Pelvic exenteration: a retrospective study in a tertiary referral cancer center in the UK.

BACKGROUND: Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years. METHODS: This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period. RESULTS: The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively). CONCLUSIONS: The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Ultra-radical surgery for advanced ovarian cancer: a retrospective cohort study in a tertiary referral cancer center in the UK.

BACKGROUND: Ovarian cancer is the leading cause of death from gynecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and efficacy of this extensive surgery. The aim of this study was to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our findings with the current literature. METHODS: This is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate. RESULTS: The study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease-free survival time was 2.9 years while median disease-free survival time was 2 years. Age (P=0.028) and complete cytoreduction (p=0.048) were found to be significantly associated with survival. Primary debulking surgery was significantly associated with lower probability of recurrence (P=0.049). CONCLUSIONS: Although the number of patients is relatively small, our study indicates that ultra-radical surgery in centers with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited gynecological oncologist and a hepatobiliary general surgeon with a special interest in ovarian cancer. A few cases required input from a colorectal and a thoracic surgeon. We believe that the careful selection of the patients that can benefit from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to establish that ultra- radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.

The Impact of COVID-19 Pandemic in Orthopaedic Surgery Hospital Admissions and Workload in a Major Trauma Center.

The coronavirus disease 2019 (COVID-19) pandemic has led to important restrictions in social life of civilians worldwide and there were lower admission rates mainly in surgical departments in many hospitals. This study presents how COVID-19 pandemic affected admissions at the orthopaedic and trauma surgery department of a major trauma center. A retrospective study was conducted that recorded all patients examined at the outpatient orthopaedic clinic and the emergency orthopaedic department, as well as patients admitted to the orthopaedic surgery clinic and patients that underwent operative procedures between March 23 and May 4, 2020 (first lockdown period) and between March 23 and May 4, 2019 (control period). In addition, all patients with hip fractures that required hospitalization and underwent hip surgery were identified during the same time periods. During lockdown period 1 compared with the lock-down period 2 were observed: 70% and 61% decrease in the number of patients examined at the outpatient clinic and the emergency orthopaedic department respectively. The number of patients admitted to the orthopaedic surgery clinic declined by 41%, whereas operative procedures decreased by 22%. Regarding hip fractures timing to surgery during the first period was significantly less compared with second lockdown period, however, hospitalization days remained almost unchanged over the two time lockdown periods. Restrictions during the first lockdown period due to COVID-19 pandemic caused an important decrease in the number of patients and theaters in all orthopaedic departments in one of the major trauma centers in Athens. However, the incidence of hip fractures in elderly was not significantly decreased. Further similar studies are needed to identify variations and patterns of these parameters in other trauma centers.

A Rare Case of Clear Cell Cervical Carcinoma to a Woman, 50 Years After Diethylstilbestrol Exposure for Lactation Suppression.

A 73-year-old lady presented with post-menopausal bleeding and a suspicious-looking endocervical polyp. She had a loop biopsy of the cervix that showed clear cell cervical carcinoma, and she was referred to our Gynaecology oncology team for further management. Following imaging for staging and an MDT discussion, she had a total abdominal radical hysterectomy that confirmed the diagnosis. The diagnosis of clear cell adenocarcinoma of the cervix is rare, accounting for 4% of cervical carcinomas. However, it is often correlated with diethylstilbestrol (DES) exposure in utero. It is well documented that daughters of mothers who received DES during pregnancy are at a higher risk of adenocarcinomas in the genital tract. In our case, the patient had been administered DES for lactation suppression 50 years earlier. After reviewing the relevant literature, we present the case of our patient, the management of this uncommon case, and help identify possible correlation/long-term implications to patients who received DES.

Prophylactic Bilateral Salpingo-oophorectomy in BRCA2 Mutation with Incidental Finding of Serous Tubal Intraepithelial Carcinoma (STIC) and Subsequent Diagnosis of Primary Peritoneal Carcinoma (PPC): A Case Report and Review of Current Literature.

A major effort to prevent serous cancer in genetically susceptible women with breast cancer susceptibility gene (BRCA) mutations has recently introduced the practice of risk-reducing prophylactic salpingo-oophorectomy. A small number of those who undergo prophylactic salpingo-oophorectomy will be found to have occult carcinomas. The majority of these appear to originate in the fallopian tube, reinforcing the theory that a significant proportion of high-grade serous carcinoma pelvic tumours have a fimbrial origin. In addition to this, histopathological and molecular biological characteristics suggest that among other serous carcinomas, fallopian tube serous carcinoma and primary peritoneal serous carcinoma really represent one entity. We present a case with breast cancer susceptibility gene 2 (BRCA2) mutation that was found to have serous tubal intraepithelial carcinoma (STIC) following prophylactic salpingo-oophorectomy. Subsequently, she was diagnosed with advanced primary peritoneal carcinoma. This prompted our team to reflect upon the case, review the current literature and recommend a rigorous preoperative assessment and meticulous intraoperative examination for prevention and early detection of high grade serous pelvic carcinomas.

Correlation Between Urodynamic and Clinical Diagnoses in Classifying the Type of Urinary Incontinence in Women.

Urodynamic tests are considered the gold standard for investigating and managing patients with urinary incontinence symptoms. The objective of this review is to determine the correlation between urodynamic and clinical diagnoses in identifying the type of urinary incontinence in pre and postmenopausal women. This is a retrospective review of 116 women with urinary incontinence symptoms that were evaluated clinically initially and then investigated further with urodynamic tests. The results of the urodynamic studies were compared with the diagnosis assigned based on the clinical evaluation. For 69 women, the clinical diagnosis was not confirmed by urodynamic tests. In addition to this, the clinical diagnosis was confirmed by urodynamic investigations in only 38% of the patients. This is in accordance with current literature, which is suggestive that the agreement between urodynamic studies and clinical evaluation in identifying the type of urinary incontinence is poor. Larger definite trials are needed to provide further evidence of the diagnostic value of urodynamic tests in the management of patients with urinary incontinence symptoms.