Hysterectomy for primary gynaecological malignancies in a non-cancer centre: prevalence, indications and surgical outcomes at a tertiary hospital in Port-Harcourt, Nigeria: a six-year review

Background: Gynaecological malignancies continue to be an important public health problem globally and are among the leading causes of morbidity and cancer-related deaths worldwide. In developing countries there is poor awareness and late presentation, and specialized cancer treatment centers are few, necessitating the gynaecologists at the tertiary hospitals to render surgical care for some cancer patients. The objective of the study was to determine the prevalence, indications, and surgical outcome of hysterectomy for primary gynaecological malignancies and assess the associated factors.Methods: This was a retrospective review of hysterectomies performed between March 2015 and February 2021. Data were obtained from operating theater and gynaecological ward records. Information on age, parity, indication, length of surgery, blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using Statistical package for social sciences (SPSS) version 20.Results: Of 1240 major gynaecological surgeries, 26 were hysterectomies for malignant conditions giving a prevalence of 2.1%. Commonest indication was Endometrial cancer 16 (61.5%), followed by cervical cancer 3 (11.5%) and ovarian malignancy 3 (11.5%). There was a significant relationship between age (p=0.027) with the indications for hysterectomy. Commonest complication was anaemia 6 (23.1%) and wound sepsis 5 (19.2%). Anaemia was significantly associated with duration of surgery (p=0.004) and estimated blood loss (p=0.005).Conclusions: The prevalence of 2.1% for a non-cancer center is a fair contribution to efforts at caring for cancer patients. All surgeries were simple TAH±BSO and more than half were done for endometrial cancer. Further training of cancer surgeons and establishment of a Cancer Centre in the State is needed.

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Non Descent Vaginal Hysterectomy: A Rational Surgical Approach

KYAMC Journal ◽

10.3329/kyamcj.v6i2.33743 ◽

2017 ◽

Vol 6 (2) ◽

pp. 637-641

Author(s):

Arifa Akter Zahan ◽

Kh Shahnewaz ◽

Ummay Salma

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Average Duration ◽

Uterine Prolapse ◽

Rational Approach ◽

Medical College ◽

Gynecological Disorders ◽

Estimated Blood Loss ◽

Duration Of Surgery

Aims: To evaluate the rational approach of non-descent vaginal hysterectomy in advancing gynaecology practice.Study Design: Retrospective study and period from 1st July 2013 to 31st June 2014. Setting Kumudini Women's Medical College & Hospital, Mirzapur, Tangail.Patients: All selective patients requiring hysterectomy for benign gynecological disorders who did not have any uterine prolapse were recruited for this study. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus.Main outcome measures: Data regarding indication, age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded.Results: A total of 50 cases were selected for non-descent vaginal hysterectomy all of them successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 46%. All patients were parous. Uterus size was less then 8 wks 21 cases, 8wks to 12 wks in 27 cases, more then 12 wks 02 cases. Commonest indication was DUB of uterus (44%). Mean duration of surgery was 50.5 minutes. Mean blood loss was 100ml. Blood transfusion was required in four cases. Average duration of hospital stay was 3.1 days. Complications were minimal which included UTI and Vault infection.Conclusions: NDVH is safe feasible and patient friendly. We suggest that our modern gynecologist will be more expertise and familiar to this procedure in near future.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 637-641

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Antifibrinolytic Therapy and Perioperative Blood Loss in Cancer Patients Undergoing Major Orthopedic Surgery

Anesthesiology ◽

10.1097/00000542-200302000-00011 ◽

2003 ◽

Vol 98 (2) ◽

pp. 337-342 ◽

Cited By ~ 55

Author(s):

David Amar ◽

Florence M. Grant ◽

Hao Zhang ◽

Patrick J. Boland ◽

Denis H. Leung ◽

...

