Blog

Blog

Gynaecological Oncology Events:


The Nottingham Total Laparoscopic Hysterectomy Masterclass courses:

The Nottingham Total Laparoscopic Hysterectomy Masterclass Course for Consultant Gynaecologists 

I am looking forward to the next TLH Masterclass course. An opportunity to interract with other gynaecology consultants from across the country who are enthusiastic about taking their laparoscopic (key-hole operation) to another level. I have been running this course now for almost 8 years. Together with my team of faculty members (gynaecologists, anaesthetists and theatre nursing staff), we are hopeful to run another very successful 2-day hands-on training course for consultants for the benefits of their patients. It is always wonderful to see these consultants make excellent progress with their laparoscopic skills after attending the course. Overall, well over 90% of consultants who attend the course do eventually progress to performing most of their hysterectomies entirely laparoscopic. This has significant impact on patients recovery and wellbeing. It is a win-win situation for all - patients, their relatives, place of work and of course the hospital. 

The two-day course comprises of lectures, hands-on cadaver lab operating and live operating by faculty members. There is usually an opportunity for mentorship training for consultant following full attendance at the course. Consultants are also awarded CME points by the Royal College of Obstetricians and Gynaecologists (RCOG) following successfull completion of the course.


International Meeting of The European Society of Gynecological Oncology (ESGO)

As usual, this promises to be another exciting ESGO meeting. I have attended all the ESGO meetings over the last 12 years and none has ever failed to live up to the very high expectations. A fantastic opportunity for learning, presentations and interractions with other members from across the globe. Innovations in the management of gynaecological cancers as well as all the latest research studies are discussed extensively. As a gynaecological cancer surgeon, I have always found these meetings invaluable in keeping my knowledge up to date and also an opportunity to see what others are doing that could potentially be of benefit to my patients.

 

The British Gynaecological Cancer Society - https://bgcs.org.uk

For the first time the meeting was held in conjuction with the the Turkish Gynaecological Cancer Society. The meeting was packed full of surgical updates in gynaecological cancers.

  • Ovarian cancer

  • Endometrial (womb) cancer

  • Cervical (neck of the womb) cancer

  • Vulvar cancer


Ovarian Cancer: There is no doubt that in the United Kingdom, we are still playing catch up, when it comes to surgical debulking for advanced stage ovarian cancer, compared to our European and North American colleagues. The British gynaecological oncologists have long been known for been very conservative with surgical radicality in advanced stages of ovarian cancer. There are properly randomised trials which have long showed that complete tumour debulking which involves extensive surgery (total hysterectomy, removal of both tubes and ovaries, total omentectomy, liver mobilisation with peritoneal resection, systematic retroperitoneal lymphadenectomy, (+/- splenectomy, +/- bowel resection, +/- distal pancreatectomy, +/- resection of tumour from the liver), are associated with better overall survival. The UK survival from ovarian cancer is poor compared to the other rich European nations (such as Germany, Belgium, Finland, France), North America, Canada and Australia. This is not just due to late ovarian cancer presentation.  A recent article in the Lancet found out that patients in Australia and Canada do not present any earlier to their specialists than UK patients. Chemotherapy is more or less universal. The only difference is in the extent of surgical debulking. At the recent BGCS conference, it was confirmed from various studies that on average, the UK gynaeclogical oncologist spends 2 hours, (compared to an average of 4 hours by our colleagues in the rest of Europe and North America) in performing advanced ovarian cancer surgery. This cannot be right if every effort is made to resect all macroscopically obvious tumour at the time of surgery. Luckily, this shortcoming is now be recognised nationwide and many gynaecological cancer surgeons are now getting additional training to be able to carry out the appropriate surgical debulking for advanced stages of ovarian cancer. Where needed, other surgical specialties, such as colorectal and hepatobilliary surgeons, are now been increasingly involved. This will eventually benefit our patients and translate into a better overall survival comparable to those in Europe, USA, Canada and Australia. Patients should be empowered to ask questions about the treatment they are receiving. The hospital managers should also provide the resources and time that is required to accomplish this goal. A surgical operating list should not just be about "Quantity" but "Quality".
For additional information, please read my information leaflet on ovarian cancer on the main website menu under "operations".

Endometrial Cancer: The surgical uterine cancer care pathway (SUCCP) on uterine cancer management is a comprehensive plan (please refer to my main website, under the menu - Expertise). Every woman with a diagnosis of uterine (womb) cancer should have at least an MRI scan of the pelvis and abdomen except of course if they have a very high BMI. I have carried out key-hole hysterectomy on women with BMI as high as 75+ where this is  virtually infeasible and you just have to rely only on pre-operative chest X-ray and pelvic ultrasound scan staging. Apart from this scenario, pre-operative MRI staging is vitally important for all endometrial cancer staging - depth of myometrial invasion and the status of the pelvic lymph nodes. This is irrespective of the the histological (cellular) type. For those with type 2 endometrial cancer (serous and clear cell type) and the carcinosarcomas, CT staging of the chest, abdomen and pelvis should also be done. Where resources are been rationalised and the decision is been made to perform only one imaging modality for staging, then, a CT scan of the chest, abdomen and pelvis only should be done. On the other hand, if it is the low grade (Type 1 endometrial cancer - grades 1 and 2), and the MRI suggests less than 50% myometrial invasion with no enlarged pelvic lymph nodes (low risk), such patients can be spared pelvic lymphadenectomy as there is no evidence of benefit. However, if the MRI suggests more than 50% myometrial invasion or enlarged pelvic lymph nodes, such patients should have pelvic lymph nodes dissection for proper staging. Remarkably, at the recent BGCS meeting, I heard of some cases that were presumed to be early stage, low grade endometrial cancer that recurred either at the vaginal vault or the pelvic sidewalls. This further justifies the proper staging of intermediate risk endometrial cancer so that appropriate adjuvant treatment (radiotherapy +/- chemotherapy) may be adminstered after surgery to help reduce the risk of recurrence. Women ought to be properly informed by their clinicians and the options extensively discussed.

international conferences attended in 2018:

International surgical video workshop Prague, 26-28 April 2018 - presented a radical minimally invasive surgical video

IGCS Kyoto, Japan, September 2018 - Presented Abstracts on my work with advanced ovarian cancer and minimally invasive fertility preservation surgery for early stage cervical cancer. A very a exciting conference with amazing Japanese culture.