新冠疫情期间外阴癌患者手术治疗后的生存趋势：一项三级医院研究
Survival Trends Following Surgical Management in Carcinoma Vulva Patients During Covid 19 Pandemic: A Tertiary Care Hospital Study.
作者信息
Kumar Naina, Nutakki Srikanth, Patel Pinakin, Lakhera Kamal Kishore, Sulaniya Chandrakanta, Kumar Arjun, Babu Agil, Singhal Pranav, Gora Bhoopendra Singh, Singh Suresh
机构信息
Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31 Prabhu Marg Tilak Nagar, Jaipur, 302004 India.
Department of GynaecOncology, SMS Medical College and Attached Group of Hospitals, Jaipur, India.
出版信息
J Obstet Gynaecol India. 2024 Dec;74(6):513-522. doi: 10.1007/s13224-023-01935-9. Epub 2024 Feb 14.
BACKGROUND
Vulval cancers account for 0.25% of new cancer cases and 0.2% of new deaths of all sites worldwide making it an uncommon malignancy according to Global cancer Statistics 2020. Covid 19 for two years made the situation worse. Proper investigations, adjuvant therapy and follow-up for complications was a challenge. The present study is a prospective observational study on treatment outcome of Carcinoma Vulva at a tertiary care hospital during COVID-19 pandemic.
METHODS
Twenty patients of non-metastatic carcinoma vulva were recruited over 22 months of Covid 19 pandemic. Surgery was individualized as wide local excision or radical vulvectomy. Inguinal nodes were addressed as per location of tumour. All cases were followed 2 monthly with virtual/physical meetings till 18 months. Changes in accordance with ongoing COVID 19 pandemic were made in carcinoma vulva diagnostic tests, preoperative work up, intra operatively, post-op complication management and follow-up.
RESULTS
The mean age of the study participants was 59.85 ± 10.32 years. In the sample population analysed, menopause was experienced on average at the age of 49.47 ± 4.29 years. Thirty five percent (7) of patients had positive lymph nodes during surgery. All 3 patients who died had positive lymph nodes. Also, all three had no taken adjuvant treatment advised to them by the tumour board. Phased resumption of complex surgeries and adaptation to better PPEs helps in the staff acclimatization to the new normal of operating under constant threat of COVID. In our study, 85% patients were disease free at 18 months follow-up. This is similar to outcomes of carcinoma vulva cases in non-Covid times. There was no difference amongst re-exploration, morbidity and mortality rates for cancer surgeries in COVID and non-COVID years highlighting the fact that effective implementation of cancer surgery and peri operative care guidelines is crucial for good surgical outcomes.
CONCLUSION
This study sheds light on good prognosis of carcinoma vulva with proper treatment and follow-up. Covid times were managed with virtual meets and talking with local practitioners. Screening programs, rural awareness camps and more studies are needed in this field.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13224-023-01935-9.
背景
根据《2020年全球癌症统计数据》，外阴癌占全球所有部位新发癌症病例的0.25%，占新死亡病例的0.2%，是一种罕见的恶性肿瘤。两年来的新冠疫情使情况更加糟糕。进行适当的检查、辅助治疗以及对并发症进行随访是一项挑战。本研究是一项关于新冠疫情期间一家三级护理医院外阴癌治疗结果的前瞻性观察研究。
方法
在新冠疫情的22个月期间招募了20例非转移性外阴癌患者。手术方式个体化，包括广泛局部切除或根治性外阴切除术。根据肿瘤位置处理腹股沟淋巴结。所有病例每2个月通过线上/线下会诊进行随访，直至18个月。根据新冠疫情的持续情况，对外阴癌诊断检查、术前评估、术中、术后并发症管理及随访进行了调整。
结果
研究参与者的平均年龄为59.85±10.32岁。在分析的样本人群中，平均绝经年龄为49.47±4.29岁。35%（7例）患者在手术时出现淋巴结阳性。所有3例死亡患者均有淋巴结阳性。此外，这3例患者均未接受肿瘤委员会建议的辅助治疗。分阶段恢复复杂手术并适应更好的个人防护装备有助于工作人员适应在新冠持续威胁下手术的新常态。在我们的研究中，85%的患者在18个月随访时无疾病。这与非新冠时期外阴癌病例的结果相似。新冠疫情期间和非疫情期间癌症手术的再次探查率、发病率和死亡率没有差异，这突出了有效实施癌症手术和围手术期护理指南对良好手术结果至关重要这一事实。
结论
本研究揭示了通过适当治疗和随访外阴癌预后良好。新冠疫情期间通过线上会诊和与当地医生沟通进行管理。该领域需要筛查项目、农村宣传活动以及更多研究。
补充信息
在线版本包含可在10.1007/s13224-023-01935-9获取的补充材料。
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