Day 1 :
Keynote Forum
Süleyman Eserdağ
International Society of Aesthetic Genital Surgery and Sexology, Turkey
Keynote: Treatment modalities of Vaginismus and Dyspareunia
Time : 11:05-11:50
Biography:
Süleyman EserdaÄŸ is a Cosmetic Gynecologist and Sexual Therapist Based in Istanbul, Turkey. He has10 years of specialist experience in the biggest maternity hospital
in Turkey, known as ‘Zekai Tahir Burak Educational and Research Hospital’ He is the owner of the 3 clinics in the 3 biggest cities of Turkey, known as ‘Hera Clinics’. He is
a Sexologist Fellow by European Federation of Sexology (EFS) and European Society of Sexual Medicine (ESSM). He founded and is the President of the International
Society of Aesthetic Genital Surgery and Sexology (ISAGSS). Based in Ankara, Turkey, Dr Eserdag trained at Zekai Tahir Burak Women’s Health and Educational Hospital,
the largest maternity hospital in Turkey. He worked as Chief of Gynecology at Kazan National Hospital .
Abstract:
Vaginismus and dyspareunia are the major sexual problems of women who are consulting gynecologists. Th ey both have been
classifi ed under the same group as genito-pelvic pain and penetration disorders in DSM (Diagnostic and Statistical Manual
for Mental Disorders by the American Psychiatric Association) in 2013, so become more in the spectrum of gynecologists. Th ese
sexual dysfunctions have been based on some psychologic and organic reasons. Vaginismus is mostly dependent on psychological
components, whereas dyspareunia has mostly organic ones. Th e gold standards of vaginismus treatments are cognitive and behavioral
sexual therapies. On the other hand, vulvar vestibulitis which is one of the main reasons of superfi cial dyspareunia has some updated
surgical and non-surgical treatments.
Keynote Forum
Rafal Kuzlik
SaskaMed Clinic, Poland
Keynote: Different techniques being used in the field of plastic and reconstructive gynaecology
Time : 11:50-12:35
Biography:
Rafal Kuzlik MD, PhD, specialist in obstetrics and gynecology. Plastic and reconstrative gynecologist with over twenty years of professional experience. He is endoscopist
and oncological surgeon. Specialist in ultrasound imaging. Doctor Rafal Kuzlik received a lot of certifi cates confi rming participation in numerous courses and trainings. He
published many scientifi c papers. Co-author of two books (in Polish): „Plastic Gynecology” and „Physiotherapy after plastic surgical procedures”. Doctor is the author of two
new surgery methods in the fi eld of plastic gynecology: ”One Cut technique” as simultaneus labia minora and clitoral hood reduction and „Double „O” technique” - reposition
of the clitoris. He is also trainer of radio frequency methods in the fi eld of non surgical treatment of female genital problems. Owner and principal of SaskaMed Clinic in
Warsaw, Poland. Principal of Obs&Gyn Ward in EMC St. Anna Hospital in Piaseczno, Poland. The founder of Polish Academy of Plastic and Reconstractive Gynecology.
Abstract:
Keynote Forum
Paul H Sugarbaker
Keynote: A surgical perspective on the management of ovarian cancer: A video presentation
Time : 09:55-10:00
Biography:
Paul H Sugarbaker has completed his college education at Wheaton College in Illinois. He graduated from Cornell University Medical College in New York (USA) and from
there he went for his surgical training at the Peter Bent Brigham Hospital in Boston (MA, USA), now known as Brigham and Women’s Hospital. He received a Master’s
degree in Immunology at the Harvard School of Arts and Sciences in 1983. At the NIH he was a Senior Investigator from 1976 to 1986. After a brief stay in Atlanta at
the Emory Clinic he moved back to Washington (DC, USA) to become the Medical Director of the Washington Cancer Institute. He has been at the Washington Cancer
Institute since 1989. Currently, he is the Director for the Program in Peritoneal Surface Oncology. His interests are in gastrointestinal cancer, gynecologic malignancy
and mesothelioma. For many years his work focused on liver metastases. Currently, his clinical and investigative work is directed at the peritoneal surface component of
gastrointestinal cancer dissemination, referred to as peritoneal metastases. He is a strong critic of surgical tradition; he believes that major changes in the technology of
cancer resection are necessary. His theme, ‘it’s what the surgeon doesn’t see that kills the patient’, summarizes the concepts behind many of his publications both in the
peer-reviewed medical literature and in the lay press. In his opinion, perioperative intravenous and intraperitoneal chemotherapy are an essential planned part of many
cancer interventions.
