Urodynamic tests are considered the gold standard for investigating and managing patients with urinary incontinence symptoms. The objective of this review is to determine the correlation between urodynamic and clinical diagnoses in identifying the type of urinary incontinence in pre and postmenopausal women. This is a retrospective review of 116 women with urinary incontinence symptoms that were evaluated clinically initially and then investigated further with urodynamic tests. The results of the urodynamic studies were compared with the diagnosis assigned based on the clinical evaluation. For 69 women, the clinical diagnosis was not confirmed by urodynamic tests. In addition to this, the clinical diagnosis was confirmed by urodynamic investigations in only 38% of the patients. This is in accordance with current literature, which is suggestive that the agreement between urodynamic studies and clinical evaluation in identifying the type of urinary incontinence is poor. Larger definite trials are needed to provide further evidence of the diagnostic value of urodynamic tests in the management of patients with urinary incontinence symptoms.
A major effort to prevent serous cancer in genetically susceptible women with breast cancer susceptibility gene (BRCA) mutations has recently introduced the practice of risk-reducing prophylactic salpingo-oophorectomy. A small number of those who undergo prophylactic salpingo-oophorectomy will be found to have occult carcinomas. The majority of these appear to originate in the fallopian tube, reinforcing the theory that a significant proportion of highgrade serous carcinoma pelvic tumours have a fimbrial origin. In addition to this, histopathological and molecular biological characteristics suggest that among other serous carcinomas, fallopian tube serous carcinoma and primary peritoneal serous carcinoma really represent one entity. We present a case with breast cancer susceptibility gene 2 (BRCA2) mutation that was found to have serous tubal intraepithelial carcinoma (STIC) following prophylactic salpingo-oophorectomy. Subsequently, she was diagnosed with advanced primary peritoneal carcinoma. This prompted our team to reflect upon the case, review the current literature and recommend a rigorous preoperative assessment and meticulous intraoperative examination for prevention and early detection of high grade serous pelvic carcinomas.
2022-RA-1609-ESGO Table 1 Conclusion Perimenopausal women with diagnosis of CAH, a pre-operative US diagnosis of endometrial thickening together with an endometrial thickness ! 20 mm should be considered at high risk of concomitant EC at final histological examination.Gynecologist should consider these factors when counselling these patients and tailoring the surgical strategy, possibly considering the need for nodal evaluation.
Background
Ovarian cancer is the leading cause of death from gynaecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and efficacy of this extensive surgery.
Objective
The aim of this study is to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our findings with the current literature.
Methods
This is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate.
Results
The study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease free survival time was 2.9 years while median disease free survival time was 2 years. Age (p=0.028) and complete cytoreduction (p=0.048) were found to be significantly associated with survival. Primary debulking surgery was significantly associated with lower probability of recurrence (p=0.049).
Conclusion
Although the number of patients is relatively small, our study indicates that ultra-radical surgery in centres with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited Gynaecological Oncologist and a Hepatobiliary General Surgeon with a special interest in ovarian cancer. A few cases required input from a Colorectal and a Thoracic Surgeon. We believe that the careful selection of the patients that can benefit from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to establish that ultra- radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.
BackgroundOvarian cancer is the leading cause of death from gynaecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and e cacy of this extensive surgery.
ObjectiveThe aim of this study is to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our ndings with the current literature.
MethodsThis is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate.
ResultsThe study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease free survival time was 2.9 years while median disease free survival time was 2 years. Age (p=0.028) and complete cytoreduction (p=0.048) were found to be signi cantly associated with survival. Primary debulking surgery was signi cantly associated with lower probability of recurrence (p=0.049).
ConclusionAlthough the number of patients is relatively small, our study indicates that ultra-radical surgery in centres with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited Gynaecological Oncologist and a Hepatobiliary General Surgeon with a special interest in ovarian cancer. A few cases required input from a Colorectal and a Thoracic Surgeon. We believe that the careful selection of the patients that can bene t from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to Page 3/18 establish that ultra-radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.
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