Subspecialty training in Europe: a report by the European Network of Young Gynaecological Oncologists.

BACKGROUND: ESGO (European Society of Gynaecological Oncology) and partners are continually improving the developmental opportunities for gynaecological oncology fellows. The objectives of this survey were to evaluate the progress in the infrastructure of the training systems in Europe over the past decade. We also evaluated training and assessment techniques, the perceived relevance of ENYGO (European Network of Young Gynaecological Oncologists) initiatives, and unmet needs of trainees. METHODOLOGY: National representatives of ENYGO from 39 countries were contacted with an electronic survey. A graduation in well/moderately/loosely-structured training systems was performed. Descriptive statistical analysis and frequency tables, as well as two-sided Fisher's exact test, were used. RESULTS: National representatives from 33 countries answered our survey questionnaire, yielding a response rate of 85%. A national fellowship is offered in 22 countries (66.7%). A logbook to document progress during training is mandatory in 24 (72.7%) countries. A logbook of experience is only utilized in a minority of nations (18%) for assessment purposes. In 42.4% of countries, objective assessments are recognized. Trainees in most countries (22 (66.7%)) requested additional training in advanced laparoscopic surgery. 13 (39.4%) countries have a loosely-structured training system, 11 (33.3%) a moderately-structured training system, and 9 (27.3%) a well-structured training system. CONCLUSION: Since the last publication in 2011, ENYGO was able to implement new activities, workshops, and online education to support training of gynaecological oncology fellows, which were all rated by the respondents as highly useful. This survey also reveals the limitations in establishing more accredited centers, centralized cancer care, and the lack of laparoscopic training.

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.

Advanced ovarian cancer imitating deep infiltrating endometriosis. Radical resection and reconstructive surgery of the anterior abdominal wall.

Endometriosis is a disease affecting approximately 10-15% of the female population of reproductive age [1]. A rare location is endometriosis in the scar after caesarean section - CSE (caesarean scar endometriosis) accounting for 0.5-1.0 % of all cases. Although endometriosis is usually a benign condition, its malignant transformation affects 0.7-1% of cases. In women diagnosed with ovarian cancer, foci of endometriosis are present in up to 30% of patients. This paper presents the case of a 36-year-old patient initially diagnosed with extensive endometriosis involving the anterior abdominal wall and the pelvis minor. After biopsy, a diagnosis of advanced low-grade serous ovarian cancer was established. The diagnostic methods used and the extent of surgery with reconstruction of the anterior abdominal wall were described.