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Daniele A, Rosso R, Ceccaroni M, Roviglione G, D’Ancona G, Peano E, Clignon V, Calandra V, Puppo A. Laparoscopic Treatment of Bulky Nodes in Primary and Recurrent Ovarian Cancer: Surgical Technique and Outcomes from Two Specialized Italian Centers. Cancers (Basel) 2024; 16:1631. [PMID: 38730583 PMCID: PMC11083283 DOI: 10.3390/cancers16091631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/20/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Minimally invasive surgery (MIS) represents a feasible approach in early-stage ovarian cancer, while this question is still unsolved for advanced and recurrent disease. (2) Methods: In this retrospective, multicenter study, we present a series of 21 patients who underwent MIS for primitive or recurrent epithelial ovarian cancer (EOC) with bulky nodal metastasis and discuss surgical technique and outcomes in relation to the current literature. (3) Results: Complete cytoreduction at primary debulking surgery was obtained in 86% of cases. No complication occurred in our patients intraoperatively and only 11.1% of our patients experienced grade 2 and 3 postoperative complications. Notably, all the patients with isolated lymph nodal recurrence (ILNR) were successfully treated with a minimally invasive approach with no intra- or postoperative complications. (4) Conclusions: The results of our study are consistent with those reported in the literature, demonstrating that MIS may represent a safe approach in advanced and recurrent EOC with nodal metastasis if performed on selected patients by expert surgeons with an adequate setting and appropriate technique.
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Affiliation(s)
- Alberto Daniele
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Roberta Rosso
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy; (M.C.); (G.R.); (G.D.)
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy; (M.C.); (G.R.); (G.D.)
| | - Gianmarco D’Ancona
- Department of Obstetrics and Gynecology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy; (M.C.); (G.R.); (G.D.)
| | - Elisa Peano
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Valentino Clignon
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Valerio Calandra
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Andrea Puppo
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
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Collin-Bund V, Lecointre L, Ross C, Faller E, Boisramé T, Minella C, Baldauf JJ, Akladios C. Preliminary observational study of the implementation of hyperthermic intraperitoneal chemotherapy in ovarian cancer in the gynecological surgery department at the University Hospital of Strasbourg. J Gynecol Obstet Hum Reprod 2023; 52:102501. [PMID: 36356941 DOI: 10.1016/j.jogoh.2022.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE According to French guidelines, hyperthermic intraperitoneal chemotherapy (HIPEC) can be performed for Federation of Gynecology and Obstetrics stage III primary epithelial ovarian, tubal, and peritoneal cancers that are initially unresectable after 3 or 4 cycles of intravenous chemotherapy. The main objective of this preliminary study was to analyze the components necessary for the establishment of HIPEC in an expert gynecological oncological surgery center. The secondary objective was to compare HIPEC using conventional laparotomy and laparoscopic approaches. METHODS We conducted a single-center retrospective study of patients who received HIPEC. All patients who met the criteria of the French HIPEC guidelines were included from 2019 to 2021. RESULTS Prior to HIPEC, there were a mean of 3.7 courses of neoadjuvant chemotherapy with carboplatin and paclitaxel. Of the 16 patients who received HIPEC, 9 (56.2%) underwent HIPEC laparoscopically, while 7 (43.8%) underwent laparotomy. There were no differences between the rates of intra- and postoperative complications between the two groups. (p > 0.05). The duration of hospitalization was significantly shorter in patients who were operated laparoscopically than in those treated using laparotomy (55.6% <10 days vs. 0 by laparotomy, p = 0.01). There was also a tendency, although not significant, for a more rapid resumption of adjuvant chemotherapy in the laparoscopy group, with 57.1% resuming chemotherapy in <6 weeks compared to 42.9% in the laparotomy group (p = 0.52). CONCLUSIONS This study demonstrates the feasibility of HIPEC in a center with expertise in gynecological surgery when there is a suitable technical platform and close collaboration between the different teams involved. We also showed the first cases of HIPEC using laparoscopy, which seems to be a promising approach.
