BACKGROUND

Intraoperative transfusion for gynecologic surgery, when appropriately used, can improve patient outcomes. However, when utilized incorrectly, blood transfusion can worsen patient outcomes and increase patient cost. This study aimed to evaluate the blood transfusion practices of tertiary hospitals in the Philippines.

The study utilized a cross-sectional design wherein prospective data were gathered through multiple sources across seven tertiary-level hospitals. Women admitted to undergo gynecologic surgery were recruited based on a set of criteria. A chart review was conducted, and blood utilization indices were calculated. Outcomes were compared between public versus private facilities and transfused versus nontransfused patients.

Among 514 patients, 79.7% underwent cross-matching and 75.1% received transfusions. Adverse events were rare, with no transfusion-related deaths. The overall crossmatch-to-transfusion ratio (C/T ratio) was 2.8, exceeding the 2.5 optimal benchmark; all public hospitals recorded a C/T ratio >2.5, whereas private centers had more efficient usage. Six hospitals met acceptable benchmarks for transfusion probability and transfusion index. Open abdominal procedures, particularly hysterectomy, accounted for the most blood used. Transfused patients had longer operative times, greater blood loss, lower preoperative hemoglobin, and more frequently involved resident physicians in training. Public hospitals recorded higher cross-match and transfusion rates, greater resident physician participation, and broader use of general anesthesia.

Results of the study highlight the importance of monitoring blood transfusion parameters to optimize blood utilization. The observed differences between public and private institutions in the country highlight the urgent need for standardized and evidence-based practice to ensure efficient transfusion protocols nationwide.

Vulvar intraepithelial neoplasia (VIN) is a precancerous lesion involving the squamous epithelium of the vulva. This retrospective descriptive study aims to determine the prevalence of VIN in a tertiary government hospital in a developing country. Medical records of outpatient consultations with the diagnosis of VIN from January 2000 to June 2012 were reviewed. The prevalence of VIN was 1.6/100,000 women over the 12 years. The diagnosis was based on biopsy results of an incidental finding of vulvar lesions on physical examination. The profile of a patient with VIN was a woman aged 40 years old and above, married, multigravid, nonsmoker, high school graduate, and unemployed. Vulvar lesions noted were multiple hyperpigmented papules located at the posterior labia majora. VIN was associated with abnormal colposcopy findings, and 40% were associated with concomitant cervical disease. Treatment was wide local excision. Prompt diagnosis and appropriate treatment of VIN aim to prevent its progression to vulvar carcinoma. Although vulvar carcinoma is a rare condition, there has been a notable rise in prevalence in recent years. Hence, gynecologists should be vigilant and have a high index of suspicion to detect the disease early in its course.
Vulvar Diseases

Background: Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage. Objective: This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy. Methodology: Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed. Results: The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course. Conclusion Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.
Female ; Gynecologic Surgical Procedures

Objective: This study aimed to determine the accuracy, sensitivity and specificity of frozen section (FS) in the diagnosis of uterine neoplasm in a tertiary government training hospital. Methodology: This is a retrospective validation study from 2004-2015 involving cases of uterine lesions from gynecologic surgeries. All histopathologic results of frozen and paraffin sections were retrieved and reviewed. Chi square test with 2x2 Fischer Exact test adjustment was used to check for associations. Accuracy indices of FS tool were estimated such as sensitivity, specificity, likelihood ratios, negative and positive predictive values, and overall accuracy. A p-value of < 0.05 alpha is considered significant. Results: A total of 143 uterine specimens were submitted for frozen section analysis. The utilization rate of FS is 1% per year. The FS results were correlated with the final histopathologic diagnosis with 96% agreement rate. Utilizing a median number of 3 sections per specimen provides an overall accuracy rate of 97%. The accuracy rate of FS is equal between combined benign-premalignant and malignant cases at 96%. The accuracy rate is not statistically affected by the procedure by which the specimen was taken, as well as the source and gross morphology of the specimen. Moreover, a minimum of 11 sections per specimen is needed to obtain an accuracy rate of 99-100%. The accuracy rate particularly for endometrial lesions is between 94 and 100%. Conclusion Accuracy rates of frozen section on uterine lesions are high regardless of the sampling procedure and source of the specimen. Increasing the number of sections during FS parallels that of the final histopathologic diagnosis. FS for uterine lesions is a vital and cost-effective intraoperative decision tool to maximize care of patients.
Frozen Sections

Background: Stillbirth has a complex pathophysiology, hence the difficulty in arriving at a specific cause. Objectives The study aimed to identify the probable causes of stillbirth in a tertiary hospital based on gross examination of the placenta and the fetus, as well as, to identify the demographic profile of the stillbirths.
Placenta

Majority of cervical cancer are squamous cell carcinoma and adenocarcinoma. The co-existence of two histologic types is rare. This article presents three cases of collision tumors of the cervix within a 10-year review. All underwent radical hysterectomy for an early stage disease. Likewise, it aims to review clinicopathologic features, management, response to treatment and prognosis of these types of tumor in the light of recent literature.