Abstract:
Background: Many unknowns exist in the optimal management of ovarian cancer. However, one management strategy that has been
accepted as the best treatment is surgical removal of all or nearly all the visible evidence of disease within the abdomen and pelvis.
Th is may occur as a primary cytoreduction before other treatments are initiated or as an interval cytoreduction aft er neoadjuvant
chemotherapy has been completed. At both of these time points complete surgical removal is always the goal of optimal treatment.
Th is extensive surgery must occur in the absence of serious complications which would delay the other crucial treatment modality
which is chemotherapy with cisplatinum and paclitaxel.
Materials & Methods: Th rough a long midline abdominal incision, the abdomen and pelvis are widely exposed using skin traction
sutures followed by a self-retaining retractor. Peritonectomy procedures and visceral resections are used to remove diseased organs
that are layered by cancer. Aft er chemotherapy washing, a reconstruction of the gastrointestinal tract occurs.
Results: With the wide exposure, dissections proceed using ball-tip electrosurgery so that peritoneal surfaces layered by cancer can
be completely removed in the absence of blood loss. Also, dissection techniques for greater omentectomy allow a rapid and bloodless
removal of this organ which is heavily involved by the infi ltration of ovarian cancer. Peritonectomy of the right upper quadrant,
left upper quadrant, and both paracolic sulci proceed under direct vision. Pelvic peritonectomy is combined with hysterectomy,
oophorectomy, and left colectomy to extirpate large volumes of disease from the lower abdomen and pelvis. Hyperthermic
intraperitoneal chemotherapy (HIPEC) is administered using cisplatinum, doxorubicin and systemic ifosfamide for 90 minutes at
42°C. Intestinal anastomoses and then abdominal wall reconstruction proceed aft er the HIPEC. An intraperitoneal port is placed
in order to facilitate long-term normothermic intraperitoneal chemotherapy (NIPEC).
Conclusions: Th e goal of complete or near-complete removal of ovarian cancer which optimizes the initial treatment of this disease
can be accomplished through cytoreductive surgery. Th is requires a long midline abdominal incision for wide exposure of the
contents of the abdomen and pelvis, meticulous hemostasis and a plan of management that involves peritonectomy procedures,
visceral resections and HIPEC.
- Gynecology | Gynecologic Cancer | Cosmetic Gynecology
Chair
Paulina Cegla
Greater Poland Cancer Centre, Poland
Session Introduction
Qu Ang
Peking University Third Hospital, China
Title: Preliminary results of nimotuzumab plus concurrent IMRT and chemotherapy on cervical cancer
Biography:
Qu Ang is the Attending Physician of the Department of Radiation Oncology, Peking University Third Hospital. Her research direction is on radiotherapy on gynecologic
cancer, including EBRT, HDR and LDR brachytherapy.
Abstract:
Objective: To evaluate the safety and effi cacy of nimotuzumab plus concurrent intensity-modulated radiation therapy (IMRT)
and chemotherapy of unresectable cervical cancer.
Methods: From December 2013 to February 2017, 34 patients with cervical cancer on stage (FIGO) IB2-IVB were received
concurrent chemoradiotherapy plus nimotuzumab. Th e prescription dose of radiation was 50.4 Gy/28f on pelvic fi eld with or
with not extended fi eld radiation. An additional 30-36 Gy to Point A were delivered with high-dose-rate techniques. Cisplatin
of 40 mg/m2 and nimotuzumab of 200mg were infused intravenously once weekly during RT for 6 weeks. Th e main outcome
measure was toxicity evaluated by CTCAE 4.0. Secondary outcome measure was short-term outcome evaluated by RESIST1.1.
