2015, Vol 13, No 3
Analysis of postoperative complications that require a repeated procedure based on the material collected in 2009–2014 in the Department of Gynecologic Oncology of the Institute of Oncology in Warsaw
Curr Gynecol Oncol 2015, 13 (3), p. 147–153
DOI: 10.15557/CGO.2015.0016

The paper presents the frequency of conducting relaparotomies and discusses indications for reoperations after primary gynecologic surgeries due to oncological diseases. Operations and reoperations were conducted in the Department of Gynecologic Oncology of Maria Skłodowska-Curie Institute of Oncology in Warsaw, Poland from 2009 to 2014. In total, 3,917 procedures due to reproductive organ neoplasms were conducted in the investigated period. The main indications were ovarian carcinoma, endometrial cancer and cervical cancer. Repeated urgent surgical interventions were needed in 116 patients, which constitutes 2.96% of all operated women. The frequency of repeated surgeries within the peritoneal cavity in gynecology, as reported in the literature, ranges from 1% to 4.7% and concerns primary indications resulting from non-malignant pathologies of the reproductive organs. The analysis involved early and urgent reoperations conducted within 48 hours after the primary procedure. Patients reoperated because of sudden progression of the diseases and those who underwent exploratory laparotomy within 60 days or who had a palliative surgery were excluded from the study. The main indication for a necessary urgent intervention was peritoneal bleeding. Other indications included: obstruction, peritonitis, bowel perforation, abdominal wall hematoma, intestinal anastomosis dehiscence and urinary complications. The mortality in the group of patients who required relaparotomy was 4.31%. An early diagnosis of complications requiring a repeated surgical intervention and implementation of appropriate management affect the outcome considerably and significantly decrease treatment-associated mortality.

Keywords: relaparotomy, postoperative complications, postoperative mortality
Self-efficacy and strategies of adaptation to disease in patients with cancer of reproductive organs
Curr Gynecol Oncol 2015, 13 (3), p. 154–164
DOI: 10.15557/CGO.2015.0017

Aim: According to Bandura’s social cognitive theory, high self-efficacy has a positive impact on one’s motivation and achievements. There are two different attitudes which patients diagnosed with cancer adopt. The active attitude consists in putting up a fight for one’s health and life and in general mobilization, whereas the passive one manifests itself in fear and general surrender. The aim of the study was to analyze the relationship between mental adaptation to cancer and self-efficacy in women after hysterectomy performed for oncological reasons. Material and methods: The research involved 37 patients with reproductive organ cancer, after hysterectomy. The authors used their own survey, the General Self-Efficacy Scale (GSES) and the Mini-Mental Adjustment to Cancer scale – Mini-MAC. The authors analyzed the relationship between the coping strategies adopted by patients and the level of self-efficacy based on sociodemographic variables. In statistical computations, planned comparison (contrast analysis), Kruskal–Wallis analysis of variance (ANOVA), Pearson’s r correlation coefficient and Kendall’s tau coefficient were used. The significance level was assumed at p ≤ 0.05. Results: 1) Women after hysterectomy adopt constructive strategies of coping with the disease. These strategies are: “fighting spirit” and “positive reinterpretation.” 2) Women in a relationship adopt a destructive strategy called “helplessness/hopelessness” more often than single women, whilst women with a better economic status tend to adopt the constructive strategy known as “positive reinterpretation.” 3) Patients with higher self-efficacy more frequently adopt the “fighting spirit” and “positive reinterpretation” strategies. 4) The level of self-efficacy is higher in women in a relationship than in single women. Conclusions: 1) The level of self-efficacy in patients after hysterectomy is higher than its average level in the Polish population and the highest among the clinical populations studied so far. 2) Higher level of self-efficacy increases the tendency to adopt constructive strategies.