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Affiliation(s)
- Virginie Collin-Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Célia Ross
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Chris Minella
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
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Macciò A, Sanna E, Lavra F, Chiappe G, Petrillo M, Madeddu C. Laparoscopic splenectomy both for primary cytoreductive surgery for advanced ovarian cancer and for secondary surgery for isolated spleen recurrence: feasibility and technique. BMC Surg 2021; 21:380. [PMID: 34711237 PMCID: PMC8555277 DOI: 10.1186/s12893-021-01368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/11/2021] [Indexed: 12/05/2022] Open
Abstract
Background This study investigated the feasibility and safety of laparoscopic splenectomy conducted in the contexts of both laparoscopic secondary surgery for isolated recurrence in the spleen and primary laparoscopic cytoreductive surgery for advanced ovarian cancer. Methods We performed a perspective observational study including all consecutive patients with ovarian cancer who underwent laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer or secondary surgery for isolated splenic recurrence between January 2016 and May 2020. Results We enrolled 13 consecutive patients, candidate to laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer (6 patients) or secondary surgery for isolated splenic recurrence of platinum-sensitive ovarian cancer (7 patients). Median operative time (509 min [range, 200–845]) for primary cytoreductive surgery varied according to surgical complexity depending on the extensiveness of the disease. Median operative time for secondary surgery for isolated splenic metastasis was 253 min (90–380). Only 1 patient with isolated splenic recurrence required conversion to an open approach. No intraoperative complication occurred, and no intraoperative blood transfusions were required. Median hospital stay was 3 days (range, 2–5) for isolated recurrence and 9 days (7–18) for primary cytoreductive surgery. Complete tumor resection was achieved in all patients. Median time from surgery to adjuvant chemotherapy was 16 days (7–24). All six patients who underwent laparoscopic splenectomy during primary cytoreductive surgery remain alive, four of whom exhibit no evidence of disease (median follow-up 25 months [4–36]). Among patients who underwent laparoscopic splenectomy during secondary surgery for isolated splenic relapse, all patients are alive and only one had a central diaphragmatic relapse 2 years after surgery (median follow-up 17 months ([5–48 months]). Conclusions The laparoscopic approach to splenectomy is feasible and safe both in patients undergoing primary cytoreductive surgery for advanced stage disease and those with isolated recurrence of ovarian cancer, without compromising survival and allowing early initiation of postoperative systemic chemotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01368-z.
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Affiliation(s)
- Antonio Macciò
- Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy. .,Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Elisabetta Sanna
- Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Fabrizio Lavra
- Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Giacomo Chiappe
- Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Mortality Rates in Laparoscopic and Robotic Gynecologic Oncology Surgery: A Systemic Review and Meta-analysis. J Minim Invasive Gynecol 2019; 26:1253-1267.e4. [DOI: 10.1016/j.jmig.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
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Ferron G, Narducci F, Pouget N, Touboul C. [Surgery for advanced stage ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:197-213. [PMID: 30792175 DOI: 10.1016/j.gofs.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 01/10/2023]
Abstract
Debulking surgery is the key step of advanced stage ovarian cancer treatment with chemotherapy. The quality of surgical resection is the main prognosis factor, thus a complete resection must be achieved (grade A) in an expert center (grade B). Surgery for stage IV is possible and has a benefit in case of complete peritoneal resection (LoE3). Pelvic and aortic lymphadenectomies are recommended in case of clinical or radiological suspicious lymph nodes (grade B). In absence of clinical or radiological suspicious lymph nodes and in case of complete peritoneal resection during initial debulking surgery, lymphadenectomy can be omitted because it won't change nor medical treatment nor overall survival (grade B). Neoadjuvant chemotherapy can be proposed in case of: impossibility to perform initial complete surgical resection (grade B) ; alteration of general state or co-morbidities or elderly patient (in order to decrease morbidity and increase quality of life) (grade B); stage IV with multiple intra-hepatic or pulmonary metastasis or important ascites with miliary (grade B). In case of stage III or IV ovarian cancer diagnosed on a biopsy during prior laparotomy, a neoadjuvant chemotherapy and interval debulking surgery should be preferred (gradeC). In case of palliative surgery or peroperative impossibility to perform a complete resection, no data regarding the type of surgery to perform influencing survival or quality of life is available. Peritoneal carcinosis description before resection and residual disease at the end of the surgery should be reported (size, location and reason of non-extirpability) (grade B). A score of peritoneal carcinosis such as Peritoneal Carcinosis Index (PCI) should be used in order to objectively evaluate the tumoral burden (gradeC). A standardized operative report is recommended (gradeC).
