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Article: Closed-Incision Negative Pressure Wound management Following Midline Laparotomy in Gynecological Oncology Operations: A Feasibility Pilot Study.

Yin, Lucia / Lau, Katherine / Mehra, Gautam / Sayasneh, Ahmad

2021 Volume 13, Issue 11, Page(s) e19871

Abstract: Introduction Surgical site infections (SSIs) are a cause of considerable morbidity and mortality in healthcare. Increasingly, closed-incision negative pressure wound therapy (ciNPWT) is being studied as a potential method of reducing incidence of SSI ... ...

Abstract	Introduction Surgical site infections (SSIs) are a cause of considerable morbidity and mortality in healthcare. Increasingly, closed-incision negative pressure wound therapy (ciNPWT) is being studied as a potential method of reducing incidence of SSI with conflicting results in the literature. Few studies however have looked at its use in the field of gynecological oncology. Objectives We aimed to compare the incidence of SSI when using ciNPWT dressings versus conventional dressings in gynecological oncology patients undergoing midline laparotomies. Methods This was a pilot study involving 14 patients receiving the ciNPWT dressing and 26 control patients. All patients were followed up for a period of 30 days. We used the American College of Surgeons (ACS) risk calculator to estimate each patient's risk of SSI in order to risk stratify the groups. Results The incidence of wound infection was 21% (3/14) in the ciNPWT group and 23% (6/26) in the control group (p=0.886). The ciNPWT group was found to be at significantly higher risk for SSI as calculated by the ACS tool (8.8% ciNPWT, 6% control, p=0.004). After stratifying for this difference in risk, still no significant difference in incidence of SSI was found between the two groups (27% (3/11) ciNPWT, 29% (2/7) control p=0.929). Conclusion The incidence of SSI does not appear to decrease by the prophylactic use of the closed-incision negative pressure wound dressing.
Language	English
Publishing date	2021-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.19871
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Article: Gynae-Oncology Surgeons' Preparedness to Undertake Colorectal Procedures during Cytoreductive Surgery for Ovarian Cancer: A Cross Sectional Survey.

Huddart, Daniel / Rajkumar, Savithri / Kolomainen, Desiree / Mehra, Gautam / Nath, Rahul / Sayasneh, Ahmad

Journal of clinical medicine

2022 Volume 11, Issue 21

Abstract: Cytoreductive surgery for advanced ovarian cancer commonly involves bowel resection. Although UK gynaecological oncologists are trained in bowel surgery, the degree to which they perform bowel surgery independently varies nationally. A recent joint ... ...

Abstract	Cytoreductive surgery for advanced ovarian cancer commonly involves bowel resection. Although UK gynaecological oncologists are trained in bowel surgery, the degree to which they perform bowel surgery independently varies nationally. A recent joint policy statement from the British Gynaecological Cancer Society (BGCS) emphasises the need for formalised colorectal support. An anonymous, online survey was emailed to BGCS members to assess the status of multidisciplinary working between UK gynaecological oncology and colorectal/general surgical teams. A total of 46 members responded (8.2% response rate). There was a large variety in the involvement of colorectal/general surgical teams in preoperative planning. A total of 13% of respondents had no formalised agreement for intraoperative support, 72.1% of respondents independently performed rectal peritoneal stripping and 60.5% independently performed small bowel resection. This was reduced to 27.9% for right hemicolectomy with primary anastomosis and 16.3% for left hemicolectomy with primary anastomosis. Respondents often involved colorectal support for post-operative complications. The majority of UK gynaecological oncologists involve colorectal/general surgical teams in bowel procedures, more commonly for large bowel procedures compared to small bowel and for left colon compared to right colon procedures. A total of 16.3% of respondents independently performed all surveyed bowel procedures. Future research should examine training and experience within these groups to address this disparity.
Language	English
Publishing date	2022-10-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11216233
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Article: Spontaneous Heterotopic Pregnancy Associated with Massive Intraperitoneal Haemorrhage and a Normal Heart Rate, Illustrating the Concept of Relative Bradycardia.

Gallaher, Charles / Tahmasebi, Farshad / Sayasneh, Ahmad / Mehra, Gautam

Case reports in obstetrics and gynecology

2019 Volume 2019, Page(s) 2893149

Abstract: A 28-year-old, 9 and a half weeks pregnant (spontaneous conception) multigravida presented with abdominal pain and vaginal bleeding. On examination, her abdomen was diffusely tender, particularly in the right iliac fossa, though guarding was absent. ... ...

