Hooman Soleymani majd1, Yixin Wang2
1Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK; 2GPM Editorial Office, AME Publishing Company
Correspondence to: Yixin Wang, GPM Editorial Office, AME Publishing Company. Email: gpm@amegroups.com.
Editor’s note
The West China International Multidisciplinary Conference on Gynecological Oncology and Female Pelvic Floor Dysfunction 2024 was held successfully in Chengdu from May 31st to June 2nd, 2024. The conference presented the latest advancements in gynecological oncology and female pelvic floor dysfunction.
During the conference, Prof. Hooman Soleymani majd from the Oxford Gynecological Cancer Centre delivered a speech on “Latest surgical developments in the management of advanced ovarian cancer in the modern Era” on June 1st, 2024. We have had the privilege of inviting Prof. Soleymani majd for a brief interview in which he graciously shared with us key highlights from his speech, as well as his unwavering dedication to gynecological oncology surgery and his vision for its future direction (Video 1, Figure 1).
Figure 1 Hooman Soleymani majd
Expert introduction
Prof. Hooman Soleymani majd started his Obstetrics and Gynecology career in London, before moving to Oxford and completing his structured postgraduate training programme. During the course of training he obtained membership of the Royal College of Obstetricians and Gynecologists (MRCOG), which culminated in a Certificate of Completion of Training (CCT) in Obstetrics and Gynecology. He then completed a further three years of Sub-Specialty Training in Gynecological Oncology at the Churchill Cancer Centre in Oxford. He is a BSCCP accredited colposcopist and trainer, a member of the British Gynecological Cancer Society (BGCS) and the European Society of Gynecology Oncology (ESGO). He is a Consultant in Gynecological Oncology at the Churchill Hospital and has been in post since 2016. He is a visiting Professor at the prestigious Guangxi Medical University Cancer Centre in Nanning, China.
Prof. Soleymani majd has a special interest in developing new surgical techniques in ultra-radical surgery for advanced ovarian cancer and radical pelvic exenteration operations. His skill set includes upper abdominal surgery, liver mobilisation and diaphragmatic reconstruction. He also has a particular interest in treating patients with Placenta Accreta Spectrum (PAS). He is a founding member and surgical lead for the OxPAT (oxford placenta accreta team). He is also a member of the Oxford Sarcoma team. He is currently collaborating with Professor Sarosh Irani in the Nuffield Department of Clinical Neurosciences and Dr Adam Al-Diwani in the department of psychiatry on auto-antibody mediated neurological diseases.
He is actively involved in teaching registrars/fellows and medical students from Oxford University. He has published numerous papers and been an invited speaker at a number of international congresses. He is on the editorial board of Current Problems in Cancer: Case Reports, Gynecology and Pelvic Medicine (GPM) and the Journal of Obstetrics, Gynecology and Cancer Research (JOGCR). He is also a reviewer for Cereus, BMJ case reports, European Journal of Gynecology Oncology (EJGO) and Frontiers in Oncology.
Interview
GPM: As a reputable expert in the field of gynecological oncology surgery, could you share what initially inspired you to become a gynecological oncology surgeon?
Prof. Soleymani majd: Many thanks for having me. It has been an absolute honour and pleasure to take part in such a prestigious meeting in China. As a medical student, I always wanted to specialize in obstetrics and gynecology because I learned early on that by becoming an obstetrician and gynecologist, I would be able to look after both mum and baby. That means in my lifetime, I would have the opportunity to care for twice as many lives as my colleagues. Additionally, I wanted to look after women because I appreciated that women are the backbone of the society. If I could look after them, fix them, and help them, they can go back to their family, and they will be able to look after the rest of the family. After I finished my training in obstetrics and gynecology, I realized there were needs in having more gynecological oncological surgeons, because this sort of speciality involves a painstaking process. Often, you have to spend years and years to get yourself familiarized with multiple specialities. I wanted to focus on cancer because if you look at the most common cancers in women, breast cancer is the most prevalent, followed by lung and colon cancer, then uterine cancer, and finally ovarian cancer. Thus, gynecological malignancies and gynecological cancers do rank high in the top ten cancers that women face. So if you are a trained gynecological oncological surgeon, you will be able to look after women on a day-to-day basis.
