Para-aortic lymph node dissection for women with endometrial adenocarcinoma and intermediate- to high-risk tumors: does it improve survival?

OBJECTIVE: Literature suggests that para-aortic lymphadenectomy (para-aortic lymph node dissection [PALND]) has a therapeutic benefit for women with intermediate- to high-risk endometrial adenocarcinoma. We hypothesized that the observed survival advantage of PALND is a reflection of the general health of the patient rather than a therapeutic benefit of surgery. METHODS: Women with intermediate- to high-risk endometrial adenocarcinoma diagnosed from 2002 to 2009 at a single institution were identified. Medical comorbidities, pathology, and survival information were abstracted from the medical record. The χ test or the t test was used for univariate analysis. Overall survival (OS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method. RESULTS: A total of 253 women with a mean age of 64 years were identified. Of these women, 174 had a pelvic lymphadenectomy (pelvic lymph node dissection [PLND]) and 82 had PLND and PALND. The rate of positive nodes was 13% (23/174) for the women who had PLND and was 7% (6/82) for those who had PLND and PALND. Only 1.2% (1/82) of the women who had PLND and PALND had negative pelvic but positive para-aortic nodes. The patients who had PALND had a lower body mass index and were less likely to have significant medical comorbidities. The patients who had PALND had improved 5-year OS (96% vs 82%, P = 0.007) but no difference in 5-year DSS (96% vs 89%, P value = not significant). CONCLUSIONS: Women with intermediate- to high-risk endometrial adenocarcinoma who undergo PALND have improved OS but no improvement in DSS. The lack of difference in DSS supports the hypothesis that underlying comorbidities as opposed to lack of PALND result in poorer outcome.

Constructed wetlands combined with UV disinfection systems for removal of enteric pathogens and wastewater contaminants.

Water shortage is an ongoing cardinal issue in the Middle East region. Wastewater reuse offers some remediation, but to-date many rural communities in the Palestinian Authority (PA) and in Jordan are not connected to centralized wastewater treatment plants (WWTPs), many of them are disposing of their wastewater using infiltration septic tanks. This highlights the need for a small, local, low cost WWTP that can directly benefit local communities, producing effluents suitable for unrestricted irrigation. Constructed wetlands (CWs) could offer a solution as they are relatively easy and cheap to construct and maintain, and effective in removal of many pollutants. Nevertheless, pathogen removal in CWs is often not adequate, calling for additional disinfection. Here we describe the use of low-cost, consumer level, UV based disinfection systems coupled to CWs for wastewater treatment in three CWs: in Israel, Jordan and in the PA. Once mature, our adapted CWs reduced chemical oxygen demand (COD) load, and, given proper use of the UV systems, inactivated indicator bacteria (faecal and E. coli) to levels suitable for irrigation, even when UV transmission (UVT) levels were low (∼40%). Our results demonstrate the promise in this combined treatment technique for cheap and simple wastewater treatment suitable for the Middle East region.

Frailty: an outcome predictor for elderly gynecologic oncology patients.

OBJECTIVES: The objective of this pilot study was to determine if frailty predicts surgical complications among elderly women undergoing gynecologic oncology procedures. METHODS: A cohort of gynecologic oncology patients age ≥ 65, undergoing surgery between March and December 2011 was identified. Frailty was evaluated using a validated assessment tool. The primary outcome measure was 30 day postoperative complication rate. RESULTS: Forty women were approached for study entry and 37 (92%) enrolled. The mean age was 73 years (range 65-95). The majority of women had a malignancy and underwent a major abdominal surgical procedure. Twenty-one women (57%) were not frail, 10 (27%) were intermediately frail and 6 (16%) were frail. There was no difference in age or prevalence of medical comorbidities between groups. Frail women had a significantly higher BMI compared to intermediately frail and not frail women, (36.0, 31.5 and 26.1 kg/m(2), p=0.02). The rate of 30-day surgical complications increased with frailty score and was 24%, versus 67% for women who were not frail as compared to the frail (p=0.04). CONCLUSIONS: Pre-operative frailty assessment is well accepted by gynecologic oncology patients and feasible in a clinic setting. Frail women had a higher BMI, indicating that low body weight is not a marker for frailty, and had a significantly higher rate of 30-day postoperative complications in this pilot study. Initial findings support the concept of measuring frailty as a possible predictor for postoperative morbidity that will allow for improved patient counseling and decision making.