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ABSTRACT: To determine the complication rates associated with differing surgical techniques for groin node dissection for vulval cancer.
We performed a retrospective case note review of patients undergoing groin node dissection for vulval cancer between 2001 and 2009 at Nottingham University Hospitals NHS Trust.
Notes for 56 patients undergoing a total of 98 groin node dissections were examined. Sixty-four percent of the patients had at least one complication from surgery. The use of suction drains was not associated with an increase in complications. However, when drains were used, a short duration of use was associated with high rates of wound breakdown and a long duration of use was associated with higher rates of lymphedema. The use of staples for skin closure was associated with an increased risk of lymphocysts and chronic lymphedema. The greater the number of nodes collected at lymphadenectomy, the higher the risk of lymphocysts and lymphedema.
We recommend the use of subcuticular suture for wound closure. Patients who undergo lymphadenectomy with a node count per groin of more than 7 should be closely monitored for lymphedema and referred promptly to specialist services. The prolonged use of suction drainage may increase the risk of lymphedema.
International Journal of Gynecological Cancer 11/2011; 21(8):1495-9. · 1.65 Impact Factor
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ABSTRACT: The objective of this study is to ascertain the presence of extrauterine spread in radiologically early stage and grade endometrial cancer. This could be the basis for offering vaginal hysterectomy without salpingo-oophorectomy as an alternative option to primary radical radiotherapy in women with significant medical co-morbidities in whom laparotomy will be contraindicated.
A retrospective cohort study assessing patients with clinically early stage endometrioid adenocarcinoma of the endometrium, treated at the Gynaecological Oncology Centre, Norfolk and Norwich University Hospital and James Paget University Hospital between January 2003 and July 2008. The cancer registry was reviewed, and 542 endometrial cancer cases were identified during the study period, of these 439 were endometrioid type. MR is the standard staging investigation unless there are contraindications. Demographic, clinic-pathologic and surveillance data were collected from hospital records, operative notes and histopathology reports. The histology included tumour type, stage and grade. Post-operative histopathological findings served as a reference standard. Sensitivity and specificity of pre-operative MRI scan were assessed.
Of the 439 cases treated during the study periods, 415 patients had an MRI pre-operatively imaging and 14% of these cases showed signs of extrauterine spread. MRI staging was then compared with the histopathology staging; the latter was taken as the gold standard. In 8% of the cases where no spread was seen on MRI, the disease was actually spread outside uterine corpus mainly to the cervix and pelvic lymph nodes. The sensitivity, specificity, positive predictive value and negative predictive value for MRI were 56, 93, 60, and 92, respectively, while predicting early stage disease. There were three cases of adnexal metastases, where the tumour had already spread to uterine serosa. Two cases had poorly differentiated and one had moderately differentiated tumour.
The risk of adnexal metastasis is less than 1% in clinically early stage disease and highly unlikely if MRI suggests that the disease is confined to the inner half of the myometrium and low-grade disease. MRI has a high specificity and negative predictive value in endometrial cancer staging with reduced sensitivity of detecting cervical, adnexal and lymphatic spread. We suggest that vaginal hysterectomy might be a safe alternative to laparotomy in the treatment of radiological early stage disease in medically compromised elderly patients. The possibility of converting a vaginal approach to an abdominal route should be always taken into consideration.
Archives of Gynecology 05/2011; 283(5):1097-101. · 0.91 Impact Factor
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Proceedings of the IEEE Congress on Evolutionary Computation, CEC 2005, 2-4 September 2005, Edinburgh, UK; 01/2005
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ABSTRACT: Neighbourhood search techniques have been successfully applied to a range of combinatorial optimisation problems, such as scheduling. Concurrently, work in the evolutionary computation community has explored the utility of interactive evolutionary algorithms that use the idea of `the user as fitness function' to tackle problems where the fitness function is hard, if not impossible, to specify. This paper will place the work above in the context of the neighbourhood search paradigm and scheduling, and tie it in with work from the OR and DSS communities, and argue that this leads to a more useful view of interactive neighbourhood search. Some of the points made in this paper will be illustrated by reference to an application domain: an emergency resource redistribution system for the developing world. 1 Introduction Combinatorial optimisation problems (COPs) are the subject of much research due to their ubquitious nature, and the fact that most are NP-hard . This has led resear...
11/1998;
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Tim Duncan
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ABSTRACT: Distribution is a substantial cost in many companies and in some sectors it contributes a high percentage of the value added to goods. Therefore the potential for savings is large, and there is much interest in improving distribution efficiency. The Vehicle Routing Problem (vrp) is an abstraction of a class of problems that has been studied both as a theoretical problem and for its practical relevance to applications. In this paper we investigate Neighbourhood Search techniques for solving the vrp and describe some experiments with variations on the approach applied to a set of benchmark problems. 1 Introduction Distribution is a major part of logistics and a substantial cost in many companies. In some sectors (e.g. soft drinks) it contributes a high percentage of the value added to goods. Therefore the potential for savings is large and there is much interest in improving distribution efficiency. The Vehicle Routing Problem (vrp) is an abstraction of a class of problems that has been...
02/1970;
