49 research outputs found
Fertility sparing and organ preservation in patients with gynecological tumours
No full textIn dieser Arbeit untersuchten wir fertilitätserhaltende operative Strategien
bei benignen und malignen gynäkologischen Erkrankungen. Operative
Organentfernungen ziehen funktionelle, somatische und psychologische
Konsequenzen für die betroffenen Patientinnen nach sich. Bei malignen
Erkrankungen des Beckens stand lange Zeit ausschließlich der onkologische
Aspekt im Vordergrund. Bei Patientinnen mit Zervixkarzinom war operativ kein
Uteruserhalt möglich. Mitte der 90er Jahre wurde die Methode der radikalen
vaginalen Trachelektomie (RVT) etabliert. Deren onkologische Sicherheit ist
gewährleistet, denn die untersuchten Rezidivraten nach RVT entsprechen denen
der radikalen Organ entfernenden Operationen. Weltweit sind Daten zu ca. 1000
Patientinnen nach RVT publiziert. Mit 320 operierten Patientinnen und deren
Langzeitdaten überblicken wir von diesen das größte beschriebene Kollektiv.
Von den Frauen, die nach RVT eine Schwangerschaft anstrebten, wurden 85%
schwanger. Die Hälfte der Kinder wurde vor der 37. SSW geboren. Nur 20% der
Frühgeborenen kamen vor der 28. SSW zur Welt. Die Hauptursache der
Frühgeburtlichkeit war der vorzeitige Blasensprung. Die neonatologischen
Ergebnisse der Kinder, die nach operativem Fertilitätserhalt von
Zervixkarzinompatientinnen geboren wurden, ist nicht alteriert. Gemessen an
ihren Entwicklungsscores ein Jahr nach ihrer Geburt trugen die Kinder kein
erhöhtes Risiko durch die Operation ihrer Mütter. Obwohl der Fertilitätserhalt
bei Patientinnen mit Zervixkarzinom Einzug in die Leitlinien gefunden hat,
werden weit weniger als 10% der Frauen, die mit Zervixkarzinom für einen
Erhalt ihrer Fertilität in Frage kommen, nach dieser Methode operiert. Dies
liegt an der technischen Komplexität der Methode, aber auch an der
Unsicherheit, die gegenüber der RVT sowohl bei den Patientinnen als auch ihren
behandelnden Ärzten besteht. Dabei treten vor allem Unklarheiten bezüglich der
onkologischen Nachsorge der anatomisch veränderten Situation im Becken und
bezüglich des Managements der Schwangerschaften auf. Wir entwickelten aus
diesem Grund ein Nachsorgeprotokoll zur onkologischen Diagnostik und
Rezidivprophylaxe sowie Empfehlungen zur Prävention von Frühgeburten in der
Schwangerschaft nach RVT. Bei benignen Erkrankungen tritt immer mehr der
Wunsch der Patientinnen nach einem Organerhalt in den Vordergrund. Wir
etablierten eine nervensparende vaginal-abdominelle Operationsmethode zur
Therapie der rektovaginalen Endometriose mit der Möglichkeit des
Fertilitätserhaltes. Die Analyse der perioperativen Ergebnisse zeigte, dass
die Komplikationsrate durch die Standardisierung der Methode gering ist. Es
kam zu keinen schweren Komplikationen, wie Anastomoseninsuffizienzen oder
rektovaginalen Fisteln. Vor allem durch die Präservation des Mesos und der
vegetativen Nerven des Beckens waren auch die längerfristigen Nachwirkungen
der Operation gering. In der Langzeitbeobachtung fanden wir keine
rektovaginalen Rezidive der Endometriose und nur bei 7% der Patientinnen ein
Wiederauftreten von Endometriose anderer Organe. Weitere Analysen der Kohorten
und Untersuchungen zu klinischen Symptomen, Fertilitätsraten, der QOL und zur
Sexualität nach Fertilitätserhalt sind derzeit in Arbeit. Um die
fertilitätserhaltenden Therapien weiter in den Fokus der Therapieoptionen zu
stellen, sollten randomisierende Studien zu den zur Verfügung stehenden
fertilitätserhaltenden Konzepten folgen.In this study we investigated the possibility of fertility and organ
preservation in patients with benign and malign gynecological illnesses.