GPM: You delivered a lecture on “The latest surgical development in the management of advanced ovarian cancer in modern era.” What are the key advancements in surgical management of advanced ovarian cancer and how do they impact current treatment approaches?
Prof. Soleymani majd: The surgical management of ovarian cancer has evolved enormously. In the last 20 years, we have seen more and more gynecological oncological surgeons performing operations beyond the pelvis, because we know that 80% of women with advanced ovarian cancer have metastases in the upper abdomen, requiring liver mobilization, diaphragmatic surgery, cardiothoracic lymph node dissection, cholecystectomy, splenectomy, and excision of the tail of pancreas. In the past, the main stumbling block was a lack of training. But over the years, due to solid clinical governance and robust training programs, gynecological oncological surgeons have become more familiar with undertaking radical operations, which would result in R0, also known as no residual disease. This is crucial because the single independent risk factor for women’s survival is leaving the operating room without any cancer being left behind. Many other areas have also improved, including maintenance therapy and also preoperative patient selection through very robust perioperative planning with the help of anaesthesiologists.
GPM: You have edited a special series on “Evolutions in the Management of Advanced Ovarian Cancer” for the journal Gynecology and Pelvic Medicine. What are the main factors that influence the decision between primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery for advanced ovarian patients?
Prof. Soleymani majd: It was my absolute honour to serve as a guest editor for GPM. We collaborated with nine esteemed colleagues who are all world experts in the field to be able to help us to produce nine state-of-the-art papers. These papers not only address the surgical aspects, but also address other aspects of patient care. If you ask any gynecological oncological surgeon about PDS versus NACT, we are duty-bound to resort to Level A evidence. Level A evidence comes from four prospective randomized controlled trials, comparing the PDS versus NACT. The first one, published in 2010 by Professor Ignace Vergote, is very good. The trial is called EURTC 55971 (1). Then, it was Professor Sean Kehoe who published a study called CHORUS study in the Lancet in 2015 (2). And in 2020, there have been two notable papers: one is a Japanese study (3), and the other is the SCORPION study led by Professor Anna Fagotti and Professor Giovanni Scambia (4). These Level A evidence studies suggest and encourage people to resort to neoadjuvant chemotherapy pathway in stage IIIc-IV cancer, especially in a stage IV cancer, to minimize the morbidity and mortality associated with these operations. Remember, PDS could be very invasive and carries significant morbidities. However, there are cases that you should exercise PDS. For example, if you have patients who are not chemo-sensitive, PDS should be considered. We do know some types or some subtypes of epithelial ovarian cancer, such as clear cell or mucinous ovarian cancer, or low-grade serous carcinoma are not chemo-sensitive, so you need to do your best and endeavor to perform PDS. Similarly, if you have patients with a high grade serous carcinoma who are amenable to PDS, and R0 resection is achievable, this approach may be appropriate. However, just be mindful of the patient's age and the quality of life of the patient after the operation, when you choose this method.
GPM: In the special series, you emphasized the multidisciplinary efforts involved in the management of advanced ovarian cancer. In your practice, how to encourage or achieve successful multidisciplinary cooperation between different departments, like surgeons, oncologists, pathologists, radiologists, and so on?
