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Wang F, Wang X, Shi Y, Li L, Zheng Y, Liu H, Zeng M, Jiang F, Wu Z. Development of a risk nomogram predicting urinary tract infection in patients with indwelling urinary catheter after radical surgery for cervical cancer. Prog Urol 2023; 33:492-502. [PMID: 37634960 DOI: 10.1016/j.purol.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cervical cancer (CC) patients receiving indwelling catheterization after radical hysterectomy (RH) are vulnerable to urinary tract infection (UTI). However, no model or method is available to predict the risk of UTIs. Therefore, our aim was to develop and verify a risk model to predict UTI for patients receiving indwelling catheterization after radical cervical cancer surgery (ICa-RCCS). METHODS We first collected clinical information of 380 patients receiving ICa-RCCS from January 2020 to December 2021 as a training cohort to develop the risk nomogram. UTI was then evaluated using 19 UTI predictor factors. The least absolute shrinkage and selection operator (LASSO) method was utilized for the extraction characteristics. Multivariable logistic regression analysis was then conducted to create the risk model for UTI prediction. The consistency coefficient and calibration curve were utilized to assess the model's fit accuracy. We performed bootstrapping with 1000 random samples for internal validation of the model, and decision curve analysis (DCA) for clinical application. RESULTS Predictors in the risk nomogram included indwelling catheterization duration, whether it is secondary indwelling catheterization, history of UTIs, age, and history of chemotherapy before surgery. The risk nomogram presented good discrimination and calibration (C-index: 0.810, 95% CI: 0.759-0.861). During interval validation, the model reached a high C-index up to 0.7930. DCA revealed the clinical utility of predictive model for UTI. Clinical benefit was initiated at the decision threshold≥3%. CONCLUSION We developed a novel UTI nomogram incorporating the age, history of chemotherapy before surgery, indwelling catheterization duration, whether it is secondary indwelling catheterization, and history of UTI to predict UTI risk for patients receiving ICa-RCCS. LEVEL OF EVIDENCE B: 3a.
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Affiliation(s)
- Fang Wang
- Chong Qing Three Gorges Medical College, Chongqing, China
| | - Xiaoli Wang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YuanXiang Shi
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Ling Li
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Yu Zheng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Huaying Liu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Min Zeng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fu dan University, Shanghai, China.
| | - Zhimin Wu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China.
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Mercadel AJ, Holloway SB, Saripella M, Lea JS. Risk factors for catheter-associated urinary tract infections following radical hysterectomy for cervical cancer. Am J Obstet Gynecol 2023:S0002-9378(23)00135-7. [PMID: 36863644 DOI: 10.1016/j.ajog.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Radical hysterectomy is the mainstay of treatment for early-stage cervical cancer. Urinary tract dysfunction is one of the most common complications after radical hysterectomy, and prolonged catheterization has previously been defined as a significant risk factor for catheter-associated urinary tract infections. OBJECTIVE This study aimed to determine the rate of catheter-associated urinary tract infections after radical hysterectomy for cervical cancer, and to identify additional risk factors for developing catheter-associated urinary tract infections in this population. STUDY DESIGN We reviewed patients who underwent radical hysterectomy for cervical cancer from 2004 to 2020 after institutional review board approval. All patients were identified from institutional Gynecologic Oncology surgical and tumor databases. The inclusion criterion was radical hysterectomy for early-stage cervical cancer. Exclusion criteria included inadequate hospital follow-up, insufficient records of catheter use in the electronic medical record, urinary tract injury, and preoperative chemoradiation. Catheter-associated urinary tract infection was defined as an infection diagnosed in a catheterized patient or within 48 hours of catheter removal, with significant bacteriuria (>103 cfu/mL) and symptoms or signs attributable to the urinary tract. Data analysis was performed using comparative analysis and univariate and multivariable logistic regression using Excel, GraphPad Prism, and IBM SPSS Statistics. RESULTS Of the 160 included patients, 12.5% developed catheter-associated urinary tract infections. In univariate analysis, catheter-associated urinary tract infection was significantly associated with current smoking history (odds ratio, 3.76; 95% confidence interval, 1.39-10.08), minimally invasive surgical approach (odds ratio, 5.24; 95% confidence interval, 1.91-16.87), estimated surgical blood loss >500 mL (odds ratio, 0.18; 95% confidence interval, 0.04-0.57), operative time >300 minutes (odds ratio, 2.92; 95% confidence interval, 1.07-9.36), and increased duration of catheterization (odds ratio, 18.46; 95% confidence interval, 3.67-336). After adjusting for interactions and controlling for potential confounders with multivariable analysis, current smoking history and catheterization for >7 days were identified as independent risk factors for development of catheter-associated urinary tract infections (adjusted odds ratio, 3.94; 95% confidence interval, 1.28-12.37; adjusted odds ratio, 19.49; 95% confidence interval, 2.78-427). CONCLUSION Preoperative smoking cessation interventions for current smokers should be implemented to decrease risk for postoperative complications, including catheter-associated urinary tract infections. In addition, catheter removal within 7 postoperative days should be encouraged in all women undergoing radical hysterectomy for early-stage cervical cancer in an effort to decrease infection risk.
