Short Commentary about the Ovarian Cancer in the Spanish Province of Castellon

Castellon is a Spanish province situated in the east of Spain. As many other Mediterranean countries the overall incidence of ovarian cancer is low when compared with northern European countries (approximately 8/100.000 habitants per year). At the same time the five year relative survival is low when compared with EEUU and in the Spanish province of Castellon is even lower than the rest of Spain

Càncer ginecològic i exercici físic

El càncer constitueix la primera causa de mort als països industrialitzats. El risc de desenvolupar un càncer abans dels 75 anys per a un espanyol és del 25% és a dir un de cada quatre espanyols desenvoluparà un càncer al llarg de la seua vida. En l’actualitat existeix gran evidència científica de que l’exercici físic per si mateix o en combinació amb la dieta i el normo pes, és capaç de disminuir el risc de patir càncer ginecològic. Així mateix, mitjançant l’activitat física podem revertir els efectes perniciosos tant del tractament del càncer com de les seues seqüeles, i es pot arribar a recuperar l’estat de forma previ a la malaltia i millorar així la qualitat de vida de la pacient.Cancer is the first death cause in industrialised countries. The risk to develop cancer before 75 years old for a Spanish citizen is 25%, which means that one out of ten Spaniards will develop cancer throughout their lives. Nowadays, it has been scientifically proven that physical exercise by itself in combination with diet and normal weight is able to diminish the risk of suffering gynaecological cancer. Moreover, the practice of physical exercise can revert the negative effects of both the treatment against cancer and the aftermath of the disease. Consequently, it is even possible for the patient to recover good shape and quality of life.El cáncer constituye la primera causa de muerte en los países industrializados. El riesgo de desarrollar un cáncer antes de los 75 años para un español es del 25%, es decir uno de cada cuatro españoles desarrollará un cáncer a lo largo de su vida. En la actualidad existe una gran evidencia científica de que el ejercicio físico por si solo o en combinación con la dieta y el normo peso, es capaz de disminuir el riesgo de sufrir cáncer ginecológico. Así mismo, mediante la actividad física podemos revertir los efectos perniciosos tanto del tratamiento del cáncer como de las secuelas del mismo, pudiendo llegar a recuperar el estado de forma previo a la enfermedad y mejorar así la calidad de vida de la paciente

Epidemiología de las neoplasias malignas de ovario en Tarragona, 1980-2005

Contribuciones y conocimientos nuevos que aporta la tesis Se trata de un estudio epidemiológico descriptivo de las neoplasias malignas de ovario en la población de la provincia de Tarragona (305.989 mujeres en el año 2001). Se investiga la incidencia, la mortalidad, la supervivencia y la prevalencia en base poblacional de los 876 casos incidentes del Registro de Cáncer de Tarragona, durante el período 1980-2005. Se analiza también la distribución por tipo histológico durante todo el período. Se realiza un estudio exhaustivo del período 2000-2004, evaluándose 233 pacientes, en el que se examinan además, el método diagnóstico, el grado histológico, el estadio y la lateralidad. Metodología utilizada Se ha utilizado la metodología propia de los registros de cáncer de base poblacional siguiendo los criterios de la Internacional Agency for Research on Cancer (IARC) para asegurar tanto la cobertura de los casos como la precisión de los datos. Se evalúan los índices de calidad estándar, resultando satisfactorios para este estudio. Resultados Se ha analizado la tendencia temporal de la incidencia y se ha calculado su proyección para los años 2010 y 2015. Se han hecho comparaciones internacionales de la incidencia y la supervivencia. Se han estudiado en detalle las variables del período 2000-2004. Conclusiones más relevantes El cáncer de ovario en Tarragona muestra un patrón occidentalizado con una posición intermedia en la comparación internacional y creciente en la incidencia. La supervivencia se ha mantenido estable y es similar a la media europea, con una mejoría en el último quinquenio (2000-2004). El análisis multivariante ha demostrado como factores pronósticos independientes de la supervivencia, la edad, el tipo histológico y el estadio tumoral, lo que coincide con la mayor parte de resultados internacionales. Publicaciones Tres estudios diferentes para su publicación están en fase de elaboración en relación a esta tesis.This is a descriptive epidemiological study on ovarian cancer in Tarragona province population (305,989 women in 2001). Data of population-based incidence, mortality, survival and prevalence, were analyzed concerning 876 ovarian malignancies recorded in the Tarragona Cancer Registry, for the period 1980-2005. Histological types during the period was also investigated. A high resolution study was conducted for the period 2000-2004 including 233 patients with particular focus on diagnostic method, histological grade, staging and laterality. The methodology of population-based cancer registries has been applied, following the criteria of the International Agency for Research on Cancer (IARC), in order to ensure both completeness and accuracy of data. Assessment of the standard quality indices showed that they were appropriate for this particular study on ovarian cancer. The temporal trend in incidence has been studied and its projection to 2010 and 2015 estimated. International comparisons of incidence and survival have been made. Variable factors for the period 2000-2004 have been studied in detail. The most relevant conclusions are: Ovarian cancer in Tarragona shows a westernized epidemiological pattern. Compared internationally age-adjusted rate of incidence is at an intermediate level in the international comparison with an increasing secular trend. The survival rate remained stable until 1999, improving in the last period (2000-2004), and is similar to the rest of Europe. Multivariate analysis has concluded that age, histological type and staging are independent prognostic factors for survival. This is in accordance with a majority of international reports. Three papers are in course of preparation for publication in scientific journals