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Affiliation(s)
- G Ferron
- Inserm CRCT 19, département de chirurgie oncologique, institut Claudius Regaud, institut universitaire du cancer, 31000 Toulouse, France
| | - F Narducci
- Inserm U1192, département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France
| | - N Pouget
- Département de chirurgie oncologique, chirurgie gynécologique et mammaire, institut Curie, site Saint-Cloud, 75005 Paris, France
| | - C Touboul
- IMRB, U955 Inserm, service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Créteil, institut Mondor de recherche biomédicale, 94000 Créteil, France.
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Report of the survey on current opinions and practice of German Society for Gynecologic Endoscopy (AGE) members regarding the laparoscopic treatment of ovarian malignancies. Arch Gynecol Obstet 2018. [PMID: 29520665 DOI: 10.1007/s00404-018-4709-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this survey was to assess the opinions of members of the German Society of Gynecologic Endoscopy (AGE) regarding the laparoscopic treatment of ovarian malignancies and current practice at their institutions. METHODS Between February and October 2015, the AGE sent an anonymous online survey via mail to its members. The questionnaire solicited participants' opinions about the laparoscopic treatment of ovarian cancers according to T stage and borderline tumors, and information about current practice at their institutions. Participants were also asked their opinions on currently available data on this issue. RESULTS Of 228 AGE members who completed the survey, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [212 (93%)] respondents stated that < 10% of all ovarian cancer cases were currently treated laparoscopically at their institutions. Most participants indicated that T1 (a, b, c) tumors [145 (64%)] and ovarian borderline tumors [206 (90%)], but not T2 [48 (21%)] or T3/4 [9 (4%) ovarian tumors] should or could be treated laparoscopically. One hundred seventy-two (75%) participants considered currently available data on this topic to be insufficient and 152 (66%) stated that they would take part in a clinical trial assessing a laparoscopic approach to T1/2 ovarian cancer. CONCLUSION According to this survey, to the opinion of the majority of AGE members, laparoscopy might be a considerable option for the treatment of early ovarian malignancies and borderline tumors and should be evaluated further in future studies.
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Misirlioglu S, Turkgeldi E, Boza A, Oktem O, Ata B, Urman B, Taskiran C. The Clinical Utility of a Pulsed Bipolar System and Its Electrosurgical Device During Total Laparoscopic Hysterectomy. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Selim Misirlioglu
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Engin Turkgeldi
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Aysen Boza
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
| | - Ozgur Oktem
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Cagatay Taskiran
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
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Liang H, Guo H, Zhang C, Zhu F, Wu Y, Zhang K, Li H, Han J. Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer: a comparison to laparotomic surgery in retrospective cohorts. Oncotarget 2017; 8:113239-113247. [PMID: 29348902 PMCID: PMC5762587 DOI: 10.18632/oncotarget.22573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/02/2017] [Indexed: 01/17/2023] Open
Abstract
Objectives To assess the feasibility and outcome of primary laparoscopic cytoreductive surgery on advanced epithelial ovarian cancer in comparison with conventional open surgery. Materials and Methods Patients undergoing primary laparoscopic cytoreductive surgery (LCS) from March 2007 to December 2016 were matched to controls treated with laparotomic cytoreduction during the same period. Procedural data and outcomes were analyzed. Results The LCS group (n = 64) and laparotomic group (n = 68) had similar age, BMI, stages, histologic type and grading. The LCS group exhibited significantly less operating time (P < 0.001), less intraoperative blood loss (P < 0.001), and shorter time to recover postoperatively (P = 0.002). No statistical difference was observed for the number of pelvic and para-aortic lymph nodes dissected (P = 0.326 and P = 0.151). Significant difference was observed in satisfaction of the cytoreduction (95.3% vs. 76.5%, P = 0.008). No significant difference were