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Background Cancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC). This study investigates the rate and causes of cancellations of elective surgeries on the DOS in various surgical departments across ten hospitals in India. Methods A research consortium ‘IndSurg’ led by World Health Organisation Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs, India conducted this multicentre retrospective cross-sectional study to analyse the cancellations of elective/planned surgical operations on DOS across urban secondary and tertiary level hospitals. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations. Results We analysed records from the participating hospitals, with an overall cancellation rate of 9.7% (508/5231) on the DOS for elective surgical operations. Of these, 74% were avoidable cancellations. A majority (30%) of these 508 cancellations were attributed to insufficient resources, 28% due to patient's refusal or failure to show-up, and 22% due to change in patient's medical status. Conclusion We saw a preponderance of avoidable reasons for elective surgery cancellations. A multidisciplinary approach with adequate preoperative patient counselling, timely communication between the patients and caregivers, adequate preoperative anaesthetic assessment, and planning by the surgical team may help reduce the cancellation rate.

ObjectivesTwitter is the most frequently used social media platform by healthcare practitioners, at medical conferences. This study aimed to analyze Twitter conversations during the virtual International Gynecological Cancer Society 2020 conference to understand the interactions between Twitter users related to the conference.MethodsTweets using the hashtag ‘#IGCS2020’ were searched using the Twitter Search Application Programming Interface (API) during the period 10–13 September 2020. NodeXL Pro was used to retrieve data. The Clauset-Newman-Moore cluster algorithm clustered users into different groups or ‘clusters’ based on how users interacted.ResultsThere were 2009 registrants for the virtual IGCS 2020 conference. The total number of users within the network was 168, and there were 880 edges connecting users. Five types of edges were identified as follows: ‘replies to’ (n=18), ‘mentions’ (n=221), ‘mentions in retweets’ (n=375), retweets (n=198), and tweets (n=68). The most influential account was that of the IGCS account itself (@IGCSociety). The overall network shape resembled a community where distinct groups formed within the network. Our current analyses demonstrated that less than 10% of the total members interacted on Twitter.ConclusionThis study identified the most influential Twitter users within the ‘#IGCS2020’ community. he results also confirmed the community network shape of the #IGCS2020 hashtag and found that the most frequent co-related words were ‘ovarian’ and ‘cancer’ (n=39).

Objectives Enhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians’ practice about ERAS in patients undergoing CRS-HIPEC. Methods An online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists. Results The response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76–95%), preoperative (50–94%), and intraoperative (55–90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated. Conclusions Most respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.

BackgroundVulvar cancer is a rare disease and despite broad adoption of sentinel lymph node mapping to assess groin metastases, inguino-femoral lymph node dissection still plays a role in the management of this disease. Inguino-femoral lymph node dissection is associated with high morbidity, and limited research exists to guide the best surgical approach.ObjectiveTo determine international practice patterns in key aspects of the inguino-femoral lymph node dissection technique and provide data to guide future research.MethodsA survey addressing six key domains of practice patterns in performing inguino-femoral lymph node dissection was distributed internationally to gynecologic oncology surgeons between April and October 2020. The survey was distributed using the British Gynecological Cancer Society, the Society of Gynecologic Oncology, authors' direct links, the UK Audit and Research in Gynecology Oncology group, and Twitter.ResultsA total of 259 responses were received from 18 countries. The majority (236/259, 91.1%) of respondents reported performing a modified oblique incision, routinely dissecting the superficial and deep inguino-femoral lymph nodes (137/185, 74.1%) with sparing of the saphenous vein (227/258, 88%). Most respondents did not routinely use compression dressings/underwear (169/252 (67.1%), used prophylactic antibiotics at the time of surgery only (167/257, 65%), and closed the skin with sutures (192 74.4%). Also, a drain is placed at the time of surgery by 243/259 (93.8%) surgeons, with most practitioners (144/243, 59.3%) waiting for drainage to be less than 30–50 mL in 24 hours before removal; most respondents (66.3%) routinely discharge patients with drain(s) in situ.ConclusionOur study showed that most surgeons perform a modified oblique incision, dissect the superficial and deep inguino-femoral lymph nodes, and spare the saphenous vein when performing groin lymphadenectomy. This survey has demonstrated significant variability in inguino-femoral lymph node dissection in cases of vulvar cancer among gynecologic oncology surgeons internationally.

