Hysterectomy in Poland between 2011 and 2016. Changing trends in the surgical approach to hysterectomy

Objectives: In Poland, approximately 35,000 women a year undergo hysterectomy. The surgical approach may vary depending on the indications and experience of the operator and advances in laparoscopic surgical techniques. The aim of the present study was to analyze trends in the use of various types of hysterectomy in Poland between 2011 and 2016. Summary values were given as numbers and percentages. Annual incidence of procedures and identify factors which influence these changes in gynecological practice.Material and methods: Data on hysterectomy procedures performed between 2011 and 2016 in Poland acquired from the National Health Fund reports were extracted and analyzed. Summary values were given as numbers, percentages and rate ratios (RR). Annual incidence of procedures and identify factors that influence these changes in gynecological practice.Results: Between 2011 and 2016, 215,744 women were treated by hysterectomy in inpatient settings. The total number of those procedures in analyzed period decreased by 11.5%; the incidence rate dropped by 2.15 per 100,000 women. A significant increase in laparoscopic procedures was observed (RR = 3.85; CI: 3.57–4.16; p < 0.001) along with a decrease in the number of abdominal operations (RR = 0.82; CI: 0.81–0.83; p < 0.001).Conclusions: Surgical technique advances, introduction of intrauterine systems and hormonal therapy, as well as recommendations of international institutions have brought about changes in the methods and frequency of hysterectomy. The laparoscopic approach has been gaining popularity since it is beneficial both for patients and public health system. However, the percentage of advanced minimally invasive hysterectomies is still low in Poland in comparison to other countries

Principal component analysis and internal reliability of the Polish version of MESA and UDI-6 questionnaires

Objectives: Urinary incontinence (UI) can affect up to 50% of the population of women over the age of 50. In order to objectively assess discomfort in women with UI prior to initiating treatment and monitoring the outcomes of the treatment, validated questionnaires need to be used to examine the impact of UI on health-related quality of life (HR-QoL). The Urogenital Distress Inventory — Short Form (UDI-6) and the Medical Epidemiologic and Social Aspects of Ageing (MESA) questionnaires are used typically. Assessment of the Polish translation of the MESA and UDI-6 questionnaires. Material and methods: 155 patients with symptoms of UI were enrolled. Each of the patients completed the MESA and UDI questionnaires prior to being examined. The final diagnosis was made after diagnostic tests were carried out in the patients. Results: Principle component analysis showed division of the Polish versions of the questionnaires into domains identical to the original version. Analyses of internal consistency reliability revealed high internal consistency for the MESA questionnaire (0.90) and a low reliability of the UDI-6 questionnaire (0.44). Conclusions: The Polish version of the MESA questionnaire was demonstrated to be a clinically useful diagnostic tool in the studied population, UDI-6 did not reached a sufficiently high reliability in the study group to be recommended as a diagnostic tool

Nowy system klasyfikacji zaawansowania nowotworów jajnika, jajowodu i otrzewnej — stan na 2014 rok