Prof. Soleymani majd: One of the main pillars of undertaking radical pelvic and abdominal surgery is to be able to work very closely and collaboratively with other specialities to achieve the best outcomes for our patients. The world of surgery is evolving rapidly, and even if you are among the best gynecological oncological surgeons in the world, you will not be able to stay on top of every development. The nitty-gritty of the surgical specialties would be accessed through multi collaborative work. So what we have done in Oxford? We have developed a multidisciplinary surgical specialities that depends on what the patients requirements are, and we have different surgeons responsible for different parts of the operation. Obviously, the leadership of the operation and the person leading these extensive operations will be a gynecological oncological surgeon. Through collaborative work, you will do your best for your patients, because ultimately, what you would like to see is the best outcomes for your patients. And the best outcomes would be achieved through a solid and robust multidisciplinary approach.
GPM: The advancement of digital healthcare and artificial intelligence could shape the future of technological innovations within the surgical process. Would these technologies alter the way surgical planning, preoperative assessment, and postoperative recovery are approached?
Prof. Soleymani majd: I think AI has already introduced itself very clearly and widely in radical pelvic and abdominal surgery, not only in ovarian cancer surgery, but also in other peritoneal surface malignancies, such as primary appendicular carcinoma or colorectal malignancies. It's very important to be able to introduce AI, because you can learn a lot from each patient, and develop a unified and universal model. For example, when you do a preoperative radiological assessment by means of PET, MRI, or CT, you can perform preoperative and anaesthetic assessments through those studies mentioned today, like CPEX (Cardiopulmonary Exercise Testing) studies; and then you incorporate these with intraoperative findings, basically trying to corroborate your intraoperative findings with the preoperative radiological findings. In the pre-rehabilitative phase, you can incorporate this information to the postoperative morbidity and mortality, as well as the toxicity of the operations up to 90 days. Through AI, you will be able to come up with a formula that will help improve patient selection in the near future.
GPM: Given your active involvement in clinical practice, academic research, as well as teaching and training the next generation of medical professionals, what aspects do you find most fulfilling? Can you share a particularly rewarding experience?
Prof. Soleymani majd: As a gynecological surgeon, it's very inspiring to see that I could inspire more junior doctors to come through the door and undertake gynecological oncological operations. That means more people will be out there in the next 20 years taking care of women with cancer. This is particularly significant because gynecology oncology is a very difficult speciality and many people tend to avoid this specialty due to the long hours and the need for full dedication to patients 24h/7days. One of the most inspiring moments was when Professor Sally Collins, one of my very good colleague at Oxford, managed to incorporate the gynecological oncological surgical skills into the management of placenta accreta spectrum, which is a benign, but fairly lethal condition for women who face this problem globally. That's very interesting because we chose to focus on gynecologic oncology, so we could stop doing obstetrics. However, I am very glad to see that we have inspired a lot of obstetricians and general surgeons around the world to undertake the same operation with the same surgical principles for problems that are benign, but equally complex, and for lethal conditions such as severe placenta accreta spectrum.
Reference
- Vergote I., Tropé C.G., Amant F., Kristensen G.B., Ehlen T., Johnson N., Verheijen R.H.M., van der Burg M.E.L., Lacave A.J., Panici P.B., et al. Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer. N. Engl. J. Med. 2010;363:943–953. doi: 10.1056/NEJMoa0908806.
- Kehoe S., Hook J., Nankivell M., Jayson G.C., Kitchener H., Lopes T., Luesley D., Perren T., Bannoo S., Mascarenhas M., et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): An open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386:249–257. doi: 10.1016/S0140-6736(14)62223-6.
- Onda T., Satoh T., Ogawa G., Saito T., Kasamatsu T., Nakanishi T., Mizutani T., Takehara K., Okamoto A., Ushijima K., et al. Comparison of survival between primary debulking surgery and neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers in phase III randomised trial. Eur. J. Cancer. 2020;130:114–125. doi: 10.1016/j.ejca.2020.02.020.
- Fagotti A., Ferrandina M.G., Vizzielli G., Pasciuto T., Fanfani F., Gallotta V., Margariti P.A., Chiantera V., Costantini B., Gueli Alletti S., et al. Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850) Int. J. Gynecol. Cancer. 2020;30:1657–1664. doi: 10.1136/ijgc-2020-001640.