Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO)

2022 ◽  
pp. ijgc-2021-002812
Author(s):  
Nicolò Bizzarri ◽  
Andrei Pletnev ◽  
Zoia Razumova ◽  
Kamil Zalewski ◽  
Charalampos Theofanakis ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Surgery ◽  
Gynecologic Oncology ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Lymph Node Biopsy ◽  
European Network ◽  
Before And After ◽  
Level Of Training

BackgroundThe European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the training for gynecologic oncology fellows. The aim of this survey was to assess the type and level of training in cervical cancer surgery and to investigate whether the Laparoscopic Approach to Cervical Cancer (LACC) trial results impacted training in radical surgery for gynecologic oncology fellows.MethodsIn June 2020, a 47-question electronic survey was shared with European Network of Young Gynaecologic Oncologists (ENYGO) members. Specialist fellows in obstetrics and gynecology, and gynecologic oncology, from high- and low-volume centers, who started training between January 1, 2017 and January 1, 2020 or started before January 1, 2017 but finished their training at least 6 months after the LACC trial publication (October 2018), were included.Results81 of 125 (64.8%) respondents were included. The median time from the start of the fellowship to completion of the survey was 28 months (range 6–48). 56 (69.1%) respondents were still fellows-in-training. 6 of 56 (10.7%) and 14 of 25 (56.0%) respondents who were still in training and completed the fellowship, respectively, performed ≥10 radical hysterectomies during their training. Fellows trained in an ESGO accredited center had a higher chance to perform sentinel lymph node biopsy (60.4% vs 30.3%; p=0.027). There was no difference in the mean number of radical hysterectomies performed by fellows during fellowship before and after the LACC trial publication (8±12.0 vs 7±8.4, respectively; p=0.46). A significant reduction in number of minimally invasive radical hysterectomies was noted when comparing the period before and after the LACC trial (38.5% vs 13.8%, respectively; p<0.001).ConclusionExposure to radical surgery for cervical cancer among gynecologic oncology fellows is low. Centralization of cervical cancer cases to high-volume centers may provide an increase in fellows’ exposure to radical procedures. The LACC trial publication was associated with a decrease in minimally invasive radical hysterectomies performed by fellows.

scholarly journals Role of Minimally Invasive Surgery in Gynecologic Oncology: An Updated Survey of Members of the Society of Gynecologic Oncology

2015 ◽  
Vol 25 (6) ◽  
pp. 1121-1127 ◽  
Author(s):  
Lesley B. Conrad ◽  
Pedro T. Ramirez ◽  
William Burke ◽  
R. Wendel Naumann ◽  
Kari L. Ring ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Endometrial Cancer ◽  
Minimally Invasive Surgery ◽  
Robotic Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Single Port ◽  
Gynecologic Oncology ◽  
Pelvic Lymphadenectomy ◽  
Single Port Laparoscopy

ObjectivesTo evaluate the current patterns of use of minimally invasive surgical procedures, including traditional, robotic-assisted, and single-port laparoscopy, by Society of Gynecologic Oncology (SGO) members and to compare the results to those of our 2004 and 2007 surveys.MethodsThe Society of Gynecologic Oncology members were surveyed through an online or mailed-paper survey. Data were analyzed and compared with results of our prior surveys.ResultsFour hundred six (32%) of 1279 SGO members responded. Eighty-three percent of respondents (n = 337) performed traditional laparoscopic surgery (compared with 84% in 2004 and 91% in 2007). Ninety-seven percent of respondents performed robotic surgery (compared with 27% in 2007). When respondents were asked to indicate procedures that they performed with the robot but not with traditional laparoscopy, 75% indicated radical hysterectomy and pelvic lymphadenectomy for cervical cancer. Overall, 70% of respondents indicated that hysterectomy and staging for uterine cancer was the procedure they most commonly performed with a minimally invasive approach. Only 17% of respondents who performed minimally invasive surgery performed single-port laparoscopy, and only 5% of respondents indicated that single-port laparoscopy has an important or very important role in the field.ConclusionsSince our prior surveys, we found a significant increase in the overall use and indications for robotic surgery. Radical hysterectomy or trachelectomy and pelvic lymphadenectomy for cervical cancer and total hysterectomy and staging for endometrial cancer were procedures found to be significantly more appropriate for the robotic platform in comparison to traditional laparoscopy. The indications for laparoscopy have expanded beyond endometrial cancer staging to include surgical management of early-stage cervical and ovarian cancers, but the use of single-port laparoscopy remains limited.

