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Short-term Outcomes of Treatment for Gynecological Cancers in a Tertiary Center in Northeast India

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Abstract

Purpose

Gynecological cancers constitute a major public health problem as they are an important cause of cancer-related mortality. Accounting for an estimated annual incidence of more than 3.6 million and mortality exceeding 1.3 million, these constitute nearly 40% of all cancer incidence and more than 30% of all cancer mortality in women worldwide. Gyne-oncology procedures need specialized training and are not routinely done in several gynecology units due to lack of expertise. This study strives to look at the short-term outcomes of treatment for gynecological cancers in a public sector hospital in Northeast India.

Methods

This is a retrospective analysis of the prospectively maintained data base of a Surgical Oncology unit at a tertiary institute in Northeast India from October 2016 to August 2021. All the data were electronically captured after performance of surgery. Demographics, staging [was done using FIGO classification], and histopathology were recorded. The morbidity and mortality were measured using Clavien–Dindo classification (CD) up to 30 days. Descriptive statistics were used.

Results

A total of 82 patients were operated for gynecological cancers during the study period. Procedures related to the ovary were performed in 56 patients. Significant morbidity (CD > 3) was seen in five patients, while mortality was seen in one patient. The average duration of hospital stay was 15 days and average blood loss was 741 ml. Average lymph node yield was 25. Primary cytoreductive surgery was the most commonly (31.71%) performed surgery.

Conclusion

With availability of expertise, gyne-oncology procedures can be offered in Northeast India with acceptable morbidity.

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References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA a cancer J clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.

    Article  Google Scholar 

  2. -India-fact-sheets. India Source: Globocan 2020. https://gco.iarc.fr/today/data/factsheets/populations/365-india-fact-sheets.pdf. Accessed 7 november 2022.

  3. Basu P, De P, Mandal S, Ray K, Biswas J. Study of ‘patterns of care’ of ovarian cancer patients in a specialized cancer institute in Kolkata, eastern India. Indian J Cancer. 2009;46(1):28–33. https://doi.org/10.4103/0019-509x.48592.

    Article  CAS  PubMed  Google Scholar 

  4. Parkin DM, Bray F, Ferlay J, Pisani P. 2002 Global cancer statistics. CA Cancer J Clin. 2005;55(2):74–108. https://doi.org/10.3322/canjclin.55.2.74.

    Article  PubMed  Google Scholar 

  5. Bookman MA, Brady MF, McGuire WP, Harper PG, Alberts DS, Friedlander M, et al. Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a phase III trial of the Gynecologic Cancer Intergroup. J Clin Oncol. 2009;27(9):1419–25. https://doi.org/10.1200/JCO.2008.19.1684.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. McGonigle KF, Muntz HG, Vuky J, Paley PJ, Veljovich DS, Greer BE, et al. Combined weekly topotecan and biweekly bevacizumab in women with platinum-resistant ovarian, peritoneal or fallopian tube cancer: results of a phase 2 study. Cancer. 2011;117(16):3731–40. https://doi.org/10.1002/cncr.25967.

    Article  CAS  PubMed  Google Scholar 

  7. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9(3):297–303. https://doi.org/10.1016/S1470-2045(08)70074-3.

    Article  PubMed  Google Scholar 

  8. Marin F, Plesca M, Bordea CI, Moga MA, Blidaru A. Types of radical hysterectomies: from Thoma Ionescu and Wertheim to present day. J Med Life. 2014;7(2):172–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Mota F, Vergote I, Trimbos JB, Amant F, Siddiquis N, Delrio A, et al. Classification of radical hysterectomy adopted by the gynaecological cancer group of the european organization for research and treatment of cancer. Int J Gynecol Cancer. 2008;18(5):1136–8. https://doi.org/10.1111/j.1525-1438.2007.01138.x.

    Article  CAS  PubMed  Google Scholar 

  10. Burger CW, de Oliveria C, Kehoe ST. The problems of surgical training in gynaecologic oncology. EurJ Gynaecol Oncol. 2000;21(2):109–14.

