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Channawi A, Pop FC, Khaled C, Gomez MG, Moreau M, Polastro L, Veys I, Liberale G. Prognostic Impact of Mesenteric Lymph Node Status on Digestive Resection Specimens During Cytoreductive Surgery for Ovarian Peritoneal Metastases. Ann Surg Oncol 2024; 31:605-613. [PMID: 37865938 PMCID: PMC10695887 DOI: 10.1245/s10434-023-14405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The most common mode of ovarian cancer (OC) spread is intraperitoneal dissemination, with the peritoneum as the primary site of metastasis. Cytoreductive surgery (CRS) with chemotherapy is the primary treatment. When necessary, a digestive resection can be performed, but the role of mesenteric lymph nodes (MLNs) in advanced OC remains unclear, and its significance in treatment and follow-up evaluation remains to be determined. This study aimed to evaluate the prevalence of MLN involvement in patients who underwent digestive resection for OC peritoneal metastases (PM) and to investigate its potential prognostic value. METHODS This retrospective, descriptive study included patients who underwent CRS with curative intent for OC with PM between 1 January 2007 and 31 December 2020. The study assessed MLN status and other clinicopathologic features to determine their prognostic value in relation to overall survival (OS) and progression-free survival (PFS). RESULTS The study enrolled 159 women with advanced OC, 77 (48.4%) of whom had a digestive resection. For 61.1% of the patients who underwent digestive resection, MLNs were examined and found to be positive in 56.8%. No statistically significant associations were found between MLN status and OS (p = 0.497) or PFS ((p = 0.659). CONCLUSIONS In anatomopathologic studies, MLNs are not systematically investigated but are frequently involved. In the current study, no statistically significant associations were found between MLN status and OS or PFS. Further prospective studies with a systematic and standardized approach should be performed to confirm these findings.
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Affiliation(s)
- Ali Channawi
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Florin-Catalin Pop
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Charif Khaled
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Galdon Gomez
- Department of Pathology, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Moreau
- Statistics Department, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Polastro
- Département of Medical Oncology, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Veys
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium.
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Karadayi K, Karabacak U. Is complete mesocolic excision or total mesorectal excision necessary during cytoreductive surgery in ovarian peritoneal carcinomatosis with colonic involvement? Acta Chir Belg 2023; 123:124-131. [PMID: 34253150 DOI: 10.1080/00015458.2021.1955193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cytoreductive surgery (CRS) and intraperitoneal chemotherapy are effective in the treatment of ovarian peritoneal carcinomatosis (OPC). Colon resection is often required to achieve maximal cytoreduction during CRS. The success of complete mesocolic excision (CME) and total mesorectal excision (TME) in the surgical treatment of primary colorectal tumors is well-known. Our study aimed to investigate the factors affecting mesocolic lymph node metastasis (MLNM) and the contribution of CME/TME techniques to maximal cytoreduction in patients diagnosed with ovarian peritoneal carcinomatosis (OPC) with colon metastasis. PATIENTS AND METHODS Between 2004-2020, 30 patients who underwent colorectal resection with CME/TME techniques due to OPC-related colon metastasis were retrospectively analyzed. RESULTS The median age of patients was 61 (33-86). Six (20%) patients underwent total colectomy, 7 (23%) subtotal colectomy, 6 (20%) right hemicolectomy, 4 (13%) left hemicolectomy, and 7 (23%) rectosigmoid resection. Histopathological diagnosis was high-grade serous carcinoma in 29 (97%) patients, and malignant mixed Mullerian tumor in 1 (3%) patient. MLNM was detected in 17 (56%) of 30 patients. There was a significant relationship between MLNM and pelvic and para-aortic lymph node metastasis (PALNM) (p = 0.009) and lymphovascular invasion in primary ovarian tumors (p = 0.017). There was no significant relationship between MLNM and depth of colonic invasion (p = 0.463), histological grade (p = 0.711), and primary/secondary surgery (p = 0.638). MLNM was seen in 8 (47%) of 17 patients with only serosal invasion. CONCLUSION A high rate of MLNM can be seen in OPC-induced colon metastasis regardless of the degree of colon wall invasion. In patients with PALNM, the frequency of MLNM increases. We believe that if colon resection is to be performed in OPC, a colectomy should be performed by CME/TME principles to achieve maximal cytoreduction.
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Affiliation(s)
- Kursat Karadayi
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Ufuk Karabacak
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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Valenti G, Sopracordevole F, Chiofalo B, Forte S, Ciancio F, Fiore M, Giorda G. Parenchymal liver metastasis in advanced ovarian cancer: Can bowel involvement influence the frequency and the related mortality rate? Eur J Obstet Gynecol Reprod Biol 2023; 280:48-53. [PMID: 36399920 DOI: 10.1016/j.ejogrb.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This retrospective study estimates the frequency of parenchymal liver metastasis (PLM) and the overall survival (OS) rate of patients with FIGO Stage IIIC-IV Advanced Epithelial Ovarian Cancer (EOC) with bowel involvement. STUDY DESIGN Between November 2008 and July 2020, all consecutive patients with FIGO Stage IIIC-IV EOC who underwent Visceral Peritoneal Debulking and bowel resection(s) at the Gynaecological Oncology Unit of "Centro di Riferimento Oncologico (CRO)", Aviano, Italy, without evidence of PLM at pre-operative imaging assessment, were included in the study. The presence and the time of the onset of PLM during the follow-up period were detected by diagnostic imaging (CT-scan, Ultrasound and PET). The OS of patients with and without PLM was compared. Considering the bowel's layers, the association between depth of bowel involvement, number of PLM, and the relative OS rate was evaluated. RESULTS The median follow-up period was 47.3 (12-138) months. PLM occurred in 24/72 (33.0%) cases; the average onset time of PLM was 13 months. PLM was associated with increased significant mortality risk and an average OS of 33.2 versus 56.8 months (p < 0.001). The risk of developing PLM correlated directly with the depth of bowel involvement. However, there was no statistical difference between the layers in terms of OS at the end of the observational period. CONCLUSIONS PLM occurred more frequently among patients with EOC and bowel involvement. The PLM arose within 15 months of follow-up and the frequency increased according to the depth of involvement. Particularly, the difference is remarkably higher starting from muscular layer where the total number of PLM arose significantly (p = 0.02). Although there was no significant difference among the infiltrated bowel layers in terms of OS, patients with bowel involvement up to muscular had a dramatic reduction in the OS rate during the first 30 months of follow-up.
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Affiliation(s)
- Gaetano Valenti
- Gynecological Oncology Unit of Oncological-National Cancer Institute, Aviano, Italy; Humanitas Medical Care, Catania, Italy.
| | | | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Forte
- Gynecological Oncology Unit of Oncological-National Cancer Institute, Aviano, Italy
| | | | - Maria Fiore
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit of Oncological-National Cancer Institute, Aviano, Italy
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Glombicki SE, Montelongo D, Dushianthan S, Perez CJ, Cervantes M, Glombicki AP. Metastatic Ovarian Mucinous Carcinoma Presenting as Ileocecal Adenocarcinoma: A Case Report. Cureus 2022; 14:e24589. [PMID: 35664390 PMCID: PMC9148533 DOI: 10.7759/cureus.24589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/05/2022] Open
Abstract
Colorectal invasion is an unusual late-stage presentation of metastatic primary mucinous ovarian cancer. In this article, we report a fatal case of a 65-year-old female who presented to our clinic with progressive weight loss, severe constipation, and postprandial early satiety. She underwent an esophagogastroduodenoscopy (EGD) and colonoscopy. Direct visualization during colonoscopy revealed acute inflammation with ulceration and highly atypical glands in the ileocecal valve. The initial biopsy was unremarkable, and a repeat biopsy was performed due to high suspicion of malignancy. The repeat biopsy revealed poorly differentiated, invasive colon adenocarcinoma with partial mucinous features. The patient was referred to the surgery service. While planning for surgical resection, they obtained a CT abdomen and pelvis, which revealed a large ovarian mass and peritoneal carcinomatosis. Immunohistochemistry for the tumor cells was positive for pancytokeratin and cytokeratin 7, partially positive (up to 20%) for cytokeratin 20 and CDX2, and negative for estrogen receptors, monoclonal carcinoembryonic antigen (CEA), and synaptophysin. This immunophenotypic pattern is strongly consistent with metastatic mucinous carcinoma of ovarian origin.
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Tanaka K, Shimada Y, Nishino K, Yoshihara K, Nakano M, Kameyama H, Enomoto T, Wakai T. Clinical Significance of Mesenteric Lymph Node Involvement in the Pattern of Liver Metastasis in Patients with Ovarian Cancer. Ann Surg Oncol 2021; 28:7606-7613. [PMID: 33821347 DOI: 10.1245/s10434-021-09899-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mesenteric lymph node (MLN) involvement is often observed in ovarian cancer (OC) with rectosigmoid invasion. This study aimed to investigate the clinical significance of MLN involvement in the pattern of liver metastasis in patients with OC. METHODS We included 85 stage II-IV OC patients who underwent primary or interval debulking surgery. Twenty-seven patients underwent rectosigmoid resection, whose status of MLN involvement was judged from hematoxylin and eosin (H&E) staining of resected specimens. The prognostic significance of clinicopathological characteristics, including MLN involvement, was evaluated using univariate and multivariate analyses. RESULTS MLN involvement was detected in 14/85 patients with stage II-IV OC. Residual tumor status, cytology of ascites, and MLN involvement were independent prognostic factors for progression-free survival (PFS; p = 0.033, p = 0.014, and p = 0.008, respectively). When patients were classified into three groups (no MLN, one MLN, two or more MLNs), the number of MLNs involved corresponded to three distinct groups in PFS (p = 0.001). The 3-year cumulative incidence of liver metastasis of patients with MLN involvement was significantly higher than that of patients without MLN involvement (61.1% vs. 8.9%, p < 0.001). MLN involvement was significantly associated with liver metastasis of hematogenous origin (p < 0.001) compared with peritoneal disseminated origin. CONCLUSION MLN involvement is an important prognostic factor in OC, predicting poor prognosis and liver metastasis of hematogenous origin.
