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ABSTRACT: Postoperative infections are a great constituent of surgical complications. The most common one is surgical site infection (SSI), as well as vaginal and/or urinary tract infections, infections affecting distant organs and systems and systemic circulation leading to sepsis and septic shock. Our aim was to emphasize the effect of malignant disease on postoperative infection and to establish malignant disease as a risk factor for SSI, per se.
We designed a retrospective study in which 538 women who underwent surgery in the Gynecology and Obstetrics Clinical Center of Serbia during a six-month period in 2009 were analyzed. We collected relevant data regarding SSI incidence (CDC definitions), malignant disease (primary site, type and stage) and other potential risk factors for SSI. We used descriptive statistics, chi-square and Student's t test for comparison of variables with statistical significance atp < 0.05. We also used univariate, multivariate logistic regression and ROC analysis.
Surgical site infection was present in 40 patients (7.5%). Univariate analysis revealed that the following factors were significantly related to SSI: age, malignant disease, stage of malignant disease, surgery longer than 120 min, postmenopause, diabetes mellitus, positive preoperative vaginal culture, ASA score and intraoperative blood loss. Multivariate analysis showed that the most important risk factors that contribute to SSI with RR of 4 and 5 are, respectively, FIGO II and FIGO III/IV stage of malignant disease (FIGO II p < 0.05 RR = 4.097; FIGO III/IV < 0.01 RR = 5.061).
In our study malignant disease erupted as the most important risk factor for SSI. This brings us to question the pathophysiological mechanisms and systemic effects associated with malignant disease. There are few studies discussing the issue of malignancy as an isolated risk factor that 4-5 fold increases the risk of SSIs. It is of utmost interest to define protocols of antimicrobial prophylaxis for gynecological malignancy surgery as are suggested for some other malignancies.
Clinical and experimental obstetrics & gynecology 01/2012; 39(1):53-6. · 0.43 Impact Factor
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ABSTRACT: In cases of advanced ovarian cancer bowel surgery is necessary during the primary surgical procedure, in the course of the disease for recurrence or palliation of the symptoms. Treatment with maximal cytoreductive surgery followed by chemotherapy in women with advanced ovarian cancer is well established.
We retrospectivly evaluated 56 women who were surgically treated for ovarian cancer over five years (from 2004 to 2008) at the Institute of Obstetrics and Gynecology, Clinical Center of Serbia. In 56 patients, 82 intestine operations were performed, which means that in some patients more than one intestine operation was performed. We analyzed patient characteristics, tumor features, intraoperative findings, pelvic node involvement, surgical procedure performed, indications for bowel surgery, and early postoperative complications.
In our study the majority of patients had Stage III (82%) or IV (10%) carcinoma with poor differentiation. Epithelial ovarian cancer was the most common histopathological finding (78%) in our group of patients. There were 30 cases (53%) with serous, nine (16%) with mucinous and five (9%) with endometriod tumors. Bowel surgery was indicated in 12.2% of our patients with ovarian cancer which was mostly performed to reduce the volume of the tumor (68%), while it was indicated in recurrence of the disease in 18% of women. In addition to the standard surgery procedure, which includes removal of internal genital organs, omentum minus/majus, peritoneal tumor masses, large and small bowel resection were performed. Of 56 patients most underwent small bowel surgery--43 of a total of 82 intestinal operations (52.4%). Of these we performed small bowel resection in 34 (41.5% of all intestinal operations), while ileostomy and jejunostomy were performed in nine cases (11%). There were 39 colon operations (47.6%) and most of the cases underwent rectosygmoid resection with the Hartman procedure (33 or 40.2% of all intestinal operations). Other colon operations included hemicolectomy (3 cases--3.7%), transverse colon resection (2 cases--2.4%) and pancolectomy (1 case--1.2%). According to our experience, wound infection and febrile morbidity were the most common early postoperative complications. Mortality rates in the literature vary between 0% and 8%, and anastomotic complications between 0 and 4%, which is in agreement with our results.
Radical surgical procedures in treatment of ovarian cancer including multi-organ resection are necesery to achieve a minimal residual disease state prior to initiating adjuvant chemotherapy. Bowel preparation and CT/MR imaging should be performed in patients with possible malignant ovarian masses.
European journal of gynaecological oncology 01/2011; 32(4):419-22. · 0.47 Impact Factor
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ABSTRACT: Krukenberg tumors are mostly found as metastatic signet-ring cell adenomucinous carcinomas in young, premenopausal women. They are bilateral in 80% of the cases, and thus can be expected in pregnancy. A 31-year-old female was diagnosed by explorative laparotomy at 27 weeks of gestation with a Krukenberg tumor due to bilateral adnexal masses and a large amount of ascites. At surgery cesarean section with total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy and pelvic lymphadenectomy was performed. The neonate died 24 hours later due to prematurity and respiratory distress syndrome. The primary site of the cancer was detected metachronously two months after surgery and postoperative chemotherapy, as stomach adenomucinous carcinoma. In spite of surgery and postoperative multiagent chemotherapy, the patient died six months from the diagnosis of Krukenberg.
European journal of gynaecological oncology 01/2011; 32(3):356-8. · 0.47 Impact Factor
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ABSTRACT: The aim of the study was to determine if radical trachelectomy with pelvic lymphonodectomy could be a method for treatment of early cervical cancer to preserve fertility. We examined 12 patients who were operatively treated from 1996. to 2006. year. Diagnostic method for cervical cancer was histologic examination, cone or biopsy. Histologic condition was planocelular carcinoma well differented. Two of the patients had Ia1 stage, seven had Ia2, and three of them had Ib1. We performed abdominal radical trachelectomy with pelvic lymphonodectomy. Resectional edges were patohistologically analyzed ex tempore, as well as lymphonodi, selectively. According to ex tempore analysis we determined if the radical trachelectomy should be done. In one patient resectional edges were positive, so she underwent radical hysterectomy. Postoperatively we found a positive lymphonodus in one patient, so we continued radiation therapy. In two-year follow-up period we did not find any sign of residual cancer. We concluded that radical trachelectomy with pelvic lymphonodectomy could be appropriate method for treatment of early stage cervical cancer.
Acta chirurgica iugoslavica 02/2008; 55(4):93-7.
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ABSTRACT: A prospective follow-up stady was performed to evaluate the effect of Burch colposuspension alone and a concomitant abdominal hysterectomy with Burch colposuspension. Twenty seven women underwent Burch colposuspension and 34 women colposuspension with abdomina hysterectomy. Subjective outcame was assessed with questionaire at 4 weeks, 6 months and 1 year. In the 1 year follow-up 81,4% were subjectively cured or improved in the Burch group and 76,4% in the hysterectomy group. No statistically significant difference in the frequency of any subgroup of complications was found.
Acta chirurgica iugoslavica 02/2006; 53(1):77-81.