Keywords: General Self-Efficacy Scale – GSES, Mini-Mental Adjustment to Cancer scale – Mini-MAC, cancer, hysterectomy
Cryotherapy and other ablation techniques in the treatment of cervical intraepithelial neoplasia
Curr Gynecol Oncol 2015, 13 (3), p. 165–171
DOI: 10.15557/CGO.2015.0018

Efficacious primary, secondary and tertiary preventive measures are necessary for effective reduction of mortality due to cervical cancer. Currently, greater awareness of the role of cytology in cervical cancer prevention is observed among Polish women. Cervical Cancer Prevention Program was implemented to ensure efficient functioning of the preventive program, which is a part of the National Program for Fighting Cancer. Its implementation is intended to create a system allowing for long-term, continuous active screening for cervical cancer in Poland (i.e. preventive and screening testing); to improve women’s attendance at cervical cancer screening; to increase women’s awareness of cervical cancer prevention; to monitor patients with detected cancer; to ensure the maximum and effective use of financial resources allocated for cervical cancer prevention. There is a need to continuously improve the efficacy of screening program as well as to develop effective methods for the treatment of cervical intraepithelial neoplasia. Loop electrosurgical excision is the most common method for the removal of dysplastic lesions. Cryotherapy is one of the oldest methods used in cervical intraepithelial neoplasia. Although this technique has been used in the treatment of cervical intraepithelial neoplasia since late 60’s of the last century, its efficacy still remains a subject for research.

Keywords: cervical intraepithelial neoplasia, oncology, treatment
Health-related quality of life – the role and manners of assessment in cancer patients
Curr Gynecol Oncol 2015, 13 (3), p. 172–179
DOI: 10.15557/CGO.2015.0019

According to the statement of the World Health Organization, the quality of life is the individual’s perception of their position in life in the context of given standards and value systems and in relation to their accomplishments, expectations and concerns. In the past twenty-five years, the role of quality of life assessment in medicine has been growing. Health-related quality of life is the self-assessment of patients with respect to the influence of a disease and treatment on the functioning in basic aspects: physical, mental, social and spiritual. The quality of life measure is a very useful tool for the assessment of the value of medical procedures. Quality of life is measured using the QALY index (quality-adjusted life years), which is the average further duration of life adjusted by the limitation of activity due to a disease or disability. Each medicinal technology, the costs of which are reimbursed from public funds, is subject to pharmacoeconomic assessment, and QALY is one of its elements. Quality of life is significant for patients but it is difficult to express in methodological categories. The basic evaluation methods include patient-reported outcomes of treatment with the use of one-dimensional analogue, numerical and verbal scales or multidimensional questionnaires.

Keywords: health-related quality of life, QALY, quality of life questionnaire
Simultaneous sex cord stromal tumor with annular tubules, adenocarcinoma of the cervix and intraductal papilloma of the breast in a patient with Peutz–Jeghers syndrome: a case report
Curr Gynecol Oncol 2015, 13 (3), p. 180–184
DOI: 10.15557/CGO.2015.0020

Peutz–Jeghers syndrome was first described by a Dutch physician, Jan Peutz, in 1921. It is an inherited syndrome characterized by intestinal hamartomatous polyps, which can cause obstruction, and mucocutaneous hyperpigmentation. This rare syndrome brings a 15-fold increase in the risk of intestinal as well as gynecologic tumors, especially ovarian cancer. We present a 49-year-old women with a huge adnexal mass and already diagnosed Peutz–Jeghers syndrome. Although the sampling of the endometrium, which was done before the surgery, was normal, cervical adenocarcinoma (adenoma malignum) was diagnosed after the operation, and complementary radical trachelectomy was conducted to complete the therapy. In conclusion, Peutz–Jeghers syndrome patients are at an increased risk of genital tract tumors. It should be kept in mind that a clinical examination could be insufficient to diagnose all the tumoral components of the disease.

