Patterns of cervical cancer care in Argentina: Applying ASCO recommendations adjusted by local resources.

There are significant differences in cervical cancer incidence and mortality between low-middle and high-income countries. The American Society of Clinical Oncology (ASCO) resource-stratified clinical practice guideline was designed to provide an appropriate cervical cancer treatment based on the best available evidence in scenarios with different diagnostic and therapeutic resources. Argentina, a Latin American high middle income country, shows however, that cervical cancer rates are similar to those of low-income countries. In addition, significant disparities in incidence and mortality are described throughout the country. The present article describes the current pattern of care of cervical cancer in Argentina and establishes recommendations adjusted to local resources in different regions of the country according to the ASCO guideline.

Four Surgical Approaches to Cervical Excision During Laparoscopic Radical Trachelectomy for Early Cervical Cancer.

STUDY OBJECTIVE: To compare the clinical and oncological outcomes of four different approaches of cervical excision (CE) during radical trachelectomy (RT) for early cervical cancer. DESIGN: A retrospective comparative observational study was performed at Gynecology Department of the Hospital Italiano de Buenos Aires in Buenos Aires, Argentine. The study was composed of all consecutive women who had undergone laparoscopic RT for early cervical cancer between May 2011 and July 2016. They were divided in four groups according with different surgical approaches to perform the CE during RT; which are also detailed. (Canadian Task Force Classification III). SETTING: Tertiary care hospital. INTERVENTION: CE during radical trachelectomy for early cervical cancer. MEASUREMENT AND MAIN RESULTS: A total of 7, 6, 6 and 3 patients undergone Type A, B, C and D cervical excision during RT, respectively. No significant differences in terms of age, BMI, surgical time and length of hospital stay were found according with different types of CE. Patients in Type D had, however, a significantly higher EBL, p =.006. Similar histology characteristics in terms of histology type, tumor grade and size, as well as lymph node count were observed among groups. Only grade 1-2 postoperative complications were noted in 9 patients. One local recurrence after Type B CE was treated with radical surgery plus chemoradiaton; while other patient after Type A CE relapsed with peritoneal carcinomatosis managed with chemotherapy. CONCLUSION: Different types of cervical excision that are here described should be used according to each case based on specific clinical factors.

Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls.

The serum cancer antigen 125 (CA-125) remains a reliable biomarker in the therapeutic management of epithelial ovarian cancer (EOC). Monitoring the efficacy of cytotoxic chemotherapy (CT) and the early detection of relapse during the follow up of patients in remission represent the two most common clinical situations where the CA-125 has been successfully applied. There are however other scenarios along the course of the disease where the CA-125 can potentially aid in the decision-making process. Preoperative levels of CA-125 can help in selecting a subset of patients where an optimal cytoreduction may not be easily achieved. Perioperative variations in the CA- 125 levels after primary surgery and, more importantly, the nadir value of the CA-125 after primary chemotherapy, are associated with patient outcome. This review focuses on the clinical relevance of dynamic changes in CA-125 levels during the primary treatment of EOC and its potential influence both in the patient management and in the design of clinical trials in the adjuvant setting.

La combinación de quimioterapia intravenosa e intraperitoneal mejora la supervivencia en el cáncer de ovario / The combination of intravenous and intraperitoneal chemotherapy improves survival for women ovarian cancer

Existen pruebas convincentes provenientes de diversos estudios aleatorizados y controlados de que la combinación de quimioterapia intravenosa (IV) e intraperitoneal(IP), administradas luego de una citorreducción quirúrgica óptima, mejora significativamente la supervivencia de las mujeres con cáncer epitelial de ovario en estadio III de la clasificación de la FIGO. En base a este concepto, el National Cancer Institute de Estados Unidos (US-NCI) emitió un anuncio clínico en enero de 2006 en el que recomendaba que las mujeres y sus médicos tratantes tuvieran en cuenta dicha quimioterapia IV/IP en los casos adecuados. Pese a los actuales esfuerzos en la enseñanza, los esquemas IV/IP no se han convertido en el tratamiento estándar en diversos hospitales. Las investigaciones clínicas actualmente en marcha buscan reducir la toxicidad asociada con la quimioterapia IP sin perder la eficacia e incorporando nuevos abordajes biológicos al tratamiento.

Evaluation of laparoscopic management of gynecologic emergencies by residents.

OBJECTIVE: To evaluate the feasibility of laparoscopic management of women with gynecologic emergencies by the residents and the chief resident in an organized resident training program. METHODS: A retrospective study of patients with gynecologic emergencies who underwent laparoscopic surgery between January 1, 1999, and May 31, 2006 was done. RESULTS: For the 369 patients included, the mean operative time of 74±31.35 minutes was significantly increased by advanced patient age (P<0.001), pelvic inflammatory disease with or without tubo-ovarian abscess (PID±TOA) (P<0.050), the first semester of chief residency (P<0.050), and conversion to laparotomy (P<0.001). Mean length of hospital stay was 40±24 hours. Factors such as advanced patient age (P<0.001), prolonged length of surgery (P<0.001), PID±TOA (P<0.001), first semester of chief residency (P<0.050), conversion to laparotomy (P<0.001), and blood transfusion (P<0.050) significantly increased the length of hospital stay. The conversion rate to laparotomy was 4.6% (n=17), and it was significantly associated with advanced women age (OR 1.11; 95% CI, 1.05-1.17, P<0.001) and PID±TOA (OR 6.04; 95%CI, 2.17-16.62, P<0.001). Postoperative complications were recorded in 3 (0.81%) patients. CONCLUSION: Laparoscopic management of gynecologic emergencies by senior residents and a chief resident within an organized resident training program is feasible. These results reinforce the relevance of a well-structured residency endoscopic training program.