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Affiliation(s)
- Kana Tanaka
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Koji Nishino
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masato Nakano
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Aqsa A, Droubi S, Amarnath S, Haddad F, Deeb L. Colorectal Metastasis from Ovarian Neoplasm Mimicking Primary Colon Cancer. Case Rep Gastroenterol 2021; 15:41-46. [PMID: 33613162 PMCID: PMC7879281 DOI: 10.1159/000510934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
Metastasis to the colon from another primary internal malignancy is an untypical and a seldom reported entity. Direct visualization during colonoscopy is considered the gold standard of diagnosis. Pathologic diagnosis with immunohistochemical staining is essential to differentiate primary colorectal malignancy from secondary metastasis to the colon. We, hereby, present a case of a 53-year-old female status-post resection of left-sided papillary serous ovarian neoplasm who presented 2 years later with a single rectosigmoid intraluminal ulcerative mass imitating a primary colon cancer. Biopsies of the mass were consistent with metastasis from her primary ovarian carcinoma. We believe this case is unique because of the rarity of ovarian cancer metastasizing to the colon intraluminally rather than through direct locoregional invasion. Furthermore, it highlights the importance of considering secondary metastasis in patients with previous history of another primary internal malignancy.
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Affiliation(s)
- Anum Aqsa
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Sami Droubi
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Shivantha Amarnath
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Fady Haddad
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
| | - Liliane Deeb
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
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Alcazar JL, Jurado M, Minguez JA, Chacon E, Martinez-Regueira F. En-bloc rectosigmoid and mesorectum resection as part of pelvic cytoreductive surgery in advanced ovarian cancer. J Turk Ger Gynecol Assoc 2020; 21:156-162. [PMID: 31927810 PMCID: PMC7495125 DOI: 10.4274/jtgga.galenos.2019.2019.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: “En-bloc” resection of pelvic tumor in ovarian cancer (OC) is still controversial. The aim was to analyze results in an OC series from a single center, all of whom underwent “en-bloc” resection as part of cytoreductive surgery. Material and Methods: Clinical and surgical records from sixty patients with ovarian carcinoma who underwent “en-bloc” resection surgery were retrospectively analyzed. Results: Patients’ mean age was 56 years; 36 patients had primary disease and 24 had recurrent disease. Carcinomatosis was present in 46.7% of patients. Primary surgery was performed in 49 and interval debulking surgery in eleven. Complete cytoreduction was achieved in 55.0% and optimal in 38.3% of patients. Carcinomatosis significantly decreased the probability of complete cytoreduction [odds ratio (OR): 0.22; p=0.021]. Mesorectal infiltration occurred in 83% of patients. Risk of death was non-significantly higher (hazard ratio: 1.9) in women with mesorectal infiltration. Median overall survival was longer for patients without infiltration (46.1 vs 79.1 months; p=0.15). Eighty-five percent suffered from mild to moderate complications and colorectal anastomosis (CRA) leak occurred in two patients (3.6%) with CRA below 6 cm. Diaphragm resection had >5 times the risk for major complications (OR: 5.35; p=0.014). There was no three month mortality. Conclusion: When contiguous gross extension of disease to pelvic peritoneum and sigmoid colon is found, in patients with advanced OC, microscopic involvement of the mesorectum and intestinal wall is present in most cases making “en-bloc” resection necessary if complete cytoreduction is to be achieved. The associated morbidity is acceptable.
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Affiliation(s)
- Juan Luis Alcazar
- Clinic of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Matias Jurado
- Clinic of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Jose Angel Minguez
- Clinic of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Enrique Chacon
- Clinic of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
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Goto S, Iwasaki R, Sakai H, Mori T. A retrospective analysis on the outcome of 18 dogs with malignant ovarian tumours. Vet Comp Oncol 2020; 19:442-450. [PMID: 32700381 DOI: 10.1111/vco.12639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Abstract
Little evidence is available regarding the prognosis of dogs with malignant ovarian tumours. The objective of this retrospective study was to describe the outcomes and determine the prognostic factors for dogs with malignant ovarian tumours following treatment, including surgery with or without adjuvant therapy. Eighteen dogs were studied, their median age was 12 years (range: 7-15 years), and their median body weight was 6.9 kg (range: 2.3-17.8 kg). Following histopathologic diagnoses revealed that granulosa cell tumour was the most common type (n = 9), followed by dysgerminoma (n = 5), and adenocarcinoma (n = 4). Eleven dogs had surgery alone. Seven dogs had surgery with adjuvant therapy, including chemotherapy and/or radiotherapy. The median survival time (ST) was 1009 days when only deaths owing to the ovarian tumours were considered, and predictors of median ST were T-category (≥ T3, 443 days vs ≤ T2, 1474 days; P = .002), presence of metastatic disease (present, 391 days vs absent, 1474 days; P < .001) and lymphovascular space invasion (present, 428 days vs absent, 1474 days; P = .003) in a univariate analysis. Median ST in dogs with granulosa cell tumour seemed longer than in dogs with dysgerminoma and adenocarcinoma, although the difference was statistically insignificant (1474 days vs 458 days, respectively; P = .10). Considering the good prognosis, aggressive treatment can be recommended for dogs with malignant ovarian tumours, especially early-stage cases. Despite metastasis being present at diagnosis, half of the dogs with metastasis survived for more than 1 year.
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Affiliation(s)
- Sho Goto
- Animal Medical Centre, Gifu University, Gifu, Japan
| | | | - Hiroki Sakai
- Laboratory of Veterinary Pathology, Joint Department of Veterinary Medicine, Gifu University, Gifu, Japan
| | - Takashi Mori
- Laboratory of Veterinary Clinical Oncology, Joint Department of Veterinary Medicine, Gifu University, Gifu, Japan
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Factors predicting recurrence in patients with stage IA endometrioid endometrial cancer: what is the importance of LVSI? Arch Gynecol Obstet 2019; 301:737-744. [PMID: 31883046 DOI: 10.1007/s00404-019-05418-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to define the clinical and pathological prognostic factors for recurrence and to evaluate the recurrence patterns and adjuvant therapies used in this group of patients with stage IA endometrioid type endometrial cancer (FIGO 2009-International Federation of Gynecology and Obstetrics). METHODS Among the patients with epithelial endometrial cancer operated between January 1993 and May 2013 in a single institution, 720 patients with stage IA endometrioid endometrial cancer were included. Patients with a tumor type of serous, clear cell, mucinous, undifferentiated, and mixed type and with a tumor containing sarcomatous component and the patients with a secondary primer cancer were excluded from the study. RESULTS Lympho-vascular space invasion (LVSI) was present in 60 (8.3%) patients. Pelvic and para-aortic lymphadenectomy was performed in 266 (36.9%) patients. Median follow-up time was 48 months (range 3-240). Recurrence occurred in 23 (3.4%) patients and 6 (0.9%) died of disease. The median time-to recurrence (TTR) was 24 months (range 4-52 months) in the patients with recurrence. LVSI was associated with recurrence in the univariate analysis. Five-year disease-free survival (DFS) decreased from 96.8 to 80.1% in the presence of LVSI (p < 0.001). This association could not be shown in patients who had had lymphadenectomy (p = 0.136). Extra-pelvic recurrence occurred in 6.7% and 1% of the patients with and without LVSI, respectively, (p = 0.001). Any independent prognostic factor could not be detected in the multivariate analysis. CONCLUSIONS Only LVSI and tumor grade were associated with DFS and disease-specific survival (DSS), respectively, in the 686 patients with stage IA endometrial cancer in the univariate analysis, since these associations could not be shown in multivariate analysis.
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Tozzi R, Traill Z, Campanile RG, Kilic Y, Baysal A, Giannice R, Morotti M, Soleymani Majd H, Valenti G. Diagnostic flow-chart to identify bowel involvement in patients with stage IIIC-IV ovarian cancer: Can laparoscopy improve the accuracy of CT scan? Gynecol Oncol 2019; 155:207-212. [PMID: 31481247 DOI: 10.1016/j.ygyno.2019.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study investigates the diagnostic power of CT scan combined with exploratory laparoscopy (EXL) at identifying large bowel involvement in patients with stage IIIC-IV primary Epithelial Ovarian Cancer (EOC) by comparing with the macroscopic surgical findings at laparotomy. METHODS All patients with FIGO Stage IIIC-IV EOC who had Visceral Peritoneal Debulking (VPD) were included in the study. Results of CT scan, EXL and laparotomy (LPT) with regards to the bowel involvement were prospectively recorded in an ad hoc study form. Setting LPT findings as the gold standard, positive and negative predictive value (PPV/NPV), sensitivity, specificity and accuracy of CT and EXL were calculated. In addition, the diagnostic power of the combination CT scan + EXL was investigated. RESULTS Ninety-four out of 177 patients (53.2%) had a bowel resection during VPD. CT-scan alone had sensitivity, specificity, PPV, NPV and accuracy of 56.7%, 72.4%, 70.8%, 58.5% and 63.8% respectively. EXL alone 84.4%, 93.8%, 93.8%, 84.3%, 88.8%. CT combined with EXL detected bowel involvement with a sensitivity, specificity, PPV, NPV and accuracy of 87.5%, 70.4%, 77.8%, 82.6% and 79.6% and respectively. The combined tests showed a statistically significant improvement vs. CT scan alone (p < 0001) in sensitivity, NPV and accuracy, with non-significant difference in specificity and PPV. CONCLUSIONS CT-scan alone shows a limited diagnostic power at detecting large bowel involvement in patients with stage IIIC-IV EOC. The combination of CT scan with EXL increases the diagnostic power and enables to appropriately plan the bowel resection and consent the patients.