Effectiveness of Hyperthermic Intraperitoneal Chemotherapy Associated with Cytoreductive Surgery in the Treatment of Advanced Ovarian Cancer: Systematic Review and Meta-Analysis

Objective: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment for epithelial ovarian cancer remains controversial. Our study aims to analyze the overall survival and disease-free survival for the use of HIPEC as a treatment for advanced epithelial ovarian cancer after neoadjuvant chemotherapy. Methods: A systematic review and meta-analysis was carried out using PubMed, Cochrane, Web of Science, and ClinicalTrials.gov. A total of six studies were used, comprising a total of 674 patients. Results: The results of our meta-analysis of all studies analyzed together (observational and randomized controlled trials (RCT)) did not achieve significant results. Contrary to the OS (HR = 0.56, 95% IC = 0.33–0.95, p = 0.03) and DFS (HR = 0.61, 95% IC = 0.43–0.86, p < 0.01) of the RCT analyzed separately, a clear impact on survival was suggested. The subgroup analysis showed that studies making use of higher temperatures (≥42 °C) for a shorter period of time (≤60 min) achieved better results for both OS and DFS, as well as the use of cisplatin as the form of chemotherapy in HIPEC. Moreover, the use of HIPEC did not increase high-grade complications. Conclusions: The addition of HIPEC to cytoreductive surgery demonstrates an improvement in OS and DFS for patients with epithelial ovarian cancer in advanced stages, without an increase in the number of complications. The use of cisplatin as chemotherapy in HIPEC obtained better results

Laparoscopic treatment of a vesico-vaginal fistula: A new approach

Vesicovaginal fistulas (VVF) are among the most distressing complications of gynecologic and obstetric procedures. Management of these fistulas has been better defined and standardized over the last decade. VVF repair is most commonly repared with transvaginal approach. We report a case of VVF which was repaired using a laparoscopic approach. The fistula was a complication of a benign laparoscopic hysterectomy. We describe a novel technique for the treatment of VVF of supratrigonal location by intraperitoneal laparoscopic approach

SARS-CoV-2 Prevalence in Laparoscopic Surgery Filters. Analysis in Patients with Negative Oropharyngeal RT-qPCR in a Pandemic Context: A Cross-Sectional Study

Objective: Surgical societies of different specialties have lately demonstrated a growing concern regarding the potential risk of SARS-CoV-2 transmission during surgery, mainly via aerosols carrying SARS-CoV-2 particles during laparoscopy smoke evacuation. Since there is not sufficient scientific evidence to rule out this hypothesis, our study aimed to evaluate the prevalence of the appearance of SARS-CoV-2 genetic material in the in-filter membrane of the smoke filter systems, used in laparoscopic surgery, in a tertiary referral hospital during the peak phases of the pandemic. Methods: During the highest incidence of the pandemic outbreak, 180 laparoscopic smoke evacuation systems were collected from laparoscopies performed between April 2020 and May 2021 in University General Hospital of Castellón. As part of the safety protocol established as a result of the pandemic, an oropharyngeal reverse-transcription polymerase chain reaction (RT-PCR) was performed before surgery. We performed RT-qPCR tests for the detection and quantification of SARS-CoV-2 genetic material in the in-filter membranes extracted from the smoke evacuation systems. Results: We found two RT-qPCR positive in-filters from a sample of 128 patients with SARS-CoV-2-negative results in their oropharyngeal RT-qPCR, i.e., 1.6% (95% CI: 0.5–5.5%). From this estimation, the predictive posterior probabilities of finding n cases of negative oropharyngeal COVID-19 patients with positive filters increases with the increasing number of surgeries performed. Conclusions: This cross-sectional study provides evidence suggesting that airborne transmission of SARS-CoV-2 particles from smoke evacuation of aerosols carrying viral particles during laparoscopy should not be ruled out

The Use of Barbed Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy

Objective: The aim of this work is to evaluate the safety and efficacy of the barbed unidirectional suture in a total laparoscopic hysterectomy. Materials and Methods: A retrospective and descriptive study was conducted, which included all of the patients that have undergone laparoscopic hysterectomy and closure of the vaginal cuff, using barbed sutures (V-loc™90 Device, CovidienTM), during the period between May 2011 and December 2014. We have analyzed the general characteristics, indications, history of previous surgery and the presence of fever or surgical re-intervention due to pelvic abscesses. The appearance of a vaginal cuff hematoma, active bleeding and vaginal cuff dehiscence were also taken into account. Results: A hundred and twenty-one laparoscopic hysterectomies with vaginal cuff closure, using barbed sutures, were performed. There was a report of one case of bladder lesion and another case of ureter lesion. Of all patients, four (3.3%) of them presented fever while one (0.8%) presented paralytic ileus. Three (2.4%) patients suffered active vaginal bleeding, and one presented a partial dehiscence of the vaginal cuff. And finally, two (1.6%) cases of vaginal cuff hematomas were observed and in one (0.8%) of the cases, a pelvic abscess was detected. Conclusion: The use of a unidirectional barbed suture is a safe technique for vaginal cuff closure in laparoscopic total hysterectomies