Como dar malas noticias / How to infirn malignant disease

El comunicar diagnóstico de enfermedades de pronóstico incierto, esconde detrás un sin número de variables relacionadas a cada paciente. En este trabajo se trata de establecer si lo que recibe el pacientes realmente lo que desea, enfatizando en: La persona encargada de transmitir el diagnóstico, forma en que se transmite el diagnóstico, quien decide el tratamiento y el papel de la familia. Se realizó un trabajo descriptivo cuantitativo a partir de una encuesta anónima a 100 pacientes oncológicos mayores de 18 a±os; 28 fueron del Hospital Provincial Lucio Molas de Santa Rosa de La Pampa y 72 del Hospital Privado de Córdoba, durante octubre de 1999 a julio del 2000. Vislumbramos las siguientes tendencias: el médico fue quien le informó el diagnóstico a la mayoría de los pacientes y lo hizo en forma directa, lo cual era similar a los que los pacientes deseaban; el tratamiento fue decidido en similares porcentajes por el médico y entre este y el paciente; la familia, en general tuvo un acompa±amiento constante. Proponemos que la manera de transmitir el diagnóstico esta sujeta a cada paciente, para la cual el médico debe evaluar su personalidad y entorno emocional. Creemos conveniente la presencia de un servicio de medicina paliativa en los hospitales. ABSTRACT: Communicate uncertain prognostic illness diagnosis hide countless number of variables related with each patient. In this work we try to establish what the patient receives and what he really desires, emphasizing on: the person in charge to communicate the diagnosis; the way they used to do that; who decides the treatment; and the familys roll. It was effectuated a quantitative descriptive work. It was used a nameless poll on 100 oncological patients of 18 year old or more, 28 patient belong to Lucio Molas Hospital of Santa Rosa , La Pampa and 72 were from Hospital Privado of Cordoba, during October 1999 to July of 2000. We glimpse the following tendencies: the doctor communicated the diagnosis in the majority of the patient and they did it in a direct way, which was similar amount by the doctor and between this and the patient; and finally, family had a constantly attendance. We propose that that the way to communicate diagnosis depends on each patient and the doctor has evaluate in each case personality and his emotional surrounding. We believe that his convenient the presence of a palliative medicine service in hospital

Como dar malas noticias / How to infirn malignant disease

El comunicar diagnóstico de enfermedades de pronóstico incierto, esconde detrás un sin número de variables relacionadas a cada paciente. En este trabajo se trata de establecer si lo que recibe el pacientes realmente lo que desea, enfatizando en: La persona encargada de transmitir el diagnóstico, forma en que se transmite el diagnóstico, quien decide el tratamiento y el papel de la familia. Se realizó un trabajo descriptivo cuantitativo a partir de una encuesta anónima a 100 pacientes oncológicos mayores de 18 a±os; 28 fueron del Hospital Provincial Lucio Molas de Santa Rosa de La Pampa y 72 del Hospital Privado de Córdoba, durante octubre de 1999 a julio del 2000. Vislumbramos las siguientes tendencias: el médico fue quien le informó el diagnóstico a la mayoría de los pacientes y lo hizo en forma directa, lo cual era similar a los que los pacientes deseaban; el tratamiento fue decidido en similares porcentajes por el médico y entre este y el paciente; la familia, en general tuvo un acompa±amiento constante. Proponemos que la manera de transmitir el diagnóstico esta sujeta a cada paciente, para la cual el médico debe evaluar su personalidad y entorno emocional. Creemos conveniente la presencia de un servicio de medicina paliativa en los hospitales. ABSTRACT: Communicate uncertain prognostic illness diagnosis hide countless number of variables related with each patient. In this work we try to establish what the patient receives and what he really desires, emphasizing on: the person in charge to communicate the diagnosis; the way they used to do that; who decides the treatment; and the family's roll. It was effectuated a quantitative descriptive work. It was used a nameless poll on 100 oncological patients of 18 year old or more, 28 patient belong to Lucio Molas Hospital of Santa Rosa , La Pampa and 72 were from Hospital Privado of Cordoba, during October 1999 to July of 2000. We glimpse the following tendencies: the doctor communicated the diagnosis in the majority of the patient and they did it in a direct way, which was similar amount by the doctor and between this and the patient; and finally, family had a constantly attendance. We propose that that the way to communicate diagnosis depends on each patient and the doctor has evaluate in each case personality and his emotional surrounding. We believe that his convenient the presence of a palliative medicine service in hospital