Goals of each cancer staging system are similar: it should give evidence about the prognosis of the patient, assist the clinician to plan appropriate treatment, allow for evaluation and comparison of treatment results in different centers and finally contribute to a deeper recognition of malignancy nature. The classification system should also meet three criteria: it should be credible, evidence-based and applicable in clinical practice. During recent years paramount changes have occurred in the pathogenesis of ovarian cancer and recent clinical studies have identified new prognostic factors. Therefore the last change in the classification of ovarian tumors in women was made at the beginning of 2014 and for the first time there were also included fallopian tube and primary peritoneal cancers. The main changes in the updated classification of cancer of the ovary, fallopian tube and the peritoneum are based on dividing the stage IC into three groups including surgical damage to the capsule of the tumor, tumor capsule rupture before the operation and the presence of malignant cells in the peritoneal fluid. Stage IIC has been omit ted. It was also considered that the presence of metastases limited to lymph nodes is a factor of better prognosis than peritoneal metastases and therefore this situation was distinguished as the stage IIIA1. Two subgroups were created on the basis of the morphology of lymph node metastases. Microscopic peritoneal metastasis outside the pelvis were staged as IIIA2. The new classification of stage IV was divided into two subgroups; IVA is defined as the presence of histologically or cytologically proven pleural involvment and IVB includs metastases to spleen or liver parenchyma as well as metastases outside the abdominal cavity.Zadania stojące przed twórcami każdego systemu klasyfikacji nowotworów są zbliżone: system powinien dawać wskazówki co do rokowania chorego, pomagać klinicyście w zaplanowaniu właściwego postępowania, pozwolić na ocenę wyników leczenia i umożliwić ich porównywanie w różnych ośrodkach oraz wreszcie przyczyniać się do pogłębiania wiedzy o nowotworach. Powinien spełniać również trzy kryteria: powinien być wiarygodny, o udokumentowanej skuteczności oraz możliwy do zastosowania w praktyce klinicznej. W ostatnich latach pojawiło się wiele nowych informacji dotyczących patogenezy raka jajnika, a w opublikowanych pracach wskazano nowe czynniki rokownicze. Klasyfikację nowotworów jajnika u kobiet zaktualizowano na początku 2014 roku i po raz pierwszy uwzględniono w niej również nowotwory jajowodu i otrzewnej. Najważniejsze zmiany w nowej klasyfikacji raka jajnika, jajowodu i otrzewnej polegają na podzieleniu stopnia IC na trzy podgrupy obejmujące sytuacje związane z chirurgicznym uszkodzeniem torebki guza, pęknięciem torebki guza przed operacją i obecnością komórek w płynie otrzewnowym. Stopień IIC pominięto. Uznano, że chore z przerzutami ograniczonymi do węzłów chłonnych charakteryzują się lepszym rokowaniem niż osoby z przerzutami do otrzewnej i dlatego wyodrębniono tę grupę jako stopień IIIA1. Wyróżniono w niej dwie podgrupy na podstawie morfologii przerzutów do węzłów chłonnych. Mikroskopowe przerzuty do otrzewnej poza obszarem miednicy mniejszej zostały sklasyfikowane jako stopień IIIA2. W nowej klasyfikacji w stopniu IV wyodrębniono dwie podgrupy — stopień IVA, definiowany jako histopatologicznie lub cytologicznie potwierdzona obecność komórek nowotworowych w płynie z jam opłucnowych, oraz IVB — obejmujący przerzuty do miąższu wątroby lub śledziony oraz przerzuty poza obszar jamy brzusznej

Recommendations of the Polish Society of Gynaecologists and Obstetricians for removal of the uterus by vaginal, laparoscopic and abdominal routes

The recommendations represent the current procedure, which may be modified and changed where justified, after a thoroughanalysis of the given clinical situation, which may be the basis for their modification and updating in the future

Reliability of The King's Health Questionnaire and the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF) Short Form in assessing urinary incontinence effects in Polish women

Objectives: The King's Health Questionnaire (KHQ) and the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF) Short Form are widely used in clinical practice. The aim of this study was to assess the reliability of KHQ and ICIQ-SF in Polish women. Material and methods: One hundred fifty-five women with urinary incontinence (UI) aged between 19–82 years underwent urodynamic investigation and completed both KHQ and ICIQ-SF. We performed Principal Component Analysis (PCA) using VARIMAX rotation for all questionnaire pieces to estimate the factor structure and construct the validity of the KHQ and ICIQ. PCA results were also confirmed by Spearman's correlations between KHQ and ICIQ items. Moreover, by Cronbach’s alpha coefficient (α) we assessed the internal consistency of the KHQ and ICIQ. STATISTICA version 13.1 software (StatSoft, Poland), and open-source R software (version 3.4.4) were used for statistical analysis. Results: Of the study group, 77 (49.6 %) patients had stress urinary incontinence (SUI), 9 (5.8%) patients had Urgency, 10 (6.45%) had OAB and 21 (13.5 %) had MUI. The factor analysis of the KHQ questions showed four main components, and ICIQ-SF- two main components. Correlations between KHQ and ICIQ-SF were from weak (0.1–0.3) to high (0.5–0.7). The KHQ’s Cronbach's alpha was 0.93 and the ICIQ- 0.7. The results obtained from the questionnaire forms did not differ among study groups. Conclusions: The Polish versions of the KHQ and ICIQ-SF questionnaires have good psychometric values and are useful diagnostic tools in the population of urinary incontinent women

Związek wieku chorych na raka endometrium z występowaniem niekorzystnych czynników prognostycznych choroby nowotworowej

