-
Medicina (Kaunas, Lithuania) Nov 2022Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms:...
Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.
Topics: Female; Humans; Uterine Artery Embolization; Uterine Neoplasms; Leiomyoma; Hysterectomy; Abdominal Pain; Treatment Outcome
PubMed: 36556934
DOI: 10.3390/medicina58121732 -
Annals of Translational Medicine Nov 2022Hysterectomy is the most common type of gynecological operation in the United States. However, complications can occur during or after the operation. Some studies...
BACKGROUND
Hysterectomy is the most common type of gynecological operation in the United States. However, complications can occur during or after the operation. Some studies suggest that hysterectomy may increase the risk of stroke. However, other studies have found different conclusions on this matter. This inconsistent conclusion may be due to small sample sizes or limited covariates. So, we sought to further investigate the correlation between hysterectomy and stroke.
METHODS
Our analysis was based on the data from 2007-2018 National Health and Nutrition Examination Survey (NHANES). We excluded participants with missing hysterectomy data (Question "Have you had a hysterectomy, including a partial hysterectomy, that is, surgery to remove {your/her} uterus or womb?"), participants with missing stroke data (Question "Has a doctor or other health professional ever told you that you had a stroke?), a total of 15,241 participants were included in our analysis. To estimate the correlation between hysterectomy and stroke, logistic regression models were used after adjusting for sociodemographic and health-related factors, including age, race, education level, marital status, annual family income, body mass index (BMI), alcohol consumption in the past 12 months, having smoked at least 100 cigarettes in a lifetime, hypertension, hypercholesterolemia, and diabetes.
RESULTS
The unadjusted model suggests that women who had undergone a hysterectomy were 3.15 [95% confidence interval (CI): 2.67-3.71] times more likely to have a stroke than women who had not undergone a hysterectomy. In the crude and fully-adjusted models, the correlation between hysterectomy and stroke was consistent [odds ratio (OR) =1.55 (95% CI: 1.30-1.85), OR =1.36 (95% CI: 1.14-1.63)]. In the subgroup analysis stratified by age, hysterectomy seemed to have more risk for stroke occurrence regardless of subgroup, even after adjusting sociodemographic and health-related factors. Interestingly, the women who were less than or equal to 50 years old had greater odds of stroke (OR =1.96) compared with women who were aged older than 50 (OR =1.42).
CONCLUSIONS
In our study, we concluded hysterectomy may increase the risk of stroke. However, as our study is a cross-sectional study and unmeasured covariates may still exist, more researches are required to confirm this conclusion.
PubMed: 36544663
DOI: 10.21037/atm-22-4681 -
Cureus Nov 2022Uterine leiomyomas commonly reduce naturally after menopause. We report a rare case of metastasizing leiomyoma that grew after surgical menopause. A 68-year-old...
Uterine leiomyomas commonly reduce naturally after menopause. We report a rare case of metastasizing leiomyoma that grew after surgical menopause. A 68-year-old woman suffered from pelvic and lung masses without clinical symptoms. Nineteen years ago, she underwent a total hysterectomy and bilateral adnexectomy for multiple uterine myomas and bilateral endometriotic cysts. She has since been regularly prescribed conjugated estrogens. Surgery was scheduled in order to rule out malignancy; abdominal masses resection and thoracoscopic left partial pulmonary resection (S3, S4, S10) were performed. The histological diagnosis was leiomyoma in both abdominal and lung masses, and there was no evidence of gene mutations, which suggested that leiomyosarcoma was indicated. This case may indicate that hormone replacement was augmented via derived nutrient vessels after a surgical ovarian absence.
PubMed: 36540532
DOI: 10.7759/cureus.31549 -
BMC Women's Health Dec 2022The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases...
BACKGROUND
The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases need to be treated with hysterectomy or localized uterine lesion resection because of chemoresistant lesions and/or massive bleeding. We present a patient with post-molar GTN in the cesarean scar who was non-invasively treated with ultrasound-guided high intensity focused ultrasound (HIFU) to preserve the uterus and fertility.