Abstract	A 28-year-old, 9 and a half weeks pregnant (spontaneous conception) multigravida presented with abdominal pain and vaginal bleeding. On examination, her abdomen was diffusely tender, particularly in the right iliac fossa, though guarding was absent. Transabdominal and transvaginal ultrasonography demonstrated a viable intrauterine pregnancy and large-volume intraperitoneal haemoperitoneum; the right ovary could not be identified. The patient became hypotensive with decreased responsiveness, yet her heart rate remained normal. She proceeded to surgery where a ruptured right tubal ectopic pregnancy was identified and right salpingectomy was performed. Estimated blood loss was 3900ml. Postoperative recovery was uneventful. Ultrasound 3 days after surgery demonstrated a viable intrauterine pregnancy of gestational age 9 weeks + 1 day. The patient remains well. Her anomaly scan at 20 weeks and 6 days showed normal growth, amniotic fluid, and Dopplers with no obvious structural defects. She is currently 27 weeks pregnant and will be rescanned at 36 weeks.
Language	English
Publishing date	2019-03-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627654-9
ISSN	2090-6692 ; 2090-6684
ISSN (online)	2090-6692
ISSN	2090-6684
DOI	10.1155/2019/2893149
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Article: Surgery of Benign Ovarian Masses by a Gynecological Cancer Surgeon: A Cohort Study in a Tertiary Cancer Centre.

Quaranta, Michela / Nath, Rahul / Mehra, Gautam / Diab, Yasser / Sayasneh, Ahmad

Cureus

2020 Volume 12, Issue 7, Page(s) e9201

Abstract: Objectives This study aimed to evaluate diagnostic performance in characterising ovarian masses by our gynaecological oncology multidisciplinary team meeting (MDM). Surgical outcome and overall impact on patients and healthcare service were also assessed. ...

Abstract	Objectives This study aimed to evaluate diagnostic performance in characterising ovarian masses by our gynaecological oncology multidisciplinary team meeting (MDM). Surgical outcome and overall impact on patients and healthcare service were also assessed. Methods This was a prospective cohort study of all women with adnexal masses presenting to the gynaecological oncology MDM at a central London tertiary cancer centre between February 2017 and February 2018. The multidisciplinary team (MDT) outcome, imaging details, subjective opinion, tumour markers, surgical details, and final histological diagnosis were collected. Diagnostic performance was also determined. Results There were 200 eligible patients in the study period. MDM imaging review demonstrated a sensitivity of 98.4% (95% CI: 94.3% to 99.8%) and a specificity of 52% (95% CI: 40.2% to 63.7%). Thirty-five cases were false positive, either presumed invasive cancers (51%) or borderline tumours (49%). The most common histological types were serous (37%) and mucinous (31%) cystadenomas. A retrospective application of the International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model suggests a potential reduction in false-positive rates (17%). Among the false-positive cases, there was no postoperative (90 days) mortality and postoperative morbidity was 14% with only grade 2 (CD2) complications according to Clavien and Dindo's CD classification. Conclusion An MDT has high sensitivity but low specificity when characterising ovarian masses referred with possible ovarian cancer to the tertiary centre. False-positive values in ovarian cancers are an important indicator of over-treatment. More research is required to assess other methods, such as the IOTA ADNEX model, to reduce the false-positive value.
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.9201
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Article ; Online: Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis.

Tranoulis, Anastasios / Georgiou, Dimitra / Founta, Christina / Mehra, Gautam / Sayasneh, Ahmad / Nath, Rahul

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2019 Volume 30, Issue 1, Page(s) 107–114

Abstract: Introduction: Electrochemotherapy involves the use of transient tumor permeabilization via electric pulses in combination with low-dose chemotherapeutic agents. It has recently emerged as an alternative treatment modality in vulvar cancer. The aim of ... ...

