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Iavazzo C, Psomiadou V, Fotiou A, Prodromidou Α, Douligeris A, Lekka S, Korfias D, Karavioti E, Vorgias G. Concurrent gynecologic surgery and panniculectomy in morbidly obese women with gynecologic cancer, a single-center experience. Arch Gynecol Obstet 2021; 304:1271-1278. [PMID: 33740102 DOI: 10.1007/s00404-021-06033-7] [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: 01/27/2020] [Accepted: 03/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE As the prevalence of obesity has been rising during the past decades worldwide and especially in Greece, surgeons have faced significant challenges concerning the treatment of morbidly obese women with gynecologic cancer. Panniculectomy is a safe procedure that offers better visualization of pelvic anatomy and prevention of major complications in these women. METHODS Aim of this study is to describe a single-center experience of surgical treatment of morbidly obese women with gynecologic cancer and concurrent panniculectomy. We, also, review the literature for articles that report concurrent gynecologic surgery and panniculectomy, to summarize the complications that were encountered. RESULTS From 2015 to 2018, 38 obese women were treated with concurrent panniculectomy at the time of gynecologic surgery for cancer in a single institution. Median age was 55.62 years old, median BMI 43.79 kg/m2, median blood loss 243.75 ml and median operative time approximately 200 min. Twenty-nine patients had endometrial cancer, one patient had concurrent endometrial cancer and fallopian tube cancer, six patients had borderline ovarian cancer, and two had adult granulosa ovarian tumour. Intraoperative and postoperative complications were documented. Five patients suffered from wound infection and were treated with antibiotics and one patient died after wound infection, wound dehiscence, and renal failure. CONCLUSION For selected obese patients, concurrent panniculectomy with surgical treatment of gynecological cancer is a safe and efficient procedure.
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Affiliation(s)
- C Iavazzo
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - V Psomiadou
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - Alexandros Fotiou
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece.
| | - Α Prodromidou
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - A Douligeris
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - S Lekka
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - D Korfias
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - E Karavioti
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - G Vorgias
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
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Prodromidou A, Iavazzo C, Psomiadou V, Douligeris A, Machairas N, Paspala A, Bakogiannis K, Vorgias G. Safety and efficacy of synchronous panniculectomy and endometrial cancer surgery in obese patients: a systematic review of the literature and meta-analysis of postoperative complications. J Turk Ger Gynecol Assoc 2020; 21:279-286. [PMID: 31927811 PMCID: PMC7726461 DOI: 10.4274/jtgga.galenos.2019.2019.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Panniculectomy combined with gynaecological surgery constitutes an alternative approach for endometrial cancer (EC) in obese patients. The present study aimed to assess the current knowledge concerning the safety and efficacy of combining panniculectomy in surgical management of EC. Four electronic databases were systematically searched for articles published up to May 2019. A total of five studies, of which two were non-comparative and three comparative, were included. Meta-analysis of complications among panniculectomy and conventional laparotomy group revealed no difference in either intra- or post-operative complication rates. Moreover, no difference was reported in surgical site complications (p=0.59), while wound breakdown rates were significantly elevated in the laparotomy group (p=0.02). Panniculectomy combined surgery for the management of EC appears to be a safe procedure and results in comparable outcomes compared with conventional laparotomy with regard to complications and improved wound breakdown rates.
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Affiliation(s)
- Anastasia Prodromidou
- Department of Obstetrics and Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Christos Iavazzo
- Department of Obstetrics and Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Victoria Psomiadou
- Department of Obstetrics and Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Athanasios Douligeris
- Department of Obstetrics and Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Nikolaos Machairas
- Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Anna Paspala
- Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - George Vorgias
- Department of Obstetrics and Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
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Zavlin D, Jubbal KT, Balinger CL, Dinh TA, Friedman JD, Echo A. Impact of Metabolic Syndrome on the Morbidity and Mortality of Patients Undergoing Panniculectomy. Aesthetic Plast Surg 2017; 41:1400-1407. [PMID: 28779409 DOI: 10.1007/s00266-017-0952-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is defined as the concomitant disease process of obesity and at least two of the following variables: diabetes, hypertension, hypertriglyceridemia, or reduced high-density lipoprotein. These entities are well established as risk factors for complications following surgery. Obese patients are particularly prone to the development of MetS. The authors therefore aimed at elucidating the impact of MetS on the perioperative panniculectomy outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was analyzed for all primary procedures of panniculectomy from 2010 through 2015. The cases were stratified based on the presence or absence of MetS and evaluated for demographic data, intraoperative details, and their morbidity and mortality within 30 days after surgery. RESULTS A total of 7030 cases were included in this study. Patients with MetS (6.2%) were of significantly worse health, required more emergency admissions (p = 0.022), longer hospitalization (p < 0.001), and more frequently inpatient procedures (p < 0.001) compared to the control group without MetS (3.8%). Plastic surgery was the predominant specialty operating on 79.5% of all cases. Surgical (23.3 vs. 8.7%) complications, readmission (8.7 vs. 3.0%), and reoperations (6.9 vs. 3.1%) rates were all significantly higher in patients with MetS that those without (p < 0.001). One fatality occurred in each cohort (0.23 vs. 0.02%, p = 0.010). CONCLUSION Comorbidities are not uncommon in patients undergoing panniculectomy, especially in those diagnosed with MetS. Health-care providers need to be aware of the increased morbidity and mortality in this high-risk subgroup and need to consider preoperative optimization and management before proceeding with surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA.