Radical Surgery in Advanced Cervical Cancer Patients Receiving Bevacizumab-Containing Chemotherapy: A “Real Life Experience”

2018 ◽  
Vol 28 (8) ◽  
pp. 1569-1575 ◽  
Author(s):  
Anna Fagotti ◽  
Carmine Conte ◽  
Francesca Stollagli ◽  
Valerio Gallotta ◽  
Vanda Salutari ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Median Time ◽  
Radical Surgery ◽  
Intraoperative Complications ◽  
Gynecologic Oncology ◽  
Operating Time ◽  
Real Life ◽  
Pelvic Surgery ◽  
Platinum Based Chemotherapy ◽  
Estimated Blood Loss

BackgroundPlatinum-based chemotherapy plus bevacizumab is the new standard of care in stage IVB cervical cancer (CC) patients. In this new scenario, radical surgery could be offered in selected cases with an optimal clinical response. Potential surgical complications related to previous bevacizumab treatment have never been described before in this type of setting.MethodsThis is a single-institutional retrospective study on women with CC who received radical pelvic surgery after platinum-based chemotherapy (platinum-taxol) plus bevacizumab.ResultsBetween April 2016 and September 2017, 15 patients with CC underwent radical surgery after bevacizumab-containing chemotherapy (platinum-taxol) at the Division of Gynecologic Oncology, Catholic University of the Sacred Heart in Rome, Italy.All patients received at least 3 cycles of treatment. Fourteen (93.4%) patients underwent radical hysterectomy, whereas 1 patient received pelvic anterior exenteration. Median operating time was 290 minutes (range, 220–400), and estimated blood loss was 250 mL (range, 50–1500). Median time of hospitalization was 5 days (range, 2–21). Pathological response in the cervix was complete in 3 cases and microscopic in 1 patient (26.7%). Intraoperative complications occurred in 3 cases: 2 vascular injuries and 1 ureteral injury. Three patients (20.0% of the whole series) experienced grade 3 complications.At last follow-up (median time, 9 months), the median overall survival is 13 months (range, 6–31): 7 (46.7%) women were free of disease, 8 (53.3%) patients progressed, and 3 of them died of disease.ConclusionsRadical surgery can be performed in women with CC previously treated with a bevacizumab-containing regimen.

Retrospective Validation of an Algorithmic Treatment Pathway for Necrotizing Pancreatitis

2019 ◽  
Vol 85 (8) ◽  
pp. 840-847
Author(s):  
Ryan C. Pickens ◽  
Jesse K. Sulzer ◽  
Allyson Cochran ◽  
Dionisios Vrochides ◽  
John B. Martinie ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Evidence Based ◽  
Robot Assisted ◽  
Delayed Treatment ◽  
Open Necrosectomy

The role of surgical intervention for necrotizing pancreatitis has evolved; however, no widely accepted algorithm has been established to guide timing and optimal modality in the minimally invasive era. This study aimed to retrospectively validate an established institutional timing- and physiologic-based algorithm constructed from evidence-based guidelines in a high-volume hepatopancreatobiliary center. Patients with necrotizing pancreatitis requiring early (≤six weeks from symptom onset) or delayed (>six weeks) surgical intervention were reviewed over a four-year period (n = 100). Early intervention was provided through laparoscopic drain-guided retroperitoneal debridement (n = 15) after failed percutaneous drainage unless they required an emergent laparotomy (due to abdominal compartment syndrome, bowel necrosis/perforation, or hemorrhage) after which conservative, sequential open necrosectomy was performed (n = 47). Robot-assisted (n = 16) versus laparoscopic (n = 22) transgastric cystgastrostomy for the delayed management of walled-off pancreatic necrosis was compared, including patient factors, operative characteristics, and 90-day clinical outcomes. Major complications after early debridement were similarly high (open 25% and drain-guided 27%), yet 90-day mortality was low (open 8.5% and drain-guided 7.1%). Patient and operative characteristics and 90-day outcomes were statistically similar for robotic versus laparoscopic transgastric cystogastrostomy. Our evidence-based algorithm provides a stepwise approach for the management of necrotizing pancreatitis, emphasizing minimally invasive early and late interventions when feasible with low morbidity and mortality. Robot-assisted transgastric cystogastrostomy is an acceptable alternative to a laparoscopic approach for the delayed treatment of walled-off pancreatic necrosis.