Result: Th e median of followed up time was 23.4 months (8.3-45.5 months). Almost all patients were local advantaged
cancer except 2 patients with distant metastases. All patients received external radiotherapy. 2 patients were not treated with
brachytherapy. 6 patients failed to fi nish radiotherapy within 56 days. All of 34 patients received concurrent treatment with
nimotuzumab for 6 times. 2 patients refused chemotherapy. Th ere was no life-threatening toxicity. Grade 1/2 of nausea,
vomiting and diarrhea were 70.6% (24/34), 32.4% (11/34) and 52.9% (18/34), respectively. Grade 3 of leucopenia, granulopenia,
thrombocytopenia and anemia were 52.9% (18/34), 17.6% (6/34), 14.7% (5/34), and 11.8% (4/34) respectively. Grade 3 of
nausea and vomiting were 8.8% (3/34) and 2.9% (1/34), respectively. No grade 3 of anorectal infl ammation. Rectovaginal
fi stula was observed in one case 6 months aft er radiotherapy, and operation was performed. Surgical treatment of intestinal
obstruction was performed in one case. 2 cases got vaginal stenosis. Th e objective response rate was 100%. Complete response
was achieved in 29 cases (85.3%) and partial response in 5 cases (14.7%).
Conclusion: Nimotuzumab plus concurrent IMRT and chemotherapy may represent an eff ective and well-tolerated treatment
in patients with unresectable cervical cancer.
Paulina Cegla
Greater Poland Cancer Centre, Poland
Title: Dual tracer FLT-FDG-PET/CT in the assessment of biological parameters for simulated treatment planning in patients with cervical cancer
Biography:
Paulina Cegla has completed her graduation at Poznan University of Medical Science, Poland in 2013 with a Master degree in Electroradiology. In 2017, she started her
PhD at the same University. Since 2011 she is working as a Nuclear Medicine Radiographer in Department of Nuclear Medicine at Greater Poland Cancer Centre. She
has presented over 20 scientifi c works in European and World Conferences of Nuclear Medicine and several articles in reputed journals.
Abstract:
Aim: Th e assessment of metabolic activity and the extend of the tumor mass has an increasing importance for radiotherapy
planning and patients prognosis. Th e aim of the study was to compare biological parameters of primary tumor assessed by
18F-FDG and 18F- fl uorothymidine (FLT) positron emission tomography (PET)/computer tomography (CT) in patients with
cervical cancer and infl uence on radiotherapy planning.
Materials & Methods: Respectively 39 women with histologically confi rmed cervical cancer underwent dual tracer PET/
CT examinations performed for radiotherapy. PET scans were acquired on separate days (within one week) 60 min aft er
IV injection of 300 MBq of 18F- fl uorodeoxyglucose (FDG) and 300 MBq of 18F-FLT. Th e reconstructed PET images were
evaluated using a dedicated workstation for metabolic tumor parameters, such as SUVmax, metabolic tumor volume (MTV),
total lesion glycolysis (TLG) and heterogeneity for primary tumor and compared using t-test.
Results: Th ere was signifi cant diff erences in the volumes calculated from FLT-gross tumor volume (GTV) and FDG-GTV
(29.86±25.17 vs. 37.10±30.7; p=0.02). Th e SUVmax, TLG and heterogeneity were in general lower for FLT-GTV than FDGGTV
(9.35±10.06 vs. 11.46±4.05, p=0.13; 136.14±138.59 vs. 281.48±322.95, p=0.002; 0.6±0.05 vs. 0.63±0.5, p=0.02 respectively)
however, in three patients SUV values for FLT-GTV were higher than for FDG-GTV. Depending on severity of the disease
patients were divided into three groups.
Conclusion: In this limited study FLT-GTV tends to show lower measured volumes as a consequence of the lower thimidine
uptake within tumor mass as compared to glucose metabolism. Our preliminary results found statistically signifi cant diff erences
between metabolic and volumetric parameters in patients with disease limited only to cervix and disease limited to the cervix
and iliac lymph nodes either FDG or FLT.