| | - Kevin T Jubbal
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Christopher L Balinger
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Tue A Dinh
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
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Hysterectomy with Concurrent Panniculectomy: A Propensity-Matched Analysis of 30-Day Outcomes. Plast Reconstr Surg 2015; 136:582-590. [PMID: 26313828 DOI: 10.1097/prs.0000000000001535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The goal of this multicenter study was to examine 30-day outcomes following combined hysterectomy and panniculectomy compared with hysterectomy alone at a national level. METHODS Female patients who underwent hysterectomy with or without concurrent panniculectomy were identified in the 2005 through 2012 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files. Propensity scores were used to match patients who underwent combined surgery to a sample of similar patients who underwent hysterectomy alone. RESULTS A total of 24,893 patients who underwent hysterectomy alone and 174 patients who underwent hysterectomy with concurrent panniculectomy were identified. Patients who underwent combined surgery were more often obese (body mass index ≥30 kg/m2), with diabetes mellitus, and cardiovascular/pulmonary comorbidities. Unadjusted outcomes for the total cohort showed that patients who underwent both procedures more often experienced venous thromboembolism (2.9 percent versus 1.0 percent; p = 0.015) and length of stay greater than 3 days (48.3 percent versus 29.2 percent; p < 0.001). In the propensity-matched sample, there were no differences shown in the proportion of patients who experienced wound complications, surgical-site infections, venous thromboembolism, medical complications, or total complications. However, patients who underwent both procedures were twice as likely to experience length of stay greater than 3 days (OR, 2.06; 95 percent CI, 1.28 to 3.31). CONCLUSIONS Combined hysterectomy and panniculectomy procedures appear to be performed infrequently among American College of Surgeons National Surgical Quality Improvement Program-participating hospitals. After propensity matching, only differences in length of stay were identified. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Massenburg BB, Sanati-Mehrizy P, Ingargiola MJ, Rosa JH, Taub PJ. Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study. Aesthetic Plast Surg 2015; 39:667-73. [PMID: 26174140 DOI: 10.1007/s00266-015-0531-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abdominoplasty (ABP) at the time of hysterectomy (HYS) has been described in the literature since 1986 and is being increasingly requested by patients. However, outcomes of the combined procedure have not been thoroughly explored. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program database and identified each ABP, HYS, and combined ABP-HYS performed between 2005 and 2012. The incidence of complications in each of the three procedures was calculated, and a multiplicative-risk model was used to calculate the probability of a complication for a patient undergoing distinct HYS and ABP on different dates. One-sample binomial hypothesis tests were performed to determine statistical significance. RESULTS There were 1325 ABP cases, 12,173 HYS cases, and 143 ABP-HYS cases identified. Surgical complications occurred in 7.7 % of patients undergoing an ABP-HYS, while the calculated risk of a surgical complication was 12.5 % (p = 0.0407) for patients undergoing separate ABP and HYS procedures. The mean operative time was significantly lower for an ABP-HYS at 238 vs. 270 min for separate ABP and HYS procedures (p < 0.0001), and the mean time under anesthesia was significantly lower at 295 vs. 364 min (p < 0.0001). CONCLUSIONS A combined ABP-HYS has a lower incidence of surgical complications than separate ABP and HYS procedures performed on different dates. These data should not encourage all patients to elect a combined ABP-HYS, if only undergoing a HYS, as the combined procedure is associated with increased risks when compared to either isolated individual procedure. However, in patients who are planning on undergoing both procedures on separate dates, a combined ABP-HYS is a safe option that will result in fewer surgical complications, less operative time, less time under anesthesia, and a trend towards fewer days in the hospital. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Fischer JP, Tuggle CT, Wes AM, Kovach SJ. Concurrent panniculectomy with open ventral hernia repair has added risk versus ventral hernia repair: An analysis of the ACS-NSQIP database. J Plast Reconstr Aesthet Surg 2014; 67:693-701. [DOI: 10.1016/j.bjps.2014.01.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/07/2014] [Accepted: 01/19/2014] [Indexed: 11/25/2022]