    CAS  Google Scholar 

  11. Owens GL, Sivalingam V, Abdelrahman M, Beirne JP, Blake D, Collins A, et al. Audit and research in gynaecological oncology (ARGO) Collaborative. Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynaecological oncology patients? Int J Gynecol Cancer. 2020;30(12):1959–65. https://doi.org/10.1136/ijgc-2020-001834.

    Article  PubMed  Google Scholar 

  12. Iyoke CA, Ugwu GO, Ezugwu EC, Ezugwu FO, Lawani OL, Onyebuchi AK. Challenges associated with the management of gynecological cancers in a tertiary hospital in South East Nigeria. Int J Womens Health. 2014;6:123–30. https://doi.org/10.2147/IJWH.S55797.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Profile of cancer and Related Health Indicators in the North East Region of India. https://ncdirindia.org/All_Reports/NorthEast2021/resources/NE_Complete.pdf . Accessed 24November, 2022.

  14. Berek JS, Kehoe ST, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet. 2018;143(Suppl 2):59–78. https://doi.org/10.1002/ijgo.12614.

    Article  PubMed  Google Scholar 

  15. Lee SI, Atri M. 2018 FIGO staging system for uterine cervical cancer: enter cross-sectional imaging. Radiology. 2019;292(1):15–24. https://doi.org/10.1148/radiol.2019190088.

    Article  PubMed  Google Scholar 

  16. Percorelli S, Bendet JL, Creasman WT, Shepherd JH. FIGO staging of gynecologic cancer. 1994–1997 FIGO committee on gynecologic oncology international federation of gynecology and obstetrics. Int J Gynaecol Obstet. 1999;64(1):5–10. https://doi.org/10.1016/s0020-7292(98)00234-3.

    Article  Google Scholar 

  17. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–26.

    CAS  PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sokol DK, Wilson J. What is a surgical complication? World J Surg. 2008;32(6):942–4. https://doi.org/10.1007/s00268-008-9471-6.

    Article  PubMed  Google Scholar 

  20. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.

    Article  PubMed  Google Scholar 

  21. Llueca A, Serra A, Climent MT, Segarra B, Maazouzi Y, Soriano M, et al. Outcome quality standards in advanced ovarian cancer surgery. World J Surg Oncol. 2020;18(1):309. https://doi.org/10.1186/s12957-020-02064-7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chang SJ, Bristow RE, Ryu HS. Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer. Ann Surg Oncol. 2012;19(13):4059–67. https://doi.org/10.1245/s10434-012-2446-8.

    Article  PubMed  Google Scholar 

  23. Chi DS, Musa F, Dao F, Zivanovic O, Sonoda Y, Leitao MM, et al. An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). Gynecol Oncol. 2012;124(1):10–4. https://doi.org/10.1016/j.ygyno.2011.08.014.

    Article  PubMed  Google Scholar 

  24. Colombo P, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, et al. Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol. 2009;35(2):135–43. https://doi.org/10.1016/j.ejso.2008.01.005.

    Article  PubMed  Google Scholar 

  25. Fagö-Olsen CL, Ottesen B, Kehlet H, Antonsen SL, Christensen IJ, Markauskas A, et al. Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A Nationwide Danish Study Gynecol Oncol. 2014;132(2):292–8. https://doi.org/10.1016/j.ygyno.2013.11.035.

    Article  PubMed  Google Scholar 

  26. Peiretti M, Zanagnolo V, Aletti GD, Bocciolone L, Colombo N, Landoni F, et al. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: surgical and oncological outcomes. Single Inst Exp Gynecol Oncol. 2010;119(2):259–64. https://doi.org/10.1016/j.ygyno.2010.07.032.

    Article  Google Scholar 

  27. Rauh-Hain JA, Rodriguez N, Growdon WB, Goodman AK, Boruta DM 2nd, Horowitz NS, et al. Primary debulking surgery versus neoadjuvant chemotherapy in stage IV ovarian cancer. Ann Surg Oncol. 2012;19(3):959–65. https://doi.org/10.1245/s10434-011-2100x.

    Article  PubMed  Google Scholar 

  28. Sehouli J, Savvatis K, Braicu EI, Schmidt SC, Lichtenegger W, Fotopoulou C. Primary versus interval debulking surgery in advanced ovarian cancer: results from a systematic single-center analysis. Int J Gynecol Cancer. 2010;20(8):1331–40. https://doi.org/10.1111/IGC.0b013e3181f15714.