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Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Zoe Traill
- Department of Radiology, Oxford University Hospital, Oxford, UK
| | | | - Yakup Kilic
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Ahmet Baysal
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Raffaella Giannice
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Matteo Morotti
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | | | - Gaetano Valenti
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
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Raś R, Barnaś E, Magierło JS, Drozdzowska A, Bartosiewicz E, Sobolewski M, Skręt A, Gutkowski K. Preoperative colonoscopy in patients with a supposed primary ovarian cancer. Medicine (Baltimore) 2019; 98:e14929. [PMID: 30896654 PMCID: PMC6709016 DOI: 10.1097/md.0000000000014929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The final diagnosis of ovarian cancer is based on surgery and pathological verification. Therefore patients who are presented to surgery may be described only as supposed ovarian cancer. According to the literature the diagnosis of ovarian cancer is confirmed only in 2/3 of them. The rest are that which mimic ovarian cancer. One of them is colorectal cancer. Colonoscopy is a gold standard in its diagnostics. On the other hand, ovarian cancer may disturb the bowel patency and makes the bowel resection or stoma necessary.The main aim was to find out the distribution of bowel patency disturbances in ovarian cancer patients during preoperative colonoscopy and to assess their predictive value with respect to the bowel resection or stoma and the additional aim to identify the pathologies which mimic the ovarian cancer.In a prospective study among 104 patients with supposed ovarian cancer, primary ovarian cancer was diagnosed in 68 patients. The rest of them suffered from colorectal cancer found at colonoscopy (N = 6), ovarian benign pathology (N = 8), ovarian borderline tumor (N = 5), and other nonandexal malignant diseases (N = 17). In ovarian cancer group dominated serous carcinoma and fedération international de gynécologie et d'obstétrique stage 3 (N = 33).During preoperative colonoscopy in ovarian cancer patients, the complete obstruction was found in 27.9%, and relative risk of bowel resection or stoma was in them 4.29 and 4.38, respectively. Another colonoscopic finding was limited patency caused by extrinsic compression (29%) which is connected with relative risk of bowel resection or stoma 3.16 and 3.21 accordingly. The last colonoscopy finding was described as moderate limited patency of unknown origin (20.6%) and the relative risk of bowel resection or stoma was 5.14 and 4.17, respectively.Colonoscopy enables the diagnoses of colorectal cancer one of the diseases which mimic ovarian cancer in patients supposed to have this diseases.Bowel patency disturbances found at colonoscopy are a potential risk factor to intestine resection or ostomy.Colonoscopy is not fully noninvasive procedure and its obligatory use in patients supposed to have ovarian cancer should be limited to the cases with specific symptoms, and tumor marker pattern. Preoperative computed tomography, dedicated to bowel examination, candidates as an alternative to colonoscopy, but not completely.
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Affiliation(s)
- Renata Raś
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
- Department of Physics, Rzeszow University of Technology
| | | | - Joanna Skręt- Magierło
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
- Medical Faculty, University of Rzeszow
| | - Anna Drozdzowska
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
| | - Ewelina Bartosiewicz
- Department of Gastroenterology and Hepatology with the Internal Diseases Unit, Clinical Hospital No.1
| | - Marek Sobolewski
- Department of Quantitative Methods, Rzeszow University of Technology, Rzeszow, Poland
| | - Andrzej Skręt
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
| | - Krzysztof Gutkowski
- Medical Faculty, University of Rzeszow
- Department of Gastroenterology and Hepatology with the Internal Diseases Unit, Clinical Hospital No.1
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Angeles MA, Ferron G, Cabarrou B, Balague G, Martínez-Gómez C, Gladieff L, Pomel C, Martinez A. Prognostic impact of celiac lymph node involvement in patients after frontline treatment for advanced ovarian cancer. Eur J Surg Oncol 2019; 45:1410-1416. [PMID: 30857876 DOI: 10.1016/j.ejso.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Completeness of cytoreduction is the most important prognostic factor in patients with advanced ovarian cancer (OC). Extensive upper abdominal surgery has allowed to increase the rate complete cytoreduction and the feasibility of resection of celiac lymph nodes (CLN) and porta hepatis disease in these patients has been demonstrated. The aim of our study was to assess the prognostic impact of CLN involvement in patients with primary advanced OC undergoing a complete cytoreductive surgery (CRS). MATERIAL AND METHODS We designed a retrospective unicentric study. We reviewed data from patients who underwent CLN resection with or without porta hepatis disease resection, within upfront or interval complete CRS in the frontline treatment of advanced epithelial OC between January 2008 and December 2015. Patients were classified in two groups according to CLN status. Univariate and multivariate analyses were conducted. Survival rates were estimated using Kaplan-Meier method. RESULTS Forty-three patients were included and positive CLN were found in 39.5% of them. The median disease-free survival in the group of patients with positive and negative CLN were 11.3 months and 25.8 months, respectively. In multivariable analysis, both CLN involvement and high peritoneal cancer index were independently associated with decreased disease-free survival. Computed tomography re-reading by an expert radiologist has good sensitivity for detection of positive CLN. CONCLUSION CLN involvement and high preoperative tumor burden are independently associated with decreased survival after complete cytoreduction for OC. CLN involvement is a marker of diffuse disease and an independent risk factor for early recurrent disease.
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Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 19, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Gisèle Balague
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 1, Toulouse, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Christophe Pomel
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 1, Toulouse, France.
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Galanopoulos M, Gkeros F, Liatsos C, Pontas C, Papaefthymiou A, Viazis N, Mantzaris GJ, Tsoukalas N. Secondary metastatic lesions to colon and rectum. Ann Gastroenterol 2018; 31:282-287. [PMID: 29720853 PMCID: PMC5924850 DOI: 10.20524/aog.2018.0244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
Metastatic lesions of the colon are a rare clinical entity that may present difficulties in management. The incidence of these metastases appears to be increasing, as a result of physicians' greater awareness during follow-up investigations of a primary neoplasm. Furthermore, the presence of a greater proportion of these abnormalities at autopsy should be a triggering factor for further investigation for doctors dealing with colorectal oncology. Their clinical presentation may vary from asymptomatic to signs similar to those of colorectal cancer. However, immunohistological analysis is considered the cornerstone for differentiating metastases to the colon, originating from other primaries, from primary colorectal neoplasms. Survival reports and treatment options vary. This article concisely presents the main characteristics of the secondary lesions to the colon from neoplasms that metastasize to the large intestine (namely, lung, ovary, breast, prostate, kidney, and melanoma) focusing on their incidence, their clinical presentation and the workup investigation. Physicians aware of this uncommon entity are much better prepared to apply an efficient diagnosis and workup, as well as an appropriate treatment strategy.
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Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Filippos Gkeros
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Christos Liatsos
- Department of Gastroenterology, 401 General Military Hospital of Athens (Christos Liatsos), Athens, Greece
| | - Christos Pontas
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Apostolis Papaefthymiou
- Department of Internal Medicine, 401 General Military Hospital of Athens (Apostolis Papaefthymiou), Athens, Greece
| | - Nikos Viazis
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Gerassimos J Mantzaris
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Nikolaos Tsoukalas
- Department of Medical Oncology, Veterans Hospital (417 NIMTS) (Nikolaos Tsoukalas), Athens, Greece
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Vizza E, Corrado G, De Angeli M, Carosi M, Mancini E, Baiocco E, Chiofalo B, Patrizi L, Zampa A, Piaggio G, Cicchillitti L. Serum DNA integrity index as a potential molecular biomarker in endometrial cancer. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2018; 37:16. [PMID: 29382392 PMCID: PMC5791183 DOI: 10.1186/s13046-018-0688-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/23/2018] [Indexed: 12/18/2022]
Abstract
Background Circulating cell-free DNA (cfDNA) and its integrity index may represent a rapid and noninvasive “liquid biopsy” biomarker, which gives important complementary information for diagnosis, prognosis, and treatment stratification in cancer patients. The aim of our study was to evaluate the possible role of cfDNA and its integrity index as a complementary tool for endometrial cancer (EC) management. Methods Alu-quantitative real-time PCR (qPCR) analysis wasprformed on 60 serum samples from preoperative EC patients randomly recruited. Both cfDNA content and DNA integrity index were measured by qPCR-Alu115 (representing total cfDNA) and qPCR-Alu247 (corresponding to high molecular weight DNA) and correlated with clinicopathologic characteristics. Lymphovascular space invasion (LVSI) was detected by hematoxylin and eosin staining. In case of doubt, LVSI status was further evaluate by immunohistochemistry using anti-CD31 and anti-CD34 antibodies. Results Total cfDNA content significantly increases in high grade EC. A significant decrease of DNA integrity index was detected in the subset of hypertensive and obese high grade EC. Serum DNA integrity was higher in samples with LVSI. The ordinal regression analysis predicted a significant correlation between decreased integrity index values and hypertension specifically in tumors presenting LVSI. Conclusions Our study supports the utility of serum DNA integrity index as a noninvasive molecular biomarker in EC. We show that a correlation analysis between cfDNA quantitative and qualitative content and clinicopathologic features, such as blood pressure level, body mass index (BMI) and LVSI status, could represent a potential predictive signature to help stratification approaches in EC. Electronic supplementary material The online version of this article (doi:10.1186/s13046-018-0688-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Enrico Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Corrado
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
| | - Martina De Angeli
- Department of Biomedicine and Prevention, Obstetrics and Gynecology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Mariantonia Carosi
- Department of Research, Advanced Diagnostics and Technological Innovation, Anatomy Pathology Unit Regina Elena National Cancer Institute, Rome, Italy
| | - Emanuela Mancini
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ermelinda Baiocco
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Benito Chiofalo
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lodovico Patrizi
- Department of Biomedicine and Prevention, Obstetrics and Gynecology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Ashanti Zampa
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Piaggio
- Department of Research, Advanced Diagnostics and Technological Innovation, Area of Translational Research, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Lucia Cicchillitti
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Berretta R, Capozzi VA, Sozzi G, Volpi L, Ceni V, Melpignano M, Giordano G, Marchesi F, Monica M, Di Serio M, Riccò M, Ceccaroni M. Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer. Arch Gynecol Obstet 2018; 297:997-1004. [PMID: 29380107 DOI: 10.1007/s00404-018-4675-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/15/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this retrospective study is to analyze the prognostic role and the practical implication of mesenteric lymph nodes (MLN) involvements in advanced ovarian cancer (AOC). METHODS A total of 429 patients with AOC underwent surgery between December 2007 and May 2017. We included in the study 83 patients who had primary (PDS) or interval debulking surgery (IDS) for AOC with bowel resection. Numbers, characteristics and surgical implication of MLN involvement were considered. RESULTS Eighty-three patients were submitted to bowel resection during cytoreduction for AOC. Sixty-seven patients (80.7%) underwent primary debulking surgery (PDS). Sixteen patients (19.3%) experienced interval debulking surgery (IDS). 43 cases (51.8%) showed MLN involvement. A statistic correlation between positive MLN and pelvic lymph nodes (PLN) (p = 0.084), aortic lymph nodes (ALN) (p = 0.008) and bowel infiltration deeper than serosa (p = 0.043) was found. A longer overall survival (OS) and disease-free survival was observed in case of negative MLN in the first 20 months of follow-up. No statistical differences between positive and negative MLN in terms of operative complication, morbidity, Ca-125, type of surgery (radical vs supra-radical), length and site of bowel resection, residual disease and site of recurrence were observed. CONCLUSIONS An important correlation between positive MLN, ALN and PLN was detected; these results suggest a lymphatic spread of epithelial AOC similar to that of primary bowel cancer. The absence of residual disease after surgery is an independent prognostic factor; to achieve this result should be recommended a radical bowel resection during debulking surgery for AOC with bowel involvement.