Keywords: Peutz–Jeghers, ovarian tumor, adenoma malignum
Ulipristal acetate in the treatment of uterine fibroids – a bridge between pharmacology and surgery
Curr Gynecol Oncol 2015, 13 (3), p. 185–190
DOI: 10.15557/CGO.2015.0021

Myomas are a common cause of infertility and miscarriages. Their pathogenesis is muftifactorial. It includes sex-hormones and their receptors, change of expression of cytokines and growth factors as well as epigenetics. Sex-hormones, mainly estrogens, play a key role in the development of myomas, which can be observed by their development in the fertility period and their regression during menopause. Other research has shown that myomas can be hereditary. The clinical symptoms of myomas vary depending on their localization and size. Submucosal myomas may cause massive menstrual bleeding and may be the cause of anemia. Enlarged myomas can be the source of pain and pressure symptoms within the pelvis; they may also be responsible for infertility and miscarriages. There are many options for the treatment of myomas – uterine artery embolization, operative myomectomy or pharmacological treatment (gonadoliberin analogues, anti-estrogens and antiprogestagens). With more treatment options available, clinical decisions are harder. A new drug – ulipristal acetate – has been registered for the preoperative treatment of uterine fibroids. It is already present in more than 30 countries, registered as Esmya, Inisia or Fibristal. The first reports of pregnancies after using this drug have been described. The article presents a case of a 30-year-old woman, gravida 0, para 0, who was admitted for myomectomy. A three-month Esmya treatment was administered followed by a successful myomectomy – we present the results of this treatment.

Keywords: myomas, ulipristal acetate, myomectomy
Venous thromboembolism – epidemiology and prophylaxis
Curr Gynecol Oncol 2015, 13 (3), p. 191–200
DOI: 10.15557/CGO.2015.0022
The term “venous thromboembolism” encompasses two disease entities, i.e. deep vein thrombosis and its very serious complication – pulmonary embolism. In Poland, this disease affects almost 50 thousand people, nearly a half of whom develop pulmonary embolism which accounts for 10% of all hospital deaths. The incidence rate increases with age, and 70% of cases concern people above the age of 60. The treatment of complications caused by these symptoms is very expensive. It is estimated that the cost is nearly as high as in the treatment of neoplasms. Risk factors of thromboembolism include: age >40, family and personal history of venous thromboembolism, major surgeries (within lower extremities, pelvis and abdomen), malignant cancers and certain anticancer treatment regimens as well as pregnancy and postpartum period. The severity of symptoms mainly depends on disorders of blood outflow from the lower extremities and the extent of thrombotic lesions. The more extensive thrombosis is, the greater the blood stasis and the greater the vascular disorders. The most common symptoms include pain and edema. Thromboembolism is asymptomatic is nearly a half of patients. That is why a careful interview and risk factor estimation are so important. Non-invasive methods are used, such as: ultrasound assessment of venous flow, Doppler ultrasound, plethysmography (assessment of blood volume in the lower extremities), venography and D-dimer level assessment. Proper thromboprophylaxis is the most important element that increases the safety of patients and considerably decreases health care expenditure. This review presents indications for venous thromboembolism prophylaxis in accordance with the latest guidelines.
Keywords: deep vein thrombosis, pulmonary embolism, venous thromboembolism, low molecular weight heparin
Prolonged thromboprophylaxis in patients undergoing major abdominal surgery decreases the risk of venous thromboembolism.
Commentary to the article: Rasmussen MS, Jorgensen LN, Wille-Jørgensen P, Nielsen JD, Horn A, Mohn AC, Sømod L, Olsen B; FAME Investigators: Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 2006; 4: 2384–2390.
Curr Gynecol Oncol 2015, 13 (3), p. 201–206
DOI: 10.15557/CGO.2015.0023

Patients undergoing major abdominal surgery carry a risk of complications associated with their underlying conditions and the surgery itself as well as venous thromboembolism (VTE), also called deep vein thrombosis (DVT). VTE consists in the formation of blood clots in the deep venous system, usually of the lower extremities or the pelvis minor. Additionally, 50% of patients develop more or less severe pulmonary embolism. DVT is a relatively common disorder. In Poland, its incidence rate is estimated at approximately 50,000 cases annually (150 cases/100,000), several per cent of which is complicated. VTE can actually be even more common. It is asymptomatic in many cases, which is shown by screening Doppler ultrasound examinations in patients hospitalized due to other diseases. The incidence rate of VTE tends to increase. This results from a rise in the number of risk factors associated with ageing population. The incidence rate increases with age. Approximately 70% of cases concern patients older than 60, and in elderly patients above the age of 80, it reaches 5%.