Wprowadzenie: Celem pracy jest ocena związku między wiekiem chorych na raka endometrium (RE) a występowaniem niekorzystnych, mikroskopowych i klinicznych czynników prognostycznych choroby. Materiał i metody: Analiza retrospektywna materiału klinicznego obejmującego 128 chorych na raka trzonu macicy, leczonych pierwotnie chirurgicznie w krakowskim Oddziale Centrum Onkologii w latach 2012–2014. Głównym źródłem informacji były historie chorób z archiwum COOK. Badanie czasu przeżycia zakończono w maju 2020 r. Stopień zaawansowania procesu nowotworowego oceniano zgodnie z klasyfi - kacją FIGO 2009. Do oceny statystycznej wyników skorzystano z testu Shapiro-Wilka oraz testu Manna-Whitney’a, a na wykresie przedstawiono mediany, kwartyle oraz zakresy wartości poszczególnych zmiennych. Do oceny przeżyć wolnych od wznowy użyto metody Kaplana-Meyera. Wyniki: Średnia wieku chorych wyniosła 63,9 lata, mediana – 65 lat. Rokowanie w całej grupie chorych było bardzo dobre, odsetek 3-letnich przeżyć wolnych od wznowy wyniósł 91,57%, a 5-letnich – 88,3%. Średnia i mediana wieku chorych z negatywnymi czynnikami prognostycznymi była wyższa niż u chorych pozbawionych tych czynników. Wnioski: Można stwierdzić, że najistotniejsze z prognostycznego punktu widzenia jest w RE współwystępowanie różnych czynników populacyjnych, klinicznych i mikroskopowych. Obecnie uważa się, że czynniki molekularne mają kluczowe znaczenie w prognozie chorych na RE, jednak wiek jest ciągle istotnym klinicznie elementem służącym prognozowaniu i planowaniu leczenia chorych na RE.Introduction: The aim of this paper is to assess the relationship between the age of patients with endometrial cancer and the occurrence of unfavorable microscopic and clinical prognostic factors concerning the disease. Materials and methods: A retrospective analysis of clinical material from 128 patients with endometrial cancer, who were initially treated surgically in the Center of Oncology (Cracow Branch) between 2012 and 2014, was carried out. The main source of information was medical records in the COOK archive. A survival time study was completed in May 2020. The stage of the neoplastic process was assessed according to the FIGO 2009 classifi cation system. The results were statistically evaluated using the Shapiro-Wilk test and the Mann-Whitney test, and the graph shows the medians, quartiles and ranges of values or individual variables. The Kaplan-Meyer method was used to assess the relapsefree survival rate. Results: The mean age of the patients was 63.9 years and the median was 65 years. The prognosis in the whole group of patients was very good, the 3-year relapse- free survival rate was 91.57%, and 5-years – 88.3%. The mean and median age of patients with negative prognostic was higher than in patients without these factors. Conclusion: It seems that from a prognostic point of view the most important factor in endometrial cancer is the coexistence of various population, clinical and microscopic factors. It is now considered that it is molecular factors that are of key importance in the prognosis of endometrial cancer patients. However age should be treated still as clinically important element in the prognosis and treatment planning of patients with endometrial cancer

Could pelvic floor sonography be a standalone method for excluding genuine stress urinary incontinence in women?

Objectives: Determine whether introital pelvic floor sonography with transvaginal probe (PFS-TV) can be an independent method in the diagnosis of genuine stress urinary incontinence (SUI) and to create a ultrasonographic diagnostic model to objectify diagnostic process. Material and methods: The study involved 315 patients with a history of urinary incontinence problems. Based on the clinical examination and urodynamic examination, the final diagnosis was made. Patients were divided into two groups. Group I included women with SUI and Group II included patients without SUI (OAB and no-UI). Each patient underwent PFS-TV at rest and during straining. The groups were compared in terms of ultrasound parameters. Results: Patients from both groups differed statistically in a significant way (p < 0.05) in terms of mean distance between the lower edge of the pubic symphysis at rest 19 mm vs 22 mm (Group I vs Group II) and during straining (D1 and D2) 22 mm vs 26 mm, the average value of the γ angle (at rest (γ1) 37.5° vs 40° and during straining (γ2) and 66° vs 58.5°, average difference value of angle γ during straining and at rest (γ2−γ1) 29° vs 14°, and frequency of urethral funneling 89% vs 17%. Two parameters studied during PFS-TV were included in the logistic regression model used to exclude the stress component of urinary incontinence. Diagnostic test parameters of model were sensitivity 86.6%, specificity 90.4%, accuracy 93.1%. Conclusions: PFS-TV makes it possible to exclude the stress component of urinary incontinence. The developed logistic regression model allows for the objectification of the results of ultrasound examination in patients with urinary incontinence

Recommendation of the Polish Society of Oncological Gynaecology on the diagnosis and treatment of epithelial ovarian cancer

The Recommendations of the Polish Society of Oncological Gynaecology offers evidence-based advice on the care and treatment of women with ovarian cancer and low malignant potential/borderline tumour

Recommendation of the Polish Society of Oncological Gynecology on the diagnosis and treatment of epithelial ovarian cancer

Zalecenia Polskiego Towarzystwa Ginekologii Onkologicznej są opartym na faktach zbiorem informacji dotyczących rozpoznawania i leczenia nowotworów nabłonkowych jajnika wraz z guzami o granicznej złośliwości.The Recommendations of the Polish Society of Oncological Gynaecology offers evidence-based advice on the care and treatment of women with ovarian cancer and low malignant potential/borderline tumour

Central Pathology Review in SENTIX, a Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2)

The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review