observed either in intra-operative or in post-operative complications between the two groups (P = 0.250). Three patients in the LCS group experienced intra-operative complications (4.7%) and were all treated laparoscopically. The conversion rate was 3.1%. No significant differences were observed in the progression-free survival and overall survival between the two groups during the medium follow-up of 18 months (P = 0.236 and P = 0.216). The 2-year and 3-year progression-free survival was 67.9%, 55.5% in LCS group and 53.8%, 33.3% respectively in the control group. The 2-year and 3-year overall survival was 95.8%, 88.7% respectively in the LCS group and 89.0%, 83.7% in the control group. Conclusions Primary laparoscopic cytoreductive surgery in some strictly selected advanced stages of EOC patients was feasible and safe, resulting in oncologic outcomes not inferior to those in open surgery.
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Affiliation(s)
- Huamao Liang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Chunyu Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - FuLi Zhu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Yu Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Kun Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Hua Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Jinsong Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
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Ceccaroni M, Roviglione G, Bruni F, Clarizia R, Ruffo G, Salgarello M, Peiretti M, Uccella S. Laparoscopy for primary cytoreduction with multivisceral resections in advanced ovarian cancer: prospective validation. "The times they are a-changin"? Surg Endosc 2017; 32:2026-2037. [PMID: 29052073 DOI: 10.1007/s00464-017-5899-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Primary cytoreduction is the mainstay of treatment for advanced ovarian cancer (AOC). We developed and prospectively evaluated an algorithm to investigate the possible role of laparoscopic primary cytoreduction (LPC) in carefully selected patients, with AOC. METHODS From June 2007 to July 2015, all patients with stage III-IV ovarian cancer and clinical conditions allowing aggressive surgery were candidate to primary cytoreduction with the aim of achieving residual tumor (RT) = 0. The possibility of attempting laparoscopic cytoreduction was carefully evaluated using strict selection criteria. The other patients were approached by abdominal primary cytoreduction (APC). At the end of LPC, an ultra-low pubic mini-laparotomy was performed to extract surgical specimens and to accomplish a laparoscopic hand-assisted exploration of the abdominal organs, in order to confirm complete excision of the disease. RESULTS Of the included 66 patients, 21 were considered eligible for LPC; the remaining 45 underwent APC. Optimal cytoreduction (i.e., RT = 0) was obtained in 95 and 88.4% in the LPC and APC groups, respectively. No intra-operative complication and 4 (19%) early post-operative complications were observed among patients who received LPC. Patients who underwent APC had 17.8 and 46.7% intra- and early post-operative complications, respectively. Median time to initiation of chemotherapy was 15 (range, 10-30) days in the LPC group and 28 (20-35) days in the APC group. After a median follow-up of 51 months, 2-year disease-free survival was 76.2% in the LPC group and 73.4% in the APC group. CONCLUSIONS After strict selection, a group of patients with AOC may undergo LPC with extremely high rates of optimal cytoreduction, satisfactory perioperative morbidity, a short interval to chemotherapy, and encouraging survival outcomes. Clinical trial registration NCT02980185.
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Affiliation(s)
- Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacro Cuore "Don Calabria" Hospital, Negrar, Verona, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacro Cuore "Don Calabria" Hospital, Negrar, Verona, Italy
| | - Francesco Bruni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacro Cuore "Don Calabria" Hospital, Negrar, Verona, Italy
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacro Cuore "Don Calabria" Hospital, Negrar, Verona, Italy
| | - Giacomo Ruffo
- Department of General Surgery, International School of Surgical Anatomy, Sacro Cuore "Don Calabria" Hospital, Negrar, Verona, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine, Sacro Cuore "Don Calabria" Hospital, Negrar, Verona, Italy
| | - Michele Peiretti
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi, 1, 21100, Varese, Italy.