On March 11, 2020 the COVID-19 outbreak was declared a ‘pandemic’ by the World Health Organization. COVID-19 is associated with higher surgical morbidity and mortality. An array of guidelines on the management of cancer during this pandemic have been published since the first reports of the outbreak. This narrative review brings all the relevant information from the guidelines together into one document, to support patient care. We present a detailed review of published guidelines, statements, comments from peer-reviewed journals, and nationally/internationally recognized professional bodies and societies' web pages (in English or with English translation available) between December 1, 2019 and May 27, 2020. Search terms included combinations of COVID, SARS-COV-2, guideline, gynecology, oncology, gynecological, cancer. Recommendations for surgical and oncological prioritization of gynecological cancers are discussed and summarized. The role of minimally invasive surgery, patient perspectives, medico-legal aspects, and clinical trials during the pandemic are also discussed. The consensus is that elective benign surgery should cease and cancer surgery, chemotherapy, and radiotherapy should continue based on prioritization. Patient and staff face-to-face interactions should be limited, and health resources used efficiently using prioritization strategies. This review and the guidelines on which it is based support the difficult decisions currently facing us in gynecological cancer. It is a balancing act: limited resources and a hostile environment pitted against the time-sensitive nature of cancer treatment. We can only hope to do our best for our patients with the resources available to us.

Surgeons constantly try to achieve optimal surgical outcome, number, or extent of postoperative complications being an important part of it. Oncological surgeries are conventionally more challenging and complex compared with most nononcological ones. Gawande et al. devised SAS in 2007 in Boston as a predictor tool for postoperative complications (J Am Coll Surg 204:201–208, 2007). A validation study was done by in another cohort of 100 patients; however, only 70% of them had pathologically confirmed malignancies (Ann Surg 240(2):205–213, 2004). We attempt to assess SAS as a tool to predict postoperative complications in a series of 100 gynecological oncological patients operated at tertiary care center. SAS score of 100 patients with gynecologic malignancies, undergoing surgery at a tertiary care center, was prospectively collected over 4 years. These patients were observed for development of any complications occurring up to 30 days postsurgery. The complication events were graded as per Clavien-Dindo classification (Indian J Gynecol Oncolog 15:49, 2017). The data obtained was statistically analyzed by chi-square test. Thirty complication events were recorded in these 100 patients over a period of 4 years. Majority of complication events were grade IIIa or less (22 out of 30); there was only one death on 8th postoperative day. Fifty percent of patients were with SAS score of 5 or less developed complications compared with just 22.9% in patients with a score of 6 or more. Lower SAS score might be associated with higher postoperative complications in patients undergoing gynecologic oncological surgeries. Thus, patients with lower scores may benefit from a triage to more intensive postoperative care.

In 1985, the International Gynecologic Cancer Society (IGCS) was established to enhance the care of women with gynecologic cancer worldwide through education, training, and public awareness. In 2020, the COVID-19 pandemic brought global travel to an abrupt halt and ushered in a new era of virtual

Introduction/Background Scientific conferences promote specific hashtags for delegates to use With the COVID-19 pandemic resulting in the cancellation of physical meetings there is considerable interest in understanding Twitter use at virtual events Here we assess the reach of '#goASOCO20', a newhashtag created to disseminate Gynaecological Oncology specific information from the American Society of Clinical Oncology (ASCO) 2020 Virtual Annual Meeting 29th May to 1st June 2020 Methodology Prospective observational study of tweets/retweets associated with #goASCO20 All tweets using #goASCO20/ #ASCO20 during ASCO 2020 were extracted using NodeXL Data was analysed in Excel identifying individual tweets, tweeters, retweets and retweeters Analysing original tweets (replies excluded) #goASCO20 was compared to #ASCO20 (official hashtag), #gyncsm and #SGOatASCO Results 1,811 tweeters used #goASCO20/#ASCO20 in 11,530 tweets These tweets received 27,962 retweets 12 4% (224) of tweeters received 80% of all retweets, while 34 2% (619) received no retweets 7,644 accounts tweeted/retweeted using #ASCO20 hashtag, producing 11,455 tweets and 27,888 retweets 11 1% of accounts (850) only tweeted, 76 3% (5,833) just retweeted, and 12 6% (961) both tweeted and retweeted #goASCO20 was used in 200 tweets and generated 262 retweets This activity stemmed from 38 accounts that tweeted/retweeted using #goASCO20 Of these accounts 13% (5) just tweeted, 74% (28) just retweeted and 13% (5) both tweeted and retweeted Top hashtags used during ASCO 2020 are shown in table 1 Figure 1 compares Gynaecology related hashtags used during the conference #goASCO20 hashtag was number 13 by tweets and 27th by retweets during the conference period Conclusion '#goASCO20', a unique Gynaecological Oncology hashtag was created to disseminate Gynaecological Oncology information from ASCO 2020 virtual event #goASCO20 was one of several gynaecological oncology hashtags used Each of these were used by relatively small groups of individuals Discussions were fragmented resulting in an overall lower profile for Gynaecological Oncology related tweets compared to general tweeting during ASCO 2020 The use of Twitter in academia is increasing Its use during such conferences facilitates the spread of clinical knowledge;arguably more than any other academic platform Gynaecological oncology tweeting needs coordination and agreement on a common hashtag to organise content at virtual events and between meetings