Ghufran Jassim
Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain
Title: Knowledge attitudes and practices regarding cervical cancer and screening among women visiting primary health care centers in Bahrain
Time : 14:45-15:15
Biography:
Ghufran Jassim has completed her graduation in Medicine at Arabian Gulf University in Bahrain. She was trained as a Family Physician and completed the Arab Board
and Irish Board in Family Medicine. She has practiced as a Consultant Family Physician in Bahrain since then. She received her Master’s degree in Health Policy and
Population Studies from Arabian Gulf University. She joined RCSI- Bahrain in 2008, and in 2014 she has completed her PhD in General Practice from the Royal College
of Surgeons in Ireland. In 2015 she has completed one year program in Global Clinical Scholars Research Training at Harvard Medical School-Harvard University. Last
year she has completed her graduation from the Health Education Profession Diploma program at RCSI. Currently, she is a full time Senior Lecturer at Royal College of
Surgeons in Ireland- Bahrain. Her research interests are child and women health, breast cancer, non-communicable diseases and evidence based medicine. She has
published many articles in international peer reviewed journals and presented in many international and local conferences. She is the Chief Editor of the Journal of Bahrain
Medical Society. Recently, she has taken up a new role as the academic coordinator for career development for medical students.
Abstract:
Background: Cervical cancer is one of the most common cancers among women, with 80% of the cases occurring in developing
countries. Cervical cancer is largely preventable by eff ective screening programs. Th is has not been possible with opportunistic
screening and its low use in the Kingdom of Bahrain. Th e objective of this study was to explore the knowledge, attitudes, and
practices of women attending primary care health centres for cervical cancer screening.
Methods: Th is was a cross-sectional study of 300 women attending primary health care centres in Bahrain. We used a validated
tool comprised of 45 items to collect data through face-to-face interviews between December 2015 and February 2016.
Descriptive data are presented for demographic data, and frequency distributions with percentages are presented for each item
of the knowledge and attitude questionnaire.
Results: Th e mean age±SD of the participants was 37.24±11.89 years, they were mostly married (221; 73.7%), and had a high
school or higher education (261; 87%). Over 64% (194 participants) had never heard of a Pap smear procedure and only 3.7%
(11 participants) had heard about the human papillomavirus (HPV) vaccine. Nearly 64% (192 participants) believed that a Pap
smear was helpful in detecting pre-cancer and cancer of the cervix, and 44.3% (133 participants) believed that they should have
a Pap smear at least every three years. Regarding the practice, only 40.7% (122 participants) had a Pap smear in their lifetime.
Th e majority of participants felt embarrassed when examined by a male doctor (250; 83.3%) and few underwent a Pap smear
screening if they were never married (69; 23.0%).
Conclusions: Th e participants demonstrated a wide range of knowledge and attitudes towards cervical cancer screening.
However, the majority demonstrated positive attitudes towards the HPV vaccine.
Süleyman Eserdağ
International Society of Aesthetic Genital Surgery and Sexology, Turkey
Title: Where are we in aesthetic genital surgeries for a better feminine life?
Biography:
Süleyman EserdaÄŸ is a Cosmetic Gynecologist and Sexual Therapist Based in Istanbul, Turkey. He has10 years of specialist experience in the biggest maternity hospital
in Turkey, known as ‘Zekai Tahir Burak Educational and Research Hospital’ He is the owner of the 3 clinics in the 3 biggest cities of Turkey, known as ‘Hera Clinics’. He is
a Sexologist Fellow by European Federation of Sexology (EFS) and European Society of Sexual Medicine (ESSM). He founded and is the President of the International
Society of Aesthetic Genital Surgery and Sexology (ISAGSS). Based in Ankara, Turkey, Dr Eserdag trained at Zekai Tahir Burak Women’s Health and Educational Hospital,
the largest maternity hospital in Turkey. He worked as Chief of Gynecology at Kazan National Hospital .
Abstract:
Aesthetic- Plastic genital operations and energy based genital cosmetic managements are the fastest growing segment
within all of the aesthetic surgeries. Th ese operations are being done for aesthetic, functional, hygienic, medical and for
sexual purposes. Labiaplasty, vaginal tightening and perineoplasty operations are the most globally demanded operations by
the patients. On the other hand, genital laser, radiofrequency and PRP (Platelet Rich Plasma) are the non-invasive methods
which can be applied for functional and cosmetic reasons as well. Th e patient’s needs, expectancy and tissue anatomy should
be very well evaluated before the surgery to get best results. And the surgeon should have training before starting these kinds
of operations.
