Alternatives to commonly used pelvic reconstruction procedures in gynecologic oncology

Objectives

The objective of this review is to discuss alternatives to commonly used methods of soft tissue reconstruction in patients with gynecologic malignancies, and in particular alternatives to skin grafts, local skin flaps, and rectus abdominis/gracilis flaps.

Methods

A review of the literature was performed on soft tissue reconstruction in patients with gynecologic malignancies.

Results

Soft tissue reconstruction is often necessary to achieve successful wound healing, minimize complications, and to restore anatomic form and function. Commonly used methods such as skin grafts, local skin flaps, and rectus abdominis/gracilis flaps are effective, but many scenarios exist where they may be suboptimal or unavailable for use. Situations faced by the gynecologic oncologist where this may be the case include patients in whom prior treatments and/or tumor involvement have affected the vascular supply and tissues of commonly used options, those with disease recurrence who have previously undergone tumor extirpation and reconstruction, and patients undergoing radical surgery where commonly used options alone are inadequate. Under these circumstances, there are several alternative options, and an understanding of the full spectrum of reconstructive techniques is essential.

Conclusions

Many clinical scenarios exist where commonly used options for soft tissue reconstruction are suboptimal or unavailable. Current evidence supports use of alternative methods of reconstruction in these situations. However, further larger scale and comparative studies are needed to refine surgical decision-making.     

An Unusual Abdominal Cystic Mass in the Round Ligament of the Uterus: A Case Report

BackgroundCystic tumor of the round ligament is extremely rare. To our knowledge, this is the first case reported in the literature of a round ligament giant serous cystadenoma.CaseA 17-year-old adolescent who presented with massive abdominal swelling and was later identified as a serous cystadenomas of the round ligament with a size of approximately 50 cm. A multidisciplinary team including gynecologist, surgeon, and urologist performed the surgical cyst excision and she has recovered well without any complications.Summary and ConclusionRound ligament serous cystadenomas could grow to any size when there is a diagnosis. In addition, even in unusual locations, round ligament serous cysts should be kept in the differential diagnosis of abdominal masses.     

Epidemiology of maternal morbidity and mortality

Maternal morbidity and mortality remains a significant health care concern in the United States, as the rates continue to rise despite efforts to improve maternal health. In 2013, the United States ranked 60th in maternal mortality worldwide. We review the definitions, rates, trends, and top causes of severe maternal morbidity and mortality, as well as risk factors for adverse maternal outcomes. We describe current local and national initiatives in place to reduce maternal morbidity and mortality and offer suggestions for future research.     

The role of the serum inflammatory markers for predicting the tubo-ovarian abscess in acute pelvic inflammatory disease: a single-center 5-year experience

Objective

To compare patients with tubo ovarian abscess (TOA) and non-TOA acute pelvic inflammatory disease (PID) and to determinate admitted day laboratory cut-off values for the TOA.

Materials and methods

Files of inpatients admitted to our clinic with the diagnoses of PID and/or TOA between the years of 2006 and 2011. Laboratory and culture results were obtained from the database of hospital. A total of 73 patients diagnosed with PID and/or TOA were evaluated. Patients who were diagnosed with TOA and PID by physical and sonographic examination were assigned to group 1 and group 2, respectively. Both groups were compared in terms of laboratory, clinical, and epidemiological parameters.

Results

Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found. Mean age of patients was determined as 41.4 ± 7.7 in group 1 and as 35.1 ± 6.8 in group 2. Abscess was detected more frequently in patients with low socio-cultural level, and this was found to be statistically significant. The diameter of abscess was found to be ≥5 cm in 39 (88.6 %) patients and <5 cm in 5 (11.4 %) patients. The average length of hospital stay was statistically significantly increased in patients with an abscess of ≥5 cm in size compared to patients with an abscess of <5 cm. When C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte counts were statistically evaluated by ROC curves, diagnostic ability of CRP, ESR and leukocyte count was found to be 73, 87, and 58 %. CRP has a specificity of 63 % and a sensitivity of 72 % if cut-off value is considered as 11.5 mg/L whereas ESR has a specificity of 83 % and a sensitivity of 79 % if cut-off value is considered as 19.5 mm/1/2 h.

Conclusion

ESR >19.5 mm/1/2 h and CRP >11.5 mg/L were the best predictors of TOA. The high level of CRP and ESR was associated with longer duration of hospitalization and disease severity, and these levels were statistically significantly associated with TOA size of ≥5 cm.     

Conservative management of cervical ectopic pregnancy: systemic methotrexate followed by curettage

Introduction

Cervical ectopic pregnancy is among the rarest clinical conditions happening in women of reproductive age. Yet its management can cause a high rate of morbidity. Therefore, conservative treatment of this condition is a matter of debate.

Material and methods

Hereby we present two cases of cervical ectopic pregnancies that were managed successfully with a conservative approach.

Conclusion

Cervical ectopic pregnancy can be managed successfully with systemic Metotroxsate followed by curettage.     

