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Hackethal A.,Queensland Center for Gynaecological Cancer
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society | Year: 2013

Abdominopelvic infiltrative disease may require aggressive surgical procedures. This study reports on our experience with distal ureterectomy, ureteroureterostomy, and extravesical ureteroneocystostomy as part of radical surgery for infiltrating gynecologic disease. Twenty-one women required surgery to the distal ureter at the Queensland Centre for Gynecological Cancer, Australia, from January 2006 to September 2012. Details of the patient's history, operation record, inpatient notes, and follow-up data were obtained through chart review. Patients' median age was 57.8 ± 14.7 years (range, 30-80 years). Seventeen patients had gynecologic cancer. Mean operating time was 3.9 ± 0.9 hours (range, 2.5-5.5 hours). Restoration of continuity was achieved through extravesical ureteroneocystostomy and ureteroureterostomy in 18 and 3 patients, respectively. Boari flap was used in 3 patients, and psoas hitch was the technique chosen in 11 patients. Urinary tract infection was the most common clinical adverse event. Albeit clinically irrelevant, 38% of the patients showed structural renal tract changes postoperatively. To achieve maximal surgical radicalness, resection of the distal ureter with subsequent ureteroureterostomy or extravesical ureteroneocystostomy is feasible and safe. Radical surgery to the urinary tract should be considered as a legitimate part of a gynecologic oncologist's surgical armamentarium to increase a patient's probability of survival and its positive effect on kidney function. Source

Graves N.,Queensland University of Technology | Janda M.,Queensland University of Technology | Merollini K.,Queensland University of Technology | Gebski V.,University of Sydney | Obermair A.,Queensland Center for Gynaecological Cancer
BMJ Open | Year: 2013

Objective: To summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer. Design: Cost-effectiveness modelling using the information from a randomised controlled trial. Participants: Two hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy. Outcome measures: Surgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits. Results: For 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were 509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by 3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery. Conclusions: The adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero. Source

Rowlands I.J.,QIMR Berghofer Medical Research Institute | Beesley V.L.,QIMR Berghofer Medical Research Institute | Janda M.,Queensland University of Technology | Hayes S.C.,Queensland University of Technology | And 6 more authors.
Gynecologic Oncology | Year: 2014

Objective To quantitatively assess and compare the quality of life (QoL) of women with a self-reported diagnosis of lower limb lymphedema (LLL), to women with lower limb swelling (LLS), and to women without LLL or LLS following treatment for endometrial cancer. Methods 1399 participants in the Australian National Endometrial Cancer Study were sent a follow-up questionnaire 3-5 years after diagnosis. Women were asked if they had experienced swelling in the lower limbs and, if so, whether they had received a diagnosis of lymphedema by a health professional. The 639 women who responded were categorized as: Women with LLL (n = 68), women with LLS (n = 177) and women without LLL or LLS (n = 394). Multivariable-adjusted generalized linear models were used to compare women's physical and mental QoL by LLL status. Results On average, women were 65 years of age and 4 years after diagnosis. Women with LLL had clinically lower physical QoL (M = 41.8, SE = 1.4) than women without LLL or LLS (M = 45.1, SE = 0.8, p =.07), however, their mental QoL was within the normative range (M = 49.6; SE = 1.1 p = 1.0). Women with LLS had significantly lower physical (M = 41.0, SE = 1.0, p =.003) and mental QoL (M = 46.8; SE = 0.8, p <.0001) than women without LLL or LLS (Mental QoL: M = 50.6, SE = 0.8). Conclusion Although LLL was associated with reductions in physical QoL, LLS was related to reductions in both physical and mental QoL 3-5 years after cancer treatment. Early referral to evidence-based lymphedema programs may prevent long-term impairments to women's QoL. © 2014 Elsevier Inc. Source

Baker J.,Queensland University of Technology | Janda M.,Queensland University of Technology | Belavy D.,University of Queensland | Obermair A.,Queensland Center for Gynaecological Cancer
Minimally Invasive Surgery | Year: 2013

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n=353) or TLH (n=407) (2005-2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P<0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0-2 days (99.7% versus 98.5%, P=0.09), a significantly higher proportion of TAH patients required opioids 3-5 days (70% versus 22%, P<0.0001), 6-14 days (35% versus 15%, P<0.0001), and 15-60 days (15% versus 9%, P=0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P<0.0001) and four weeks (0.89 versus 0.63, P=0.01) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH. © 2013 Jannah Baker et al. Source

Singh P.,Queensland Center for Gynaecological Cancer | Nicklin J.,Queensland Center for Gynaecological Cancer | Hassall T.,Royal Childrens Hospital
International Journal of Gynecological Cancer | Year: 2011

Background: Clear cell adenocarcinoma of the cervix (CCAC) may affect pediatric and younger women in absence of diethylstilbestrol exposure and other classic predisposing factors for cervical cancer. Prognosis is similar for early-stage CCAC, squamous cell cancer and nonYclear cell adenocarcinoma of the cervix. Vaginal radical trachelectomy (VRT) and abdominal radical trachelectomy (ART) with pelvic lymph node dissection have evolved as valuable fertility-preserving treatment options. Neoadjuvant chemotherapy (NACT) before abdominal radical trachelectomy/VRT may reduce tumor size and thereby facilitate surgery. In some cases, adjuvant treatment in the presence of high-risk prognostic features may be required to optimize treatment. Methods: A 13-year-old adolescent with International Federation of Obstetrics and Gynecology stage IB1 CCAC was treated with NACT using carboplatin and paclitaxel (CP) followed by laparoscopic pelvic lymphadenectomy, VRT, and adjuvant chemotherapy. Results: Neoadjuvant chemotherapy using CP was well tolerated with no toxicity. Neoadjuvant chemotherapy reduced the tumor size and facilitated radical vaginal trachelectomy. Adjuvant treatment was recommended in the presence of risk factors. The patient elected to conserve the uterus and underwent 3 further cycles of adjuvant chemotherapy with CP. Conclusions: This is the first reported case of CCAC treated with NACT using CP followed by laparoscopic pelvic lymphadenectomy, VRT, and adjuvant chemotherapy. A successful treatment outcome achieved using this novel approach suggests its applicability in selected cases. Copyright © 2010 by IGCS and ESGO. Source

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