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Quintana-Bertó R, Padilla-Iserte P, Lago V, Tauste C, Díaz-Feijoo B, Cabrera S, Oliver-Pérez R, Coronado PJ, Martín-Salamanca MB, Pantoja-Garrido M, Marcos-Sanmartin J, Cazorla E, Lorenzo C, Rodríguez-Hernández JR, Roldán-Rivas F, Gilabert-Estellés J, Muruzábal JC, Cañada A, Domingo S. Endometrial cancer: predictors and oncological safety of tumor tissue manipulation. Clin Transl Oncol 2024; 26:1098-1105. [PMID: 37668932 DOI: 10.1007/s12094-023-03310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The main goal of this study is to assess the impact of tumor manipulation on the presence of lympho-vascular space invasion and its influence on oncological results. METHODS We performed a retrospective multi-centric study amongst patients who had received primary surgical treatment for apparently early-stage endometrial cancer. A multivariate statistical analysis model was designed to assess the impact that tumor manipulation (with the use of uterine manipulator or preoperative hysteroscopy) has on lympho-vascular development (LVSI) in the final surgical specimen. RESULTS A total of 2852 women from 15 centers were included and divided into two groups based on the lympho-vascular status in the final surgical specimen: 2265 (79.4%) had no LVSI and 587 (20.6%) presented LVSI. The use of uterine manipulator was associated with higher chances of lympho-vascular involvement regardless of the type used: Balloon manipulator (HR: 95% CI 4.64 (2.99-7.33); p < 0.001) and No-Balloon manipulator ([HR]: 95% CI 2.54 (1.66-3.96); p < 0.001). There is no evidence of an association between the use of preoperative hysteroscopy and higher chances of lympho-vascular involvement (HR: 95% CI 0.90 (0.68-1.19); p = 0.479). CONCLUSION Whilst performing common gynecological procedures, iatrogenic distention and manipulation of the uterine cavity are produced. Our study suggests that the use of uterine manipulator increases the rate of LVSI and, therefore, leads to poorer oncological results. Conversely, preoperative hysteroscopy does not show higher rates of LVSI involvement in the final surgical specimen and can be safely used.
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Affiliation(s)
- Raquel Quintana-Bertó
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain.
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Carmen Tauste
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Reyes Oliver-Pérez
- Gynecologic Oncology-Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Pluvio J Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC, University Complutense, Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, Sevilla, Spain
| | - Josefa Marcos-Sanmartin
- Department of Obstetrics and Gynecology, Dr. Balmis General University Hospital, Alicante, Spain
- Department of Public Health, Miguel Hernández University, Sant Joan d'Alacant, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Eduardo Cazorla
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, Alicante, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Nuestra Señora de La Calendaria, Santa Cruz de Tenerife, Spain
| | | | - Fernando Roldán-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of València, València, Spain
| | - Juan Carlos Muruzábal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Antonio Cañada
- Department of Biostatistics, Health Research Institute La Fe, València, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
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Lago V, Albert MM, Cruz MA, Guijarro Campillo RA, Padilla-Iserte P, Matute L, Gurrea M, Flor B, Domingo S. A restrictive stoma policy after colorectal anastomosis in ovarian cancer based on ghost ileostomy use. Eur J Surg Oncol 2024; 50:108325. [PMID: 38636248 DOI: 10.1016/j.ejso.2024.108325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The incidence of anastomotic leak after colorectal anastomosis in ovarian cancer has been reported to be much lower than that in colorectal cancer patients. Regarding the use of protective manoeuvres (diverting ileostomy) as suggested by clinical guidelines, the goal should be the implementation of a restrictive stoma policy for ovarian cancer patients, given the low rate of anastomotic leakage in this population. MATERIAL AND METHODS Patients who underwent cytoreduction surgery in a single centre (University Hospital La Fe, Valencia Spain) due to ovarian cancer between January 2010 and June 2023 were classified according to two groups: a non-restrictive stoma policy group (Group A) and a restrictive stoma policy group (Group B). RESULTS A total of 256 patients were included in the analysis (group A 52 % vs group B 48 %). The use of protective diverting ileostomy was lower in the restrictive stoma policy group (14 % vs 6.6 %), and the use of ghost ileostomy was 32 % vs 87 % in groups A and B, respectively (p < 0.00001). No differences were found in the anastomotic leak rate, which was 5.2 % in the non-restrictive group and 3.2 % in the restrictive stoma policy group (p = 0.54). CONCLUSION The use of a restrictive stoma policy based on the use of ghost ileostomy reduces the rate of diverting ileostomy in patients with ovarian cancer after colorectal resection and anastomosis. Furthermore, this policy is not associated with an increased rate of anastomotic leakage nor with an increased rate of morbi-mortality related to the leak.