Keyword(s):

Blood Loss ◽

Cancer Patients ◽

Orthopedic Surgery ◽

Controlled Trial ◽

Caproic Acid ◽

Double Blind ◽

Perioperative Blood Loss ◽

Transfusion Requirements ◽

Major Orthopedic Surgery ◽

Duration Of Surgery

Background Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether epsilon amino-caproic acid (EACA) is effective in this population are sparse. Methods Sixty-nine adults with malignancy scheduled for either pelvic, extremity or spine surgery during general anesthesia entered this randomized, double-blind, placebo-controlled trial, and received either intravenous aprotinin (n = 23), bolus of 2 x 10(6) kallikrein inactivator units (KIU), followed by an infusion of 5 x 10(5) KIU/h, or EACA (n = 22), bolus of 150 mg/kg, followed by a 15 mg/kg/h infusion or saline placebo (n = 24) during surgery. Our goal was to determine whether prophylactic EACA or aprotinin therapy would reduce perioperative blood loss (intraoperative + first 48h) >30% when compared to placebo. Results The mean age of the study population was 52 +/- 17 yr. The groups did not differ in age, duration of surgery, perioperative blood loss or number of packed erythrocyte units transfused. When compared to the placebo group, the two treated groups had a significantly lower D-Dimer level immediately after surgery, P < 0.01. Conclusions Under the conditions of this study, we were unable to find a clinical benefit to using aprotinin or EACA to reduce perioperative blood loss or transfusion requirements during major orthopedic surgery in cancer patients.

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Technique and feasibility of radical para-aortic and pelvic lymphadenectomy for gynecologic malignancies: a prospective study

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.1991.tb00028.x ◽

1991 ◽

Vol 1 (3) ◽

pp. 133-140 ◽

Cited By ~ 49

Author(s):

Benedetti. P. Panici ◽

G. Scambia ◽

G. Baiocchi ◽

S. Greggi ◽

S. Mancuso

Keyword(s):

Endometrial Cancer ◽

Blood Loss ◽

Operating Time ◽

Proximal Part ◽

Median Number ◽

Pelvic Lymphadenectomy ◽

Lymph Node Status ◽

Retroperitoneal Abscess ◽

Operating Data ◽

Estimated Blood Loss

Of 284 patients evaluated for entry into the study between January 1986 and June 1990, systematic para-aortic and pelvic lymphadenectomy was performed in 208 cases (108 cervical cancer, 43 and 57 ovarian and endometrial cancer, respectively). The median number of nodes removed was 58, 49 and 54 for cervical, ovarian and endometrial cancer, respectively. The operating data are divided into 2 groups according to the consecutive number of the cases. The median operating time and the median estimated blood loss of lymphadenectomy was 230 minutes (range 120–270) and 390 ml (range 200–3300) in the first 95 cases. These operating data decreased to 150 minutes (range 100–240) and 250 ml (range 100–2800) in the second 113 cases. No surgery-related deaths occurred. Severe hemor-rages (blood loss exceeding 1000 ml) occurred in 6 patients. The obturator nerve was dissected in 1 patient and in 1 case the left ureter was cut. Formation of lymphoceles occurred in 20.4% of patients. Eighteen patients (8.8%) developed deep venous thrombosis. Nine of these patients experienced pulmonary microembolism. In 3 patients a retroperitoneal abscess was diagnosed. One patient developed a fistula of the most proximal part of the right ureter during the third postoperative week. The resection or coagulation of branches of the genito-femoral and obturator nerves determined mild paresthesis localized at the supero-anterior and internal side of thigh in 11 cases (5.4%). No statistically significant differences were found between the clinical (age, weight and previous chemotherapy) and pathological (type of cancer and lymph node status) parameters considered on one hand and postoperative complications on the other.

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Cost comparison of treating low- and intermediate-risk endometrial cancer using time-derived, activity-based costing (TDABC) in a large regional cancer network delivery model.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.10 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 10-10

Author(s):

Nicole D. Fleming ◽

Karen H. Lu ◽

John D. Calhoun ◽

Anuja Jhingran ◽

Isidora Arzu ◽

...

