The aim of this study was to assess the efficacy of a postoperative steroid regimen in maintaining vulvovaginal architecture and vaginal patency following surgical adhesiolysis in severe erosive lichen planus (ELP) and genital graft versus host disease (GVHD). Sixteen women applied potent topical steroids to the vulva and vagina from 48 hours after surgery. Sexual and urinary function and vulvovaginal anatomy were assessed at 6 weeks, 6, 12 and 24 months. All of the patients had failed sexual function due to vaginal stenosis. Eleven patients were unable to have cervical smears and three had associated haematocolpos. Vaginal adhesiolysis achieving complete patency occurred in all patients with stenosis. Fifteen (93.7%) patients were compliant with the regimen. After two years, 12 (75%) patients had maintained complete vaginal patency. Four patients (25%) developed vaginal restenosis. This study demonstrates that the potent topical steroids used post-operatively are very effective in maintaining vaginal patency and function. Impact statement What is already known on this subject? Potent topical steroids are the first line treatment for ELP and GVHD and have been reported to be helpful after surgery to release adhesions. What do the results of this study add? Topical steroids used immediately after surgical adhesiolysis in patients with vulvo-vaginal lichen planus and graft-versus-host disease improves the outcomes and maintains function, which can give a prolonged benefit. What are the implications of these findings for clinical practice and/or further research? The use of potent topical steroids should be considered as routine practice after surgery in erosive inflammatory disease to control inflammation and improve the long term outcomes for these patients.
Gynae-oncology patients are increasingly older and living with frailty and multimorbidity, resulting in higher rates of perioperative or treatment-associated adverse outcomes. Collaborative shared decision making (SDM), where healthcare professionals and patients work in partnership to reach a treatment decision, can be used to engage patients in treatment decisions. Comprehensive geriatric assessment (CGA), a multidimensional, interdisciplinary process assessing medical, psychological and functional capabilities, can inform individualised management and SDM in older gynae-oncology patients with complex conditions. Evidence is emerging for the use of CGA to inform individualised management and underpin integrated care pathways and SDM for older people. This methodology is advocated in NHS England's Cancer Strategy through integrated pathways for older cancer patients with geriatrician involvement. Using clinical case studies, this review contextualises the application of SDM through CGA in older patients with gynaecological malignancy.
Learning objectivesKnow that SDM takes proposed risks and benefits into account, together with projected disease progression with and without treatment and patient preferences. Understand that limitations to SDM in older people include the effects of multimorbidity, cognitive impairment and frailty, limited data on long-term clinician and patient-reported outcomes and frequent exclusion of older people from research trials.
Large cell neuroendocrine cervical carcinoma (LCNEC) is a rare and aggressive cancer that tends to spread and recur early despite intensive multimodal treatment. Conventional treatment strategies for early stage neuroendocrine tumour (NET) include radical hysterectomy followed by adjuvant chemotherapy. There are only 2 reported cases of fertility sparing treatment for NET. We report on the first case of successful conception and delivery at term following radical trachelectomy for early stage LCNEC.
Cytoreductive surgery for advanced ovarian cancer commonly involves bowel resection. Although UK gynaecological oncologists are trained in bowel surgery, the degree to which they perform bowel surgery independently varies nationally. A recent joint policy statement from the British Gynaecological Cancer Society (BGCS) emphasises the need for formalised colorectal support. An anonymous, online survey was emailed to BGCS members to assess the status of multidisciplinary working between UK gynaecological oncology and colorectal/general surgical teams. A total of 46 members responded (8.2% response rate). There was a large variety in the involvement of colorectal/general surgical teams in preoperative planning. A total of 13% of respondents had no formalised agreement for intraoperative support, 72.1% of respondents independently performed rectal peritoneal stripping and 60.5% independently performed small bowel resection. This was reduced to 27.9% for right hemicolectomy with primary anastomosis and 16.3% for left hemicolectomy with primary anastomosis. Respondents often involved colorectal support for post-operative complications. The majority of UK gynaecological oncologists involve colorectal/general surgical teams in bowel procedures, more commonly for large bowel procedures compared to small bowel and for left colon compared to right colon procedures. A total of 16.3% of respondents independently performed all surveyed bowel procedures. Future research should examine training and experience within these groups to address this disparity.
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