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Affiliation(s)
- Roberto Berretta
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Vito Andrea Capozzi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy.
| | - Giulio Sozzi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Lavinia Volpi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Valentina Ceni
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Mauro Melpignano
- The Department of Obstetrics and Gynecology of Oglio Po, Cremona, Italy
| | - Giovanna Giordano
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Federico Marchesi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Michela Monica
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Maurizio Di Serio
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Matteo Riccò
- Local Health Unit of Reggio Emilia, Department of Public Health, Reggio Emilia, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Sacred Heart Hospital of Negrar, Verona, Italy
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Zhou X, Wang H, Wang X. Preoperative CA125 and fibrinogen in patients with endometrial cancer: a risk model for predicting lymphovascular space invasion. J Gynecol Oncol 2016; 28:e11. [PMID: 27894164 PMCID: PMC5323282 DOI: 10.3802/jgo.2017.28.e11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to build a model to predict the risk of lymphovascular space invasion (LVSI) in women with endometrial cancer (EC). METHODS From December 2010 to June 2013, 211 patients with EC undergoing surgery at Shanghai First Maternity and Infant Hospital were enrolled in this retrospective study. Those patients were divided into a positive LVSI group and a negative LVSI group. The clinical and pathological characteristics were compared between the two groups; logistic regression was used to explore risk factors associated with LVSI occurrence. The threshold values of significant factors were calculated to build a risk model and predict LVSI. RESULTS There were 190 patients who were negative for LVSI and 21 patients were positive for LVSI out of 211 patients with EC. It was found that tumor grade, depth of myometrial invasion, number of pelvic lymph nodes, and International Federation of Gynecology and Obstetrics (FIGO) stage (p<0.05) were associated with LVSI occurrence. However, cervical involvement and age (p>0.05) were not associated with LVSI. Receiver operating characteristic (ROC) curves revealed that the threshold values of the following factors were correlated with positive LVSI: 28.1 U/mL of CA19-9, 21.2 U/mL of CA125, 2.58 mg/dL of fibrinogen (Fn), 1.84 U/mL of carcinoembryonic antigen (CEA) and (6.35×10⁹)/L of white blood cell (WBC). Logistic regression analysis indicated that CA125 ≥21.2 (p=0.032) and Fn ≥2.58 mg/dL (p=0.014) were significantly associated with LVSI. CONCLUSION Positive LVSI could be predicted by CA125 ≥21.2 U/mL and Fn ≥2.58 mg/dL in women with EC. It could help gynecologists better adapt surgical staging and adjuvant therapies.
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Affiliation(s)
- Xingchen Zhou
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China
| | - Husheng Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China
| | - Xipeng Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China.
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Kim JR, Kim BM, Kim YM, Lee WA, Namgung H. Colonic Metastasis Presenting as an Intraluminal Fungating Mass 8 Years After Surgery for Ovarian Cancer. Ann Coloproctol 2015; 31:198-201. [PMID: 26576399 PMCID: PMC4644708 DOI: 10.3393/ac.2015.31.5.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/16/2015] [Indexed: 12/04/2022] Open
Abstract
We report a case of colonic metastasis from ovarian cancer presented as an intraluminal fungating mass mimicking primary colon cancer 8 years after surgery for ovarian cancer. A 70-year-old woman presented with constipation. She had undergone an extended total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian papillary serous cystadenocarcinoma 8 years earlier. Colonoscopy showed a large fungating mass 10 cm from the anal verge that was suspected to be colorectal cancer. A computed tomography scan showed a bulky intraluminal fungating mass in the rectosigmoid junction. After a lower anterior resection and a pathologic diagnosis, a diagnosis of a papillary serous adenocarcinoma due to metastasis from an ovarian tumor was made for this patient.
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Affiliation(s)
- Jeong Rye Kim
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
| | - Bong Man Kim
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
| | - You Me Kim
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
| | - Won Ae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Hwan Namgung
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
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Chen M, Jin Y, Bi Y, Li Y, Shan Y, Pan L. Prognostic significance of lymphovascular space invasion in epithelial ovarian cancer. J Cancer 2015; 6:412-9. [PMID: 25874004 PMCID: PMC4392049 DOI: 10.7150/jca.11242] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/19/2015] [Indexed: 11/06/2022] Open
Abstract
Object: To assess the effects of lymphovascular space invasion (LVSI) on cancer recurrence and survival in patients with primary epithelial ovarian cancer. Methods: A retrospective study was conducted of patients with stage I-IV primary epithelial ovarian cancer who underwent cytoreductive surgery. LVSI is defined as the presence of tumor cells within an endothelium-lined space, and the patients' pathologic slides were reevaluated by gynecological pathologists. Survival analysis was performed to compare risk factors. Results: A total of 492 patients were included in the analysis. The incidence of LVSI was 58.5% in our cohort (288 cases), and it was significantly associated with advanced stage, high-grade serous histology, high grade, and lymph node metastasis (P<0.001). Kaplan-Meier analysis demonstrated that LVSI was only correlated with decreased PFS (5-year rate, 39% vs. 66%, P<0.001) and OS (5-year rate, 44% vs. 78%, P<0.001) in patients at early stage but not at advanced stage (5-year rate, PFS: 14% vs. 11%, P<0.001; OS: 29% vs. 29%, P=0.141). Multivariate analysis showed that LVSI remained a significant variable with PFS and OS in early-stage ovarian cancer (PFS: HR 2.29, 95% CI 1.45-3.57; OS: HR 2.20, 95% CI 1.59-3.44, both P<0.001). Conclusion: LVSI is an independent predictor of progression and survival in patients with primary epithelial ovarian cancer at early stage but not at advanced stage.
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Affiliation(s)
- Ming Chen
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Jin
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yalan Bi
- 2. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Shan
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingya Pan
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hiller J, Ismail H, Riedel B. Improved quality of anesthesia and cancer recurrence studies. Anesth Analg 2014; 119:751-752. [PMID: 25137012 DOI: 10.1213/ane.0000000000000290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jonathan Hiller
- Department of Cancer Anaesthesia and Pain Medicine Peter MacCallum Cancer Center Melbourne, Australia
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BRCA1-IRIS inactivation sensitizes ovarian tumors to cisplatin. Oncogene 2014; 34:3036-52. [PMID: 25132263 DOI: 10.1038/onc.2014.237] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 12/27/2022]
Abstract
Ovarian cancer is the first in mortalities among gynecologic cancers in the United States, often due to late diagnosis and/or acquired platinum-resistant recurrences. This study investigates whether BRCA1-IRIS is a novel treatment target for ovarian cancers and in platinum-resistant recurrences. Here we show that more than half of the ovarian cancer samples analyzed showed BRCA1-IRIS and survivin overexpression and lacked nuclear FOXO3a expression. Normal ovarian epithelial cells overexpressing BRCA1-IRIS formed metastasis in mice when injected in the peritoneal cavity, whereas aggressive ovarian cancer cell lines failed to form tumors or metastases in mice when BRCA1-IRIS was silenced in them. We show that BRCA1-IRIS activates two autocrine signaling loops, brain-derived neurotrophic factor/tyrosine kinase B receptor (BDNF/TrkB) and neuregulin 1 (NRG1)/ErbB2. These loops are involved in anoikis resistance and metastasis promotion. These loops operate in several ovarian cancer cell lines, and BRCA1-IRIS silencing or inactivation using a novel inhibitory peptide renders both non-functional and promoted cell death. In a mouse xenograft model, BRCA1-IRIS inactivation using this novel inhibitory peptide resulted in significant reduction in ovarian tumor growth. More importantly, this treatment sensitized ovarian tumors to low cisplatin concentrations. Taken together, these data strongly suggest that BRCA1-IRIS and/or BDNF/TrkB and NRG1/ErbB2 could serve as rational therapeutic targets for advanced ovarian cancers.