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Fagotti A, Perelli F, Pedone L, Scambia G. Current Recommendations for Minimally Invasive Surgical Staging in Ovarian Cancer. Curr Treat Options Oncol 2016; 17:3. [PMID: 26739150 DOI: 10.1007/s11864-015-0379-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OPINION STATEMENT Minimally invasive surgery (MIS) currently is performed to stage and treat ovarian cancer at different stages of disease; however, the higher level of evidence from existing studies is IIB. Despite the absence of randomized controlled trials, MIS represents a safe and adequate procedure for treating and staging early ovarian cancer, and its use has increased significantly in clinical practice. Major concerns are related to minimizing tumor disruption or dissemination, removing the adnexal mass intact, adequate retroperitoneal staging, and fertility-sparing surgery for young patients. The main goal for patients with advanced ovarian cancer is to determine the best therapeutic strategy by evaluating the risks and benefits of primary debulking surgery versus neoadjuvant chemotherapy followed by interval debulking surgery. The use of staging laparoscopy in patients with advanced epithelial ovarian cancer appears to be the most researched and accepted approach. Regarding other types and stages of ovarian cancer, although the evidence is very promising, clinical trials performed by expert gynecologic oncology surgeons in referral centers are still needed to prove the efficacy of such an approach in these patients. In particular, MIS has provided an opportunity to remove localized recurrences, with both retroperitoneal and intraperitoneal diffusion.
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Affiliation(s)
- Anna Fagotti
- Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Federica Perelli
- Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luigi Pedone
- Obstetrics and Gynecology, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Obstetrics and Gynecology, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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Gallotta V, Ghezzi F, Vizza E, Fagotti A, Ceccaroni M, Fanfani F, Chiantera V, Ercoli A, Rossitto C, Conte C, Uccella S, Corrado G, Scambia G, Ferrandina G. Laparoscopic Management of Ovarian Cancer Patients With Localized Carcinomatosis and Lymph Node Metastases: Results of a Retrospective Multi-institutional Series. J Minim Invasive Gynecol 2016; 23:590-6. [PMID: 26872630 DOI: 10.1016/j.jmig.2016.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To investigate the feasibility and safety of laparoscopic cytoreduction in ovarian cancer patients with localized carcinomatosis or lymph node involvement. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING Multi-institutional study performed in 6 referral gynecologic oncology units. PATIENTS Between June 2005 and December 2014, preoperatively presumed early-stage ovarian cancer patients, who accidentally revealed localized carcinomatosis or lymph node involvement at laparoscopic evaluation or at postoperative pathological examination managed by the laparoscopic approach. INTERVENTIONS All patients with limited carcinomatosis and/or lymph node metastases underwent complete laparoscopic cytoreduction. MEASUREMENTS AND RESULTS Sixty-nine patients were included in the analysis. Twenty-eight (40.6%) patients were staged III C because they had lymph node metastases. Pelvic lymphadenectomy was performed in 75.4% of cases, whereas aortic lymphadenectomy was performed in 79.7% of cases. Lymph node metastases were found in pelvic and aortic regions in 11 and 13 patients, respectively, whereas 4 patients had lymph node metastases in both regions. Twelve (17.4%) patients underwent complete pelvic peritonectomy because of the presence of nodules localized in several pelvic region sites. As of May 2015, the median follow-up was 35 months, and the median disease-free survival was 29 months. The 2-year disease-free survival rate was 77.1%, whereas the 2-year overall survival rate was 90.6%. The median time to recurrence was 26 months (range, 6 -55 months); 15 (21.7%) patients developed recurrence. CONCLUSION The present study shows the technical and clinical feasibility of laparoscopic cytoreduction in ovarian cancer patients with limited carcinomatosis or lymph node involvement.