    Article  PubMed  Google Scholar 

  29. Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemo- therapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943–53. https://doi.org/10.1056/NEJMoa0908806.

    Article  CAS  PubMed  Google Scholar 

  30. Chi DS, Eisenhauer EL, Zivanovic O, Sonoda Y, Abu-Rustum NR, Levine DA, et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol. 2009;114(1):26–31. https://doi.org/10.1016/j.ygyno.2009.03.018.

    Article  PubMed  Google Scholar 

  31. Venesmaa P, Ylikorkala O. Morbidity and mortality associated with primary and repeat operations for ovarian cancer. Obstet Gynecol. 1992;79(2):168–72.

    CAS  PubMed  Google Scholar 

  32. Vergote I, Wever I, Tjalma W, Gramberen M, Decoloedt J, van Dam P. Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol. 1998;71(3):431–6. https://doi.org/10.1006/gyno.1998.5213.

    Article  CAS  PubMed  Google Scholar 

  33. Shih KK, Chi DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol. 2010;21(2):75–80. https://doi.org/10.3802/jgo.2010.21.2.75.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Georgeena P, Rajanbabu A, Vijaykumar DK, Pavithran K, Sundaram KR, Deepak KS, et al. Surgical treatment pattern and outcomes in epithelial ovarian cancer patients from a cancer institute in Kerala, India. Ecancermedicalscience. 2016;4(10):619. https://doi.org/10.3332/ecancer.2016.619.

    Article  Google Scholar 

  35. Vergote I, Coens Nankivell M, Kristensen GB, Parmar MKB, Ehlen T, et al. Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials. Lancet Oncol. 2018;19(12):1680–7. https://doi.org/10.1016/S1470-2045(18)30566-7.

    Article  PubMed  Google Scholar 

  36. Vernooij F, Heintz P, Witteveen E, Van der Graff Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol. 2007;105(3):801–12. https://doi.org/10.1016/j.ygyno.2007.02.030.

    Article  PubMed  Google Scholar 

  37. du Bois A, Rochon J, Pfisterer J, Hoskins WJ. Variations in institutional infrastructure, physician specializatio nband experience, and outcome in ovarian cancer: a systematic review. Gynecol Oncol. 2009;112(2):422–36. https://doi.org/10.1016/j.ygyno.2008.09.036.

    Article  PubMed  Google Scholar 

  38. Fung-Kee-Fung M, Kennedy EB, Biagi J, Colgan T, D’Souza D, Elit LM, et al. The optimal organization of gynecologiccservices: a systematic review. Curr Oncol. 2015;22(4):e282–93. https://doi.org/10.3747/co.22.2482.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Fung-Kee-Fung M, Kennedy EB, Biagi J, Colgan T, D’Souza D, Elit LM, et al. An organizational guideline for gynecologic oncology services. Int J Gynecol Cancer. 2015;25(4):551–8. https://doi.org/10.1097/IGC.0000000000000400.

    Article  PubMed  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Surgical Oncology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, 793018, India

    Caleb Harris, Samapti Debnath & Pallabika Mandal

  2. Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, 793018, India

    Wansalan Karu Shullai, Manika Agarwal, Nalini Sharma & Subrat Panda

  3. Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, 793018, India

    Jaya Mishra

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Contributions

Conceptualization was done by CH; methodology was done by CH; formal analysis and investigation were done by CH, SD, and PM; writing—original draft preparation were done by CH, SD, and PM; writing—review and editing were done by CH, SD, PM, WS, MA, NS, SP, and JM; funding acquisition was not applicable; resources were done by CH, WS, MA, NS, SP, and JM; supervision was done by CH.

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Correspondence to Caleb Harris.

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This is an audit of prospectively maintained database. As per the SOP of Institute Ethics Committee, no ethical approval is required.

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Harris, C., Debnath, S., Mandal, P. et al. Short-term Outcomes of Treatment for Gynecological Cancers in a Tertiary Center in Northeast India. Indian J Gynecol Oncolog 21, 63 (2023). https://doi.org/10.1007/s40944-023-00743-3

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