Purpose In the absence of vaccine, proper use of personal protective equipment (PPE) is the most important strategy to protect healthcare workers against COVID-19 infection. The recommendations on pharmacological prophylaxis against COVID-19 infection are controversial. The aim of current study was to assess PPE practices during surgery on COVID-19 negative gynecological cancer patients and use of pharmacologic prophylaxis by clinicians practicing gynecologic oncology. Methods We disbursed a survey questionnaire through various social media platforms among clinicians practicing gynecologic oncology. The survey consisted of 37 questions divided into five subgroups evaluating demographic details, use of pharmacological prophylaxis against COVID-19, preoperative COVID-19 screening protocol, details on PPE usage and associated discomfort, if any. Results Two hundred twenty oncologists from 13 countries responded to the survey. Pharmacological prophylaxis was being used by 85 (38.6%) respondents; most common agent was hydroxychloroquin (HCQ) by 24.5% respondents. Routine preoperative screening for COVID-19 was performed by 214 (97.3%) respondents. Some degree of discomfort during surgery due to PPE use was reported by 170 (77.3%) respondents, which was moderate to severe in 73 (33.2%) respondents. Most common difficulties associated with face mask/shield were problems in communication (69.5%) and breathing (58.1%). Eye protection was associated with poor visibility, fogging and headache. Unusual fatigue attributed to PPE use was experienced by 143(65%) respondents. Conclusion Use of pharmacological prophylaxis against COVID-19 is controversial and the same is reflected in our survey. Most respondents adhered to PPE use despite experiencing some physical discomfort. Supplementary Information The online version contains supplementary material available at 10.1007/s40944-021-00500-4.

Background The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected global health care services to varying extent. Emergency Services were also affected along with elective surgeries, which were deferred to accommodate the added burden of COVID 19 affected patients, on the healthcare systems. We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic.Methodology A research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low- and Middle-Income countries (LMIC), India, conducted this retrospective cross-sectional study with 12 recruited centers. All surgeries performed during the months of April 2020 were compared with those performed in April 2019. These surgeries were stratified into emergency and elective, and further categorized based on NHS surgery prioritization documents. Results A total of 4396 surgeries were performed at these centers in April 2019 and 1216 surgeries were performed in same month during 2020, yielding a fall of 72.3% (1216 /4396).We found a 54% reduction in emergency surgeries and a 91% reduction in the elective surgeries. Number of cesarean sections reduced by 29.7% and fracture surgeries declined by 85.3% Laparotomies and surgeries for local soft tissue infections with necrotic tissue reduced by 71.7% and 69.5% respectively.Conclusion Our study quantifies the effects of COVID 19 pandemic on surgical care delivery in India and documents that the overall surgical volume reduced by three fourths in the pandemic period. Emergency surgeries reduced to half when compared with pre-pandemic period. Cesarean section surgeries were affected the least by pandemic, whereas the fracture surgeries and laparotomies were affected the most.

Mature cystic teratoma (MCT) is the commonest benign tumour arising in an ovary. Malignant transformation in a MCT of ovary is exceptionallyrare, seen only in1-2% cases.The most common malignant transformation in a benign teratoma of ovary is squamous cell carcinoma. The other malignant transformations in teratoma include adenocarcinoma, melanoma and basal cell carcinoma. The patients having this malignant transformation in teratoma have a very low 5-year survival rate of 20% approximately. Here; we describe a case of advanced-stage squamous cell carcinoma arising in a mature cystic teratoma in a 34-year-old woman.This solid high grade malignancy was missed in the pre-operative imaging which showed a right adnexal mass with echogenic foci within and septations, and was reported as a dermoid cyst. The intraoperative frozen section too taken from the thin portion of the cyst wall was reported as cystic teratoma. However in the staging laparotomy,right salpingo-oophorectomy and left oophorectomy, specimen the patient was reported to have moderately differentiated squamous cell carcinoma arising in a benign mature cystic teratomawith extensive tumour necrosis with omental tumour deposits.In view of initial incomplete surgery and advanced stage, decision of completion cytoreductive surgery was taken. The patients with mature cystic teratoma with high age (post-menopausal), a size of more than 10 cm and increased serum tumour markers should be suspected to have a malignant transformation and should be investigated thoroughly.