Comparative effectiveness of laparoscopic radical hysterectomy for cervical cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17015-e17015
Author(s):  
Jung-Yun Lee ◽  
Jae-Weon Kim ◽  
Kidong Kim ◽  
Myong Cheol Lim ◽  
Jin Hee Kim
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Laparoscopic Approach ◽  
Population Level ◽  
Laparoscopic Radical Hysterectomy ◽  
Perioperative Morbidity ◽  
Level Data ◽  
Hospital Stays ◽  
Perioperative Complication

e17015 Background: Despite the benefits of minimally invasive surgery for cervical cancer, population-level data describing the surgery’s effectiveness in unselected patients are lacking. We compared morbidity, cost, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Methods: We used the Korean Health Insurance Review and Assessment Service database to identify women with cervical cancer who underwent radical hysterectomy from 2011 to 2014. Patient who underwent abdominal radical hysterectomy were compared with those who had minimally invasive hysterectomy. Perioperative morbidity, use of adjuvant therapy, and survival were evaluated. Results: We identified 6,335 patients including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. Uptake of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger and treated at larger hospital were more likely to undergo laparoscopic procedure (P<0.001). Laparoscopic radical hysterectomy had lower rates of complication, less transfusion requirement, shorter hospital stays, and reduced total medical costs (P<0.001). There was no significant association between use of laparoscopic approach and recurrence-free survival (P=0.194). Conclusions: Laparoscopic radical hysterectomy was associated with lower risk of perioperative complication and have comparable outcomes with abdominal radical hysterectomy.

scholarly journals Make New Friends But Keep the Old: Minimally Invasive Surgery Training in Gynecologic Oncology Fellowship Programs

2015 ◽  
Vol 25 (6) ◽  
pp. 1115-1120 ◽  
Author(s):  
Kari L. Ring ◽  
Pedro T. Ramirez ◽  
Lesley B. Conrad ◽  
William Burke ◽  
R. Wendel Naumann ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Objective Assessment ◽  
Gynecologic Oncology ◽  
Fellowship Training ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Fellowship Programs

ObjectivesTo evaluate the role of minimally invasive surgery (MIS) in gynecologic oncology fellowship training and fellows’ predictions of their use of MIS in their future practice.MethodsAll fellows-in-training in American Board of Obstetrics and Gynecology–approved training programs were surveyed in 2012 through an online or mailed-paper survey. Data were analyzed and compared to results of a similar 2007 survey.ResultsOf 172 fellows, 69 (40%) responded. Ninety-nine percent of respondents (n = 68) indicated that MIS was either very important or important in gynecologic oncology, a proportion essentially unchanged from 2007 (100%). Compared to 2007, greater proportions of fellows considered laparoscopic radical hysterectomy and node dissection for cervical cancer (87% vs 54%; P < 0.0001) and trachelectomy and staging for cervical cancer (83% vs 32%; P < 0.0001) appropriate for MIS. Of the respondents, 92% believed that maximum or some emphasis should be placed on robotic-assisted surgery and 89% on traditional laparoscopy during fellowship training. Ten percent rated their fellowship training in laparoendoscopic single-site surgery as very poor; 44% said that the question was not applicable. Most respondents (60%) in 2012 performed at least 11 procedures per month, whereas most respondents (45%) in 2007 performed 6 to 10 procedures per month (P = 0.005). All respondents at institutions where robotic surgery was used were allowed to operate at the robotic console, and 63% of respondents reported that in robotic-assisted surgery cases when a fellow sat at the robot, the fellow performed more than 50% of the case at the console.ConclusionsThese findings indicate that MIS in gynecologic oncology is here to stay. Fellowship programs should develop a systematic approach to training in MIS and in individual MIS platforms as they become more prevalent. Fellowship programs should also develop and apply an objective assessment of minimum proficiency in MIS to ensure that programs are adequately preparing trainees.