- Gynecology | Gynecologic Cancer | Uro-Gynecology | Gynecologic Cancer: Case Reports
Chair
Daniel U Reimer
Medical University Innsbruck, Austria
Session Introduction
Rafal Kuzlik
SaskaMed Clinic, Poland
Title: Radiofrequency - new solution for treatment of vaginal laxity, urinary incontinence and sexual disorders
Biography:
Rafal Kuzlik MD, PhD, specialist in obstetrics and gynecology. Plastic and reconstrative gynecologist with over twenty years of professional experience. He is endoscopist
and oncological surgeon. Specialist in ultrasound imaging. Doctor Rafal Kuzlik received a lot of certifi cates confi rming participation in numerous courses and trainings. He
published many scientifi c papers. Co-author of two books (in Polish): „Plastic Gynecology” and „Physiotherapy after plastic surgical procedures”. Doctor is the author of two
new surgery methods in the fi eld of plastic gynecology: ”One Cut technique” as simultaneus labia minora and clitoral hood reduction and „Double „O” technique” - reposition
of the clitoris. He is also trainer of radio frequency methods in the fi eld of non surgical treatment of female genital problems. Owner and principal of SaskaMed Clinic in
Warsaw, Poland. Principal of Obs&Gyn Ward in EMC St. Anna Hospital in Piaseczno, Poland. The founder of Polish Academy of Plastic and Reconstractive Gynecology.
Abstract:
Introduction: Vaginal laxity, urinary incontinence and sexual disfunction, Th ey are very serious problems of many women. All
over the world there are many devices to treat patients with these disorders.
Objectives: To prove, that radiofrequency is a safe procedure with fast results.
Materials and methods: 24 patients took part in the study, aged between 30 and 70 y.o. with vaginal laxity and urinary
incontinence. Excluding criteria: vagina’s width over 3 fi ngers, level of SUI over second degree, vaginal bleeding, unproper
PAP smear or other pathologies of the vagina and uterus, Besides vaginal and urinary problems, sexual satisfaction was taken
under consideration. In the study Th ermiVa was used as radiofrequency device. 3 examinations were made: before, aft er fi rst
and second procedure. All procedures were performed with temperature 45-47 º C.
Results: Over 30% of improvement was observed. Conclusions: Radiofrequency procedures using Th ermiVa are safe and
eff ective, without any side eff ects.
Qu Ang
Peking University Third Hospital, China
Title: Dosimetry and efficacy analysis of 125i radioactive seeds implantation for cervical cancer with pelvic recurrent after radiotherapy
Biography:
Qu Ang is the Attending Physician of the Department of Radiation Oncology, Peking University Third Hospital. Her research direction is on radiotherapy on gynecologic cancer, including EBRT, HDR and LDR brachytherapy
Abstract:
Purpose: Pelvic recurrent aft er radiotherapy of cervical cancer was diffi cult to treat. Th e implantation of radioactive 125I seeds
was suitable for recurrent patients aft er radiotherapy. Th erefore, we evaluated the effi cacy of radioactive 125I seeds implantation
for pelvic recurrent cervical cancer aft er radiotherapy. Th e dosimetric parameters aff ecting outcome were further analyzed to
guidance therapy.
Methods: A retrospective analysis was made with pelvic recurrent cervical cancer aft er radiotherapy from July 2005 to October
2015 in our hospital with 125I seeds implantation, under ultrasound or CT guidance. Treatment planning was performed before
implantation to estimate the number, activity of the seeds. Th e seeds numbers ranged from 10-140 with a median numbers
of 62.5 and the activity of seeds ranged from 0.5-0.8 mCi with a median activity of 0.7 mCi. Dosimetric verifi cation was
performed using CT scan immediately aft er 125I seeds implantation. D90, D100, V100, V150and V200 was evaluated in postoperative
plan. Th e Kaplan-Meier method was used to calculate the local progression free survival (LPFS) rate and overall survival (OS)
rate. Th e Log-rank test and Cox regression were used for univariate and multivariate analysis.
Results: All of the 36 patients received pelvic radiotherapy previously, 13.88%(5/36) of the patients received re-irradiation.
