Recent Research Publications- June 2024

Radiation Therapy With or Without Cisplatin for Local Recurrences of Endometrial Cancer: Results From an NRG Oncology/GOG Prospective Randomized Multicenter Clinical Trial.

Klopp AH, Enserro D, Powell M, Randall M, Schink JC, Mannel RS, Holman L, Bender D, Kushnir CL, Backes F, Zweizig SL, Waggoner S, Bradley KA, Lawrence LD, Hanjani P, Darus CJ, Small W Jr, Cardenes HR, Feddock JM, Miller DS.

J Clin Oncol. 2024 Apr 25:JCO2301279. doi: 10.1200/JCO.23.01279. Epub ahead of print. PMID: 38662968.

Purpose: Pelvic recurrence is a frequent pattern of relapse for women with endometrial cancer. A randomized trial compared progression-free survival (PFS) after treatment with radiation therapy alone as compared with concurrent chemotherapy.

Materials and methods: Between February 2008 and August 2020, 165 patients were randomly assigned 1:1 to receive either radiation treatment alone or a combination of chemotherapy and radiation treatment. The primary objective of this study was to determine whether chemoradiation therapy was more effective than radiation therapy alone at improving PFS.

• The majority of patients had low-grade (1 or 2) endometrioid histology (82%) and recurrences confined to the vagina (86%). External beam with either the three-dimensional or intensity modulated radiation treatment technique was followed by a boost delivered with brachytherapy or external beam. Patients randomly assigned to receive chemotherapy were treated with once weekly cisplatin (40 mg/m2). Rates of acute toxicity were higher in patients treated with chemoradiation as compared with radiation treatment alone. Median PFS was longer for patients treated with radiation therapy alone as compared with chemotherapy and radiation (median PFS was not reached for RT v 73 months for chemoradiation, hazard ratio of 1.25 (95% CI, 0.75 to 2.07). At 3 years, 73% of patients treated definitively with radiation and 62% of patients treated with chemoradiation were alive and free of disease progression.

• Excellent outcomes can be achieved for women with localized recurrences of endometrial cancer when treated with radiation therapy. The addition of chemotherapy does not improve PFS for patients treated with definitive radiation therapy for recurrent endometrial cancer and increases acute toxicity. Patients with low-grade and vaginal recurrences who constituted the majority of those enrolled are best treated with radiation therapy alone.

For a full text of the article, click here: https://ascopubs.org/doi/10.1200/JCO.23.01279

A Statewide Mobile Simulation Program For Improving Obstetric Skills in Rural Hospitals.

Thenuwara K, Santillan D, Henkle J, Forman J, Dunbar A, Faro E, Hunter S.

Anesth Analg. 2024 May 17. doi: 10.1213/ANE.0000000000006883. Epub ahead of print. PMID: 38758671.

Background: Closure of rural obstetric (OB) units has led to maternal care deserts, causing mothers to travel long distances for maternity care. Emergency departments (EDs) in hospitals where OB units have closed require regular training for personnel to maintain OB skills, as do rural Level-1 OB units with low volumes of maternity cases. We used a federal grant to develop an OB mobile simulation program to bring simulation-based training to rural providers. Our goal was to improve OB skills and standardize care through the framework of the Alliance for Innovation in Maternal Health (AIM) Patient Safety Bundles.

Methods: We conducted needs assessments and built a mobile simulation unit. We defined 2 groups of learners: those in Level-1 OB units and those in EDs without OB units. For Level-1 OB units, we created a train-the-trainer curriculum, to create a statewide cohort of simulation experts to implement simulations in their facilities between our visits. We gifted each Level-1 unit an OB task trainer, implemented virtual train-the-trainer simulation and task trainer workshops, and conducted post-workshop assessments. We then traveled to each Level-1 unit and helped the cohort implement in situ simulations for their staff using facility-specific resources. We conducted assessments for the cohort and the hospital staff after the simulations. For EDs, we delivered virtual didactics to improve basic OB knowledge, then traveled to ED units, implemented in situ simulations, and conducted post-simulation assessments. We chose a postpartum hemorrhage (PPH) scenario for our first round of simulations.

After train-the-trainer simulation workshops, 98% of participants surveyed agreed that workshop goals and objectives were achieved. After the task trainer workshop, 95% surveyed agreed that their knowledge of using the simulator had improved. After implementing in situ simulations in Level-1 OB units, 98.8% of the train-the-trainer cohort found that their ability to implement simulations had improved. The hospital staff participating in the simulations identified a 30% increase in ability to manage PPH. For the ED staff, postdidactic evaluations identified that 95.4% of participants reported moderate improvement in basic OB knowledge and after participation in the simulations >95% reported better skills as an ED team member when caring for pregnant patients.