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Affiliation(s)
- Víctor Lago
- Gynecologic Oncology Unit, University Hospital La Fe, Valencia, Spain; CEU Cardenal Herrera University, Valencia, Spain.
| | | | - Marta Arnaez Cruz
- Gynecologic Oncology Unit, University Hospital La Fe, Valencia, Spain
| | | | | | - Luis Matute
- Gynecologic Oncology Unit, University Hospital La Fe, Valencia, Spain
| | - Marta Gurrea
- Gynecologic Oncology Unit, University Hospital La Fe, Valencia, Spain
| | - Blas Flor
- Colorectal Surgery Unit, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Gynecologic Oncology Unit, University Hospital La Fe, Valencia, Spain
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Bebia V, Díaz-Feijoo B, Tejerizo Á, Torne A, Benito V, Hernández A, Gorostidi M, Domingo S, Bradbury M, Luna-Guibourg R, Gil-Moreno A. Patterns of First Recurrence and Oncological Outcomes in Locally Advanced Cervical Cancer Patients: Does Surgical Staging Play a Role? Cancers (Basel) 2024; 16:1423. [PMID: 38611101 PMCID: PMC11011205 DOI: 10.3390/cancers16071423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). METHODS This study was a multicenter observational retrospective cohort study of patients with LACC treated at tertiary care hospitals throughout Spain. The inclusion criteria were histological diagnosis of squamous carcinoma, adenosquamous carcinoma, and/or adenocarcinoma; FIGO stages IB2, IIA2-IVA (FIGO 2009); and planned treatment with primary chemoradiotherapy between 2000 and 2016. Propensity score matching (PSM) was performed before the analysis. RESULTS After PSM and sample replacement, 1092 patients were included for analysis (noPALND n = 546, PALND n = 546). Twenty-one percent of patients recurred during follow-up, with the PALND group having almost double the recurrences of the noPALND group (noPALND: 15.0%, PALND: 28.0%, p < 0.001). Nodal (regional) recurrences were more frequently observed in PALND patients (noPALND:2.4%, PALND: 11.2%, p < 0.001). Among those who recurred regionally, 57.1% recurred at the pelvic nodes, 37.1% recurred at the aortic nodes, and 5.7% recurred simultaneously at both the pelvic and aortic nodes. Patients who underwent a staging PALND were more frequently diagnosed with a distant recurrence (noPALND: 7.0%, PALND: 15.6%, p < 0.001). PALND patients presented poorer overall, cancer-specific, and disease-free survival when compared to patients in the noPALND group. CONCLUSION After treatment, surgically staged patients with LACC recurred more frequently and showed worse survival rates.
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Affiliation(s)
- Vicente Bebia
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
| | - Berta Díaz-Feijoo
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Aureli Torne
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08035 Barcelona, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mikel Gorostidi
- Department of Gynecology and Obstetrics, Hospital Universitario Donostia, 20014 San Sebastián, Spain;
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Melissa Bradbury
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
| | - Rocío Luna-Guibourg
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
- CIBERONC Centro de Investigación Biomédica en Red Cáncer, 08193 Madrid, Spain
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Lago V, Arnaez M, Padilla-Iserte P, Guijarro-Campillo AR, Matute L, Gurrea M, Bello P, Domingo S. Alternatives of the pelvic sentinel lymph node migration pathway in early ovarian cancer: the simplest the best. Int J Gynecol Cancer 2024; 34:639-640. [PMID: 37945057 DOI: 10.1136/ijgc-2023-004912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Victor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Comunitat Valenciana, Spain
| | - Marta Arnaez
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Luis Matute
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Marta Gurrea
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Bello