CASE PRESENTATION
A 32-year-old woman was diagnosed with low-risk GTN (FIGO Stage I: 2 prognostic score) after partial hydatidiform mole. The 5th cycle of chemotherapy was interrupted because of persistent hepatic toxicity and impaired ovarian reserve function. However, the uterine lesion persisted (diameter of residual uterine lesion in the cesarean scar: 2.0 cm). Therefore, ultrasound-guided HIFU treatment was performed. A significant gray-scale change was observed during the HIFU treatment. Color Doppler ultrasonography and contrast-enhanced ultrasound (CEUS) was performed to evaluate the ablation effectiveness. Color Doppler ultrasonography showed disappearance of the signal of vascularity and CEUS showed no perfusion in the lesion located in the cesarean scar. The uterine lesion was obviously shrunken one month after HIFU treatment. Menstrual cycle resumed 48 days after HIFU. HIFU treatment decreased the number of chemotherapy cycles and there was complete disappearance of the GTN lesion at 4-month follow-up. The patient has shown no signs of recurrence as of 58-month follow-up.
CONCLUSION
Ultrasound-guided HIFU may be a useful alternative to lesion resection for GTN in the cesarean scar in patients who show chemoresistance or are not suitable for chemotherapy. It has the potential to ablate the residual uterine lesion noninvasively to preserve the uterus and fertility, avoiding perioperative risks of lesion resection, especially acute bleeding.
Topics: Pregnancy; Female; Humans; Adult; Cicatrix; Gestational Trophoblastic Disease; Hydatidiform Mole; Hysterectomy; Ultrasonography, Interventional; Uterine Neoplasms
PubMed: 36522625
DOI: 10.1186/s12905-022-02114-0 -
BMC Cancer Dec 2022Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB3 and IIA2 cervical cancer. However, the effectiveness of NACT and treatment options for NACT-insensitive patients have been concerning. This study will assess prognostic differences between NACT and primary surgery treatment (PST), determine factors associated with prognosis, and explore better adjuvant treatment modalities for NACT-insensitive patients.
METHODS
This study analyzed clinical characteristics, pathological characteristics, treatment options, and follow-up information of 774 patients with FIGO stages IB3 and IIA2 cervical cancer from 28 centers from January 2016 to October 2019 who participated in a multicenter, prospective, randomized controlled trial.
RESULTS
For patients undergoing NACT, the 5-year OS and PFS rate was 85.8 and 80.5% respectively. They were similar in the PST group. There was no significant difference in OS and PFS between clinical response (CR)/partial response (PR) groups and stable disease (SD)/progressive disease (PD) groups. Apart from deep cervical invasion (p = 0.046) affecting OS for patients undergoing NACT, no other clinical and pathological factors were associated with OS. 97.8% of NACT-insensitive patients opted for surgery. If these patients did not have intermediate- or high-risk factors, whether they had undergone postoperative adjuvant therapy was irrelevant to their prognosis, whereas for patients with intermediate- or high-risk factors, adjuvant chemotherapy resulted in better PFS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.019) and OS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.002).
CONCLUSIONS
NACT could be a choice for patients with FIGO stages IB3 and IIA2 cervical cancer. The main risk factor influencing prognosis in the NACT group is deep cervical invasion. After systematic treatment, insensitivity to NACT does not indicate a poorer prognosis. For NACT-insensitive patients, Chinese prefer surgery. Postoperative adjuvant therapy in patients with no intermediate- or high-risk factors does not improve prognosis, and chemotherapy in patients with intermediate- and high-risk factors is more effective than radiation therapy and other treatments.
TRIAL REGISTRATION
The study was prospectively registered on ClinicalTrials.gov (NCT03308591); date of registration: 12/10/2017.
Topics: Female; Humans; Neoadjuvant Therapy; Uterine Cervical Neoplasms; Prospective Studies; Neoplasm Staging; Retrospective Studies; Treatment Outcome; Chemotherapy, Adjuvant; Hysterectomy; Antineoplastic Combined Chemotherapy Protocols
PubMed: 36471257
DOI: 10.1186/s12885-022-10355-3 -
Advanced Biomedical Research 2022Hysterectomy is one of the most common gynecology surgeries. This study aimed to compare perioperative bleeding in transabdominal and transvaginal hysterectomy.