Keyword(s):

Health Care ◽

Endometrial Cancer ◽

Cancer Patients ◽

Care Delivery ◽

Cancer Center ◽

Intermediate Risk ◽

Cost Difference ◽

Regional Network ◽

Network Location ◽

Cancer Network

9 Background: Value-based and quality health care delivery has become an important focus for many health care systems. The purpose of this study was to assess the cost differences in treating low and intermediate risk endometrial cancer using time-derived activity based costing (TDABC) in a large regional cancer network model. Methods: Process mapping and TDABC was performed in treating endometrial cancer patients at a large tertiary cancer center (main) with a regional cancer network program. Clinical visits and adjuvant therapy including high-dose rate vaginal cuff brachytherapy (VBT) and pelvic radiation (PRT) were performed in ambulatory treatment centers at each location. Surgery for endometrial cancer was performed at the main cancer center. Costs for each process point was determine by cost-capacity rates, and compared by treatment center location. Results: TDABC costing determined a 28.3% cost difference in ambulatory clinic visits for endometrial cancer patients, favoring treatment at the regional network location. There was no cost difference in surgery for endometrial cancer patients since all procedures were performed at main. Delivering adjuvant VBT was 44.2% more in the ambulatory regional center compared to main, primarily due to the radiation quality assurance checks at the regional site. TDABC costing determined a 39.8% cost difference in delivering PRT for intermediate risk endometrial cancer patients, favoring treatment at the regional network location. Overall, there was a 13.2% cost savings, favoring treatment at the regional cancer network location. Conclusions: Delivering care for low and intermediate risk endometrial cancer in a regional network model may represent a cost effective health care delivery method. Quality assurance checks at the regional locations are required for quality treatment delivery, however, may represent an area for cost effective process improvements or need to stratify treatment location based on complexity.

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Reduced 90-day postoperative mortality through geriatric comanagement after cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11512 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11512-11512 ◽

Cited By ~ 1

Author(s):

Armin Shahrokni ◽

Amy Tin ◽

Saman Sarraf ◽

Koshy Alexander ◽

Soo Jung Kim ◽

...

Keyword(s):

Cancer Patients ◽

Preoperative Evaluation ◽

Frailty Index ◽

Postoperative Mortality ◽

Operation Time ◽

Urgent Care ◽

Hospital Length Of Stay ◽

Cancer Center ◽

P Value ◽

Estimated Blood Loss

11512 Background: We explored the association between geriatric comanagement and 90-day postoperative mortality of cancer patients aged 75 or older. Methods: A retrospective review of a prospectively maintained database was performed on patients over 75 years old who underwent elective surgery with hospital length of stay of ≥1 day at Memorial Sloan Kettering Cancer Center from 2015-2018. Geriatric comanagement group (GCG) patients had geriatric preoperative evaluation and inpatient geriatric comanagement. Patients in the surgical management group (SMG) did not have geriatric preoperative evaluation or postoperative geriatric comanagement. We utilized a multivariable logistic regression model with 90-day mortality as the outcome, geriatric co-management as the predictor, and adjusted for age, gender, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index, preoperative albumin level, operation time, and estimated blood loss. The same logistic model was used to assess the association between adverse surgical events within 30-days (any major complication, readmission, or urgent care center visit) and geriatric comanagement. Results: Of 1,855 patients (median age 80), 1,009 patients (54%) were co-managed by geriatricians. GCG patients were slightly older, less likely to be male, had longer operation time, and stayed in the hospital longer. Adjusted rates of 90-day mortality was lower in GCG vs. SMG (4.3% and 9.2%, respectively; 95% CI around difference -7.3%, -2.5%; p-value < 0.0001). We did not find evidence of a difference in adverse surgical events between groups (OR 0.96, p-value = 0.8). A greater proportion of GCG patients received inpatient physical therapy (80% vs. 64%) and occupational therapy (37% vs. 25%) compared to SMG patients. Conclusions: Our study shows that geriatric comanagement is associated with reduced 90-day postoperative mortality in cancer patients aged ≥75. A randomized trial study is needed to confirm this finding.