Conclusions: These results demonstrate improved skills of hospital staff in simulated PPH in Level-1 OB units and simulated OB emergencies in EDs that no longer have OB units. Further studies are warranted to assess improvement in maternal outcomes.

For a full text of the article, click here: https://journals.lww.com/anesthesia-analgesia/fulltext/9900/a_statewide_...

Not all operative time is created equal: operative time in relation to 30-day complications in benign laparoscopic hysterectomies.

Ikoma D, Ikoma M, Haugsdal ML.

Proc Obstet Gynecol. 2024;13(1): Article 2 [17 p.]. doi: https://doi.org/10.17077/2154-4751.33790.

STUDY OBJECTIVE: To assess the relationship between operative time and specific 30-day postoperative complications across different intervals of operation duration in total laparoscopic hysterectomies (TLHs).

• A retrospective cohort study.

• American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020.

• 131,146 TLH cases.

• Eligible cases included benign laparoscopic hysterectomies with operative times between 20 and 499 min. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures.

• Multivariable logistic regression analysis was used to evaluate the relationship between specific postoperative complications and operative time. Spline regression was used to analyze differences in the association between postoperative complications and operative time across different tertiles of operative duration.

MAIN RESULTS: Multivariable logistic regression analysis demonstrated a significant association between operative time and complication occurrence for each complication type investigated, including unplanned readmission, urinary tract infections, superficial surgical site infections, blood transfusion administration, return to the operating room, and deep organ space infections. Multivariable logistic spline regression demonstrated that operative time contributed more strongly to the odds of a complication for shorter procedures than longer procedures. This relationship was more pronounced for major complications than minor complications.

1. : Operative time is a stronger risk factor for developing complications for shorter duration procedures than longer procedures. This is especially evident in major complications such as return to the operating room and deep organ space infections. Our results suggest that longer procedure duration may not affect the likelihood of a complication as much as previously thought, and operative times should not be a primary factor in deciding to convert to laparotomy or alter post-operative management.

For a full text of the article, click here: https://pubs.lib.uiowa.edu/pog/article/id/33790/

Surgical management of cornual heterotopic using intraoperative sonography depth resection guidance: case report.

Hagenow A, Shaffer SA, Jain SC.

Proc Obstet Gynecol. 2024;13(1): Article 3 [7 p.]. doi: https://doi.org/10.17077/2154-4751.33791.

Heterotopic pregnancy is an uncommon phenomenon in which an ectopic and intrauterine pregnancy coexist. This condition can be life-threatening and poses a significant therapeutic challenge. Here we describe management of a heterotopic pregnancy with the ectopic pregnancy located in the right cornua. Resection of the ectopic pregnancy was performed via open laparotomy with intraoperative sonography. A sonography guided approach may optimize resection depth while secondarily allowing monitoring of the intrauterine pregnancy and prevention of disruption in cases in which the gestational sacs are in close proximity. After resection, the course of the pregnancy was uncomplicated, and a healthy baby was delivered via planned cesarean delivery at 36 weeks. While the optimal management of heterotopic pregnancies is often individualized, prompt diagnosis and treatment can result in favorable outcomes. The use of ultrasound intraoperatively allows for more precise resection depth, and which may lead to improved outcomes including increased intrauterine fetal survival rates and decreased myometrial scarring.

For a full text of the article, click here: https://pubs.lib.uiowa.edu/pog/article/id/33791/

Letter from the Editor.

Santillan DA.

Proc Obstet Gynecol. 2024;13(1):Article 1 [ 1 p.]. doi: https://doi.org/10.17077/2154-4751.33789.

For a full text of the article, click here: https://pubs.lib.uiowa.edu/pog/article/id/33789/

Contraception utilization and barriers to use in an Iowan population.

Johnson JC, Ramesh A, Radke SM.

Proc Obstet Gynecol. 2024;13(1): Article 5 [1 p.]. doi: https://doi.org/10.17077/2154-4751.33797.

Extended Abstract

For a full text of the article, click here: https://pubs.lib.uiowa.edu/pog/article/id/33797/

The effect of race and rurality on poor pregnancy outcomes.

Meierding K, Santillan, MK.

Proc Obstet Gynecol. 2024;13(1): Article 6 [2 p.]. doi: https://doi.org/10.17077/2154-4751.33798.

Extended Abstract

For a full text of the article, click here: https://pubs.lib.uiowa.edu/pog/article/id/33798/