Tragic results of suboptimal gynecologic cancer operations

Objective: The goal of this study was to analyze gynecological cancer patients who underwent suboptimal or failed surgeries with unsatisfactory and undesired results. Study design: During 1997-2007, 74 women were referred to our gynecological oncology service after suboptimal or failed surgeries for ovarian, cervix, endometrium and vulvar cancers. Medical records were evaluated retrospectively to determine the reasons of suboptimal surgery. Results: Optimal cytoreduction was achieved in ten women (21.7%), 32 women (69.5%) had suboptimal surgical cytoreduction and four women (8.6%) had failed surgery, Seven patients were recurrences (3 had liver metastasis, 2 had pelvic metastasis, 2 had bladder metastasis); two patients died due to bladder metastasis, one patient died six days after surgery due to a pulmonary embolism in the suboptimal cytoreduction group, and one patient died due to ascites in the failed surgery group. Optimal surgery was achieved in three women (27.2%) and eight women (72.7%) had suboptimal surgery in the cervical cancer population. One patient had a recurrence with pelvic metastasis in the suboptimal group. Suboptimal surgery was achieved in one woman with vulvar cancer. Optimal surgery was achieved in seven women (43.7%) and nine women (56.2%) had suboptimal surgery in the endometrial cancer population. One patient died 11 days after surgery due to sepsis in the optimal surgery group. One patient died 21 months after primary surgery and the other patient had a recurrence with paraaortic lymph nodes, ascites and omental thickening in the suboptimal surgery group. The prognosis of 30 (65.2%) women in the ovarian cancer population, eight (72.7%) women in the cervical cancer group, 11 (68.7%) women in the endometrial cancer group, and one woman (100%) in the vulvar cancer population was unknown. The unknown cases of all genital cancers were missed during followup and we could not reach them using their phone or address information. Conclusion: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase "primum non nocere" means and should refer patients to a gynecological oncology center without performing any surgery. Optimal gynecologic surgery can only be carried out correctly when education becomes available throughout the world. Thus postgraduate fellowship programs should be considered urgently to extend the general gynecologists' surgical experience and expertise in developing and undeveloped countries.

Gynecological cancer; Optimal cytoreduction; Suboptimal surgery; Optimal surgey

[1] Kehoe S.: “Treatments for gynaecological cancers”. Best Pract. Res. Clin. Obstet. Gynaecol., 2006, 20, 985.

[2] Stovall G.T.: “Hysterectomy”. In: Berek J.S. Berek & Novak’s Gynecology. 2007, Philadelphia, Lippincott Williams and Wilkins, 1457.

[3] Everett E.N., Heuser C.C., Pastore L.M., Anderson W.A., Rice L.W., Irvin W.P.: “Predictors of suboptimal surgical cytoreduction in women treated with initial cytoreductive surgery for advanced stage epithelial ovarian cancer”. Am. J. Obstet. Gynecol., 2005, 193, 568.

[4] Münstedt K., Johnson P., von Georgi R., Vahrson H., Tinneberg H.R.: “Consequences of inadvertent, suboptimal primary surgery in carcinoma of the uterine cervix”. Gynecol. Oncol., 2004, 94, 515.

[5] Behtash N., Mousavi A., Mohit M., Modares M., Khanafshar N., Hanjani P.: “Simple hysterectomy in the presence of invasive cervical cancer in Iran”. Int. J. Gynecol. Cancer, 2003, 13, 177.

[6] Bristow R.E., Tomacruz R.S., Armstrong D.K., Trimble E.L., Montz F.J.: “Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis”. J. Clin. Oncol., 2002, 20, 1248.

[7] http://www.un.org/News/Press/docs/2006/org1460.doc.htm.