| 1. |
- Iliadis, Stavros I, 1983-, et al.
(författare)
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Conservative management of early-stage endometrial cancer for fertility preservation : a survey study among Swedish gynecologists and gynecological oncologists
- 2023
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Conservative management of endometrial cancer (CMEC) is viable for women with early-stage disease wishing to preserve fertility, but there is poor knowledge regarding clinicians' attitudes towards treatment or guidelines adherence. This 55-item survey study investigated CMEC-related experience, practice and attitudes among clinically active Swedish gynecologists and gynecological oncologists, focusing on reproductive eligibility criteria. The survey consisted of a general and two specific subsets, selectively delivered to clinicians active in infertility (subset A) and endometrial cancer (subset B) care. Answers from 218 clinicians were included. More than half agreed on CMEC whereas only 5% explicitly disagreed. The majority supported a fertility work-up to substantiate reasonable chances to pregnancy and live birth. Most disagreed about CMEC in case of previous unsuccessful fertility treatments, while more than 1/3 disagreed about CMEC in known fertility problems, recurrent miscarriages or previous children. Over 50% of respondents in subset A (n = 107) found it applicable with fertility investigations such as ovarian reserve testing or, in case of male partner, semen analysis. Respondents in subset B (n = 165) agreed on items based on existing recommendations regarding the oncological management of CMEC, including the use of continuous progestins, hysteroscopic resection of macroscopic lesions, control biopsy with curettage or hysteroscopy after 6 months of treatment, pursuing pregnancy as soon as possible after complete response, and performing a hysterectomy once live birth is achieved. While many clinicians were familiar with CMEC, the overall experience is limited. Fertility specialists seem less involved than oncologists in patient care but there is broad support for fertility-related eligibility criteria.
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| 3. |
- Herrera Cappelletti, Erica, et al.
(författare)
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Chances of pregnancy and live birth among women undergoing conservative management of early-stage endometrial cancer: a systematic review and meta-analysis
- 2021
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Ingår i: Human Reproduction Update. - : Oxford University Press. - 1355-4786 .- 1460-2369. ; 28:2, s. 282-295
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Endometrial cancer is common and usually occurs after menopause, but the number of women diagnosed during reproductive age is increasing. The standard treatment including hysterectomy is effective but causes absolute uterine factor infertility. In order to avoid or postpone surgery, conservative management of endometrial cancer (CMEC) has been proposed for younger women who want to retain their fertility.OBJECTIVE AND RATIONALE The main objective of this study was to estimate the chances of pregnancy and live birth for women with early-stage endometrial cancer (EEC) who are managed conservatively for fertility preservation.SEARCH METHODS The PRISMA recommendations for systematic reviews and meta-analyses were followed. Structured searches were performed in PubMed, Embase and the Cochrane Library, from inception until 13 June 2021. Inclusion was based on the following criteria: group or subgroup of women with Clinical Stage IA, well-differentiated, endometrioid endometrial cancer (from now on, EEC); CMEC for fertility preservation; and reported frequencies of women achieving pregnancy and/or live birth after CMEC. The following exclusion criteria applied: impossibility to isolate/extract outcome data of interest; second-line CMEC for persistent/recurrent disease; CMEC in the presence of synchronous tumours; case reports; non-original or duplicated data; and articles not in English. Qualitative synthesis was performed by means of tabulation and narrative review of the study characteristics. Study quality was assessed with an ad hoc instrument and several moderator and sensitivity analyses were performed.OUTCOMES Out of 1275 unique records, 133 were assessed in full-text and 46 studies were