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Gallotta V, Fanfani F, Fagotti A, Chiantera V, Legge F, Alletti SG, Nero C, Margariti AP, Papa V, Alfieri S, Ciccarone F, Scambia G, Ferrandina G. Mesenteric Lymph Node Involvement in Advanced Ovarian Cancer Patients Undergoing Rectosigmoid Resection: Prognostic Role and Clinical Considerations. Ann Surg Oncol 2014; 21:2369-75. [DOI: 10.1245/s10434-014-3558-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Indexed: 11/18/2022]
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Hahn HS, Lee IH, Kim TJ, Lee KH, Shim JU, Kim JW, Lim KT. Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer. Aust N Z J Obstet Gynaecol 2013; 53:293-7. [DOI: 10.1111/ajo.12089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 03/13/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ho-Suap Hahn
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
| | - In-Ho Lee
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
| | - Ki-Heon Lee
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
| | - Jae-Uk Shim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
| | - Jae-Wook Kim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
| | - Kyung-Taek Lim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center; Kwandong University College of Medicine; Seoul; Korea
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Depth of colorectal-wall invasion and lymph-node involvement as major outcome factors influencing surgical strategy in patients with advanced and recurrent ovarian cancer with diffuse peritoneal metastases. World J Surg Oncol 2013; 11:64. [PMID: 23497091 PMCID: PMC3600023 DOI: 10.1186/1477-7819-11-64] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 02/16/2013] [Indexed: 01/27/2023] Open
Abstract
Background More information is needed on the anatomopathological outcome variables indicating the appropriate surgical strategy for the colorectal resections often needed during cytoreduction for ovarian cancer. Methods From a phase-II study cohort including 70 patients with primary advanced or recurrent ovarian cancer with diffuse peritoneal metastases treated from November 2000 to April 2009, we selected for this study the 52 consecutive patients who needed colorectal resection. Data collected included type of colorectal resection, peritoneal cancer index (PCI), histopathology (depth of bowel-wall invasion and lymph-node spread), cytoreduction rate and outcome. Correlations were tested between possible prognostic factors and Kaplan-Meier five-year overall and disease-free survival. A Cox multivariate regression model was used to identify independent variables associated with outcome. Results In the 52 patients, the optimal cytoreduction rate was 86.5% (CC0/1). In all patients, implants infiltrated deeply into the bowel wall, in 75% of the cases up to the muscular and mucosal layer. Lymph-node metastases were detected in 50% of the cases; mesenteric nodes were involved in 42.3%. Most patients (52%) had an uneventful postoperative course. Operative mortality was 3.8%. The five-year survival rate was 49.9% and five-year disease-free survival was 36.7%. Cox regression analysis identified as the main prognostic factors completeness of cytoreduction and depth of bowel wall invasion. Conclusions Our findings suggest that the major independent prognostic factors in patients with advanced ovarian cancer needing colorectal resections are completeness of cytoreduction and depth of bowel wall invasion. Surgical management and pathological assessment should be aware of and deal with dual locoregional and mesenteric lymphatic spread.
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Matsuo K, Sheridan TB, Yoshino K, Miyake T, Hew KE, Im DD, Rosenshein NB, Mabuchi S, Enomoto T, Kimura T, Sood AK, Roman LD. Significance of lymphovascular space invasion in epithelial ovarian cancer. Cancer Med 2012; 1:156-64. [PMID: 23342265 PMCID: PMC3544453 DOI: 10.1002/cam4.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 12/18/2022] Open
Abstract
While the prognostic significance of lymphovascular space invasion (LVSI) is well established in endometrial and cervical cancer, its role in ovarian cancer is not fully understood. First, a training cohort was conducted to explore whether the presence and quantity of LVSI within the ovarian tumor correlated with nodal metastasis and survival (n = 127). Next, the results of the training cohort were applied to a different study population (validation cohort, n = 93). In both cohorts, histopathology slides of epithelial ovarian cancer cases that underwent primary cytoreductive surgery including pelvic and/or aortic lymphadenectomy were examined. In a post hoc analysis, the significance of LVSI was evaluated in apparent stage I cases (n = 53). In the training cohort, the majority of patients had advanced-stage disease (82.7%). LVSI was observed in 79.5% of cases, and nodal metastasis was the strongest variable associated with the presence of LVSI (odds ratio [OR]: 7.99, 95% confidence interval [CI]: 1.98–32.1, P = 0.003) in multivariate analysis. The presence of LVSI correlated with a worsened progression-free survival on multivariate analysis (hazard ratio [HR]: 2.06, 95% CI: 1.01–4.24, P = 0.048). The significance of the presence of LVSI was reproduced in the validation cohort (majority, early stage 61.3%). In apparent stage I cases, the presence of LVSI was associated with a high negative predictive value for nodal metastasis (100%, likelihood ratio, P = 0.034) and with worsened progression-free survival (HR: 5.16, 95% CI: 1.00–26.6, P = 0.028). The presence of LVSI is an independent predictive indicator of nodal metastasis and is associated with worse clinical outcome of patients with epithelial ovarian cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California Los Angeles, CA, USA.
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Akhtar K, Sherwani R, Anees A. Synchronous ovarian carcinoma with colorectal metastases: an unusual presentation. Clin Pract 2012; 2:e53. [PMID: 24765452 PMCID: PMC3981276 DOI: 10.4081/cp.2012.e53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/03/2012] [Accepted: 04/02/2012] [Indexed: 11/23/2022] Open
Abstract
This report describes the case of a 50-year-old female patient who presented with bilateral adnexal lump and dysfunctional uterine bleeding with altered bowel habits. Computed tomography of the abdomen and pelvis revealed a bilateral adnexal lump situated in both the ovaries and a lobular mass of 8 cm in the rectum. Proctoscopy revealed an elevated irregular rectal lesion. The microscopic examination of the ovarian lump revealed a bilateral serous adenocarcinoma with a papillary pattern with psammomatous calcification. A left hemicolectomy with lymphadenectomy was also performed. Immunohistochemical staining was positive for cytokeratin 7 and negative for cytokeratin 20. The use of immunohistochemistry demonstrated the tumor to be of ovarian origin. We report this case of synchronous involvement of the ovary and the colorectum because of its rarity and unusual presentation.
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Affiliation(s)
| | | | - Afzaal Anees
- Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh (U.P), India
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Gouy S, Goetgheluck J, Uzan C, Duclos J, Duvillard P, Morice P. Prognostic factors for and prognostic value of mesenteric lymph node involvement in advanced-stage ovarian cancer. Eur J Surg Oncol 2012; 38:170-5. [DOI: 10.1016/j.ejso.2011.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/10/2011] [Indexed: 01/09/2023] Open
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Douglas peritonectomy compared to recto-sigmoid resection in optimally cytoreduced advanced ovarian cancer patients: Analysis of morbidity and oncological outcome. Eur J Surg Oncol 2011; 37:1085-92. [DOI: 10.1016/j.ejso.2011.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/21/2011] [Accepted: 09/05/2011] [Indexed: 11/15/2022] Open
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Bijek J, Ehnart N, Mathevet P. Dissémination métastatique par voie hématogène d’un cancer épithélial de l’ovaire : à propos d’un cas. ACTA ACUST UNITED AC 2011; 40:465-8. [DOI: 10.1016/j.jgyn.2010.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 06/27/2010] [Accepted: 07/02/2010] [Indexed: 01/22/2023]
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El Mehdi T, Essadi I, M'rabti H, Errihani H. Rare recurrence of a rare ovarian stromal tumor with luteinized cells: a case report. J Med Case Rep 2011; 5:350. [PMID: 21816048 PMCID: PMC3163610 DOI: 10.1186/1752-1947-5-350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 08/04/2011] [Indexed: 11/23/2022] Open
Abstract
Introduction Sex cord-stromal tumors of the ovary are uncommon. They behave unpredictably and often have a late recurrence, making counseling, management, and prediction of prognosis challenging. Case presentation A 52-year-old Moroccan woman with an sex cord-stromal tumors underwent a bilateral oophorectomy. The histology was unusual but was likely to be a luteinized thecoma with suspicious features for invasion. Seven years later, after a gastrointestinal bleed, a metastasis within the small bowel mucosa was detected. This represents probable isolated hematogenous or lymphatic spread, which is highly unusual, especially in the absence of concurrent peritoneal disease. Conclusions To the best of our knowledge, this is the second reported case of an sex cord-stromal tumors recurring in small bowel mucosa and mimicking a primary colorectal tumor. This highlights the diverse nature and behavior of these tumors.
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Affiliation(s)
- Tazi El Mehdi
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
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Baiocchi G, Cestari LA, Macedo MP, Oliveira RAR, Fukazawa EM, Faloppa CC, Kumagai LY, Badiglian-Filho L, Menezes ANO, Cunha IW, Soares FA. Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection. J Surg Oncol 2011; 104:250-4. [DOI: 10.1002/jso.21940] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/17/2011] [Indexed: 11/06/2022]
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Low Colorectal Anastomosis After Pelvic Exenteration for Gynecologic Malignancies: Risk Factors Analysis for Leakage. Int J Gynecol Cancer 2011; 21:397-402. [DOI: 10.1097/igc.0b013e31820b2df7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective:To study risk factors for low colorectal anastomotic leak after pelvic exenteration for gynecologic malignancies.Methods:Data from 60 patients, 32 with ovarian cancer and 28 with nonovarian cancer who underwent pelvic exenteration with colorectal anastomosis (CRA) were retrospectively analyzed.Results:Overall rate of CRA leak was 20%. The CRA leak was associated with type of tumor (3% for the ovarian cancer and 40.8% for the nonovarian cancer,P= 0.004), CRA height (<5 cm vs ≥5 cm, 75% vs 6.3%;P= 0.001), and previous radiotherapy (RT; 53.3% vs 8.9%;P= 0.001). Multivariate analysis showed that only previous RT and CRA height were associated with the CRA leak. Rectosigmoid wall involvement (81.8% vs 27%;P= 0.001) and mesorectum infiltration (69.2% vs 21.7%;P= 0.001) were more frequent among patients with ovarian cancer patients.Conclusion:Previous RT and CRA at or less than 5 cm from the anal verge pose a high risk for CRA leak. In these cases, a definitive colostomy should be recommended.