Operative removal of reproductive organs leads to functional, somatic and
psychological consequences for the patients concerned. In patients with malign
diagnosis the oncological aspect was considered for a long time only.
Especially in patients with cancer of the cervix operative uterus preservation
was not possible or considered. In the nineties the organ preserving technique
of radical vaginal trachelectomy (RVT) was established. Its oncological safety
has been proven and found equivalent to radical hysterectomy. Worldwide data
for 1000 patients who underwent RVT is available and has been published. We
overlook the biggest collective of patients described with a number of over
320 women. Pregnancy rates are up to 85% in women who wish to become pregnant
after RVT. One of the challenges is the high number of preterm delivered
babies to women without a cervix. 50% of the children are delivered before 37
GW and 20% before 28 GW. The main cause of preterm delivery after RVT is the
premature rupture of the membranes due to the missing cervical barrier for
ascending bacteria. Neonatological performance of the children is not altered
negatively evaluated by developmental scores after RVT however. Even though
organ preservation in patients with early cervical cancer has found its way
into the European guidelines, less than 10% of the patients who could be
offered organ preservation are operated by RVT. This is partially due to the
technical complexity of the method and thus the resulting reservation in the
treating doctors. An uncertainty remains of how to monitor the patients and
how to manage pregnancies. We developed a follow-up protocol to improve the
oncological situation and to reduce the rate of preterm deliveries for
patients and their treating doctors. In patients with benign pathologies of
the reproductive organs organ preservation becomes more and more important,
too. Fertility preservation in patients with rectovaginal endometriosis can be
achieved by applying a vaginal-abdominal resection of the endometriotic
nodula. Analysis of perioperative data shows good results if the operation
method is standardized. Long term follow up shows the severity of the disease
with remaining symptoms but low recurrence rates of rectovaginal or
endometriosis itself. Further analysis of the patients regarding clinical
symptoms, fertility rates, QOL and sexuality after organ preservation is
conducted at the moment. To strengthen the role of organ preserving
strategies, randomized controlled studies should be undertaken in the future
Fertilitätserhaltende laparoskopische Therapiestrategien bei Patientinnen mit gynäkologischen Erkrankungen
No full textFertility outcome after radical vaginal trachelectomy: A prospective study of 212 patients
No full textObjective: For treatment in patients with early-stage cervical cancer, radical vaginal trachelectomy (RVT) as a fertility-preserving surgery can be put on a par with radical hysterectomy as to oncologic safety. Our aim was to investigate the fertility concerns and outcome. Methods: Prospective collection of fertility data of patients treated with RVT. The data were collected on personal communication, by telephone, or e-mail correspondence. Descriptive statistical analysis was performed. Results: Between March 2005 and April 2010, 212 patients were followed up after RVT. Only 76 patients (35.9%) were seeking parenthood currently. Sixty pregnancies occurred in 50 women. Five patients (8.3%) had first-trimester miscarriage, 3 had second-trimester miscarriage (5.0%), 2 patients decided for pregnancy termination (3.3%), and 1 patient (1.7%) had an ectopic pregnancy. Three women (5.0%) delivered prematurely before 28th weeks of gestation, 15 (25.0%) delivered between 28 and 36 weeks, and 27 women (45.0%) reached full term. Four pregnancies are ongoing. Conclusions: Preservation of childbearing function is a great advantage for patients with early-stage cervical cancer. Many patients do not seek parenthood immediately. We see no impairment of fertility and have solid data on pregnancy outcome. Premature labor is the main problem in pregnancy after RVT. Copyright copy; 2011 by IGCS and ESGO
Radical vaginal trachelectomy (RVT) combined with laparoscopic lymphadenectomy: Prospective study of 225 patients with early-stage cervical cancer