included in the review. Data from 861 women with EEC undergoing CMEC were available. Progestin-based treatment was reported in all but three studies (93.5%; 836 women). Complete response to treatment was achieved in 79.7% of women, with 35.3% of them having a disease recurrence during follow-up. Of 286 pregnancies obtained after CMEC; 69.4% led to live birth (9% of them multiple births) and 66.7% were achieved through fertility treatment. Based on random-effects meta-analyses, women treated with progestin-based CMEC have a 26.7% chance of achieving pregnancy (95% CI 21.3–32.3; I2 = 53.7%; 42 studies, 826 women) and a 20.5% chance to achieve a live birth (95% CI 15.7–25.8; I2 = 40.2%; 39 studies, 650 women). Sample size, average age, publication year, study design and quality score were not associated with the outcomes of progestin-based CMEC in moderator analyses with meta-regression. However, mean follow-up length (in months) was positively associated with the chances of pregnancy (regression coefficient [B] = 0.003; 95% CI 0.001–0.005; P = 0.006) and live birth (B = 0.005; 95% CI 0.003–0.007; P < 0.001). In sensitivity analyses, the highest chances of live birth were estimated in subsets of studies including only women of age 35 or younger (30.7%), the combination of progestins with hysteroscopic resection (30.7%), or at least 3 years of follow-up (42.4%).WIDER IMPLICATIONS Progestin-based CMEC is viable for women with well-differentiated, Clinical Stage 1A, endometrioid endometrial cancer who want to preserve their fertility, but there is room for improvement as only one-fifth of them are estimated to achieve live birth according to this meta-analysis. Further investigations on prognosis-driven selection, hysteroscopic resection and long-term surveillance are arguably needed to improve the reproductive outcomes of CMEC.
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| 4. |
- Angeles Martinez-Maestre, Maria, et al.
(författare)
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Total Laparoscopic Hysterectomy With and Without Robotic Assistance : A Prospective Controlled Study
- 2014
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Ingår i: Surgical Innovation. - : SAGE Publications. - 1553-3506 .- 1553-3514. ; 21:3, s. 250-255
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Tidskriftsartikel (refereegranskat)abstract
- Background. Hysterectomies are very common, and most of them are still performed abdominally. The minimally invasive alternatives are perceived as difficult by gynecologists. Robotic assistance is thought to facilitate laparoscopic surgery. The aim of this study was to compare the surgical outcomes of robotic-assisted and conventional total laparoscopic hysterectomy. Methods. Patients, candidate to hysterectomy for benign indications, were allocated to either robotic or conventional laparoscopy in a quasi-randomized fashion. Patients were operated following a standardized surgical protocol. Main outcome measures were total surgical time, conversions to laparotomy, blood loss, hospital stay, and complications. Results. Fifty-one patients underwent robotic hysterectomy (mean age = 46.59 years) and 54 conventional laparoscopy (mean age = 50.02 years). The groups were homogeneous in body mass index and uterine weight. Robotic-assisted hysterectomies were significantly shorter (154.63 +/- 36.57 vs 185.65 +/- 42.98 minutes in the control group; P =.0001). Patients in the robotic group also had a significantly smaller reduction in hemoglobin (9.69% +/- 8.88% vs 15.29% +/- 8.39% in controls; P =.0012) and hematocrit (10.56% +/- 8.3% vs 14.89% +/- 8.11%; P =.008). No intraoperative conversions to laparotomy were required. Complication rate was low and similar in both groups. All patients were fully recovered at 1-month follow-up outpatient visit. Conclusions. Significantly lower operative times and blood loss indicate that robotic assistance can facilitate surgery already during the learning curve period. Nevertheless, proficiency can be reached in conventional laparoscopy through training, and the cost-effectiveness of robotic hysterectomy for benign conditions is yet to be confirmed.
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| 5. |
- Gambadauro, Pietro, et al.
(författare)
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Depressive symptoms among women with endometriosis : a systematic review and meta-analysis.