Purpose: The notorious COVID 19 pandemic has caused rapid and drastic changes in cancer care all over the world in 2020. This online survey aims to assess the extent to which the pandemic has affected cancer care in gynecological oncology amongst members of Association of Gynecological Oncologists of India (AGOI), a registered professional society, founded in 1991. Methods: We developed and administered a cross-sectional, flash survey to members of The Association of Gynecological Oncologists of India (AGOI) in the first week of April 2020. Data were analyzed using Microsoft Office Excel 2016. Results were expressed as percentages of total responses excluding blank or unattended response. Overall theme-specific responses were expressed as a spectrum of finding and related inferences were drawn.Results: Among approached practitioners, 90 responded to the survey, more than 80 % were practicing consultants and more than 50 % from academic institutions. Results of the survey showed that the ongoing pandemic had severely affected gynecological oncology practice and care amongst all responders. There were modifications in diagnostic pathways, interventions and follow ups across all organ sites. There was near unanimous opinion on use of general safety measures to combat the virus and to use complete PPEs in high risk situation. There was mixed responses to alternative educational activities especially using electronic technology and distant learning methods. There was an optimism among responders with regards to the current situation normalizing in 3 to 6 months. Conclusion: This study documents the pandemic affected scenario of gynecological cancer care and perceptions of Gynecological Oncologists in India. Significant effect on all aspects of cancer care were observed. Technological learning methods both for patient care and educational activities were being adopted by many responders. Keywords: COVID-19, pandemic, gynecological oncology care, survey, AGOI

In 2019, Dr Pedro T. Ramirez, Editor-in-Chief of IJGC, in partnership with the European Network of Young Gynecological Oncologists (ENYGO), European Society for Gynecological Oncology (ENYGO-ESGO) and the International Gynecologic Cancer Society (IGCS) launched a joint IJGC Editorial Fellowship. The

IntroductionEnhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns.MethodsRequests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods.ResultsData from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding.ConclusionThis international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.

Serous papillary carcinoma of the cervix is a rare variant of the adenocarcinoma of the cervix with less than 50 cases reported worldwide. There are no clear guidelines for the management of this particular subtype, and the treatment is tailor-made based on retrospective analysis and the physician’s discretion. We present a case of locally advanced papillary serous cancer cervix that was managed radically with concurrent chemoradiotherapy and is presently disease free on follow-up.

Gawande et al. developed a simple intraoperative score (surgical Apgar score based on estimated blood loss, lowest mean arterial pressure and lowest heart rate) to identify patients at higher risk of postoperative complications. We attempted to validate this score in subset of patients undergoing surgery for gynecological malignancies at a tertiary care center. A total of 100 consecutive patients being operated at the Department of Gynecologic-Oncology, Gujarat Cancer & Research Institute, Ahmedabad, were included in the study. Their clinical preoperative, intraoperative and postoperative parameters were recorded, and each patient was followed for a period of 30 days from the day of surgery. The median age was 51 years, mean ASA class was 2, and mean BMI was 25.8. Of our cohort, 42% underwent surgery for ovarian malignancy, 31% for benign pathology, 17% endometrial, 6% cervical and 4% vulvar cancer. Average SAS was 7. There was significant association between SAS and postoperative complications. With each unit increase in SAS, there was 37.8% reduction in postoperative complications. This was significant even after adjustment with other covariates like age, BMI. Low SAS significantly associates with morbidity in women undergoing surgery for gynecological malignancies.

IntroductionAnovulation is a common cause of infertility with poly cystic ovarian disease being the commonest.ObjectiveTo estimate the prevalence of various causes of anovulation in patients younger than 35 years of age attending infertility clinics and to ascertain the nature and extent of metabolic abnormalities and efficacy of therapy.Materials and methodsSixty cases of anovulatory infertility diagnosed by standard method were recruited for the study. Transvaginal sonography and hormonal profile like LH, FSH, Prolactin and Thyroid profile evaluated to establish the cause of anovulation. Menstrual history, Body Mass Index, Waist Hip ratio and presence of hirsutism, acanthosis nigricans were recorded. Metabolic parameters like lipid profile, OGTT and Glucose insulin ratio were also assessed. All parameters were reevaluated at 3 and 6 months of treatment and were statistically analyzed. Response to treatment in terms ovulation and pregnancy achieved was also analyzed.ConclusionWomen with anovulatory infertility has shown good improvement to appropriate treatment.How to cite this articleBhandoria G, Rudra S. Anovulatory Infertility: A Prospective Study. Int J Infertility Fetal Med 2013; 4(1):18-23.