Page 53 - Test PDF v5

« Back to Contents
LiFE re
Literature for ENYGO
Prevention and management of complications in surgical treatment of gynae-
cological malignancies (i.e., lymphocele, urological, wound, etc.) & technical
aspects/tricks of surgery in management of gynaecological malignancies
Editor Elisa Piovano
Descriptive summary
During the period covered by the third edition of the LiFE report, a
lot of published studies focused on intraoperative and postoperative
complications, especially in endometrial cancer. In particular, Cunning-
ham et al., Corrado et al. and Uccella et al. analysed the relationship
between obesity, minimally invasive surgery, and complications.
According to Cunningham et al. and Corrado et al, in robotic surgery,
high BMI was not associated with a higher complications and conver-
sion rates, with superimposable oncological outcomes. This was true
even in severely obese patients (note that similar conclusions on BMI
are reached in a parallel study by Mahdi et al. in patients affected by
ovarian cancer submitted to robotic surgery, even in terms of postop-
erative mortality). Uccella et al., on the other hand, suggested a higher mortality.
number of conversions from laparoscopy to laparotomy, total compli-
cations, wound complications, and venous thromboembolic events in
obese women compared to non-obese women in a non-randomised
study of 1,266 patients. They also report a lower number of lymphad-
enectomies performed in patients with BMI ≥40 in this last group of
patients. Despite all this, in obese patients laparoscopy was a more
favourable approach than laparotomy.
Guy et al. suggested, in their retrospective study on 16,980 women,
that the risks of surgery (both laparotomic and robotic) increase with
the age of the patient. A subanalysis on older patients found that
robotic approach has statistically significantly lower rates of periop-
erative surgical complications (8.3 % vs. 20.5 %, P < .001) and shorter
hospitalization than laparotomy. Nhokaew et al. studied 357 patients
treated with laparotomic hysterectomy in terms of wound complica-
tions (including seroma, hematoma, separation, or infection). They
report 7.8 % of wound complications are significantly associated with
obesity, diabetes mellitus, and prior abdominal surgery.
Bogani et al. then analysed the incisional recurrences after endo-
metrial cancer: This is a rare event (0.1 %) with a good prognosis if
incisional recurrence is isolated and treated with integrated local and
systemic treatment.
Another interesting topic, analysed by Minig et al. and Melamed et
al., is the fast track care (removal of urinary catheter at the end of
the surgery, early mobilization, and solid food intake) with same-day
discharge in women undergoing laparoscopic hysterectomy. They
reported there was no increased risk of complications and suggested
larger prospective studies to definitively establish the safety of this
Continued on the next page 
International Journal of Gynecological Cancer, Volume 26, Supplement #1
SURGICAL MANAGEMENT
approach. This could be a good point for a future multicentre study to
be shared among ENYGO members.
Four interesting papers dealing with the role of critical care units,
frailty, bowel obstruction and the use of PEG in gyne-onc patients
were published. Davidovic-Grigoraki et al. reviewed the role of critical
care units in the management of gynaecological oncology patients
and in the prevention of postoperative complications, underlining that
the management of patients in this setting should be part of gynaeco-
logic oncology fellowship programmes. George et al. retrospectively
analysed the correlation of frailty (defined as the loss of physical or
mental reserve that impairs function, often in the absence of a defined
comorbidity) and morbidity-mortality in patients undergoing major
gynaecological surgery: They suggest that a modified frailty index
correlates with more wound infections, severe complications, and
Furnes et al. investigated a series of women admitted to a surgical
unit with bowel obstruction and a history of previous gynaecologic
cancer: Bowel obstruction was frequently associated with recurrent
malignancy and a short life expectancy. Ovarian cancer (OR: 6.29, 95
% CI 1.95-20.21), residual tumour during initial surgery (R2-stage) (OR:
18.7, 96 % CI: 4.35-80.46), and chemotherapy (OR: 7.19, 95 % CI: 2.28-
22.67) were all associated with malignant bowel obstruction.
An Italian study by Zucchi et al. involved patients with small-bowel
obstruction from advanced gynaecological and gastroenteric can-
cers who underwent PEG (decompressive percutaneous endoscopic
gastrostomy) positioning for decompressive purposes (all of them were
unfit for any other surgical procedures). The data from 158 patients
suggest that PEG is feasible, effective, relieves nausea and vomiting
and improves QoL, and therefore should be kept in mind in this difficult
setting.
Among papers dealing with technical aspects of gyne-onc surgery, two
papers should be pointed out: Buda et al. discussed the role of tachosil
in preventing complications after inguinofemoral lymphadenectomy for
gynaecological malignancies, with positive results in terms of drain-
age volume, lymphocyst requiring drainage, cellulitis, wound infection,
and late lymphedema.
Hokenstad et al. presented a video demonstrating a technique for
using a pedicled gracilis muscle flap to repair rectovaginal fistula.
Page 53