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Qian X, Xi X, Jin Y. The Grading of Lymphovascular Space Invasion in Epithelial Ovarian Carcinoma. Int J Gynecol Cancer 2010; 20:895-9. [DOI: 10.1111/igc.0b013e3181e02fc7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction:To assess the prognostic value of lymphovascular space invasion (LVSI) in epithelial ovarian carcinoma.Methods:We reexamined single representative hematoxylin and eosin-stained sections of 66 patients with epithelial ovarian carcinoma to identify LVSI. A 4-grade system was used to classify LVSI: absent (no LVSI), mild (1-2 foci of LVSI), moderate (3-8 foci of LVSI), and severe (≥9 foci of LVSI). We investigated the possible associations between the grade of LVSI and clinicopathologic factors.Results:Lymphovascular space invasion was present in 36 patients (54.5%) and absent in 30 (45.5%). Statistical analysis indicated that LVSI was significantly associated with advanced clinical stage, poor histological grade, and lymph node metastasis. Follow-up studies indicated that the disease-free survival time for patients without LVSI was significantly longer than that for patients with moderate LVSI (P = 0.01) and severe LVSI (P = 0.001). The overall survival (OS) time for patients with moderate or severe LVSI was significantly shorter than that for patients with mild or no LVSI. The grade of LVSI was found to be significantly associated with OS (P = 0.004). The grade of LVSI showed poor correlation with disease-free survival and OS.Conclusions:The grade of LVSI is an important predictive factor for disease recurrence and poor survival of patients with epithelial ovarian carcinoma.
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Secondary cytoreductive surgery including rectosigmoid colectomy for recurrent ovarian cancer: Operative technique and clinical outcome. Gynecol Oncol 2009; 114:173-7. [DOI: 10.1016/j.ygyno.2009.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 05/01/2009] [Accepted: 05/05/2009] [Indexed: 11/23/2022]
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Silver DF, Bou Zgheib N. Extended left colon resections as part of complete cytoreduction for ovarian cancer: tips and considerations. Gynecol Oncol 2009; 114:427-30. [PMID: 19555997 DOI: 10.1016/j.ygyno.2009.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 05/26/2009] [Accepted: 05/29/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Colectomy is a common part of cytoreductive surgery. The most common segment of the colon resected is the rectosigmoid. Extended left-sided colectomies are rarely performed. With increased emphasis on the importance of maximal cytoreductive surgery it is becoming more important to understand the outcomes related to such a procedure. The purpose of this report is to evaluate the quality of life issues related to extended left colectomies. METHODS Data on all patients who underwent cytoreductive surgery between April 2007 and April 2009 was prospectively recorded. Nineteen patients underwent extended left colon resections. The data from these cases was evaluated with particular attention directed at the quality of life issues surrounding postoperative bowel function, and tolerance of postoperative chemotherapy. RESULTS Nine underwent resection of the left hemicolon plus the hepatic flexure. Six underwent resection of the left hemicolon, hepatic flexure, and the ascending colon. Four underwent subtotal colectomies. Temporary diverting loop ileostomies were performed on 18 of the 19 patients each of whom consented for intraperitoneal chemotherapy. No delays in chemotherapy were observed. Median number of bowel movements at 6, 9 and 12 months were 2, 2 and 1, respectively. No fecal incontinence was observed. Patients expressed satisfaction with their bowel surgery and denied any significant decrease in their quality of life due to their bowel function. CONCLUSION Extended left colon resection is a reasonable technique to include in patients requiring maximal cytoreduction. Quality of life related to bowel function is acceptable and chemotherapy is not delayed.
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Affiliation(s)
- David F Silver
- Department of Obstetrics and Gynecology, St. Luke's Hospital, Bethlehem, PA, USA.
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O’Brien DJ, Flannelly G, Mooney EE, Foley M. Lymphovascular space involvement in early stage well-differentiated endometrial cancer is associated with increased mortality. BJOG 2009; 116:991-4. [DOI: 10.1111/j.1471-0528.2009.02162.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Hoffman MS, Zervose E. Colon resection for ovarian cancer: Intraoperative decisions. Gynecol Oncol 2008; 111:S56-65. [DOI: 10.1016/j.ygyno.2008.07.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
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37
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Rekhi B, George S, Madur B, Chinoy RF, Dikshit R, Maheshwari A. Clinicopathological features and the value of differential Cytokeratin 7 and 20 expression in resolving diagnostic dilemmas of ovarian involvement by colorectal adenocarcinoma and vice-versa. Diagn Pathol 2008; 3:39. [PMID: 18801162 PMCID: PMC2556647 DOI: 10.1186/1746-1596-3-39] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 09/18/2008] [Indexed: 11/10/2022] Open
Abstract
The distinction between metastasis from a colorectal adenocarcinoma into the ovary and an ovarian adenocarcinoma is vital, but challenging at times, due to overlapping morphological features. Similarly, a distinction between an ovarian metastasis into the colorectum and a colorectal adenocarcinoma, although rare; is important and can be daunting. We report an analysis of 20 cases of ovarian involvement by metastatic colorectal adenocarcinomas and colorectal involvement by metastatic ovarian adenocarcinomas, including the value of differential expression of cytokeratins 7 & 20 by immunohistochemistry (IHC), in these cases. Nine cases (45%) were identified as colorectal adenocarcinomas metastatic to the ovary. On biopsy, all these cases showed a 'garland-like' tumor necrosis, with desmoplasia and predominantly exhibited a tubuloalveolar pattern (67% cases). On IHC, all 8 of 9 such cases, where staining for cytokeratin 20 was performed, displayed strong positivity and 7 cases, where staining for carcinoembryogenic antigen (CEA) was performed, revealed positivity for this marker (100%). Other 11 cases (55%) were ovarian adenocarcinomas, metastatic to the colorectum. These showed metachronous presentations, with the ovarian tumor preceding the colorectal tumor deposits. Morphologically, psammomatous calcification was noted in 73% of these cases, whereas 'garland-like' necrosis was absent in all. The chief morphological subtype was serous papillary cystadenocarcinoma (55% cases). On IHC, CK7 and CA 125 were positive in all 6 of 11 such cases, whereas CK 20 was negative in all these cases.In cases of complex presentations like an ovarian involvement by a metastatic colorectal adenocarcinoma and vice-versa, certain clinicopathological features are useful. Differential expression of CK 7 and CK20 is vital in resolving these dilemmas. CK20 positivity and CK7 negativity is associated with a colorectal adenocarcinoma. Markers like CEA and CA-125 have an added value.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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38
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Abstract
The acute abdomen accounts for up to 40% of all emergency-surgical hospital admissions and is considered in the differential in the more than 7 million visits to the emergency department annually for abdominal pain in the United States. A large percentage of these cases are secondary to perforation or impending gastrointestinal perforation. Gastrointestinal perforation causes considerable mortality and usually requires emergency surgery.Rapid diagnosis and treatment of these conditions is essential to reduce the high morbidity and mortality of late-stage presentation. Successful treatment requires a thorough understanding of the anatomy, microbiology, and pathophysiology of this disease process and in-depth knowledge of the therapy, including resuscitation,antibiotics, source control, and physiologic support.
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Affiliation(s)
- John T Langell
- Department of Surgery, University of Utah, 30 North 1900 East, SOM 3B115, Salt Lake City, UT 84132, USA.
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Transverse colectomy in ovarian cancer surgical cytoreduction: operative technique and clinical outcome. Gynecol Oncol 2008; 109:364-9. [PMID: 18396322 DOI: 10.1016/j.ygyno.2008.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 02/09/2008] [Accepted: 02/14/2008] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe the operative techniques and associated clinical outcomes of patients undergoing transverse colectomy as a component of cytoreductive surgery for advanced or recurrent ovarian cancer. METHODS Thirty-nine patients underwent transverse colectomy as part of primary (n=33) or secondary (n=6) cytoreductive surgery for ovarian cancer between 1/97 and 4/07. The surgical techniques, associated morbidity, and clinical outcomes are described. RESULTS Among primary surgery patients, 75.6% had Stage IIIC disease, and 24.2% had Stage IV disease. Transverse colon surgery consisted of: partial colectomy in 33 cases and total transverse colectomy in 6 cases. Transverse colectomy with rectosigmoid colectomy was performed in 61.5% of patients, with two separate colonic anastomoses in 48.7%. The majority (89.7%) of transverse colon anastomoses were stapled, most commonly a functional end-to-end colocolostomy. Two patients required end colostomy. The median EBL was 500 cm(3). Residual disease was: no gross in 33.3%, 0.1-1.0 cm in 59.0%, and >1 cm in 7.7% of patients. Post-operative morbidity occurred in 25.6% of patients, with a fistula rate of 5.1% and a mortality rate of 2.6%. The median survival time after primary surgery was 68.3 months. CONCLUSIONS Transverse colectomy can contribute significantly to a maximal ovarian cancer cytoreductive surgical effort and carries acceptable morbidity. Resection of a non-contiguous segment of rectosigmoid colon is frequently necessary, and placement of two separate colonic anastomoses is associated with a low risk of anastomotic breakdown.
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Duncan TJ, Lee S, Acheson AG, Hammond RH. An ovarian stromal tumor with luteinized cells: an unusual recurrence of an unusual tumor. Int J Gynecol Cancer 2007; 18:172-5. [PMID: 17999678 DOI: 10.1111/j.1525-1438.2007.00957.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Sex cord-stromal tumors (SCSTs) of the ovary are uncommon. Their behavior is unpredictable, often with late recurrence, making counseling, management, and prediction of prognosis challenging. A 65-year-old woman presenting with a SCST underwent a bilateral oophorectomy, the histology was unusual but likely to be a luteinized thecoma with suspicious features for invasion. Two years later following a gastrointestinal bleed, a metastasis within the small bowel mucosa was detected. This represents probable isolated hematogenous or lymphatic spread, which is highly unusual especially in the absence of concurrent peritoneal disease. This is the first reported case of a SCST recurring in small bowel mucosa, mimicking a primary colorectal tumor. This highlights the diverse nature and behavior of these tumors.