BACKGROUND
Hysterectomy is one of the most common gynecology surgeries. This study aimed to compare perioperative bleeding in transabdominal and transvaginal hysterectomy.
MATERIALS AND METHODS
This prospective, double-blind, randomized, controlled clinical trial was performed on 80 patients undergoing hysterectomy referred to Shahid Beheshti Hospital, Isfahan, Iran. Patients were divided into two groups of 40; the first group (T) received 1 g intravenous tranexamic acid (TXA) for 20 min preoperatively. The second group (S) received 10 cc normal saline as placebo. Blood samples were taken before and 12 h after surgery for assessment of hemoglobin, hematocrit, and platelet count, the prothrombin time, activated partial thromboplastin time, and serum creatinine as well as volume of blood transfusion.
RESULTS
There were no significant differences between the two groups in heart rate, diastolic blood pressure (BP), systolic BP, and mean arterial pressure before, during, and after surgery ( > 0.05). There was no significant difference in blood variables before and after surgery ( > 0.05) except the platelet count that was in the normal range in both groups after surgery ( = 0.022). The mean volume of blood transfused in the case group was significantly lower than the control group during surgery ( = 0.008) and 12 h after surgery ( = 0.01).
CONCLUSION
The prophylactic administration of TXA results in a significant reduction in need for blood transfusion and the duration of surgery. Given the lower risks of using TXA compared to the other drugs, it is recommended in hysterectomy to control bleeding.
PubMed: 36325167
DOI: 10.4103/abr.abr_56_21 -
Innovative Surgical Sciences Jun 2022Mucinous cystadenomas are among the most common benign adnexal masses. The peak incidence of mucinous cystadenoma appears between the third and fifth decades of life,...
OBJECTIVES
Mucinous cystadenomas are among the most common benign adnexal masses. The peak incidence of mucinous cystadenoma appears between the third and fifth decades of life, but rare cases in younger and older women have also been reported. Ovarian cystic formations are usually asymptomatic at early stages, until they grow in size and various compression symptoms appear, such as abdominal discomfort, distention, nausea, vomiting, and increased urination.
CASE PRESENTATION
This is a case of an 86-year-old woman with partial bowel obstruction due to a sizeable adnexal mass. The patient was submitted to exploratory laparotomy due to intestinal obstruction symptoms, the mass was removed and the final histopathological report indicated a benign mucinous cystadenoma (maximum diameter 25 cm). Physical examination was remarkable due to the large size of the mass. Computed tomography revealed the sizeable abdominal mass in contact with the uterus and the ovaries resulting in bowel compression. Exploratory laparotomy due to bowel obstruction symptoms confirmed the imaging results. The abdominal mass was removed without being ruptured, and total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy were done.
CONCLUSIONS
Our case report highlights the clinical suspicion that is required for the diagnosis and appropriate treatment of this clinical entity. These tumors are uncommon in postmenopausal women, and when they do appear, they can be difficult to differentiate from cancer.
PubMed: 36317011
DOI: 10.1515/iss-2022-0003 -
Journal of Robotic Surgery Jun 2023As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required...
As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic-assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: "robot*", "surgery", "volume" and "outcome" was performed. The included procedures were gynecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, esophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983,149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Significant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.
Topics: Male; Humans; Robotic Surgical Procedures; Robotics; Prostatectomy; Outcome Assessment, Health Care; Hospitals
PubMed: 36315379
DOI: 10.1007/s11701-022-01461-2 -
International Journal of Surgery Case... Nov 2022Report of an extremely rare case of triple Mullerian anomaly consisting of cervical agenesis, partial vaginal agenesis and complete bicorporeal uterus with functioning...
INTRODUCTION AND IMPORTANCE
Report of an extremely rare case of triple Mullerian anomaly consisting of cervical agenesis, partial vaginal agenesis and complete bicorporeal uterus with functioning endometrium associated with adenomyosis and pelvic endometriosis in a young girl managed with hysterectomy of both uterine horns and excision of pelvic endometriosis.
