Do critical care units play a role in the management of gynaecological oncology patients? The contribution of gynaecologic oncologist in running critical care units

Abstract

Routine post-operative care in high dependency unit (HDU), surgical intensive care unit (SICU) and intensive care unit (ICU) after high-risk gynaecological oncology surgical procedures may allow for greater recognition and correct management of post-operative complications, thereby reducing long-term morbidity and mortality. On the other hand, unnecessary admissions to these units lead to increased morbidity - nosocomial infections, increased length of hospital stay and higher hospital costs. Gynaecological oncology surgeons continue to look after their patient in the HDU/SICU and have the final role in decision-making on day-to-day basis, making it important to be well versed in critical care management and ensure the best care for their patients. Post-operative monitoring and the presence of comorbid illnesses are the most common reasons for admission to the HDU/SICU. Elderly and malnutritioned patients, as well as, bowel resection, blood loss or greater fluid resuscitation during the surgery have prolonged HDU/SICU stay. Patients with ovarian cancer have a worse survival outcome than the patients with other types of gynaecological cancer. Dependency care is a part of surgical management and it should be incorporated formally into gynaecologic oncology training programme.

Performing gynecologic cancer surgery during the COVID‐19 pandemic in Turkey: A multicenter retrospective observational study

“…During this period, 200 cases of gynecologic cancer that underwent surgery were identified and 1% were considered “suspected” cases of COVID‐19 postoperatively (by CT findings). The primary concern for surgery in gynecologic cancers is that most cases are old and have pre‐existing co‐morbidities and radical procedures are needed for the vast majority, which increases the complication risk and the subsequent risk of requiring care in the ICU 14 . Furthermore, the risk of hospital‐acquired COVID‐19 infection and concerns about operating asymptomatic positive cases are other issues.…”

Postoperative Admission in Critical Care Units Following Gynecologic Oncology Surgery: Outcomes Based on a Systematic Review and Authors' Recommendations

“…As far as the responsibilities of gynecologic oncologists is concerned, preoperatively, a consistent assessment of the extend of the disease and a thorough planning of the required surgical procedures on the basis of the patient's comorbidities and performance status are paramount. Moreover, postoperatively, the gynecologic oncologist is the practitioner who is mainly responsible for the daily monitoring of the patient and for making the final decisions with regards to the patient's course as knowing the exact patients' condition along with the performed operative procedure (5). Consequently, we strongly advocate the incorporation of rotation in CCUs in gynecologic oncology fellowship programs aiming at efficiently managing these patients and improve their quality of life and survival.…”

“…Therefore, critical care management is critical for surgically managed patients with the intent to establish a closer monitoring and to prevent or treat postoperative complications (4). Intensive monitoring of gynecologic oncology patients in the postoperative setting is implemented in various types of critical care units (CCUs) which include post anesthesia care units (PACU), high dependency units (HDU), surgical intensive care units (SICU) and intensive care units (ICU) (5).…”

Fertility preservation in women affected by gynaecological cancer: the importance of an integrated gynaecological and psychological approach

“…For this purpose, the involvement of a psychologist in the multidisciplinary team deeply reduces the level of stress, anxiety, and depression. Moreover, it allows a better adherence to therapy, reducing the negative impact on women's quality of life [12,59,60].…”

“…Gynaecological cancers have a prevalence of 15%-20% of the total neoplasms involving women. The most common is uterine cancer (53%) [3][4][5], followed by ovarian (25%) [6,7], cervical (14%) [8][9][10], vaginal and vulvar cancers [11][12][13], with more rare neoplastic forms, such as trophoblastic tumours [14]. About 20% of gynaecological cancer affects women under 40 years of age, who often have not completed parity or are before their first pregnancy [15][16][17][18][19][20].…”