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Affiliation(s)
- Valerio Gallotta
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Gynecologic Oncology Unit, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology Abano Terme Hospital, Padova, Italy
| | - Cristiano Rossitto
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Conte
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Giacomo Corrado
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
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Tse K, Ngan HY. The role of laparoscopy in staging of different gynaecological cancers. Best Pract Res Clin Obstet Gynaecol 2015; 29:884-95. [DOI: 10.1016/j.bpobgyn.2015.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022]
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Bae J, Choi JS, Lee WM, Koh AR, Jung US, Ko JH, Lee JH. Feasibility and efficacy of laparoscopic restaging surgery for women with unexpected ovarian malignancy. Eur J Obstet Gynecol Reprod Biol 2015; 193:46-50. [PMID: 26232726 DOI: 10.1016/j.ejogrb.2015.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 06/09/2015] [Accepted: 06/30/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the feasibility, surgical outcomes and complications of laparoscopic restaging surgery for women with unexpected ovarian malignancy. STUDY DESIGN We conducted a retrospective chart review of 14 women with unexpected ovarian malignancy who underwent laparoscopic restaging surgery including peritoneal washing cytology, laparoscopic pelvic and paraaortic lymphadenectomy up to the left renal vein level, omentectomy, and multiple peritoneal biopsies, and hysterectomy except three fertility saving surgery. RESULTS The median age and median body mass index women were 49 years (range, 22-63) and 24.2m/kg(2) (range, 18.9-25.3), respectively. The median operating time was 230min (range, 155-370). The median numbers of harvested pelvic and paraaortic lymph nodes were 26 (range, 6-41) and 18 (range, 2-40), respectively. The median return of bowel activity was 28h (range, 21-79). Four of the women were upstaged from the initial presumed stage. There were two intraoperative complications, laceration of the inferior vena cava and cisterna chyli rupture. There was one postoperative complication, port-site metastasis. There was no conversion to laparotomic surgery. The median follow-up period was 33 months. Thirteen of the patients have no evidence of recurrences, however one patient died after 22 months after the surgery. CONCLUSION Laparoscopic restaging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in the management of unexpected ovarian malignancies.
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Affiliation(s)
- Jaeman Bae
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joong Sub Choi
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Won Moo Lee
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - A Ra Koh
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Un Suk Jung
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Hwa Ko
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Jung Hun Lee
- Department of Obstetrics and Gynecology, MizMedi Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
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Fanning J, Kesterson J, Benton A, Farag S, Dodson-Ludlow K. Laparoscopy-assisted supracervical hysterectomy for ovarian cancer: cervical recurrence. JSLS 2014; 18:JSLS-D-13-00232. [PMID: 25392621 PMCID: PMC4154411 DOI: 10.4293/jsls.2014.00232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: The purpose of our study is to evaluate the incidence of cervical recurrence after laparoscopic supracervical hysterectomy for ovarian cancer debulking or staging. Methods: From a prospective surgical database, we identified 51 cases of laparoscopic supracervical hysterectomy for ovarian cancer debulking or staging. No cases were excluded. Results: From 2009 to 2012, 51 patients were identified. The median age was 62 years (range, 32–83 years), and the median body mass index was 29 kg/m2 (range, 16–41 kg/m2). Medical comorbidities were present in 40 patients (78%), and 53% had prior abdominal surgery. The median operative time was 2 hours (range, 1–3.5 hours), and the median blood loss was 200 mL (range, 50–900 mL). The median length of stay was 1 day (range, 0–12 days). The stage was I in 12 patients, II in 6, and III/IV in 33. At a median follow-up time of 1.7 years (range, 0.3–2.6 years), 20 patients (39%) had recurrence of cancer, with a median time of recurrence of 1.1 years (range, 0.3–2.3 years). All recurrences were in the abdomen or pelvis except for 1 axillary node recurrence and 1 recurrence in the distal vagina. There were no recurrences in the remaining cervical stump. No patient had a postoperative vaginal cuff infection. Among the 104 cycles of intraperitoneal chemotherapy, there was no vaginal leakage of intraperitoneal chemotherapy. Conclusion: Laparoscopic supracervical hysterectomy for ovarian cancer debulking or staging does not result in cervical recurrence.