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Meriwether KV, Antosh DD, Knoepp LR, Chen CCG, Mete M, Gutman RE. Increased morbidity in combined abdominal sacrocolpopexy and abdominoplasty procedures. Int Urogynecol J 2013; 24:385-91. [PMID: 22814931 PMCID: PMC10013994 DOI: 10.1007/s00192-012-1857-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 06/03/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was performed to determine whether abdominoplasty combined with abdominal sacrocolpopexy (ASC + A) increases perioperative morbidity compared with ASC alone. We hypothesized that patients undergoing combined procedures would have increased complications. METHODS This was a multicenter, retrospective cohort study of all women undergoing ASC + A from 2002 to 2010 at Washington Hospital Center and Johns Hopkins University. We selected two women undergoing ASC alone for comparison with each ASC + A patient. Baseline demographics, surgical data, length of hospitalization, and perioperative complications were recorded. The primary outcome was any major complication within 6 weeks of surgery, including intraoperative complications, pulmonary embolism (PE), deep venous thrombosis (DVT), cardiac compromise, intensive care unit (ICU) admission, reoperation, and readmission. Surgical data and minor complications were also compared. RESULTS Twenty-six ASC + A patients and 52 ASC patients were identified. There were no significant differences in baseline characteristics between groups. Patients with ASC + A had longer operating times (337 vs 261 min, p < 0.01), more intravenous fluid administration intraoperatively (4,665 vs 3181 ml, p < 0.01), and longer hospital stays (3.7 vs 2.7 days, p < 0.01). Major complications occurred in 23 % of the ASC + A group compared with 12 % of the ASC group (p = 0.20). The ASC + A group had greater declines in hematocrit levels and higher rates of PE, ICU admission, and blood transfusion, all of which were statistically significant. CONCLUSIONS ASC + A increases length of stay and perioperative complications, such as PE, ICU admission, and blood transfusion, compared with ASC alone. Surgeons should consider recommending interval abdominoplasty due to increased morbidity risk with a combined procedure.
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Affiliation(s)
- K V Meriwether
- Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Washington Hospital Center, Washington, DC, USA.
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Abstract
BACKGROUND Plastic surgeons are faced with increasing numbers of patients presenting for insurance-covered skin excision procedures following bariatric surgery. Panniculectomy for symptomatic relief of rashes is commonly performed, but an isolated infraumbilical amputation-type panniculectomy is a highly unaesthetic procedure, leaving many patients deeply dissatisfied. It may be also fraught with complications due to large incisions and potential for dead-space. In these patients, many surgeons avoid the fleur-de-lis panniculectomy, despite the body contour aesthetic advantage, because of increased time, more scarring, and a perceived increase in complications. METHODS This is a retrospective chart review of 130 consecutive postbariatric surgery patients who had panniculectomy over a 2-year period at our institution. RESULTS A total of 30 patients underwent a traditional panniculectomy and 100 patients had a fleur-de-lis panniculectomy. Mean weight loss from bariatric surgery to panniculectomy was 58.2 kg, with an average body mass index (BMI) of 30. Fifty-seven patients had additional procedures performed at the time of panniculectomy. Twenty-two patients (17%) had complications, with 5 in the traditional group (17%) and 17 in the fleur-de-lis group (17%) (P = 1.0). Six males (40%) had more complications compared with 18 females (15.7%) (P = 0.034). Patients with BMI <30 had 10 complications compared with patients with BMI ≥30 had 15 complications. CONCLUSIONS There are many benefits of fleur-de-lis over traditional panniculectomy, even for medical necessity cases. There is limited undermining of tissue which minimizes/eliminates skin necrosis. Our experience with primarily fleur-de-lis panniculectomies shows a complication rate lower than most published data. Fleur-de-lis potentially creates a better symptom correction and cosmetic outcome by resecting maximal skin in both vertical and horizontal directions. These findings must be balanced against a potentially longer operation.
