery in Women of Childbearing Age, Timing Between an Operation and Birth, and Associated Perinatal Complications

Metabolic changes after maternal bariatric surgery may affect subsequent fetal development. Many relevant perinatal outcomes have not been studied in this postoperative population, and the risks associated with short operation-to-birth (OTB) intervals have not been well examined. To examine the risk for perinatal complications in women with a history of bariatric surgery (postoperative mothers [POMs]) by comparing them with mothers without operations (nonoperative mothers [NOMs]) and examining the association of the OTB interval with perinatal outcomes. This investigation was a population-based retrospective cohort study (January 1, 1980, to May 30, 2013) at hospitals in Washington State. Data were collected from birth certificates and maternally linked hospital discharge data. Participants were all POMs and their infants (n = 1859) and a population-based random sample of NOMs and their infants frequency matched by delivery year (n = 8437). Bariatric operation before birth or categories of OTB intervals. The primary outcomes were prematurity, neonatal intensive care unit (NICU) admission, congenital malformation, small for gestational age (SGA), birth injury, low Apgar score (≤8), and neonatal mortality. Poisson regression was used to compute relative risks (RRs) and 95% CIs, with adjustments for maternal body mass index, delivery year, socioeconomic status, age, parity, and comorbid conditions. A total of 10 296 individuals were included in the analyses for this study. In the overall cohort, the median age was 29 years (interquartile range, 24-33 years). Compared with infants from NOMS, infants from POMs had a higher risk for prematurity (14.0% vs 8.6%; RR, 1.57; 95% CI, 1.33-1.85), NICU admission (15.2% vs 11.3%; RR, 1.25; 95% CI, 1.08-1.44), SGA status (13.0% vs 8.9%; RR, 1.93; 95% CI, 1.65-2.26), and low Apgar score (17.5% vs 14.8%; RR, 1.21; 95% CI, 1.06-1.37). Compared with infants from mothers with greater than a 4-year OTB interval, infants from mothers with less than a 2-year interval had higher risks for prematurity (11.8% vs 17.2%; RR, 1.48; 95% CI, 1.00-2.19), NICU admission (12.1% vs 17.7%; RR, 1.54; 95% CI, 1.05-2.25), and SGA status (9.2% vs 12.7%; RR, 1.51; 95% CI, 0.94-2.42). Infants of mothers with a previous bariatric operation had a greater likelihood of perinatal complications compared with infants of NOMs. Operation-to-birth intervals of less than 2 years were associated with higher risks for prematurity, NICU admission, and SGA status compared with longer intervals. These findings are relevant to women with a history of bariatric surgery and could inform decisions regarding the optimal timing between an operation and conception.

Effectiveness of Pelvic Organ Prolapse Surgery in Women with Depressive Symptoms and Decreased Quality of Life

Objective: To know the effectiveness of pelvic organ prolapse surgery&#x0D; in decreasing depressive symptoms (based on PHQ9) and improving&#x0D; quality of life in women with pelvic organ prolapse.&#x0D; Methods: This experimental study without control is conducted at&#x0D; the Obstetrics and Gynecology Department of Dr. Mohammad&#x0D; Hoesin Hospital Palembang/Faculty of Medicine Sriwijaya University,&#x0D; from October 03 2012 until May 31, 2014. Data containing selfadministrated&#x0D; questionnaire about depressive symptoms (PHQ9)&#x0D; and quality of life (PFIQ and PFDI) were recorded. Questionnaire&#x0D; was performed before and six months after surgery. Sample included&#x0D; 26 women with pelvic organ prolapse seeking pelvic organ&#x0D; prolapse surgery, which qualified the inclusion criteria. Data were&#x0D; analyzed using Chi Square and Fisher Exact test. Data analysis was&#x0D; done using SPSS 18.0.&#x0D; Results: According to paired T test there is a significant difference&#x0D; between mean PHQ9 score before (6.69±3.80) and 6 months after&#x0D; surgery (1.96±1.75)(p=0.001). Total PFIQ score decreased from&#x0D; 17.15±9.39 to 2.88±4.01 with 14.27±5.38 reduction. PFDI score before&#x0D; surgery were 29.85±15.73 and decreased to 11.50±10.99, with&#x0D; a reduction of 18.35±4.74.&#x0D; Conclusion: There was significant reduction in depressive symptoms&#x0D; and improved quality of life in women with prolapse after surgery,&#x0D; compared to before surgery.&#x0D; [Indones J Obstet Gynecol 2015; 3-4: 196-199]&#x0D; Keywords: depression, quality of life, uterine prolapse

Lymphedema Following Elective Hand and Wrist Surgery in Women who are Post Axillary Lymph Node Dissection: A Prospective, Cohort Study: Level 2 Evidence

Lymphedema Following Elective Hand and Wrist Surgery in Women who are Post Axillary Lymph Node Dissection: A Prospective, Cohort Study: Level 2 Evidence

Factors Associated with Persistently Positive Margin Status after Breast-Conserving Surgery in Women with Breast Cancer: An Analysis of the National Cancer Database

Margin status after definitive breast-conserving surgery (BCS) is a key predictor of local tumor recurrence. This study utilized the National Cancer Database, which captures 70 per cent of all cancer cases nationally, to determine factors associated with persistently positive margins status post-BCS. From 1998 to 2010, there were 1,170,284 patients with stage 0 to 3 breast cancer who underwent BCS. After final definitive surgery, 7.3 per cent of patients had positive margins. On bivariate analysis, persistently positive margin status post-BCS was correlated with patient age, race, ethnicity, comorbidities, facility type and location, tumor size, grade, presence of invasive disease, lymph node positivity, as well as receipt of neoadjuvant chemotherapy and adjuvant radiation therapy (P < 0.001). On multivariate analysis, patients who were black, with multiple comorbidities, living in a Pacific state, who had larger, high-grade, node-positive invasive tumors, who did not receive neoadjuvant chemotherapy, and who did not receive adjuvant radiation therapy were more likely to have persistently positive margins (P < 0.05). Although the goal of BCS is the attainment of negative margins, 7.3 per cent of patients have persistently positive margins after definitive surgery. These patients tend to have more aggressive disease and greater comorbidities, and are less likely to receive adjuvant radiation therapy.