Clear Cell Adenocarcinoma of Cervix: Radical Trachelectomy to Preserve the Fertility

Carcinoma of the uterine cervix is a common gynecologic malignant neoplasm all over the world. The most common histological type of malignant cervical neoplasms is squamous cell carcinoma [1,2]. Clear cell adenocarcinomas (CCAC) of the uterine cervix is a rare disease accounting for only 4% of all adenocarcinomas of the uterine cervix [3]. Primary CCAC of the uterine cervix is a rare neoplastic entity which occurs in young women exposed to DES in utero; primary CCAC without DES exposure in utero is extremely rare. Here we report a 23- years-old Spanish female with primary CCA of the uterine cervix with no maternal history of DES ingestion during pregnancy

Biomarkers in Ovarian Pathology: From Screening to Diagnosis. Review of the Literature.

Background: Ovarian cancer has a low incidence, but high mortality due to a habitual diagnosis in advanced cancer stages. Currently, used biomarkers have good sensitivity, but low specificity. Aim: To determine the usefulness of the biomarkers and algorithms used up to now in the screening, diagnosis, response to treatments and identification of recurrence in patients with ovarian masses. Methodology: Systematic search of publications in English in the Medline-PubMed database with the terms: “biomarkers”, “tumour”, “tumour biomarkers”, “marker”, “tumour marker”, “ovarian cancer”, “ovarian”, “Neoplasms”, “cancer”, CA-125 Antigen; Human Epididymis-specific Protein E4; Risk of Malignancy Index (RMI); Risk of Ovarian Malignancy Algorithm (ROMA); Ovarian Neoplasms. Original articles, clinical trials, reviews, systematic reviews and meta-analyses, published between January 2000 and November 2020, were selected to determine the usefulness (among others) of CA 125 and HE4 antigen in ovarian cancer. Results: Finally, 39 transcendental publications were selected to write this article to determine the usefulness of tumour markers and algorithms in ovarian cancer. Conclusions: The usefulness of the tumour markers antigen CA125 and antigen HE4 individually or as a basis for decision-making algorithms has low specificity; however, there is little evidence that confirms their usefulness as markers in ovarian cancer screening.post-print723 K

Surgical technique for video endoscopic inguinal lymphadenectomy in vulvar cancer

Introduction: Inguinal lymph node involvement is an important prognostic factor in patients with vulvar cancer. Inguinal lymph node dissection allows for staging and treatment of inguinal node disease but causes morbidity and is associated with complications such as lymphocele formation, wound dehiscence, and infection. Video endoscopic inguinal lymphadenectomy (VEIL) seems to be a new and attractive approach with lower morbidity than the standard open procedure. The objective of this study was to report our surgical technique for VEIL for the treatment of vulvar cancer. Methods: We retrospectively evaluated a case involving a 78-year-old woman with vulvar cancer who underwent bilateral VEIL. Findings: The operative time was 140 min, and there were no complications. After 3 months of follow-up, there were no signs of vulvar oedema, lymphedema, or lymphocele. Conclusions: In patients with vulvar cancer, VEIL is feasible in clinical practice. Additional studies with a larger number of patients and longer-term follow-up are needed to confirm the oncological efficacy and the possible reduction in morbidity of this new approach.Introduccio´n: La afectacio´n de los no´dulos linfa´ticos inguinales es un factor prono´stico importante en pacientes con ca´ncer de vulva. La diseccio´n de los no´dulos linfa´ticos inguinales nos permite la estadificacio´n y el tratamiento de la afectacio´n ganglionar inguinal. Por otra parte, causa morbilidad y esta´ asociada a complicaciones como linfocele, dehiscencia de la herida e infeccio´n. La linfadenectomı´a inguinal videoendosco´pica parece ser una nueva y atractiva te´cnica con menor morbilidad que el abordaje abierto. El objetivo de este trabajo es reportar nuestra te´cnica de linfadenectomı´a inguinal videoendosco´pica para el tratamiento del ca´ncer de vulva. Me´todos: Se evaluo´ de manera retrospectiva el caso de una paciente de 78 an˜os de edad con ca´ncer de vulva a la que se realizo´ una linfadenectomı´a inguinal videoendosco´pica bilateral. Hallazgos: El tiempo operatorio fue de 140 min y no hubo complicaciones. Tras 3 meses de seguimiento no se observaron signos de edema vulvar, linfedema o linfocele. Conclusiones: La linfadenectomı´a inguinal videoendosco´pica en pacientes con ca´ncer de vulva es factible en la pra´ctica clı´nica. Estudios adicionales con un mayor nu´mero de pacientes y a ma´s largo plazo de seguimiento son necesarios para confirmar la eficacia oncolo´gica y la posible menor morbilidad de este nuevo enfoque