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Affiliation(s)
- Alyssa J Mercadel
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Parkland Memorial Hospital, Dallas, TX
| | - Steven B Holloway
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Monica Saripella
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jayanthi S Lea
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
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Rocher G, Azaïs H, Favier A, Uzan C, Castela M, Moawad G, Lavoué V, Morandi X, Nyangoh Timoh K, Canlorbe G. Relationships between pelvic nerves and levator ani muscle for posterior sacrocolpopexy: an anatomic study. Surg Radiol Anat 2022; 44:891-898. [DOI: 10.1007/s00276-022-02955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
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Enhanced Recovery after Surgery (ERAS) Protocol for Early Discharge within 12 Hours after Robotic Radical Hysterectomy. J Clin Med 2022; 11:jcm11041122. [PMID: 35207395 PMCID: PMC8874658 DOI: 10.3390/jcm11041122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022] Open
Abstract
To evaluate safety of quick discharge after robotic radical hysterectomy (RRH) in a tertiary hospital which has the enhanced recovery after surgery (ERAS) protocol. Among 94 consecutive cervical cancer patients who had undergone RRH, operative outcomes and the rate of unexpected visit after surgery were analyzed retrospectively. Patients were categorized as a surgery-to-discharge time of ≤12 h (early discharge [ED]) or >12 h (late discharge [LD]). About 77% (n = 72) of analyzed 94 patients discharged within 12 h after RRH. The ED group had significant correlation with shorter duration for urinary catheter required, less operative blood loss, and less voiding difficulty after long-term follow up compared to the LD group. There was no difference of perioperative complications and unexpected visit between the two groups. Performing nerve sparing (NS) RRH was only independent predictor for ED (p = 0.043, hazard ratio for LD = 0.22, confidence interval = 0.05–0.95). In conclusion, the ED within 12 h after RRH was safe in the setting of ERAS protocol. The NS-RRH could avoid the delay of genitourinary function recovery after surgery which caused LD. It can become the reasonable clinical pathway to discharge early patients who undergo NS-RRH with ERAS protocol.
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Komatsu H, Okawa M, Hikino K, Iida Y, Osaku D, Kudoh A, Chikumi J, Sato S, Oishi T, Harada T. A simplified procedure of nerve‐sparing radical hysterectomy. J Obstet Gynaecol Res 2022; 48:766-773. [DOI: 10.1111/jog.15154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Masayo Okawa
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Kohei Hikino
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Daiken Osaku
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Akiko Kudoh
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Jun Chikumi
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Tetsuro Oishi
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology Tottori University School of Medicine Yonago Tottori Prefecture Japan
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Functional Changes of the Genitourinary and Gastrointestinal Systems before and after the Treatment of Endometrial Cancer-A Systematic Review. J Clin Med 2021; 10:jcm10235579. [PMID: 34884279 PMCID: PMC8658546 DOI: 10.3390/jcm10235579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Endometrial cancer is currently one of the most common gynecological cancer and accounts for around 5% of all female cancers. The treatment strategy most often includes surgery and adjuvant radiation therapy. Thanks to the high effectiveness of used treatment methods, the patients can live longer lives. Unfortunately their quality of life can be negatively affected by side effects resulting from weakening pelvic floor such as urinary incontinence, pelvic organ prolapse and fecal incontinence. In our paper we analyzed the studies published between 2010 and 2020 that touch upon the prevalence and management of pelvic floor dysfunction in endometrial cancer patients. Our results show increase in the incidence of pelvic floor disorders after various forms of endometrial cancer treatment and the need for more good quality research in the subject to be able to provide patients with holistic care focused on minimizing treatment side effects and prioritizing their quality of life. Abstract The incidence of endometrial cancer (EC), which coexists with such civilization diseases as diabetes, obesity or hypertension, is constantly increasing. Treatment includes surgery as well as brachytherapy, teletherapy, rarely chemotherapy or hormone therapy. Due to the good results of the treatment, the occurrence of side effects of therapy becomes a problem for the patients. One of the large groups of side effects includes the pelvic organ prolapse, urinary and fecal incontinence. The aim of this study was to present current knowledge on the occurrence of pelvic floor dysfunction in women treated for EC. A literature review was conducted in the PubMED and WoS databases, including articles on pelvic floor dysfunction in women with EC. PRISMA principles were followed in the research methodology. A total of 1361 publications were retrieved. Based on the inclusion and exclusion criteria, 24 papers were eligible for the review. Mostly retrospective studies based on different questionnaires were evaluated. No prospective studies were found in which, in addition to subjective assessment, clinical examination and objective assessment of urinary incontinence were used. Studies show a significant increase in the incidence of pelvic floor disorders, including urinary incontinence, after various forms of EC treatment. We believe that assessment of complications after endometrial cancer treatment is clinically relevant. The review emphasizes the importance of programming prospective studies to prevent and address these disorders at each stage of oncologic treatment.