- 2019
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier. - 0002-9378 .- 1097-6868. ; 220:3, s. 230-241
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate whether endometriosis is associated with depressive symptoms, and whether the association is modulated by pelvic pain.DATA SOURCES: PubMed, Embase, PsychINFO, and the Cochrane Library, were systematically searched through September 2017.STUDY ELIGIBILITY CRITERIA: The following eligibility criteria applied: full-text original article; quantitative data about depressive symptoms or depression; comparison of women with and without endometriosis, or women with endometriosis with and without pelvic pain. Articles reporting duplicated data were excluded.STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers selected and reviewed the studies. Disagreements were resolved through discussion or a third opinion. Qualitative synthesis was performed through tabulation and assessment using a modified version of the Newcastle-Ottawa Scale. Effect sizes were pooled through meta-analysis, and moderator analyses were performed to identify potential confounders with several variables: region of the sample, method of ascertainment of endometriosis, method of measurement of depression, year of publication, and quality score.RESULTS: A meta-analysis of 24 studies (99,614 women) showed higher levels of depression among women with endometriosis compared to controls (standardized mean difference [SMD], 0.22, 95% confidence interval [CI], 0.13-0.32). The heterogeneity in this analysis (I2 = 68%) was not explained by any of the moderating variables. When only healthy controls were considered, a larger endometriosis-depression effect was found (11 studies, SMD, 0.49; 95% CI, 0.24-0.73; I2 = 69%). Endometriosis patients reporting pelvic pain had significantly higher levels of depression compared to those without pain (4 studies; SMD, 1.01; 95% CI, 0.71-1.31; I2 = 0%). No significant difference was found between women with pelvic pain and endometriosis and those with pelvic pain but without endometriosis (11 studies, SMD, -0.11; 95% CI, -0.25 to 0.04; I2 = 0%).CONCLUSION: The association between endometriosis and depressive symptoms is largely determined by chronic pain but may also be modulated by individual and context vulnerabilities. Awareness of the complex relationship between endometriosis and depressive symptoms informs tailored care and patient-centered research outcomes.
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| 6. |
- Gambadauro, Pietro, et al.
(författare)
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Digital video recordings for training, assessment, and revalidation of surgical skills
- 2010
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Ingår i: Surgical technology international. - 1090-3941. ; 20, s. 36-9
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Tidskriftsartikel (refereegranskat)abstract
- Surgical training is undergoing drastic changes, and new strategies should be adopted to keep quality standards. The authors review and advocate the use of surgical recordings as a useful complement to current training, assessment, and revalidation modalities. For trainees, such recordings would promote quality-based and competence-based surgical training and allow for self-evaluation. Video logbooks could be used to aid interaction between trainer and trainee, and facilitate formative assessment. Recordings of surgery could also be integrated into trainees' portfolios and regular assessments. Finally, such recordings could make surgeons' revalidation more sensible. The routine use of records of surgical procedures could become an integral component of the standard of care. This would have been an unattractive suggestion until recently, as analogue recording techniques are inconvenient, cumbersome, and time consuming. Today, however, with the advent of inexpensive digital technologies, such a concept is realistic and is likely to improve patient care.
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| 7. |
- Gambadauro, Pietro, et al.
(författare)
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Digital video technology and surgical training
- 2007
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Ingår i: European Clinics in Obstetrics and Gynaecology. - : Springer Science and Business Media LLC. - 1613-3412 .- 1613-3420. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- For several reasons, surgical training is suffering important reductions in terms of time and opportunities. New approaches to surgical training are required, and new training strategies should be proposed to maintain surgical standards. Affordable technologies allowing digital capture and recording of surgical procedures are now widely available, and we believe that the use of such technologies could play a role in the surgical training. Digital videos are useful to surgeons involved in teaching, because they are much easier to edit and share. In the operating theatre, the use of real-time digitised video during operations performed by trainees has different useful applications. A computer screen, with the use of a mouse cursor, can enhance the interaction between trainees and supervisors and can provide valuable information for observers. Recordings can be used for self-assessment, audit and as a basis for digital logbooks. Finally, digital videos can be sent real-time on network connections, allowing for several different telemedicine applications. Every physician involved with surgical teaching and training should be aware of the potential applications of digital videos and eventually become familiar with them. © European Board and College of Obstetrics and Gynaecology 2007.
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