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Singh S, Laughingwell R, Rosenblum NG. Perioperative morbidity associated with medically necessary panniculectomy in gynecologic oncology surgery. Int J Gynaecol Obstet 2012; 118:47-51. [DOI: 10.1016/j.ijgo.2012.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 01/15/2012] [Accepted: 03/19/2012] [Indexed: 11/30/2022]
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Crosbie EJ, Estabragh ZR, Murphy J, Ahmed AS, Slade RJ. Apronectomy combined with laparotomy for morbidly obese endometrial cancer patients. Surg Oncol 2011; 20:e187-93. [DOI: 10.1016/j.suronc.2011.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 04/15/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022]
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El-Nashar SA, Diehl CL, Swanson CL, Thompson RL, Cliby WA, Famuyide AO, Stanhope CR. Extended antibiotic prophylaxis for prevention of surgical-site infections in morbidly obese women who undergo combined hysterectomy and medically indicated panniculectomy: a cohort study. Am J Obstet Gynecol 2010; 202:306.e1-9. [PMID: 20207249 DOI: 10.1016/j.ajog.2010.01.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 12/19/2009] [Accepted: 01/20/2010] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare surgical-site infection rates in obese women who had extended prophylactic antibiotic (EPA) vs standard prophylactic antibiotic. STUDY DESIGN An electronic records-linkage system identified 145 obese women (body mass index, >30 kg/m(2)) who underwent combined hysterectomy and panniculectomy from January 1, 2005, through December 31, 2008. The EPA cohort received standard antibiotics (cefazolin, 2 g) and continued oral antibiotic (ciprofloxacin) until removal of drains. Regression models were used to adjust for known confounders. RESULTS The mean age was 56.0 + or - 12.1 years, and mean body mass index was 42.6 + or - 8.4 kg/m(2) (range, 30-86.4 kg/m(2)). The EPA cohort experienced fewer surgical-site infections (6 [5.9%] vs 12 [27.9%]; P < .001; adjusted odds ratio, 0.16; 95% confidence interval, 0.04-0.51; P < .001), had lower probability of incision and drainage (3 [2.9%] vs 5 [11.6%]; P = .05), and required fewer infection-related admissions (5 [4.9%] vs 6 [13.9%]; P = .08). CONCLUSION Extended antibiotic prophylaxis can reduce surgical-site infections in obese women after combined hysterectomy and panniculectomy.
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Affiliation(s)
- Sherif A El-Nashar
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
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Leitao MM. Current and future surgical approaches in the management of endometrial carcinoma. Future Oncol 2008; 4:389-401. [DOI: 10.2217/14796694.4.3.389] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The surgical approach to endometrial carcinoma has been and continues to be inconsistent. It ranges from hysterectomy alone for all patients, hysterectomy with lymphadenectomy based on the surgeon’s criteria for risk of nodal metastasis based on preoperative grading and/or intraoperative assessments, and hysterectomy with limited lymphadenectomy, to hysterectomy with full pelvic and para-aortic lymphadenectomy for all patients. Recent evidence has clearly described the very poor correlation of pre- and/or intraoperative assessments with final hysterectomy pathologic findings. Lymphadenectomy has also been found to be therapeutic in high-risk groups. Despite this, many surgeons have not adopted a policy of comprehensive staging for all patients with endometrial carcinoma. All patients with endometrial carcinoma diagnosed on preoperative endometrial sampling should undergo comprehensive surgical staging if technically and medically possible. Surgical cytoreduction of metastatic disease is also associated with improved outcomes.
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Affiliation(s)
- Mario M Leitao
- Memorial Sloan–Kettering Cancer Center, Gynecology Service, Department of Surgery, 1275 York Avenue, NY 10065, USA
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The Safety of Pelvic Surgery in the Morbidly Obese With and Without Combined Panniculectomy. Ann Plast Surg 2008; 60:10-3. [DOI: 10.1097/sap.0b013e318058ad7d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kryger ZB, Dumanian GA, Howard MA. Safety issues in combined gynecologic and plastic surgical procedures. Int J Gynaecol Obstet 2007; 99:257-63. [PMID: 17662984 DOI: 10.1016/j.ijgo.2007.05.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 05/13/2007] [Accepted: 05/18/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The combination of gynecologic and plastic surgery procedures in a single surgical setting is becoming increasingly common because it reduces the number of general anesthetics and shortens overall recovery time. The primary concern should be patient safety. METHODS A MEDLINE search from 1980 to 2007 was conducted. Articles addressing combined gynecologic surgery with one of the various plastic surgical procedures of the abdomen (abdominoplasty, panniculectomy, and abdominal liposuction) were reviewed. The authors' comprehensive approach to the management of these patients was evaluated. RESULTS A unique set of safety issues exists depending on the specific combination of procedures. A review of the literature is discussed, as well as recommendations for maximizing the aesthetic outcomes while optimizing patient safety. Preoperative planning, intraoperative concerns, and postoperative care are all addressed in detail. CONCLUSIONS Using a team approach and employing the outlined strategies to minimize complications, combined plastic and gynecologic procedures can be performed safely in appropriate patients.
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Affiliation(s)
- Z B Kryger
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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