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Paek J, Lim PC. The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer. Int J Med Sci 2021; 18:2697-2704. [PMID: 34104102 PMCID: PMC8176165 DOI: 10.7150/ijms.59267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/27/2021] [Indexed: 12/09/2022] Open
Abstract
Objective: To identify the pattern of recurrence and assess the clinicopathologic prognostic factors for survival after robotic radical hysterectomy (RRH) in the treatment of stage IB cervical cancer. Methods: From December 2008 to March 2018, 64 cervical cancer patients who underwent RRH with pelvic lymph node dissection by a single surgeon were enrolled in this retrospective historical cohort timeline study. The patient's status was estimated in terms of operative outcomes, pathologic results, and survival outcomes. Results: The median follow-up was 63 months. The recurrence rate was 9.4% (6/64). There were two recurrences at the vaginal vault, two in the pelvic cavity, and two at the peritoneum in the intraabdominal cavity. The overall survival rate was 95.3% (61/64). When patients were divided into three groups in order based on surgery date, the first surgical period showed significantly higher recurrence rate (21%) compared to both the second (10%) and the third period (0%) (p=0.037). Multivariate analysis showed that the early period of RRH (p=0.025) and clinical tumor size more than 3 cm (p=0.003) were prognostic factors related to the recurrence. Although there was no statistical significance, there has been no recurrence since a uterine manipulator was not used. Conclusion: The early surgical period and large tumor were related to the disease recurrence after RRH. We suggest that the achievement of proficiency and appropriate patient selection are critical for prognosis after RRH in stage IB cervical cancer.
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Affiliation(s)
- Jiheum Paek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Peter C. Lim
- Department of Gynecology Oncology and Robotic Surgery, Center of Hope, University of Nevada, Reno School of Medicine, Reno, NV, USA
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Opławski M, Smoczyńska M, Grabarek BO, Boroń D. Assessment of Dysfunction in the Urinary System as Well as Comfort in the Life of Women during and after Combination Therapy Due to Ovarian and Endometrial Cancer Based on the SWL, II-Q7 and UDI-6 Scales. J Clin Med 2021; 10:jcm10061228. [PMID: 33809612 PMCID: PMC8000855 DOI: 10.3390/jcm10061228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
This work aimed to assess the influence of oncological combination therapy that was done on endometrial or ovarian cancer and how the urinary system is influenced as well as the quality of life in comparison to a group of female patients after the removal of the uterus with appendages due to endometrial cancer, which did not require the supplementation of therapy after operative treatment. The study included 87 patients with endometrial cancer, where, after the removal of the uterus, there was no need for conducting adjuvant therapy (C), as well as 92 female patients with endometrial cancer or 38 patients with ovarian cancer in whom combination therapy was conducted (group A, B). The assessment of the quality of life was conducted using the questionnaires: Satisfaction Life Scale (SWLS), Incontinence Impact Questionnaire, Short Form (IIQ-7), and Urogenital Distress Inventory (UDI-6) for three, six, nine, and 12 months after the conclusion of oncological treatment. It was observed that there was a statistically significant decrease in the quality of life in female patients who underwent combination therapy in comparison to a group in whose treatment only included surgery (p < 0.05). The risk of developing urinary incontinence increases alongside an increase in the scope of the operation and in the case of supplementing treatment with brachytherapy in comparison to chemotherapy.