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Affiliation(s)
- T J Duncan
- Department of Gynaecological Oncology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
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41
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Salani R, Diaz-Montes T, Giuntoli RL, Bristow RE. Surgical Management of Mesenteric Lymph Node Metastasis in Patients Undergoing Rectosigmoid Colectomy for Locally Advanced Ovarian Carcinoma. Ann Surg Oncol 2007; 14:3552-7. [PMID: 17896149 DOI: 10.1245/s10434-007-9565-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/15/2007] [Accepted: 07/17/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND We sought to determine the incidence of mesenteric lymph node metastases in patients undergoing rectosigmoid resection for epithelial ovarian carcinoma and to evaluate the potential contribution of sigmoid mesocolectomy toward achieving complete surgical cytoreduction. METHODS Pathology results for patients undergoing rectosigmoid colectomy for epithelial ovarian carcinoma from August 1998 through September 2005 were retrospectively reviewed. Fifty-three patients with pathological documentation of mesenteric lymph nodes were selected for further review. A focused analysis was performed on cases with an adequate surgical sampling of mesenteric lymph nodes (more than one positive or five total mesenteric lymph nodes) to determine the overall incidence of nodal metastases. Chi2 analysis was used to identify clinicopathologic factors associated with mesenteric lymphatic spread. RESULTS A total of 39 (73.6%) of 53 patients had an adequate mesenteric resection suitable for nodal analysis. In this subgroup, 32 (82.1%) of 39 patients had one or more mesenteric lymph nodes containing metastatic ovarian carcinoma. Invasion beyond the serosa of the rectosigmoid colon was present in 31 (79.5%) of 39 of cases; however, increasing depth of invasion was not associated with risk of mesenteric nodal disease. In addition to bowel wall involvement, the only clinical factor that correlated with mesenteric lymph node involvement was concurrent tumor spread to retroperitoneal lymph nodes (P = .025). CONCLUSIONS Locally advanced ovarian carcinoma involving the rectosigmoid colon is associated with a high incidence of mesenteric nodal metastasis. Standard surgical technique should include a sigmoid mesocolectomy with resection of the associated lymphatic tributaries at the time of rectosigmoid colectomy if the surgical objective is complete cytoreduction of occult nodal disease.
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Affiliation(s)
- Ritu Salani
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 N Wolfe St/Phipps 281, Baltimore, Maryland 21224, USA.
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Ushijima K. Management of retroperitoneal lymph nodes in the treatment of ovarian cancer. Int J Clin Oncol 2007; 12:181-6. [PMID: 17566840 DOI: 10.1007/s10147-007-0672-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Indexed: 10/23/2022]
Abstract
The mechanisms and clinical significance of lymph node involvement in ovarian cancer have been revealed since the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new clinical staging including retroperitoneal lymph node status. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of disease progression and the histological type. Thus, it is difficult to specify a single node as the sentinel node. As a surgical approach, systemic lymphadenectomy is necessary to obtain accurate clinical stage, and it has obvious diagnostic value. Nevertheless, a recent large randomized trial in patients with advanced ovarian cancer revealed that systemic lymphadenectomy had no impact on survival compared with removing only macroscopic lymph nodes. Other factors, such as chemosensitivity, histological grade, and the size of residuals have also influenced survival in ovarian cancer. From the viewpoint of adverse effects and survival benefit, the efficacy of lymphadenectomy remains controversial. Therefore, further accumulation of clinical data is needed to establish the indications for lymph node dissection; when this procedure is done, it should be performed by experienced gynecologic oncologists at selected institutions.
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Affiliation(s)
- Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
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Abstract
PURPOSE OF REVIEW This review examines the current role of intestinal surgery in advanced ovarian cancer. Institutions differ considerably in surgical procedures and therapeutic outcomes for this disease. Moreover, therapeutic outcomes are influenced by the inclusion criteria for surgical procedures and the degree of surgical completion. We discuss the role of intestinal surgery and suggest surgical indications for intestinal surgery in advanced ovarian cancer. RECENT FINDINGS Prognosis in advanced ovarian cancer is better when there is a smaller postoperative tumor mass. However, it is necessary to investigate the effects of intestinal surgery on residual tumor mass and its prognostic benefits. Here, recent reports were reviewed to ascertain the usefulness and safety of intestinal surgery for advanced ovarian cancer and examine surgical indications and institutional requirements. SUMMARY By performing aggressive intestinal surgery such as combined bowel resection, optimal cytoreductive surgery can be performed in 70-98% of cases. The morbidity associated with intestinal surgery is acceptably low. Prognostic benefits for intestinal surgery are clear in patients with operable ovarian cancer with no residual disease. Women with suspected ovarian cancer should therefore be referred to centers with experienced tumor surgeons.
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Affiliation(s)
- Osamu Takahashi
- Department of Obstetrics and Gynecology, Akita City Hospital, Kawamoto, Akita, Japan.
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Tebes SJ, Cardosi R, Hoffman MS. Colorectal resection in patients with ovarian and primary peritoneal carcinoma. Am J Obstet Gynecol 2006; 195:585-9; discussion 589-90. [PMID: 16730631 DOI: 10.1016/j.ajog.2006.03.079] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 03/13/2006] [Accepted: 03/19/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examines the operative details and complications of colorectal resection in patients with ovarian and primary peritoneal carcinoma. STUDY DESIGN Patients who underwent colorectal resection for ovarian and primary peritoneal cancer were identified in our surgical database for the period 1988 through 2002. RESULTS Of the 125 patients who were identified, 73% were undergoing primary cytoreduction; 18% were undergoing secondary cytoreduction, and 7% were undergoing interval cytoreduction. The mean length of colon that was removed was 15.7 cm. The method of anastomosis was stapler in 63% and hand sewn in 22%; 15% patients had no anastomosis performed. A protective ostomy was used in 13% of patients. Optimal cytoreduction (<1 cm) was achieved in 74%. Operative complications occurred in 37% of patients, with the most common being hemorrhage (25%). Anastomotic leaks occurred in 2.5% of the patients, and the most common postoperative complication was ileus (28%). Postoperative bowel function returned to normal in 71% of patients. CONCLUSION To obtain optimal cytoreduction in patients with ovarian cancer, colorectal resection often is necessary. Colorectal resection can be performed with a low risk of anastomotic complications, and patients frequently have the return of normal bowel function.
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Affiliation(s)
- Stephen J Tebes
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
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Park JY, Seo SS, Kang S, Lee KB, Lim SY, Choi HS, Park SY. The benefits of low anterior en bloc resection as part of cytoreductive surgery for advanced primary and recurrent epithelial ovarian cancer patients outweigh morbidity concerns. Gynecol Oncol 2006; 103:977-84. [PMID: 16837030 DOI: 10.1016/j.ygyno.2006.06.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2006] [Revised: 06/01/2006] [Accepted: 06/05/2006] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this study was to assess the safety, efficacy and impact on survival of low anterior resection and primary anastomosis at the time of en bloc resection for primary and recurrent epithelial ovarian carcinoma. METHODS We performed a retrospective review of 46 primary and 14 recurrent epithelial ovarian carcinoma patients who underwent procedures between April 2001 and May 2005 in our center. Data were obtained from patient medical records and the cancer registry. Parameters for safety, efficacy and survival were considered as primary endpoints. RESULTS For primary advanced ovarian cancer patients, 43.5% showed no visible tumor at the completion of surgery and optimal cytorection (residual tumor [RT] less than or equal 5 mm) was achieved in 89.2%. Complications associated with en bloc resection occurred in two patients (1 leakage of anastomosis site and 1 rectovaginal fistula), and these were managed with diversion colostomy. Patients with no visible residual tumor had longer disease-free survival compared to those with visible RT (median, 30 vs. 7 months; P=0.0082) and longer overall survival (3-year survival rate, 82.03% vs. 66.63%; P=0.0437). Patients with rectal invasions up to the serosa/subserosa had longer disease-free survival than those with rectal invasion up to the muscle/mucosa (P=0.0176) but did not differ significantly in terms of overall survival (P=0.0880). For recurrent ovarian cancer patients, 42.9% showed no visible tumor at the completion of surgery and optimal cytorection was achieved in 64.3%. One patient experienced an en-bloc-resection-associated complication (a rectovaginal fistula), which was managed conservatively. Patients with no visible residual tumor (RT) had longer disease-free survival than visible RT patients (median, not reached vs. 5 months; P=0.0156) but did not differ significantly in terms of overall survival (median, 32 months for no visible RT vs. 24 months for visible RT patients; P=0.0833). There were no surgery-related deaths among the overall 60 primary and recurrent ovarian cancer patients. CONCLUSIONS En bloc resection of primary and recurrent epithelial ovarian carcinomas with low anterior resection permits a high rate of complete debulking with acceptable morbidity and mortality rates. Patients with no visible RT after surgery had a survival advantage over patients with visible RT.
