Pilot of an International Collaboration to Build Capacity to Provide Gynecologic Oncology Surgery in Botswana
Pilot of an International Collaboration to Build Capacity to Provide Gynecologic Oncology Surgery in Botswana
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DOI：
10.1097/igc.0000000000001372
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发表时间：
2018-11-01
影响因子：
4.8
通讯作者：
Grover, Surbhi
中科院分区：
文献类型：
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作者：
Luckett, Rebecca;Kalenga, Kitenge;Grover, Surbhi
目的妇科恶性肿瘤是博茨瓦纳妇女癌症死亡的主要原因。25%的宫颈癌处于可以手术治愈的阶段；然而，没有妇科肿瘤学家提供根治性手术。一个可持续的先进手术模式对于推进妇科恶性肿瘤的治疗是至关重要的。方法/材料在博茨瓦纳开发了一个提供妇科肿瘤手术的模式，由美国的妇科肿瘤学家每年提供四个为期两周的单元。一家地区医院计划开展妇科肿瘤学试点活动。符合条件的患者是通过区域转诊医院的妇科肿瘤多学科诊所确定的，那里提供妇科肿瘤治疗计划。结果1名在美国工作的妇科肿瘤医生、2名在博茨瓦纳工作的妇科医生和2名外科医生参与了试点活动。术后7天共进行16次手术。适应症包括宫颈癌(4例)、卵巢癌(3例)、外阴癌(1例)、复杂性不典型增生(1例)、宫颈浸润性前期疾病(2例)、良性疾病(3例)，以及2例产科急症。唯一的妇科肿瘤并发症是出血需要输血和术后重症监护病房入院。随访护理通过妇科肿瘤多学科诊所进行协调。结论在缺乏进行高级手术的当地能力的情况下，定期开展妇科肿瘤活动是创建通道和建设当地能力的可行模式。强有力的地方合作至关重要。未来增加影响的战略包括招募更多的妇科肿瘤学家，以增加服务和培训的可用性。
Objectives Gynecologic malignancies are the leading cause of cancer death among women in Botswana. Twenty-five percent of cervical cancers present at a stage that could be surgically cured; however, there are no gynecologic oncologists to provide radical surgeries. A sustainable model for delivery of advanced surgery is essential to advance treatment for gynecologic malignancies.Methods/Materials A model was developed to provide gynecologic oncology surgery in Botswana, delivered by US-based gynecologic oncologists in four 2-week blocks per year. A pilot gynecologic oncology campaign was planned at a district hospital. Eligible patients were identified through the gynecologic oncology multidisciplinary clinic at the regional referral hospital, where gynecologic oncology treatment planning is provided. Local providers were invited to participate to build local surgical capacity.Results One US-based gynecologic oncologist, 2 gynecologists, and 2 surgeons working in Botswana participated in the pilot campaign. Sixteen operations were performed over 7 days. Indications included cervical cancer (4), ovarian cancer (3), vulvar cancer (1), complex atypical hyperplasia (1), pre-invasive cervical disease (2), and benign disease (3), as well as 2 obstetric emergencies. The only gynecologic oncology complication was a case of bleeding requiring transfusion and postoperative intensive care unit admission. Follow-up care was coordinated through the gynecologic oncology multidisciplinary clinic.Conclusions Periodic gynecologic oncology campaigns in settings otherwise lacking local capacity to perform advanced surgery are a feasible model to create access and build local capacity. Strong local collaboration is essential. Future strategies to increase impact include recruitment of more gynecologic oncologists to increase service and training availability.