Title : Principles and practice of collaborative surgical procedures at oncogynecology
Abstract:
Background: We describe our experience of treatment of benign and malignant gynecologic pathology with make an emphasis on combined and simultaneous surgical procedures and collaborative team approach for optimization of the clinical outcomes of specialized care cases.Recently the combination of gynecologic and different surgical procedures is become more common in various institutions,but there are still some controversial questions concerning classification,terminology,proper definition and clinical assessment of traumatizm of performed surgical procedures. Methods: A retrospective review of 1327 patients of gynecologic surgery at 2012-2015 is analyzed. Analyzed data included: indications for surgery,initialtreatment,pre-operative status, extent of the procedure, operative time, blood loss, infussions and complications. Results: Of,1327patients,the median age was 51 years(range:27-76). Benign gynecologic pathology was diagnosed at 1114 (83%) and correspondingly gynecologic malignancies at 221 (17%) with I-II stage of disease in 70% and III-IV stage – at 30% of all cases.Recurrent tumors was revealed at 18 cases: cervical stump tumors – 10 cases and another 8 cases with following localization: retroperitoneum – 3,omentum – 3, abdominal wall/bladder – 1, mesentery/sigmoid colon – 1. Concomitant surgical pathology was revealed at 95 of all cases and the most often were found: abdominal adhesions – 33,hernias – 18 and cholecystolithiasis – 16. There was no operative mortality in the immediate postoperative period, 16 deaths occurred at follow up period(6months – 2 years). The overall prevalence of composite 30 day major postoperative complications was 4,3% (57 cases).
Conclusions: Based on our experience and appropriate anatomo-surgical landmarks we propose a new more optimal classification of abdominal hysterectomies. Our results suggests that joint surgical treatment is the best approach in repeated surgery and advanced cases to achieve the surgical adequacy. Thus,collaborative surgical management is feasible and realistic approach for optimization of clinical outcomes of treatment.