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Affiliation(s)
- Marcin Opławski
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Correspondence:
| | - Magdalena Smoczyńska
- Department of Rehabilitation Psychology, Ludwik Rydygier Collegium Medium, Mikołaj Kopernik’s University CM UMK, 30-835 Bydgoszcz, Poland;
| | - Beniamin Oskar Grabarek
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
- District Hospital in Chrzanów, 32-500 Chrzanów, Poland
- Department of Nursing and Maternity, High School of Strategic Planning in Dąbrowa Górnicza, 41-300 Dąbrowa Górnicza, Poland
| | - Dariusz Boroń
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
- District Hospital in Chrzanów, 32-500 Chrzanów, Poland
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Zapardiel I, Kocian R, Köhler C, Klat J, Germanova A, Jacob A, Bajsova S, Böhmer G, Lay L, Gil-Ibañez B, Havelka P, Kipp B, Szewczyk G, Toth R, Staringer JC, De Santiago J, Coronado PJ, Poka R, Laky R, Luyckx M, Fastrez M, Dusek L, Hernandez A, Cibula D. Voiding recovery after radical parametrectomy in cervical cancer patients: An international prospective multicentre trial - SENTIX. Gynecol Oncol 2021; 160:729-734. [PMID: 33419610 DOI: 10.1016/j.ygyno.2020.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Voiding dysfunctions represent a leading morbidity after radical hysterectomy performed in patients with early-stage cervical cancer. The aim of this study was to perform ad hoc analysis of factors influencing voiding recovery in SENTIX (SENTinel lymph node biopsy in cervIX cancer) trial. METHODS The SENTIX trial (47 sites, 18 countries) is a prospective study on sentinel lymph node biopsy without pelvic lymphadenectomy in patients with early-stage cervical cancer. Overall, the data of 300 patients were analysed. Voiding recovery was defined as the number of days from surgery to bladder catheter/epicystostomy removal or to post-voiding urine residuum ≤50 mL. RESULTS The median voiding recovery time was three days (5th-95th percentile: 0-21): 235 (78.3%) patients recovered in <7 days and 293 (97.7%) in <30 days. Only seven (2.3%) patients recovered after >30 days. In the multivariate analysis, only previous pregnancy (p = 0.033) and type of parametrectomy (p < 0.001) significantly influenced voiding recovery >7 days post-surgery. Type-B parametrectomy was associated with a higher risk of delayed voiding recovery than type-C1 (OR = 4.69; p = 0.023 vs. OR = 3.62; p = 0.052, respectively), followed by type-C2 (OR = 5.84; p = 0.011). Both previous pregnancy and type C2 parametrectomy independently prolonged time to voiding recovery by two days. CONCLUSIONS Time to voiding recovery is significantly related to previous pregnancy and type of parametrectomy but it is not influenced by surgical approach (open vs minimally invasive), age, or BMI. Type B parametrectomy, without direct visualisation of nerves, was associated with longer recovery than nerve-sparing type C1. Importantly, voiding dysfunctions after radical surgery are temporary, and the majority of the patients recover in less than 30 days, including patients after C2 parametrectomy.
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Affiliation(s)
- Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain.
| | - Roman Kocian
- Gynaecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, CEEGOG, Prague, Czech Republic
| | - Cristhardt Köhler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jaroslav Klat
- Department of Obstetrics and Gynaecology, University Hospital Ostrava, Ostrava, Poruba, Czech Republic
| | - Anna Germanova
- Gynaecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, CEEGOG, Prague, Czech Republic
| | - Anna Jacob
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Sylva Bajsova
- Department of Obstetrics and Gynaecology, University Hospital Ostrava, Ostrava, Poruba, Czech Republic
| | - Gerd Böhmer
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Laura Lay
- Department of Gynaecology, Institute of Oncology Angel H Roffo University of Bueno s Aires, Buenos Aires, Argentina
| | - Blanca Gil-Ibañez
- Unit of Gynaecological Oncology, Institute Clinic of Gynaecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pavel Havelka
- Department of Obstetrics and Gynaecology, Bata Hospital Zlin, Czech Republic, CEEGOG, Zlin, Czech Republic
| | - Barbara Kipp
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Grzegorz Szewczyk
- Department of Obstetrics and Gynaecology, Institute of Mother and Child, Warsaw, Poland
| | - Robert Toth
- Oncology Institute of East Slovakia, Košice, Slovakia
| | - Juan Carlos Staringer
- Department of Gynaecology and Obstetrics, Hospital Español de Buenos Aires, Buenos Aires, Argentina
| | | | - Pluvio J Coronado
- Departamento de Obstetricia y Ginecología, Hospital Clínico San Carlos, Madrid, Spain
| | - Robert Poka
- Institute of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rene Laky
- Gynaecology, Medical University of Graz, Graz, Austria
| | - Mathieu Luyckx
- Department of Gynaecology, Universite catholique de Louvain, Cliniques Universitaires St Luc, 1200, Brussels, Belgium
| | - Maxime Fastrez
- Department of Obstetrics and Gynaecology, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alicia Hernandez
- Gynaecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - David Cibula
- Gynaecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, CEEGOG, Prague, Czech Republic
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