Abstract	Introduction: Electrochemotherapy involves the use of transient tumor permeabilization via electric pulses in combination with low-dose chemotherapeutic agents. It has recently emerged as an alternative treatment modality in vulvar cancer. The aim of this meta-analysis was to ascertain the effectiveness of electrochemotherapy in the context of palliative care. Methods: The following databases were searched: MEDLINE, Scopus, and Cochrane Database, to identify all registered articles pertaining to palliative vulvar cancer treatment with electrochemotherapy from inception until August 2019, in line with PRISMA guidelines. A single-proportion meta-analysis was performed for the outcomes of overall response, complete response, partial response, stable disease, and progressive disease raterespectively, using the random-effect model. Sensitivity analysis was performed to address heterogeneity. Results: Four studies were included totaling 104 women. The studies were of moderate quality. Pooled results from four studies rendered a summary proportion of 78.8% (95% CI 70.4% to 86.1%) for the outcome of overall response. The median age ranged between 68 and 85 years. The sample size per study ranged between eight and 61 women. The tumors' histological types included: squamous-cell carcinoma (96.2%), Paget's disease (2.9%), and malignant melanoma (0.9%). A total of 65 patients (62.5%) presented with a single nodule, whilst 39 patients (37.5%) presented with multiple nodules. Eighty-nine women (85.6%) were previously submitted to other treatment modalities. The overall response rate ranged from 73.2% to 80.9%. The pooled proportion for the outcomes of complete and partial response rate was 48.7% (95% CI 30.74% to 61.5%) and 30.2% (95% CI 21.7% to 39.4%), respectively. The follow-up ranged from 1 to 51 months. No severe adverse effects were reported. The safety profile of electrochemotherapy was favorable. Conclusions: Electrochemotherapy is an effective and minimally invasive treatment modality in the palliative care management of patients with vulvar cancer. The effective control of vulvar tumors by electrochemotherapy may contribute to improvement of quality-of-life. In light of the moderate quality of evidence, a multi-center cooperation is warranted to confirm its palliative benefit.
MeSH term(s)	Electrochemotherapy/methods ; Female ; Humans ; Palliative Care/methods ; Quality of Life ; Randomized Controlled Trials as Topic ; Vulvar Neoplasms/drug therapy
Language	English
Publishing date	2019-12-03
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2019-000868
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Article: Systemic Approach to Formalizing the Informal Sector in E-waste

Tiwari, Dharna / Mehra, Gautam / Khan, Ambrina Sardar / Dhawan, Nidhi Gauba

Annals of biology

2019 Volume 35, Issue 2, Page(s) 173

Document type	Article
ZDB-ID	15373-4
ISSN	0970-0153
Database	Current Contents Nutrition, Environment, Agriculture

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Article ; Online: Advanced stage (IIIC/IV) endometrial cancer: Role of cytoreduction and determinants of survival.

Rajkumar, Savithri / Nath, Rahul / Lane, Geoffrey / Mehra, Gautam / Begum, Shahina / Sayasneh, Ahmad

European journal of obstetrics, gynecology, and reproductive biology

2018 Volume 234, Page(s) 26–31

Abstract: Objective: Primary aim of this study was to assess the impact of optimal cytoreduction in women who had surgical treatment of advanced stage (IIIC/IV) endometrial cancer. Secondary objective was to define demographic and surgico-pathologic variables ... ...

Abstract	Objective: Primary aim of this study was to assess the impact of optimal cytoreduction in women who had surgical treatment of advanced stage (IIIC/IV) endometrial cancer. Secondary objective was to define demographic and surgico-pathologic variables that exerted a significant influence on survival outcomes. Study design: Records of 45 patients with stage IIIC/IV Endometrial cancer who underwent surgery with cytoreductive intent between 2010 and 2016 were analysed. Data on disease distribution, surgical procedures, adjuvant therapy and survival times was collated. Survival curves were plotted by Kaplan Meier method and median survival estimates were compared using log rank test. Cox proportional hazards model was used to identify independent variables predictive of survival. Results: 28 women (62.2%) had undergone primary surgery and 17 (37.8%) received neoadjuvant chemotherapy prior to delayed primary surgery. Optimal cytoreduction to </ = 1 cm visible disease was achieved in 29 women (64.4%). Among 29 women who had optimal debulking, 24 had no visible disease. Median overall survival for the entire study cohort was 24 months. Median progression free survival in the optimal cytoreduction group was 16 months as opposed to 11.5 months in women who had > 1 cm residual disease (p = 0.02). Median overall survival was 29 months in patients who had optimal cytoreduction and 17.5 months in women who had bulky residual disease (p=0.002). Only poor performance status (p = 0.035), presence of bowel disease (p = 0.05) and suboptimal cytoreduction (p = 0.006) retained significance as predictors of poor survival on multivariate analyses. Suboptimal cytoreduction surgery, compared to optimal cytoreduction, showed a 3.55-fold increased risk of death independent of performance status and anatomic region with disease (Hazard Ratio 3.55 (95% confidence interval 1.44-8.73) p = 0.006). Conclusion: Survival analyses demonstrate significantly better progression free survival and overall survival when optimal cytoreduction is achieved. A prospective, multicentre study is recommended to establish conclusive evidence.
MeSH term(s)	Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemotherapy, Adjuvant/statistics & numerical data ; Cytoreduction Surgical Procedures/methods ; Cytoreduction Surgical Procedures/mortality ; Disease-Free Survival ; Endometrial Neoplasms/mortality ; Endometrial Neoplasms/surgery ; Female ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Retrospective Studies
Language	English
Publishing date	2018-12-21
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2018.11.029
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Article ; Online: Prognostic implications of histological tumor regression (Böhm's score) in patients receiving neoadjuvant chemotherapy for high grade serous tubal & ovarian carcinoma.