Th e median dose of cumulative radiotherapy was 56 (42-107) Gy EQD2. Th e interval time of the last radiotherapy to 125I
implantation was 12 (2-60) months. 15 cases were central recurrence (41.67%, 15/36), and 21 cases were pelvic wall recurrence
(58.33%, 21/36). Th e median follow-up time was 11.5 months (2-30 months). Vaginal fi stula occurred in 1 case. No other
severe adverse eff ects. Th e downgrade rate of pain was 79.2% (19/24). Th e short-term local control rate was 88.9% (32/36).
1-year and 2-year local progression-free survival (LPFS) rate were 34.9% and 20%, respectively. 1-year and 2-year OS rate
were 52% and 19.6%, respectively. Multivariate analysis showed that the location of the recurrence volume of lesion and D90
was signifi cantly related to LPFS (P<0.05). And the location of the recurrence was also signifi cantly related to OS (P<0.05).
33 cases were entered in dosimetric analysis. D90 was 128.5±47.4 Gy, D100 was 50.4±23.7 Gy, and V100 was 86.7%±12.9%.
Univariate analysis showed that D100, D90, V100 were signifi cantly associated with LPFS (P<0.05). D90>105 Gy and <105 Gy,
1-year LPFS were 53.3% and 0% (P<0.05), respectively. D100>55 Gy and <55 Gy, 1-year LPFS were 49.2% and 15.8% (P<0.05),
respectively. V100>91% and <91%, 1-year LPFS were 55% and 15.6% (P<0.05), respectively. Multivariate analysis showed D100
was the independent factors.
Conclusions: Radioactive 125I seeds implantation was a safe, eff ective salvage treatment for pelvic recurrent cervical cancer
aft er radiotherapy. It could relieve the pain for patients undergone multiple treatment aft er relapse. 125I radioactive seed
implantation was recommended for patients with recurrent in pelvic wall, compared with recurrent in central pelvic. D100>55Gy
or D90>105Gy or V100>91% could signifi cantly improve the local control.
Biography:
Roshan Prajapati has pursued his MBBS from Chuvash State University Medical Academy, Russia. He completed her MD in Medical Oncology from Zhengzhou University.
Presently he is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. He received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi Cancer Institute.
Abstract:
Background: Epithelial ovarian cancer (EOC) is the leading cause of death in women with gynecological malignancy.
Approximately 70% of women with EOC are diagnosed with advanced stage of disease, which is associated with high morbidity
and mortality. Currently, standard primary therapy for patients with advanced EOC is primary debulking surgery (PDS)
aiming to remove all visible tumor tissue, followed by adjuvant chemotherapy (ACT) with paclitaxel and carboplatin. EOC
is one of the most sensitive of all solid tumors to cytotoxic drugs, with over 80% of women showing a response to standard
chemotherapy combining taxane and platinum. Due to inadequate screening tools and a lack of early clinical symptoms,
approximately 70% of women with EOC are diagnosed with advanced stage of disease, which is associated with high morbidity
and mortality. Recently, interval debulking surgery (IDS) aft er a short course of neoadjuvant chemotherapy (NACT), usually
three cycles of chemotherapy, has become a possible alternative treatment option to standard treatment in patients unable to
undergo complete resection during PDS.
Objectives: To evaluate the benefi ts and toxicity of nano particle formulation paclitaxel (nanoxel) in advanced ovarian cancer
as neo adjuvant chemotherapeutic agent instead of conventional paclitaxel.
Design: Retrospective descriptive study.
Methods: Th e case records of patient presenting with advanced ovarian cancer stage IIIc to IV who received neo adjuvant
chemotherapy prior interval cytoreductive surgery between 2016 Jan to 2017 Jan at Bhaktapur Cancer Hospital were analyzed.
Demographic and clinical data were reviewed.