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The public health significance of Trichuris trichiura

Parasitology ◽

10.1017/s0031182000006867 ◽

2000 ◽

Vol 121 (S1) ◽

pp. S73-S95 ◽

Cited By ~ 146

Author(s):

L.S. STEPHENSON ◽

C.V. HOLLAND ◽

E.S. COOPER

Keyword(s):

Public Health ◽

Blood Loss ◽

Protein Energy Malnutrition ◽

Public Health Problem ◽

Preschool Age ◽

Educational Opportunities ◽

Community Control ◽

Repeated Treatment ◽

Important Public Health Problem ◽

Poor Growth

An estimated 1049 million persons harbour T. trichiura, including 114 million preschool-age children and 233 million school-age children. The prevalence of T. trichiura is high and may reach 95% in children in many parts of the world where protein energy malnutrition and anaemias are also prevalent and access to medical care and educational opportunities is often limited. The Trichuris dysentery syndrome (TDS) associated with heavy T. trichiura, which includes chronic dysentery, rectal prolapse, anaemia, poor growth, and clubbing of the fingers constitutes an important public health problem, as do lighter but still heavy infections, even if not strictly TDS, especially in children. The profound growth stunting in TDS can be reversed by repeated treatment for the infection and, initially, oral iron. However findings from Jamaica strongly suggest that the significant developmental and cognitive deficits seen are unlikely to disappear without increasing the positive psychological stimulation in the child's environment. The severe stunting in TDS now appears likely to be a reaction at least in part to a chronic inflammatory response and concomitant decreases in plasma insulin-like growth factor-1 (IGF-1), increases in tumor necrosis factor-α (TNF-α) in the lamina propria of the colonic mucosa and peripheral blood (which likely decrease appetite and intake of all nutrients) and a decrease in collagen synthesis. Improvements in cognitive performance have been found after treatment for relatively heavy infections (without chronic dysentery) in school-going children; it is unclear precisely how much T. trichiura interferes with children's ability to access educational opportunities, but treatment of infections whenever possible is obviously sensible. The blood loss that can occur in T. trichiura infection is likely to contribute to anaemia, particularly if the child also harbours hookworm, malaria and/or has a low intake of dietary iron. Community control is important, particularly for the individuals within a population who harbour heavy worm burdens; this means children, with special attention to girls who will experience increased iron requirements and blood loss due to menstruation, pregnancies, and lactation. Mebendazole and albendazole, both of which are on the WHO Essential Drugs List, are very effective against T. trichiura; multiple doses are needed to attain complete parasitological cure in all cases. However the goal of control programmes in endemic areas is morbidity reduction, which follows when intensity of infection is significantly reduced.

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The Effectiveness and Safety of Ultrasonic Bone Scalpel Versus Conventional Method in Cervical Laminectomy: A Retrospective Study of 311 Patients

Global Spine Journal ◽

10.1177/2192568219876246 ◽

2019 ◽

Vol 10 (6) ◽

pp. 760-766

Author(s):

Bharat R. Dave ◽

Ajay Krishnan ◽

Ravi Ranjan Rai ◽

Devanand Degulmadi ◽

Shivanand Mayi ◽

...

Keyword(s):

Blood Loss ◽

Conventional Method ◽

Nerve Root ◽

Surgical Complications ◽

Nerve Root Injury ◽

Cervical Laminectomy ◽

C5 Palsy ◽

Root Injury ◽

Estimated Blood Loss ◽

Duration Of Surgery

Study Design: Retrospective cohort study. Objectives: The aim of this study was to compare the results of cervical laminectomy (CL) performed with ultrasonic bone scalpel (UBS) or conventional method (CM). Method: This study comprised 311 CL performed by a single surgeon between January 2004 and December 2017. Group A (GpA) comprised 124 cases of CL performed using UBS, while Group B (GpB) comprised 187 cases of CL performed using CM. These 2 groups were compared in terms of demographic characteristics of patients, duration of surgery, estimated blood loss, and surgical complications. Results: GpA included 112 males and 12 females, mean age being 61.18 years. GpB comprised 166 males and 21 females, mean age being 62.04 years. Mean duration of surgery, estimated blood loss, and length of hospital stay was 65.52/70.87 minutes, 90.24/98.40 mL, and 4.80/4.87 days in GpA and GpB, respectively. Six patients were reported to have dural injuries in each group. In GpA, 2 cases of C5 palsy and 1 nerve root injury was observed, while in GpB, 3 cases of C5 palsy and no nerve root injury was reported. One patient had developed transient neurological deterioration postsurgery in GpA as against 11 patients in GpB. Conclusion: Neurological complications observed in CM leads to intensive care unit admission, additional morbidity, and additional expenditure, whereas UBS provides a safe, rapid, and effective means of performing CL, thereby decreasing the rate of surgical complications and postoperative morbidity.