Rajkumar, Savithri / Polson, Alexander / Nath, Rahul / Lane, Geoffrey / Sayasneh, Ahmad / Jakes, Adam / Begum, Shahina / Mehra, Gautam

Gynecologic oncology

2018 Volume 151, Issue 2, Page(s) 264–268

Abstract: Objective: Primary objective of this study was to determine prognostic significance of Bohm's histopathological regression score in patients who received neoadjuvant chemotherapy (NACT) for treatment of high grade serous (HGS) tubal & ovarian carcinoma.! ...

Abstract	Objective: Primary objective of this study was to determine prognostic significance of Bohm's histopathological regression score in patients who received neoadjuvant chemotherapy (NACT) for treatment of high grade serous (HGS) tubal & ovarian carcinoma. Methods: This was a retrospective cohort study of patients who received NACT between 2010 and 2015. The 3 point histopathological regression score of Böhm was used to classify chemotherapy response. Survival outcomes between the 3 different subgroups was analysed and compared with standard clinico-pathological variables using the Cox proportional hazards model and log-rank test. Results: Study cohort comprised 111 patients. Chemotherapy response score (CRS) 3 was observed in 47 (42.4%) and CRS 1and CRS 2 in 22 (19.8%) and 42 (37.8%) women respectively. Women with CRS score of 1 and 2 combined showed a three-fold increased risk of progression on both univariate and multivariate assessment (HR 3.54; C.I 2.19-5.72, p < 0.001). The median overall survival for patients with CRS 1 was 34 months, CRS 2 was 30 months and 47 months for CRS 3. CRS 1 and 2 combined was the only variable that held significance in prediction of reduced overall survival on multivariate assessment (HR 3.26, C.I 1.91-5.54, p 0.0006). CRS 1 and 2 were also associated with 5.15-fold increased risk of relapse within 6 months of completion of chemotherapy (Odds ratio OR 5.15, C.I 0.07-0.47, p - 0.002). Conclusion: CRS is an independent prognosticator of survival and reliable predictor of relapse within 6 months in advanced high grade serous tubal and ovarian carcinoma patients receiving NACT.
MeSH term(s)	Age Factors ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; CA-125 Antigen/metabolism ; Carboplatin/administration & dosage ; Chemotherapy, Adjuvant ; Cohort Studies ; Cystadenocarcinoma, Serous/drug therapy ; Cystadenocarcinoma, Serous/metabolism ; Cystadenocarcinoma, Serous/mortality ; Cystadenocarcinoma, Serous/pathology ; Fallopian Tube Neoplasms/drug therapy ; Fallopian Tube Neoplasms/metabolism ; Fallopian Tube Neoplasms/mortality ; Fallopian Tube Neoplasms/pathology ; Female ; Humans ; Membrane Proteins/metabolism ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/metabolism ; Ovarian Neoplasms/mortality ; Ovarian Neoplasms/pathology ; Paclitaxel/administration & dosage ; Prognosis ; Regression Analysis ; Retrospective Studies ; Survival Rate
Chemical Substances	CA-125 Antigen ; MUC16 protein, human ; Membrane Proteins ; Carboplatin (BG3F62OND5) ; Paclitaxel (P88XT4IS4D)
Language	English
Publishing date	2018-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2018.08.042
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Article ; Online: Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia after large loop excision of transformation zone: do we need a different follow-up strategy?

Kodampur, Mallikarjun / Kopeika, Julia / Mehra, Gautam / Pepera, Theodora / Menon, Padma

The journal of obstetrics and gynaecology research

2012 Volume 39, Issue 1, Page(s) 280–286

Abstract: Aims: The aim of this study was to determine the effect of endocervical crypt involvement in specimens with clear margins on recurrence following large loop excision of transformation zone (LLETZ).: Material and methods: This was an observational ... ...