Result: Total of 32 patients, received NACT, and all patients received nano paclitaxel and carboplatin based regimen weekly
day 1, day 8 and day 15 every 4 weeks. Out of 32 patients, 15 (46.87%) patients were of high grade serous adenocarcinoma,
5(15.62%) were of mucinous cystadenocarcinoma, and rest of 12 (37.5%) were of other histology. 26 patients were presented
with stage IIIC, 6 patients with stage IV. On the basis of CT scan report and clinical examination, the clinical effi cacy and
toxicities were evaluated, 6(18.75%) obtained complete response to NACT, 24(74%) obtained partial response, and 2(6.25%)
were non-responder to NACT. All the patients who received neo adjuvant nano paclitaxel based chemotherapy were observed
for its toxicity and no any signifi cant results were found.
Conclusion: Nano particle formulation paclitaxel
Sristee Shrestha Prajapati
Bhaktapur Cancer Hospital, Nepal
Title: Outcome of staging laparotomy in ovarian mass in limited resource centre
Biography:
Sristee Shrestha Prajapati has pursued her MBBS from Dagestan State Medical Academy, Russia. She completed her MD in Obstetrics & Gynecology from Zhengzhou
University. Presently she is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. She received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi
Cancer Institute in 2015.
Abstract:
Background: Ovarian cancer is the second most common gynecologic cancer in women and the leading cause of death caused
by gynaecologic malignancy. Th e clinical diagnosis of ovarian malignancy is problematic, given the nonspecifi c nature of
presentation and the diffi culty in obtaining a histological diagnosis prior to defi nite treatment. Surgery plays a fundamental
role in treating this challenging disease. Goals of primary surgery for ovarian cancer are to establish diagnosis, proper staging,
and determination of prognosis and optimal cytoreduction of gross disease before chemotherapy for improved outcome.
Objectives: Th e objective of this study is to evaluate the benefi ts and risks of staging laparotomy in diagnosis of ovarian
tumor; to correlate CA 125 with benign and malignant ovarian tumor and to determine the age distribution in the benign and
malignant ovarian tumor.
Design: Retrospective descriptive study
Methods: Th e case records of patient presenting with ovarian masses that underwent staging laparotomy between 2016 May
to 2017 September at Bhaktapur Cancer Hospital were analyzed. Demographic and clinical data were reviewed. Correlation of
CA 125 in both malignant and benign cases was studied.
Results: 44 patients with ovarian masses undergoing staging laparotomy were included with age variation from 19 to 88. Th e
mean age was 52 years. 15 (34%) were malignant cases, 2 (4.5%) cases had borderline tumor and remaining 27 (61%) benign.
Th e mean age group in malignant cases, borderline cases and benign cases were 45, 64 and 55 years respectively. P value is
signifi cant (P=0.0234). Th is study shows mean value of CA 125 as 212.8 in malignant cases, 9.8 and 80.49 in borderline tumor
and benign cases respectively. P value signifi cant (p=0.0315). Out of 15 malignant cases, 8(53.3%) cases were in stage Ia,
1(7%) case in stage Ic and 6(40%) cases were in stage IIIc. Among malignant cases 4 out of 15 had lymphovascular invasion,
in which 2 out of 4 had omental metastasis and 2 out of 4 had lymph node metastasis. All these 4 cases were stage IIIc. Th e
CA 125 level was signifi cantly high in 4 out of 6 malignant cases ranging from 400 to 1000 units/ml with stage IIIc whereas 1
case with sarcoma had 20 units/ml, and another with mature cystic teratoma with squamous cell carcinoma had 24.4 units/ml.
In 27 benign cases, 1 had raised CA 125 level upto 862 units/ml with diagnosis of abdominal tuberculosis with mature cystic
teratoma whereas 3 cases of endometriosis had CA 125 level ranging from 150-200 units/ml.
Conclusion: Detection of pelvic mass with raised CA 125 level raises suspicion for ovarian malignancy, but there are various
benign pelvic conditions that are associated with raised CA 125 level. Th is is more important in the Nepalese subcontinent
where genital tuberculosis and endometriosis is common as seen in our case series where 11.11 % of cases of benign pelvic
masses with raised CA 125 level turned out to be endometrioma. However, 26.66% of malignant cases had signifi cantly raised
CA 125 level. Th e use of frozen section service for immediate intra-operative reporting is highly attractive for the gynecologic
oncology surgeon. It allows for a single optimal operative staging procedure where indicated and, likewise, for a non-staging
procedure if not required.