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Comparison of Laparoscopy and Laparotomy in Early-Stage Endometrial Cancer: Early Experiences from a Developing Country

Journal of Oncology ◽

10.1155/2020/2157520 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Yusuf Cakmak ◽

Duygu Kavak Comert ◽

Isik Sozen ◽

Tufan Oge

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Cancer Patients ◽

Early Stage ◽

Perioperative Complications ◽

Length Of Hospital Stay ◽

Endometrioid Endometrial Cancer ◽

Early Stage Endometrial Cancer

After minimally invasive surgery gained popularity in gynecology, laparoscopic operations became widespread among oncologic operations. However, more studies evaluating experiences of oncologic surgeons during the learning period of laparoscopy are needed. To compare the surgical outcomes and perioperative complications of laparoscopic surgery and laparotomy in the treatment of early-stage endometrioid endometrial cancer patients, we retrospectively investigated patients who underwent surgery due to endometrial cancer at our institution between 2014 and 2018. Early-stage (stage I) endometrioid endometrial cancer patients were included in the study. Operative times, length of hospital stay, extracted pelvic lymph nodes, perioperative complications, and blood loss were compared. A total of 128 patients were treated for stage I endometrial cancer during the study period. Sixty-two patients (48.4%) underwent laparoscopic surgery, and 66 (51.6%) patients underwent laparotomy. Median operation time and pelvic lymph node count in the laparotomy and laparoscopy groups did not demonstrate statistically significant differences. However, the length of hospital stay, estimated blood loss, and perioperative complication rate were lower in the laparoscopic surgery group. Laparoscopic surgery in early-stage endometrial cancer may be performed with less blood loss, shorter duration of hospital stays, and similar lymph node counts compared to laparotomic surgery.

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MICROBIOLOGICAL MONITORING OF PURULENT COMPLICATIONS IN CANCER PATIENTS

Problems in oncology ◽

10.37469/0507-3758-2018-64-1-121-125 ◽

2018 ◽

Vol 64 (1) ◽

pp. 121-125

Author(s):

Olga Khokhlova ◽

A. Alabusheva ◽

D. Kapshuk ◽

O. Yeremeeva ◽

V. Sergeeva ◽

...

Keyword(s):

Cancer Patients ◽

Public Health Problem ◽

Infectious Complications ◽

Antimicrobial Drugs ◽

Important Public Health Problem ◽

Microbiological Monitoring ◽

Oncological Patients ◽

Extended Action ◽

Bacteriological Method ◽

Clinically Significant

Infectious complications in cancer patients are an important public health problem. The purpose of the work is microbiological monitoring of purulent complications in cancer patients for the period 2003-2015. 4209 specimens from oncological patients were examined. The bacteriological method of investigation and PCR were used. It was established that gramnegative microflora occupied one of the leading places in the occurrence of purulent complications. A significant role was played by non-fermenting gram-negative pathogens - 32.8% of the total number of clinically significant strains. The main pathogens were characterized by a high degree of resistance to antimicrobial drugs - the proportion of MDR was 23.33%, XDR - 28.33%. The main mechanism of resistance in enterobacteria was the production of beta-lactamase of extended action (81.0%) including in K.pneumoniae (87.5%), E.coli (60.0%). During the follow-up period the number of methicillin -resistant strains increased significantly: MRSA - up to 52.5%, MRSE - up to 72.0%.

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Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center

Journal of Blood Transfusion ◽

10.1155/2014/301467 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Babatunde O. Akinbami ◽

Bisola Onajin-Obembe

Keyword(s):

Blood Loss ◽

Surgical Procedures ◽

Significant Relationship ◽

Cleft Lip ◽

Soft Tissues ◽

Care Center ◽

Mean Value ◽

Health Care Center ◽

Estimated Blood Loss ◽

Duration Of Surgery

Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3±(18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4±10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures.

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