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Affiliation(s)
- James Fanning
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Joshua Kesterson
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Andrea Benton
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Sara Farag
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Katherine Dodson-Ludlow
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, PA, USA
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Nezhat FR, Pejovic T, Finger TN, Khalil SS. Role of minimally invasive surgery in ovarian cancer. J Minim Invasive Gynecol 2014; 20:754-65. [PMID: 24183269 DOI: 10.1016/j.jmig.2013.04.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 12/18/2022]
Abstract
The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic-assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology.
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Affiliation(s)
- Farr R Nezhat
- Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, St. Luke's and Roosevelt Hospitals, New York, New York.
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Fanning J, Kesterson J, Davies M, Green J, Penezic L, Vargas R, Harkins G. Effects of electrosurgery and vaginal closure technique on postoperative vaginal cuff dehiscence. JSLS 2014; 17:414-7. [PMID: 24018078 PMCID: PMC3771760 DOI: 10.4293/10860813x13693422518515] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence. METHODS From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure--laparoscopically in the TLH group and vaginally in the LAVH group. RESULTS Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02). CONCLUSION It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique.
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Affiliation(s)
- James Fanning
- Division of Gynecologic Oncology, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Dr, Room C-3620, Hershey, PA 17033, USA.
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Laparoscopic cytoreductive surgery and early postoperative intraperitoneal chemotherapy for patients with colorectal cancer peritoneal carcinomatosis: initial results from a single center. Surg Endosc 2013; 28:1555-62. [PMID: 24368743 DOI: 10.1007/s00464-013-3351-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 11/20/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent decades, a combination of cytoreductive surgery and intraperitoneal chemotherapy has yielded improvements in the survival of patients with peritoneal carcinomatosis. Laparoscopic cytoreductive surgery and intraperitoneal chemotherapy comprise a challenging and rarely reported surgical procedure. METHODS Between November 2004 and February 2010, 29 patients underwent cytoreductive surgery and early postoperative intraperitoneal chemotherapy for peritoneal carcinomatosis secondary to colorectal cancer. Of the 29 patients, 15 underwent laparoscopic surgery and 14 underwent open surgery. RESULTS The patient characteristics did not differ significantly between the two groups. Synchronous peritoneal carcinomatosis with a primary tumor was more common in the laparoscopic group, and the Gilly stage of peritoneal carcinomatosis was found more frequently in the open group. Complication rate and hospital stay were less in the laparoscopic group. However, the outcomes for the patients undergoing the combined treatment were similar between the two groups with respect to completeness of cytoreduction, operation morbidity, and overall survival. The laparoscopic group had a cytoreduction completeness of 86.7 % and an operative morbidity of 13.3 %. Operative mortality occurred for one patient after open surgery. CONCLUSIONS Laparoscopic cytoreductive surgery and early postoperative intraperitoneal chemotherapy can be performed safely for selected patients with peritoneal carcinomatosis from colorectal cancer to a limited extent. Further studies with longer follow-up periods and larger numbers of patients are warranted to confirm the study findings.
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Tangjitgamol S, Hanprasertpong J, Cubelli M, Zamagni C. Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:153-166. [DOI: 10.5317/wjog.v2.i4.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery (PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon’s skill, influences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy (NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery (IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a definite benefit of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or findings from imaging studies may be predictive of resectability. However, no specific features have been consistently identified in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.