Abstract	Aims: The aim of this study was to determine the effect of endocervical crypt involvement in specimens with clear margins on recurrence following large loop excision of transformation zone (LLETZ). Material and methods: This was an observational cohort study. In the colposcopy unit in a university teaching hospital we prospectively collected data for women who underwent LLETZ treatment for high-grade cervical intraepithelial neoplasia (CIN) between 2003 and 2004. We determined the difference in recurrence rate and need for repeat treatment between groups with and without crypt involvement in the primary histology. We prospectively collected data of follow up until 2010. The recurrence was analyzed using Cox regression. Results: A total of 309 women had complete excision of the margins following LLETZ treatment for CIN 2 or 3. There was no significant difference in age between groups with (30.2) and without (29.7) crypt involvement (P<0.25). There was a significant difference in the prevalence of abnormal smear results before and after LLETZ between groups with or without crypt involvement (P=0.043). The need to perform a repeated treatment was significantly different between groups with and without crypt involvement (P<0.024). A full model significantly predicted recurrence of cervical pathology (P<0.009) that necessitated treatment when crypt involvement was present. The odds ratio for repeat treatment with crypt involvement was 2.67 (confidence interval, 1.27-5.64). Conclusions: Our study showed that positive involvement of endocervical crypt by CIN in a cervical loop excision specimen increases the frequency of subsequent episodes of treatment.
MeSH term(s)	Adult ; Cervical Intraepithelial Neoplasia/pathology ; Cervical Intraepithelial Neoplasia/surgery ; Cervix Uteri/pathology ; Cervix Uteri/surgery ; Colposcopy/methods ; Female ; Humans ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/surgery ; Prospective Studies ; Treatment Outcome ; Uterine Cervical Dysplasia/pathology ; Uterine Cervical Dysplasia/surgery ; Uterine Cervical Neoplasms/pathology ; Uterine Cervical Neoplasms/surgery
Language	English
Publishing date	2012-07-06
Publishing country	Australia
Document type	Journal Article ; Observational Study
ZDB-ID	1327307-3
ISSN	1447-0756 ; 1341-8076
ISSN (online)	1447-0756
ISSN	1341-8076
DOI	10.1111/j.1447-0756.2012.01943.x
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Article ; Online: Behavioral characteristics of manual palpation to localize hard nodules in soft tissues.

Konstantinova, Jelizaveta / Li, Min / Mehra, Gautam / Dasgupta, Prokar / Althoefer, Kaspar / Nanayakkara, Thrishantha

IEEE transactions on bio-medical engineering

2014 Volume 61, Issue 6, Page(s) 1651–1659

Abstract: Improving the effectiveness of artificial tactile sensors for soft-tissue examination and tumor localization is a pressing need in robot-assisted minimally invasive surgery. Despite the availability of tactile probes, guidelines for optimal palpation ... ...

Abstract	Improving the effectiveness of artificial tactile sensors for soft-tissue examination and tumor localization is a pressing need in robot-assisted minimally invasive surgery. Despite the availability of tactile probes, guidelines for optimal palpation behavior that best exploit soft-tissue properties are not available as yet. Simulations on soft-tissue palpation show that particular stress-velocity patterns during tissue probing lead to constructive dynamic interactions between the probe and the tissue, enhancing the detection and localization of hard nodules. To the best of our knowledge, this is the first attempt to methodically evaluate the hypothesis that specific human palpation behaviors (defined by the fingers' velocity, trajectory, and exerted force) directly influence the diagnosis of soft-tissue organs. Here, we use simulation studies involving human participants to establish open hypotheses on the interaction and influence of relevant behavioral palpation variables, such as finger trajectory, its velocity, and force exerted by fingers on the accuracy of detecting embedded nodules. We validate this hypothesis through finite element analysis and the investigation of palpation strategies used by humans during straight unidirectional examination to detect hard nodules inside silicone phantoms and ex-vivo porcine organs. Thus, we conclude that the palpation strategy plays an important role during soft-tissue examination. Our findings allow us, for the first time, to derive palpation behavior guidelines suitable for the design of controllers of palpation robots.
MeSH term(s)	Animals ; Fingers/physiology ; Humans ; Kidney/physiology ; Models, Biological ; Neoplasms/diagnosis ; Neoplasms/physiopathology ; Palpation/methods ; Phantoms, Imaging ; Swine ; Touch/physiology
Language	English
Publishing date	2014-05-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2013.2296877
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