PRESENTATION OF CASE
A 20-year-old young woman presented with primary amenorrhoea and severe cyclical pain abdomen. She was diagnosed with a rare triple Mullerian anomaly consisting of cervical agenesis, partial vaginal agenesis and complete bicorporeal uterus with functioning endometrium associated with adenomyosis and pelvic endometriosis. She had undergone laparoscopic hematosalpinx drainage in an outside setting which provided her a temporary relief from symptoms. After an accurate pre-operative diagnosis of her condition, she underwent hysterectomy of both uterine horns as both the horns were grossly adenomyotic with hematometra.
DISCUSSION
This case is unique as two different developmental anomalies agenesis and lateral fusion defect were found together leading to a triple Mullerian anomaly with co-existing adenomyosis and endometriosis. Conservative surgery in this particular case had high probability for developing obstruction, sepsis or pelvic abscess later or repeat procedures/surgeries leading to increased morbidity. She was given the option for oocyte freezing along with gestational surrogacy if she desired fertility in future.
CONCLUSION
Early diagnosis and tailored intervention of Mullerian anomalies is essential to improve patients' quality of life. Definitive surgery in the form of hysterectomy should be considered if there are associated pathologies such as adenomyosis and endometriosis and findings such as hematometra.
PubMed: 36302313
DOI: 10.1016/j.ijscr.2022.107762 -
Gynecologic and Obstetric Investigation 2022The objective of this study was to explore a better adjuvant treatment for patients with high-grade (HG) neuroendocrine cervical carcinomas (NECC) who had undergone...
OBJECTIVES
The objective of this study was to explore a better adjuvant treatment for patients with high-grade (HG) neuroendocrine cervical carcinomas (NECC) who had undergone surgery as a primary treatment.
DESIGN
A retrospective cohort study, which involved women diagnosed as HG-NECC, was conducted in the Obstetrics and Gynecology Hospital of Fudan University. All patients had undergone radical surgery and pelvic lymphadenectomy with a laparotomy or a minimally invasive surgery. An analysis was made of the prognosis of HG-NECC.
METHODS
Overall survival (OS) and progression-free survival (PFS) curves were drawn using the Kaplan-Meier method to be compared via log-rank tests. A Cox proportional hazards model was used to estimate the independent prognostic factors.
RESULTS
A number of 110 patients diagnosed as HG-NECC at the pathological stage IA2 to IIIC2 according to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system were initially treated with a primary surgery between 2008 and 2020. The eligible patients had the median age of 42.5 years (range: 22-76), with the median follow-up period of 39.6 months (range: 1.0-156.6). The 5-year OS of the patients at pathological stage I, II, and III accounted for 84.9%, 85.7%, and 60.9%, respectively. The Kaplan-Meier survival curves revealed no significant differences in OS and PFS between postoperative chemoradiotherapy and chemotherapy alone (OS: p = 0.77; PFS: p = 0.41). Etoposide plus platinum therapy did not improve OS when compared with platinum plus paclitaxel therapy after surgery (p = 0.71). The univariable analysis showed that chemotherapy with cycles ≥4 presented a better prognosis than with cycles <4 (OS: p = 0.01; HR = 6.71; PFS: p = 0.02; HR = 5.18). The multivariate analysis indicated that the cycles of chemotherapy (p = 0.02; HR 0.29) were a prognostic factor for PFS.
LIMITATIONS
A retrospective design and the absence of partial follow-up data are limitations of the study.
CONCLUSIONS
In initially surgically treated HG-NECC, postoperative chemotherapy alone showed no inferiority when compared with chemoradiotherapy for HG-NECC, and 4+ cycles of chemotherapy tended to produce a better prognosis than 4-ones.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Middle Aged; Aged; Cervix Uteri; Retrospective Studies; Neoplasm Staging; Platinum; Hysterectomy; Prognosis; Carcinoma, Neuroendocrine; Uterine Cervical Neoplasms; Chemotherapy, Adjuvant
PubMed: 36273460
DOI: 10.1159/000527661