Current Practice Patterns in Locally Advanced Rectal Cancer at Academic Institutions: A National Survey Among Radiation Oncologists,Medical Oncologists,and Colorectal Surgeons

PurposeTo assess the current treatment patterns in locally advanced rectal cancer (LARC) among radiation oncologists (RO), medical oncologists (MO), and colorectal surgeons (SR) specializing in gastrointestinal (GI) malignancies at academic institutions.Materials and MethodsAn online survey consisting of 7 LARC clinical vignettes was distributed to GI specialists practicing at ACGME accredited academic institutions. Treatment paradigms consisted of long-course chemoradiation (LC-CRT) and short-course (SCRT) radiotherapy, chemotherapy (CHT), and surgery. The survey was open from January to April 2021.ResultsThirty-six RO, 14 MO and 21 SR (71/508 physicians) replied resulting in a response rate of 14.0%. For low rectal node positive tumors, 88.7% of primary recommendations incorporated TNT (73.1% LC-CRT, 26.9% SCRT). NOM was preferred by 41.3% if a clinical complete response (cCR) was achieved. The presence of high-risk features led 95.8% of physicians to employ TNT (79.4% LC-CRT, 20.6% SCRT). For a cT3N1-2 mid-rectal tumor without high-risk features, 85.9% would primarily recommend TNT (56.6% LC-CRT, 43.4% SCRT). For a cT4bN2a mid-rectal tumor without high-risk features, 97.2% of primary recommendations included TNT (76.9% LC-CRT, 23.1% SCRT).ConclusionAmong academic RO, MO, and SR, the traditional regimen of LC-CRT, surgery, and adjuvant CHT is now infrequently recommended for LARC. TNT has been widely adopted for locally advanced node positive rectal tumors with variable patterns of care with respect to sequencing of CHT and RT. Fractionation with LC-CRT remained the majority. Non-operative management after a cCR in low rectal tumors has gained traction transforming LARC from a once classically perceived surgical disease.     

Altered expression of TGF-β1 and TGF-βR2 in tissue samples compared to blood is associated with food habits and survival in esophageal squamous cell carcinoma

In the transforming growth factor β (TGF-β) signaling pathway, TGF-β1 and TGF-β receptor 2 (TGF-βR2) are essential regulatory components which play an important role in different type of cancer. Expressions of TGF-β1 and TGF-βR2 were done by real-time qPCR in both biopsy and blood samples collected from esophageal squamous cell carcinoma (ESCC) patients (n = 76). The expression profiles were correlated with different lifestyle factors and clinicopathological parameters. Kaplan-Meier survival analysis and Cox regression analysis were performed to estimate survival and hazard outcomes of different parameters. TGF-β1 showed upregulation in 91% tissue samples (2.84 ± 1.34*) and 55% blood samples (2.43 ± 1.24*) whereas expression of TGF-βR2 showed downregulation in 89% tissue samples (0.27 ± 0.23*) and 75% blood samples (0.30 ± 0.26*). Among all the parameters, TGF-β1 expression is significant with histopathology grade, consumption of betel nut and smoked food whereas TGF-βR2 expression is significant only with dysphagia grade in both blood and tissue samples and while analyzing both male and female patients separately. Consuming alcohol and hot food, difference in tumor stage and metastasis were found to have statistically significant (P < 0.05) impact on survival and mortality of male patients while consuming hot food, tobacco, metastasis and TGF-βR2 expression in tissue level were found to associate with survival and mortality of female patients. Expression of both TGF-β1 and TGF-βR2 in tissue samples may be prospective biomarkers for screening of ESCC among the Northeast population. Survival outcomes and hazard analysis supports the importance of some clinicopathological and lifestyle factors on ESCC development, whereas expression study depicts association of change in expression of the studied genes in ESCC patients.*Mean fold change.     

Exploring prior diseases associated with pancreatic cancer

Background Pancreatic cancer (PC) is among the most deadly forms of cancer; however, the risk factors of PC have yet to be sufficiently identified. In the present study, we sought to screen all prior diseases associated with PC incidence concurrently and construct pathways for the diseases. Materials and methods This total population-based case–control study used data collected from Taiwan's National Health Insurance Research Database for the period covering 1997–2013. The case group included 3726 patients newly diagnosed with PC, who were precisely matched to 3726 controls based on gender, age, residence, and insurance premiums. Stepwise multivariate logistic regression was used to screen previous diseases in windows of 1, 2 …, 9 years prior to the first diagnosis of PC. Path analysis was used to construct the pathways between relevant prior diseases and PC. Results Within 1 year prior to PC diagnosis, a total of 11 diseases were significantly correlated with PC, included 9 positive and 2 negative associations. Path analysis identified diabetes, pancreatitis as diseases with direct positive pathways to PC incidence, and dementia with direct negative pathways. Conclusions It appears that diabetes, peptic ulcer, and digestive conditions were the prior diseases associated with PC incidence.