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MESH Headings
- Adult
- Aged
- Anastomosis, Surgical/methods
- Disease-Free Survival
- Female
- Gynecologic Surgical Procedures/methods
- Gynecologic Surgical Procedures/statistics & numerical data
- Humans
- Intestines/surgery
- Korea/epidemiology
- Medical Records
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasms, Glandular and Epithelial/epidemiology
- Neoplasms, Glandular and Epithelial/mortality
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/surgery
- Outcome Assessment, Health Care
- Ovarian Neoplasms/epidemiology
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Postoperative Complications
- Registries
- Retrospective Studies
- Survival Analysis
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Affiliation(s)
- Jeong-Yeol Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 411-351, Republic of Korea
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46
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Hoffman MS, Griffin D, Tebes S, Cardosi RJ, Martino MA, Fiorica JV, Lockhart JL, Grendys EC. Sites of bowel resected to achieve optimal ovarian cancer cytoreduction: implications regarding surgical management. Am J Obstet Gynecol 2005; 193:582-6; discussion 586-8. [PMID: 16098902 DOI: 10.1016/j.ajog.2005.03.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 02/23/2005] [Accepted: 03/19/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to 1) report on the distribution of bowel segments resected in a population of patients who underwent primary optimal cytoreductive surgery for epithelial ovarian cancer, and 2) discuss implications for surgical management regarding resection of these bowel segments. STUDY DESIGN This was a retrospective study from 1995 to 2003 of 144 ovarian cancer patients who underwent primary optimal cytoreductive operations that included bowel resection. RESULTS Bowel segments removed and major complications are presented in tabulated form. Eighty-one out of 144 resections were rectosigmoid only. Thirty-six percent had extensive involvement of colon segments separate from the rectosigmoid. Excluding hemorrhage, 9 patients (6%) experienced a major complication. CONCLUSION The present study does suggest the necessity for a highly individualized approach to the surgical management of epithelial ovarian cancer patients who can be optimally cyto-reduced by resection of multifocal colonic involvement. Further study is needed to better assess the complications, function, and oncologic outcome of the different surgical approaches to these patients.
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Affiliation(s)
- Mitchel S Hoffman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, USA.
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47
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Briët JM, Hollema H, Reesink N, Aalders JG, Mourits MJE, ten Hoor KA, Pras E, Boezen HM, van der Zee AGJ, Nijman HW. Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol 2005; 96:799-804. [PMID: 15721428 DOI: 10.1016/j.ygyno.2004.11.033] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Indexed: 11/22/2022]
Abstract
PURPOSE OF INVESTIGATION To evaluate whether lymphvascular space involvement (LVSI) is a risk factor for relapse of disease and lymph node metastasis in endometrial cancer. METHODS From 1978 till 2003, 609 patients with epithelial endometrial cancer were treated at the Groningen University Medical Center. The association of LVSI and relapse of disease was evaluated in the total group of 609 patients and in a 'low' and 'high' risk stage I endometrial cancer group. In 239 surgically staged patients, the relation of LVSI and lymph node metastasis was investigated. RESULTS The median age at diagnosis was 63 years (range 27-92 years) with a median follow-up of 58 months (range 0-236 months). More than half of the patients (56%) received adjuvant radiotherapy. LVSI was present in 123 patients (25,6%), and a prognostic factor for relapse of disease (multivariate analysis, P < 0.0001). In the 'low' and 'high' risk stage I endometrial cancer patients an increase of 2.6 times in relapse of disease was observed in the presence of LVSI. LVSI positive tumors were more likely to have metastasized to the pelvic lymph nodes (multivariate analysis, P = 0.001). In patients with proven negative nodes, LVSI was a prognostic factor for relapse of disease (univariate analysis, P = 0.02). CONCLUSION LVSI is a predictor of nodal disease and an independent prognostic factor for relapse of disease in all stages of endometrial cancer. Patients with stage I endometrial cancer with positive LVSI are at risk for relapse of disease and might therefore benefit from adjuvant therapy. CONTENT The presence of lymphvascular space involvement (LVSI) in endometrial cancer is significantly and independently associated with an increased risk of pelvic lymph node metastases and/or relapse of disease.
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Affiliation(s)
- Justine M Briët
- Department of Gynecologic Oncology, Groningen University Medical Center, CMC V, 4th floor, PO Box 30.001, 9700 RB Groningen, The Netherlands
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48
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Zighelboim I, Broaddus R, Ramirez PT. Atypical sigmoid metastasis from a high-grade mixed adenocarcinoma of the ovary. Gynecol Oncol 2004; 94:850-3. [PMID: 15350388 DOI: 10.1016/j.ygyno.2004.05.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intraperitoneal seeding is the most common form of dissemination of epithelial ovarian cancer. Metastasis to the bowel mucosa can occur by invasion from the serosal surface or infiltration of the submucosal capillary network. Hematogenous dissemination usually occurs in the presence of advanced peritoneal disease. CASE A 39-year-old gravida 3 para 2 woman was diagnosed in October 2000 with a large pelvic mass. She underwent an exploratory laparotomy and a left salpingo-oophorectomy with multiple abdominal and pelvic biopsies. She was diagnosed with an ovarian tumor of low malignant potential, and no further treatment was recommended. Six months later, she developed abdominal discomfort and constipation. A colonoscopy was performed, and a biopsy showed metastatic carcinoma of ovarian origin. The patient presented to The University of Texas M.D. Anderson Cancer Center in September 2001 for consultation. The surgical pathology evaluation from her previous surgery indicated high-grade ovarian carcinoma. The patient underwent a total abdominal hysterectomy, right salpingo-oophorectomy, infracolic omentectomy, right pelvic lymph node sampling, and segmental resection with primary end-to-end sigmoid colon anastomosis. The tumor within the colon was a polypoid mass arising from the mucosa with no involvement of the colonic wall. Microscopically, the tumor was a high-grade ovarian papillary serous carcinoma with areas of endometrioid adenocarcinoma. The colonic tumor was immunohistochemically positive for cytokeratin-7 and negative for cytokeratin-20. The patient was treated with six cycles of carboplatin and paclitaxel. The patient then incidentally developed disseminated sarcoidosis. At the time of this report, the patient had no evidence of recurrent or metastatic disease for 2 years. CONCLUSIONS Epithelial ovarian carcinomas may recur as intraluminal bowel lesions with serosal sparing even in the absence of peritoneal disease. Immunohistochemical staining using cytokeratins-7 and -20 may prove useful in differentiating such lesions from primary colonic malignancies.
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MESH Headings
- Adult
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/secondary
- Carcinoma, Endometrioid/surgery
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Carcinoma, Papillary/surgery
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/secondary
- Cystadenocarcinoma, Serous/surgery
- Female
- Humans
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Sigmoid Neoplasms/pathology
- Sigmoid Neoplasms/secondary
- Sigmoid Neoplasms/surgery
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Affiliation(s)
- Israel Zighelboim
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Hertel H, Diebolder H, Herrmann J, Köhler C, Kühne-Heid R, Possover M, Schneider A. Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer. Gynecol Oncol 2001; 83:481-4. [PMID: 11733959 DOI: 10.1006/gyno.2001.6338] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We compare the indication for colorectal resection in patients with advanced ovarian cancer with histopathologic findings. We describe the effect on pelvic control and morbidity associated with surgery. METHODS Between February 1995 and March 2001, 100 patients with FIGO stage IIIc ovarian cancer underwent pelvic en bloc resection with excision of the rectosigmoid colon as part of primary or secondary cytoreductive surgery. Decision for resection was made by the surgeon when tumor involvement of the cul-de-sac was suspected. Rectosigmoid infiltration was histopathologically defined as infiltration of the serosa or deeper. RESULTS In 73 of 100 patients (73%) tumor involvement of the rectum was confirmed histopathologically: infiltration of the serosa in 28 (28%) patients, infiltration of the muscularis in 31 (31%) patients, and infiltration of the mucosa in 14 (14%) patients; in 27 (27%) patients no infiltration was found. Histopathologically confirmed pelvic R0 resection was achieved in 85 (85%) patients. In 11 (11%) patients the pelvic resection margins were tumor-involved and in four (4%) patients visible parametric tumor remained in situ. Pelvic recurrence occurred in 4 (4.7%) of 85 optimally debulked patients compared with 9 (60%) of 15 patients with suboptimal pelvic resection status (P < 0.05). End colostomy could be prevented in 94 (94%) of 100 patients. CONCLUSION Pelvic en bloc surgery with rectosigmoid resection was justified by histopathologic outcome since deperitonealization with preservation of the rectosigmoid would have left tumor in situ in 73% of patients with suspected cul-de-sac involvement.
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Affiliation(s)
- H Hertel
- Department of Gynecology, Institute of Pathology, Friedrich-Schiller-University of Jena, Bachstrasse 18, Jena, D-07740, Germany
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Scarabelli C, Gallo A, Franceschi S, Campagnutta E, De G, Giorda G, Visentin MC, Carbone A. Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma. Cancer 2000; 88:389-97. [PMID: 10640973 DOI: 10.1002/(sici)1097-0142(20000115)88:2<389::aid-cncr21>3.0.co;2-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of radical bowel resection with multiple organ resection on the survival if patients with advanced ovarian carcinoma has not been well defined. The authors investigated whether primary cytoreductive surgery including rectosigmoid colon resection would affect the recurrence free interval and survival of these patients. METHODS Between April 1990 and April 1997, 66 previously untreated Stage IIIC-IV ovarian carcinoma patients with macroscopic involvement of the rectosigmoid colon were enrolled. All patients underwent cytoreductive surgery with rectosigmoid colon resection to remove residual tumor less than 2 cm in greatest dimension and received 6 cycles of cisplatin-based postoperative chemotherapy. RESULTS The median follow-up was 26 months (range, 7-104 months). In multivariate analysis, residual disease and depth of tumor infiltration of the bowel wall were independently associated with overall survival and recurrence free interval. Disease stage was independently associated only with overall survival. Residual tumor was the most strongly predictive factor for recurrence or death. The 2-year estimated survival rates according to the amount of residual tumor were 100% for 24 patients with no macroscopic residual disease and 77.3% for 28 patients with residual disease less than 1 cm. None of the 14 patients with residual disease larger than 1 cm were alive 2-years after operation. Overall, 48 patients (72.7%) developed disease recurrence: 43 (65.1%) in the abdomen, 19 (29.8%) in the liver, and 3 (4.5%) in the pelvis. CONCLUSIONS The current findings suggest that cytoreductive surgery with rectosigmoid colon resection should be considered for ovarian carcinoma patients with bulky pelvic disease to help ensure that they are left with no residual disease after debulking surgery.
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Affiliation(s)
- C Scarabelli
- Division of Gynecologic Oncology, Centro di Riferimento Oncologico di Aviano, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico; Aviano, Italy
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