Objective 
To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC).


Methods 
The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Random-effects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS).


Findings 
Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19–0.41, P = 0.00, I2 = 97.81), nerve injury 1% (95%CI 0.00–0.03, I2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I2 = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01–0.03, I2 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I2 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, I2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy.


Conclusion 
This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation.

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Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis.

We collected the clinical data of 156 patients diagnosed with condyloma acuminatum (CA), including age, gender, marriage, education level, stay up late, smoking, drinking, number of sexual partners, HPV infection status of sexual partners, genitourinary and anal diseases, condom use, other diseases of HPV infection, location and number of warts, HPV typing, etc. Analyze the risk factors affecting the recurrence of CA, explore the influencing factors and independent influencing factors of CA recurrence, establish the prediction model of CA recurrence, and evaluate its prediction value. Univariate analysis showed that stay up late, HPV infection status of sexual partners, urogenital diseases, condom use, other diseases of HPV infection and the number of CA were the influencing factors of CA recurrence. Multivariate analysis showed that condom use (OR = 0.166), HPV infection status of sexual partners (OR = 4.848), number of warts (OR = 1.212) and urogenital diseases (OR = 3.179) were independent factors affecting the recurrence of CA (P < 0.05). Therefore, the prediction model of CA recurrence can be established, and the area under the curve AUC of the prediction model was calculated to be 0.867 (95% CI 0.812-0.923). The model established in this study has certain prediction value for the recurrence of CA and can be used to preliminarily predict the recurrence of CA. 

/pdf/establishing-a-prediction-model-for-recurrence-of-condyloma-hzopv90u.pdf

Establishing a prediction model for recurrence of condyloma acuminatum

Introduction. Since 1897, when the first radical hysterectomy with
 lymphadenectomy was done by Wertheim in Vienna, this operation has had the
 central role in the surgical treatment of invasive cervical tumors. Material
 and methods. In the period from 1997 to 2010, 177 patients diagnosed with
 invasive cervical cancer according to the International Federation of
 Gynecology and Obstetrics (FIGO) stage IB1 - II were operated at the
 Department of Obstetrics and Gynecology in Banja Luka. All patients underwent
 radical hysterectomy by Wertheim - Meigs. The aim of this study is to present
 the technique of this operation, as well as its effectiveness in the
 treatment of cervical cancer. Results. The distribution of the patients
 having invasive cervical cancer according to the International Federation of
 Gynecology and Obstetrics classification was as follows: I B1 - 35.67%, I B2
 - 23.17%, II A - 15.48%, II B - 25.68% on average is 21.3 removed lymph
 glands. The rate of intraoperative and postoperative complications was 8
 (4.51%) and 17 (9.60%), respectively. Of the 26 patients who were operated in
 the period from 2005 - 2010, 13 had stage II B according to the International
 Federation of Gynecology and Obstetrics; there were 6 lethal outcomes (23.08)
 and the five-year survival rate was 76.92%. Discussion and conclusion. By
 applying the proper surgical technique and early prevention of immediate
 complications, we achieved satisfactory results in operative morbity and
 mortality, intraoperative and postoperative complications of the lesion for
 radical surgery by the Wertheim- Meigs-in the treatment of cancer of the
 uterus in the I B - II B stage according to the International Federation of
 Gynecology and Obstetrics classification.

/pdf/treatment-of-cervical-cancer-in-the-republic-of-srpska-3drmyoay8i.pdf

Treatment of cervical cancer in the Republic of Srpska

The authors in their paper show the case with the female patient D.S. 51 years old, which was surgically treated for genital condyloma in 1981, 1986, 1999, 2006 and 2008. Under registration number 3119/2006 was received at Gynecology and Obstetrics Clinic in Banja Luka with the diagnosis of condyloma acuminatum permagnum. Patient suffered from a huge tumorous, cauliflower formation, which was located on the mons pubis, and down to the anus, laterally to the right of the gluteal region to the left thigh. Patient was operated–Vulvectomia simplex cum extirpatio tumoris reg glutealis l dex. We obtained pathohistological findings (no. 4876 / 06) which read: condyloma acuminatum permagnum. After two years patient was rehospitalized at Gynecology and Obstetrics Clinic in Banja Luka, (registration number 1311/08) with almost identical findings in the same region under the diagnosis of condyloma acuminatum permagnum recidivans, St. post. vulvectomiam simplex et extitpationem tumoris glutealis reg l dex. All preoperative findings – laboratory analysis, X-ray of the lung and heart and ultrasound of the small pelvis were within the reference values. In this paper we describe the location of the tumor and how it is resolved – Extirpatio tumoris reg glutealis l. dex. et perianalis.

Pathohistological findings confirmed previous diagnosis. In this paper we highlight our experiences regarding the operations of an unusually large tumors of genital condyloma and recurrent genital condyloma that were almost of the same size. Our experience could be useful to work on the education about sexually transmitted diseases, in order to improve the prevention of the viral diseases (vaccination), the treatment of these illnesses and to disseminate the warning that the regular check-ups with gynecologist are necessary.

/pdf/surgery-of-condyloma-acuminatum-permagnum-and-permagnum-107sax9hsr.pdf

Surgery of condyloma acuminatum permagnum and permagnum recurrence after two years.

Objectives: The objective of the study is comparing pathohistological picture and test results of the activity of the enzymes of the anti-oxidative protection –cytoplasmic super-oxide dismutase (CuZnSOD) from the blood and endometrium in the promotion of the progression or regression of the hyperplasia and endometrium carcinoma. Materials and Methods: The study has been carried out on 70 patients. We have analysed:The age patients, the supersonic test – transvaginal probe, pathohistological diagnosis (PHD) analysis of the curet of the patient–we have gathered the tissue of the normal and the pathologicaly changed endometrium from the exploratory curretage, determining the CuZnSOD in the blood and in the tissue of the normal and pathological endometrium of the uterus. The Group A has been made out of 30 of them who did not have the irregular bleeding from the uterus, and 40 of them represented the Group B with the irregular bleeding, who also had PHD confirmed hyperplasia or malign changes of the endometrium. We have tested if there has been the pathalogical changes in the small pelvis(the ovary tumor, myoma etc.) in both groups. Results: Dominant age in the Group B is 41 – 50 (55%), in Group A, age difference is not that apparent (p>0.05).The results of the arithmetic mean of the CuZnSOD in the blood (19.90%) and (29.05%) in the endometrium which is lower than the Group A (blood-29.95%, endometrium-32.56%). Lower values CuZnSOD in the blood(18,9%) and endometrium (30,09%) we have in the experimental group patients who have had bleeding as well as those beside bleeding had some other gynecological – patological proces (myoma, cyst on the ovary etc.) Conclusions: According to the facts we can see the significance of the activity of the enzymes of the anti – oxidative system in the diagnostic of the hyperplasia and endometrium carcinoma as well as the possibility of their application in the clinical practice.

/pdf/importance-of-the-cytoplasmic-super-oxide-dismutase-in-the-2bx28r7lyi.pdf

Zora Antonic

Papers

Treatment of cervical cancer in the Republic of Srpska

Surgery of condyloma acuminatum permagnum and permagnum recurrence after two years.

Importance of the cytoplasmic super-oxide dismutase in the normal tissue of the endometrium and the endometrium carcinoma.