Simple vaginal trachelectomy for early stage cervical cancer: A tertiary cancer center experience

Objectives: Less radical fertility sparing procedures have been introduced to reduce morbidity and adverse obstetric outcome in cervical cancer. Our objective was to describe oncological and obstetric outcomes of women with early-stage cervical cancer who underwent a simple vaginal trachelectomy (SVT). Material and methods: From 01/2013 to 05/2017, 14 women underwent SVT preceded by laparoscopic pelvic lymph node dissection. Results: Patients’ median age was 32 years and all of them were nulliparous. Histology included squamous cell carcinoma and adenocarcinoma in 12 (85.7%) and 2 (14.3%) patients, respectively. Three patients had stage 1A1 with lymphovascular space invasion, 4 1A2 and 7 1B1. After obtaining final histopathology, one patient underwent radical hysterectomy due to positive surgical margin and excluded from analysis. None of the patients had lymph node metastasis. None of the 13 patients developed a recurrence within a median follow-up of 27 (6–56) months. Seven patients have conceived: 4 were term deliveries, 2 were late preterm deliveries and 1 was spontaneous abortion. Conclusions: SVT in well selected early-stage cervical cancer patients seems to be a safe treatment option with excellent oncologic outcome, preserving reproductive function. Literature data will need to be confirmed in large prospective series

See and treat strategy by LEEP conization in patients with abnormal cervical cytology

Objectives: To determine the overtreatment and re-LEEP rates of see and treat strategy (S & T) in women who underwent S & T by LEEP and to identify the risk factors for overtreatment and surgical margin and/or endocervical curettage positivity. Material and methods: A total of 800 patients who underwent S & T in Istanbul University Cerrahpasa Medical Faculty between June 2010 and June 2016 were retrospectively analyzed. Results: Overtreatment rate was found to be 46.6%, decreasing with higher grade of cervical smear abnormalities. Age more than 45, low grade of cervical cytologic abnormality and absence of glandular involvement were associated with higher overtreatment rates. The more advanced the histopathology, the more increased risk of surgical margin on LEEP and ECC positivity (p < 0.0001, for both). Glandular involvement was associated with both surgical margin and ECC positivity. Conclusions: S & T can be used in patients with high grade cytologic anomaly with an acceptable overtreatment rate. In addition, bigger pieces of specimens may need to be removed during LEEP in patients who have suspicious images of higher grade of abnormalities on colposcopy to reduce surgical margin or ECC positivity. When high rate of ECC positivity in patients with HSIL cytology is considered, we suggest performing ECC to every patients with HSIL

Incidence and Risk Factors of Venous Thromboembolism in Patients Undergoing Surgery for Gynecologic Malignancies

Introduction:A potentially fatal complication of gynecological cancer surgery is venous thromboembolism (VTE). Low-molecularweight heparin prophylaxis does not reduce the risk of VTE. This research determined the incidence of VTE and to identify the risk factors in patients having surgery for gynecological malignancy with extended dual prophylaxis.Methods:In this retrospective cohort study, all patients with gynecological cancer undergone surgery at the Division of Gynecologic Oncology of İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine were identified between January 2008 and April 2018. Age, body mass index (BMI), menopausal status, comorbidities, the primary site of the neoplasm in gynecology, surgical details, and operative time, the need for intensive care unit admission, perioperative complications, the patient’s smoking habits, the diagnosis of VTE, and follow-up assessments up to one month after surgery were among the data collected.Results:With a 2.4% incidence rate, 29 of 1,201 analyzed patients experienced postoperative VTE events. BMI >30, operation duration >180 min, paraaortic and/or pelvic lymphadenectomy, neoadjuvant chemotherapy, smoking, and chronic renal failure were revealed to be significant variables [odds ratio (OR): 5.357; 95% confidence interval (CI): 1.833-15.654; p=0.002; OR: 5.698; 95% CI: 1.971-16.474; p=0.001; OR: 0.252; 95% CI: 0.068-0.933; p=0.039; OR: 0.002; 95% CI: 0.001-0.025; p=0.001; OR: 0.217; 95% CI: 0.082-0.577; p=0.002; OR: 0.033; 95% CI: 0.003-0.379; p=0.006, respectively].Conclusion:We suggest that every patient undergoing gynecological oncology surgery should have preoperative pharmacological and postoperative extended dual prophylaxis to achieve the lowest incidence of VTE in this group

Transtubal Transport of Carcinoma Cells Into the Peritoneal Cavity After Saline Infusion via Transcervical Route in Patients With Endometrial Carcinoma

The aim of this study was to evaluate the rate of transtubal passage of carcinoma cells into the abdominal cavity after saline infusion in patients with endometrial carcinoma

Vaginal-assisted laparoscopic nerve sparing radical trachelectomy

Fertility-sparing surgery has gained popularity in the last three decades for the management of cervical cancer in women under 40 years of age. Radical trachelectomy is a fertility-sparing surgical technique for women who wish to retain their fertility. Vaginal-assisted laparoscopic radical trachelectomy is feasible in selected patients with early cervical cancer. The aim of this video is to present a nerve-sparing vaginal-assisted laparoscopic radical trachelectomy demonstrating pelvic anatomical structures

Ways of coping with stress and perceived social support in gynecologic cancer patients

WOS:000349907900006PubMed: 25122133Background: Stress is commonly encountered among cancer patients and may be a challenge affecting immune system resistance. Social support may contribute positively to the health of cancer patients, playing a role in coping with stress. Objective: The aim of this study was to determine whether ways of coping are related to social support given to women with gynecologic cancer. Methods: The study was performed as a cross-sectional design in a university hospital in Istanbul, Turkey, with 221 women with gynecologic cancer; the data were collected via 3 questionnaires, the first with sociodemographic and clinical features, the second with multidimensional scale of perceived social support, and the third with the scale of ways of coping with stress. Results: Women with gynecologic cancer who were employed and declared their incomes as balanced and reported more years of education were more likely to perceive higher social support and to use the ineffective coping ways with stress at a lower rate (P < .05) than other participants. Based on correlational analysis, effective coping ways with stress increase as perceived social support from family, friends, significant other, and total increases (P < .05). Conclusions: Social support from family members is the mainstay of coping with stress by women with gynecologic cancer. Implications for Practice: Nurses are indispensable in increasing social support required by women with gynecologic cancer. Well-trained clinical nurses via in-service programs should be experienced and aware of women diagnosed with gynecologic cancer in need of social support during hospital visits and provide necessary guidance

Failure of sentinel lymph node mapping in a patient with endometrial cancer with chronic lymphocytic leukemia: A case report

We aimed to report a detection failure of sentinel lymph node (SLN) mapping via indocyanine green in a patient with endometrial cancer with a previous history of chronic lymphocytic leukemia (CLL), which is a potential risk factor to obstruct lymphatic channels. A 64-year-old woman with a 12-year history of CLL presented to the clinic with grade 2 endometrioid carcinoma. The patient underwent laparoscopic surgical staging. Indocyanine green was used intraoperatively to locate the SLN. No lymph node or lymphatic vessels were identified during SLN mapping. At the final pathology, the morphological findings of CLL were detected in the lymph nodes without metastasis of endometrial cancer. Sentinel lymph node mapping failure due to obstruction of lymphatic channels in a patient with CLL was demonstrated in this study. This is the first report to the best of our knowledge showing SLN mapping failure in the presence of lymphoproliferative diseases