BACKGROUND: Epithelial ovarian cancer remains to be the leading cause of death from gynecologic malignancy. Survival is influenced primarily by FIGO stage amount of residual disease and histologic type. Unfortunately, such prognostic factors still fail to account fully for the biologic behavior of ovarian carcinomas. It is of interest therefore to identify new prognostic factors which are more objective, quantifiable and reproducible. DNA ploidy has been shown to be an independent prognostic factor in epithelial ovarian malignancies.
OBJECTIVE: The general objective of the study was to determine the ploidy characteristics of epithelial tumors of ovary. The specific objectives were to determine the association of age and aneuploidy, the association of tumor size and aneuploidy and the association of stage and aneuploidy.
METHODS: Patients who underwent surgical staging and/or tumor debulking for ovarian cancer with final histopathologic results of epithelial ovarian carcinoma were included in the study. Exclusion criteria included previous treatment with chemotheraphy or radiotherapy and previous or concomitant malignant diseases. DNA ploidy was determined using flow cytometry of paraffin embedded blocks.
RESULTS: DNA ploidy was obtained in 109 paraffin-embedded blocks of epithelial cancers of the ovary. Aneuploidy was establish in 14 of the total 109 samples (12.8%) as follows: 2 from 24 mucinous cystadenocarcinoma (14.2%), 2 from 24 mucinous tumor of low malignant potential (14.2%), 5 from 29 serious cystadenocarcinoma (17%), 5 from 30 endometriod carcinoma (16%).
CONCLUSION: The prevalence of aneuploidy in epithelial ovarian cancer is 12.8% and aneuploidy is higher for serous adecarcinoma and endometriod adenocarcinoma compared to mucinous tumors of low malignant potential and mucinous cystadenocarcinoma.

Cervical cancer remains to be one of the leading malignancies among Filipino women. High-risk human papillomavirus (HPV) types, such as 16 and 18, are consistently identified in Filipino women with cervical cancer. Factors identified to increase the likelihood of HPV infection and subsequent development of cervical cancer include young age at first intercourse, low socioeconomic status, high parity, smoking, use of oral contraception and risky sexual behaviors. Cancer screening programs presently available in the Philippines include Pap smears, single visit approach utilizing visual inspection with acetic acid followed by cryotherapy, as well as colposcopy. However, the uptake of screening remains low and is further compounded by the lack of basic knowledge women have regarding screening as an opportunity for prevention of cervical cancer. Prophylactic HPV vaccination of both quadrivalent and bivalent vaccines has already been approved in the Philippines and is gaining popularity among the Filipinos. However, there has been no national or government vaccination policy implemented as of yet. The standard of treatment of cervical cancer is radiotherapy concurrent with chemotherapy. Current researches are directed towards improving availability of both preventive and curative measures of cervical cancer management.
Acetic Acid ; Coitus ; Colposcopy ; Contraception ; Cryotherapy ; Early Detection of Cancer ; Female ; Humans ; Mass Screening ; Papillomavirus Vaccines ; Parity ; Philippines ; Sexual Behavior ; Smoke ; Smoking ; Social Class ; Uterine Cervical Neoplasms ; Vaccination ; Vaccines

OBJECTIVES: Postoperative bladder dysfunction of varying severity is common after radical hysterectomy due to damage to the pelvic autonomic nerves during surgical resection. In order to reduce bladder morbidity, a new surgical technique known as nerve-sparing radical hysterectomy (NSRH) has been proposed. The aim of this study was to describe the local experience in the use of NSRH technique in the treatment of early stage cervical cancer.

RESULTS: Twenty patients with early stage cervical cancer underwent NSRH, all with satisfactory results. The mean operating time was 198.5 minutes, ranging from 75 minutes to 319 minutes. The mean blood loss was 710 ml (range: 200 ml 1500 ml). The average period of hospitalization was 7 days. A total of 12 patients out of the 20 (60%) was discharged from the hospital without foley catheter, with ability to void spontaneously by the 4th day postoperatively.

CONCLUSION: The technique of serving the pelvic autonomic nerves employed in the treatment of early stage invasive cervical carcinoma is feasible, with an ability to provide a better quality of life in terms of bladder function, without sacrificing the radicality of the procedure. However, further studies clarifying neuroanatomy and neurophysiology of the autonomic nervous structures of this region need to be done. (Author)

Patients with cervical carcinoma who have failed first-line treatment with chemoradiation have combination chemotherapy to look into for progression-free and overall survivals. Objective: To determine the efficacy and safety of combination therapy of CPT-11 and cisplatin for persistent and recurrent cervical cancer. Methods: A retrospective review of medical records of persistent or recurrent cervical cancer patients who received treatment with Irinotecan (CPT-11) and Cisplatin combination was conducted in UP-PGH Cancer Institute CPT-11 60mg/m2 was administered on Days 1, 8 & 15. Cisplatin 60 mg/m2 was administered on Day 1 only. This cycle was repeated every 4 weeks. Active follow-up included physical and pelvic examinations, laboratory tests and evaluation of adverse experiences. Results: The study was performed in a total of 21 patients (age range: 35-69 years). The histologic types were squamous cell carcinoma, adenocarcinoma and adenosqamous carcinoma. Complete clinical response was achieved in 4 patients (19%). Anemia and diarrhea were the most common grade 3-4 side effects. Conclusion: The combination of CPT-11 and Cisplatin shows moderate activity with acceptable toxicity in the treatment of persistent and recurrent cervical carcinoma. (Author)
Cisplatin ; Drug Therapy ; Uterine Cervical Neoplasms