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Watson JM, Rice PF, Marion SL, Brewer MA, Davis JR, Rodriguez JJ, Utzinger U, Hoyer PB, Barton JK. Analysis of second-harmonic-generation microscopy in a mouse model of ovarian carcinoma. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:076002. [PMID: 22894485 PMCID: PMC3389559 DOI: 10.1117/1.jbo.17.7.076002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 04/25/2012] [Accepted: 05/18/2012] [Indexed: 05/23/2023]
Abstract
Second-harmonic-generation (SHG) imaging of mouse ovaries ex vivo was used to detect collagen structure changes accompanying ovarian cancer development. Dosing with 4-vinylcyclohexene diepoxide and 7,12-dimethylbenz[a]anthracene resulted in histologically confirmed cases of normal, benign abnormality, dysplasia, and carcinoma. Parameters for each SHG image were calculated using the Fourier transform matrix and gray-level co-occurrence matrix (GLCM). Cancer versus normal and cancer versus all other diagnoses showed the greatest separation using the parameters derived from power in the highest-frequency region and GLCM energy. Mixed effects models showed that these parameters were significantly different between cancer and normal (P<0.008). Images were classified with a support vector machine, using 25% of the data for training and 75% for testing. Utilizing all images with signal greater than the noise level, cancer versus not-cancer specimens were classified with 81.2% sensitivity and 80.0% specificity, and cancer versus normal specimens were classified with 77.8% sensitivity and 79.3% specificity. Utilizing only images with greater than of 75% of the field of view containing signal improved sensitivity and specificity for cancer versus normal to 81.5% and 81.1%. These results suggest that using SHG to visualize collagen structure in ovaries could help with early cancer detection.
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Affiliation(s)
- Jennifer M. Watson
- University of Arizona, Biomedical Engineering, 1657 E. Helen Street, Building 240, P.O. Box 210240, Tucson, Arizona 85721
| | - Photini F. Rice
- University of Arizona, Biomedical Engineering, 1657 E. Helen Street, Building 240, P.O. Box 210240, Tucson, Arizona 85721
| | - Samuel L. Marion
- University of Arizona, Department of Physiology, Basic Sciences, Room 4122, 1501 N. Campbell Avenue, P.O. Box 245051, Tucson, Arizona 85724-5051
| | - Molly A. Brewer
- University of Connecticut Health Center, Carole and Ray Neag Comprehensive Cancer Center, Division of Gynecologic Oncology, 263 Farmington Avenue, MC 1614, Farmington, Connecticut 06030-2875
| | - John R. Davis
- University of Arizona, Department of Pathology, Tucson, Arizona
| | - Jeffrey J. Rodriguez
- University of Arizona, Electrical/Computer Engineering, P.O. Box 210104, Tucson, Arizona
| | - Urs Utzinger
- University of Arizona, Biomedical Engineering, 1657 E. Helen Street, Building 240, P.O. Box 210240, Tucson, Arizona 85721
| | - Patricia B. Hoyer
- University of Arizona, Department of Physiology, Basic Sciences, Room 4122, 1501 N. Campbell Avenue, P.O. Box 245051, Tucson, Arizona 85724-5051
| | - Jennifer K. Barton
- University of Arizona, Biomedical Engineering, 1657 E. Helen Street, Building 240, P.O. Box 210240, Tucson, Arizona 85721
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Schorge JO, Eisenhauer EE, Chi DS. Current surgical management of ovarian cancer. Hematol Oncol Clin North Am 2011; 26:93-109. [PMID: 22244664 DOI: 10.1016/j.hoc.2011.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgical management of ovarian cancer requires excellent judgment and mastery of a wide array of procedures. Involvement of a gynecologic oncologist improves outcomes. Staging of apparent stage I disease is important. Minimally invasive techniques provide advantages. Primary debulking surgery provides the best long-term survival of any strategy in advanced ovarian cancer. Aggressive surgical paradigms have the greatest success. Further cytoreductive surgery may be appropriate. Most relapsed patients require management of bowel obstruction at some point. Palliative intervention can enhance quality of life. Surgical correction may extend survival. For end-stage patients with progressive disease, the treating gynecologic oncologist must manage expectations.
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Affiliation(s)
- John O Schorge
- Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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