scholarly journals Robotic radical hysterectomy for early-stage cervical cancer: A systematic literature review

2021 ◽  
Vol 2 (2) ◽  
pp. 33-42
Author(s):  
Gun Oh Chong
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Radical Hysterectomy ◽  
Open Surgery ◽  
Early Stage ◽  
Laparoscopic Approach ◽  
Robotic Radical Hysterectomy ◽  
Early Stage Cervical Cancer

Robotic technology has recently come into widespread use to overcome the limitations of laparoscopic radical hysterectomy in the treatment of early-stage cervical cancer. Most comparative studies showed that blood loss and hospital stays for patients undergoing minimally invasive surgery, including robotic procedures, were superior compared to open surgery. Moreover, the survival outcomes of robotic radical hysterectomy were not inferior to open radical hysterectomy. Unexpectedly, the Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized, open-label, noninferiority study that compared minimally invasive radical hysterectomy with open radical hysterectomy, revealed that minimally invasive surgery was associated with a higher risk of recurrence and death compared with open surgery. Strict guidelines for robotic radical hysterectomy for the treatment of early-stage cervical cancer should be established in accordance with objective Korean data. In addition, it is recommended that further studies should be performed on how to avoid the use of uterine manipulators and the dissemination of cancer cells by ensuring a more effective vaginal closure using a standardized approach.

scholarly journals Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

2015 ◽  
Vol 143 (7-8) ◽  
pp. 410-415 ◽  
Author(s):  
Milos Bjelovic ◽  
Tamara Babic ◽  
Dragan Gunjic ◽  
Milan Veselinovic ◽  
Bratislav Spica
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Standard Of Care ◽  
High Volume ◽  
Thoracic Esophagus ◽  
Digestive Surgery ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE) has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE) as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach) for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36%) middle thoracic esophagus tumors and 28 (64%) tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes). The average blood loss was 173.6 ml. A total of 12 (27%) of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE), better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

scholarly journals Total Laparoscopic Nerve-Sparing Radical Hysterectomy Using the No-look No-touch Technique

2021 ◽  
Author(s):  
Atsushi Fusegi ◽  
Hiroyuki Kanao
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Poor Prognosis ◽  
Early Stage ◽  
Laparoscopic Approach ◽  
Nerve Sparing ◽  
Cancer Trial ◽  
Early Stage Cervical Cancer ◽  
Tumor Spillage

AbstractRadical hysterectomy is a standard operation for patients with early-stage cervical cancer. Over the recent decades, laparoscopic radical hysterectomy has been considered an alternative treatment. In 2018, the results of the laparoscopic approach to cervical cancer trial suggested that women with early-stage cervical cancer who underwent minimally invasive surgery for radical hysterectomy had poorer prognosis than those who underwent open surgery. This finding was unexpected, and direct evidence supporting poor prognosis related to minimally invasive radical hysterectomy was not available because the trial was not designed to evaluate the cause of the inferior outcomes. Tumor spillage caused by surgeon-related factors, including squeezing of the uterine cervix and tumor exposure to circulating CO2 gas, is considered to be associated with the poor prognosis of patients who underwent minimally invasive radical hysterectomy. We believe that protective maneuver to avoid tumor spillage is the key to improve oncologic outcomes of cervical cancer. Here, we present a procedure of total laparoscopic nerve-sparing radical hysterectomy for early-stage cervical cancer in which techniques, such as the “no-look no-touch technique,” were used to prevent tumor spillage.

Sign in / Sign up

Export Citation Format

Share Document