No full textObjective: The aim of the study was to prove the surgical and oncological safety of radical vaginal trachelectomy (RVT) and laparoscopic lymphadenectomy for patients with early-stage cervical cancer who are seeking parenthood. Methods: A database of 225 patients with early-stage cervical cancer and intention to treat by RVTafter laparoscopic lymphadenectomy was prospectively maintained. A total of 212 patients were treated according to the protocol. The procedure was preformed in a standardized manner, and life table analysis was applied. Results: In the cohort of patients treated according to protocol, 8 recurrences occurred and 4 patients died from recurrence. The median follow-up time was 37 months (range, 0-171 months). The 5-year recurrence-free and overall survival was 94.4% and 97.4%, respectively. Perioperative and short-term postoperative complications were rare (2.8% and 7.5%, respectively). No severe long-term complications occurred. Conclusions: Radical vaginal trachelectomy combined with laparoscopic lymphadenectomy is a safe method for treatment of patients with early-stage cervical cancer who are seeking parenthood
Prevalence of lymph nodes in the parametrium of radical vaginal trachelectomy (RVT) specimen
No full textObjective: In order to evaluate radicality in fertility preserving surgery in women with early invasive cervical cancer we analyzed the parametrium of specimens of patients treated by radical vaginal trachelectomy for the presence of lymph nodes. We tried to identify morphologic factors associated with the presence of parametrial lymph nodes. Methods: We analyzed surgical specimens of 112 patients who underwent radical trachelectomy between June 2004 and April 2009 at the Department of Gynecologic Oncology at Charité Campus Benjamin Franklin and Campus Mitte. All parametrial tissue was step sectioned and a total of 1878H&E stained histological sections were analyzed. Results: In 8 patients (7.1%) a total of 13 lymph nodes were detected. Five lymph nodes in four patients had been primarily detected by routine histological examination. In one of these patients (0.9%) a 2 mm lymph node metastasis was found. Serial sectioning revealed additional seven lymph nodes in four patients. The thickness of parametrium correlated significantly with the presence of lymph nodes in the parametrium. Conclusion: The presence of small lymph nodes in the parametrium of specimens of radical trachelectomy is low. In patients with early-stage cervical cancer, the incidence of metastasis is less than 1%. Preoperative assessment of the volume of the parametrium may indicate which patients need parametrial resection. © 2011 Elsevier Inc. All rights reserved
Female physician and pregnancy- effect of the amended German maternity protection act on female doctors' careers.
No full textOBJECTIVES
In Germany, the 2018 amended Maternity Protection Act frequently leads to fundamental restrictions for female physicians, especially surgeons, and now even also for students impeding the progress of their careers. Our goal was to assess the current situation for pregnant female physicians and students, respectively, and their perspective on this amendment regarding their career path.
METHODS
A nationwide survey was conducted in Germany from December 2020 to February 2021. The questionnaire included 790 female physicians and students who were pregnant after the inception of the amended Act. Those women pregnant after the beginning of the corona pandemic were excluded.
RESULTS
The survey revealed that two thirds of female physicians worked a maximum of 50% in their previous professional activity as soon as they reported pregnancy. Amongst medical students this amounted up to 72%. 18% of the female physicians and 17% of the female medical students respectively could not follow the sense of these restrictions. 44% of female medical physicians and 33% of female students felt their career impeded. This led up to 43% amongst female medical doctors and 53% amongst female medical students, respectively, who were concerned to announce their pregnancy. As a consequence, pregnancies were reported at 12 weeks in female physicians compared to 19 weeks in medical students.
CONCLUSIONS
Analyses of the current survey revealed that a relevant number of female physicians and medical students felt impeded in their career path through the application of the amended Maternity Act
Pregnancy after lymphadenectomy and neoadjuvant chemotherapy followed by radical vaginal trachelectomy in FIGO stage IB1 cervical cancer
No full textFollow-up after radical vaginal trachelectomy (RVT): patients’ problems and physicians’ difficulties
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