Pregnancy after sugery and brachytherapy for vaginal cancer.

Introduction: Primary vaginal cancer is infrequent, corresponding to 1-2% of all female genital tract cancer diagnoses.Treatment for vaginal cancer varies depending on tumor histology, size, location and staging, and may include one or more of the following: surgical excision, radiation therapy and/or chemotherapy. All treatments negatively affect fertility/pregnancy outcomes.Pelvic radiation therapy, even in doses < 2 Gy, may extinguish up to 50% of immature oocytes. In addition, radiotherapy may cause modifications in cervical length, loss of uterine junctional zone anatomy and lead to myometrial atrophy and fibrosis, increasing the risk for adverse pregnancy outcomes. Methods: Case report of a patient who carried a pregnancy to term after surgery and brachytherapy for vaginal cancer. Results: A 28 year-old woman, presented with a 3 cm right midvagina wall tumor, diagnosed as grade 2, vaginal squamous cell carcinoma - FIGO 2009, stage IB. Computed tomography showed no evidence of lymph node involvement or distant metastasis. The patient underwent surgery followed by 4 fractions of vaginal brachytherapy, once a week, with a dose of 6 Gy at a 5 mm depth, amounting to a total dose of 24 Gy.One year and 9 months after treatment, the patient gave birth to a healthy child at 39 weeks pregnancy. A C-section was needed due functional dystocia during labor. Conclusion: This case report recounts a successful pregnancy carried to term after surgery and brachytherapy for squamous cell vaginal cancer.

Oncological Surgery During the COVID-19 Pandemic: Effectiveness of Preoperative Screening and Factors Associated with Postoperative SARS-CoV-2 Infection.

BACKGROUND: Routine preoperative screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with reverse transcriptase-polymerase chain reaction (RT-PCR) may reduce in-hospital SARS-CoV-2 transmission. METHODS: This was a prospective, observational, cohort study. The endpoints were the incidence of asymptomatic patients with positive preoperative RT-PCR results and the incidence and factors associated with postoperative SARS-CoV-2 infection in patients with cancer referred for elective surgery. Patients with elective surgery between May and October 2020 were included. RT-PCR of nasopharyngeal swabs was performed preoperatively for all patients. Postoperative SARS-CoV-2 infection was assessed within 30 postoperative days. RESULTS: A total of 1636 preoperative screening RT-PCR tests were performed. Of these, 102 (6.2%) cases were positive, and 1,298 surgical procedures were analyzed. The postoperative SARS-CoV-2 infection rate was 0.9%. The length of stay (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.04-1.11; p < 0.001), surgical time (OR 1.004; 95% CI 1.001-1.008; p = 0.023), intensive care unit admission (OR 7.7; 95% CI 2.03-29.28; p = 0.003), and hospital readmissions (OR 9.56; 95% CI 2.50-36.56; p = 0.001) were associated with postoperative coronavirus disease (COVID-19). Using unadjusted and adjusted logistic regression, length of stay (OR 1.08; 95% CI 1.04-1.11; p < 0.001), and readmission (OR 9.02; 95% CI 2.30-35.48; p = 0.002) were independent factors of postoperative COVID-19. CONCLUSIONS: Screening patients preoperatively may reduce in-hospital SARS-CoV-2 transmission. Length of stay and readmission were independently correlated with postoperative COVID-19.

Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve.

BACKGROUND: Laparoscopic stripping is the gold-standard treatment for ovarian endometriosis. The choice of hemostasis method might affect ovarian reserve. OBJECTIVES: To determine whether bipolar electrocoagulation is more detrimental to ovarian reserve than non-thermal hemostasis methods. SEARCH STRATEGY: Entry terms associated with the MeSH terms "endometrioma," "laparoscopy," and "ovarian reserve" were used to search databases for articles published up to April 3, 2017, in English, Spanish, Portuguese, French, and Italian. SELECTION CRITERIA: Randomized controlled trials comparing the 3-month postoperative serum anti-Müllerian hormone (AMH) level in premenopausal women undergoing laparoscopic stripping with bipolar hemostasis or non-thermal hemostasis methods were selected. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers and a meta-analysis was performed. MAIN RESULTS: Three studies met the inclusion criteria; overall, 105 patients underwent surgery with bipolar electrocoagulation and 105 patients underwent surgery with an alternative hemostasis method. The AMH level 3 months after surgery was decreased in the bipolar electrocoagulation group (mean difference -0.79 ng/mL, 95% confidence interval -1.19 to -0.39). CONCLUSIONS: Bipolar electrocoagulation negatively impacts ovarian reserve and should be avoided, especially for patients with reproductive goals.