- Department of Nuclear Medicine, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Padilla-Iserte P, Iváñez M, Muruzabal JC, Navarro R, Díaz-Feijoo B, Iacoponi S, García-Pineda V, Díaz C, Utrilla-Layna J, Gil-Moreno A, Serra A, Gilabert-Estellés J, Martínez Canto C, Tejerizo Á, Lago V, Cárdenas-Rebollo JM, Domingo S. Oncological outcomes of intraperitoneal chemotherapy in advanced ovarian cancer: BRCA mutation role. Eur J Surg Oncol 2024; 50:108263. [PMID: 38492526 DOI: 10.1016/j.ejso.2024.108263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION The knowledge of BRCA status offers a chance to evaluate the role of the intraperitoneal route in patients selected by biomolecular profiles after primary cytoreduction surgery in advanced ovarian cancer. MATERIALS AND METHODS We performed a retrospective, multicenter study to assess oncological outcomes depending on adjuvant treatment (intraperitoneal [IP] vs intravenous [IV]) and BRCA status (BRCA1/2 mutated vs. BRCA wild type [WT]). The primary endpoint was to determine progression-free survival. The secondary objectives were overall survival and toxicity. RESULTS A total of 288 women from eight centers were included: 177 in the IP arm and 111 in the IV arm, grouped into four arms according to BRCA1/2 status. Significantly better PFS was observed in BRCA1/2-mutated patients with IP chemotherapy (HR: 0.35; 95% CI, 0.16-0.75, p = 0.007), which was not present in BRCA1/2-mutated patients with IV chemotherapy (HR: 0.65; 95% CI, 0.37-1.12, p = 0.14). Significantly better OS was also observed in IP chemotherapy (HR: 0.17; 95% CI, 0.06-043, p < 0.0001), but was not present in IV chemotherapy in relation with BRCA mutation (HR: 0.52; 95% CI, 0.22-1.27, p = 0.15). For BRCA WT patients, worse survival was observed regardless of the adjuvant route used. The IP route was more toxic compared to the IV route, but toxicity was equivalent at the long-term follow-up. CONCLUSION This retrospective study suggests that BRCA status can help to offer an individualized, systematic treatment after optimal primary surgery for advanced ovarian cancer, but is limited by the small sample size. Prospective trials are essential to confirm these results.
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Affiliation(s)
- Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Maria Iváñez
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Rafael Navarro
- Department of Gynecologic Oncology, MD Anderson Cancer Center Madrid, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Sara Iacoponi
- Department of Obstetrics and Gynaecology, University Quirónsalud Madrid Hospital, Spain
| | | | - Cristina Díaz
- Department of Gynecology, Valencian Institute of Oncology (IVO), Spain
| | | | - Antonio Gil-Moreno
- Gynecologic Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Biomèdica en Ginecologia-VHIR, CIBERONC, Barcelona, Spain
| | - Anna Serra
- Department of Obstetrics and Gynecology, Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of Valencia Spain, Spain
| | | | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación i+12, Universidad Complutense de Madrid, Spain
| | - Víctor Lago
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Santiago Domingo
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Padilla-Iserte P, Montesinos-Albert M, Arnaez M, Lago V, Frasson M, Matute L, Domingo S. Laparoscopic sigmoidectomy with ghost ileostomy in ovarian cancer recurrence. Int J Gynecol Cancer 2024; 34:641-642. [PMID: 37973362 DOI: 10.1136/ijgc-2023-004853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Affiliation(s)
- Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Marta Arnaez
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Victor Lago
- Department of Gynecologic Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain, Valencia, Spain
| | | | - Luis Matute
- Hospital Universitari i Politècnic La Fe, Valencia, Valenciana, Spain
| | - Santiago Domingo
- Department of Gynecology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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Sánchez-Iglesias JL, Morales-Coma C, Minig L, Lago V, Domingo S, Mancebo G, Siegrist J, Fidalgo García MS, Llueca A, Serra A, Cobas Lozano P, Lekuona Artola A, Gómez-Hidalgo NR, Acosta Ú, Ferrer-Costa R, Bradbury M, Pérez-Benavente A, Gil-Moreno A. Procalcitonin and C-reactive protein as early markers of anastomotic leakage in intestinal resections for advanced ovarian cancer (EDMOCS). Acta Obstet Gynecol Scand 2024. [PMID: 38532280 DOI: 10.1111/aogs.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Serum levels of procalcitonin and C-reactive protein (CRP) have been used to predict anastomotic leakage after colorectal surgery, but information is scarce in advanced ovarian cancer (AOC) surgery with bowel resection. This study aimed to assess the predictive value of procalcitonin and CRP in detecting anastomotic leakage after AOC surgery with bowel resection. The study also aimed to determine the optimal postoperative reference values and the best day for evaluating these markers. MATERIAL AND METHODS This prospective, observational and multicentric trial included 92 patients with AOC undergoing debulking surgery with bowel resection between 2017 and 2020 in 10 reference hospitals in Spain. Procalcitonin and CRP levels were measured at baseline and on postoperative days 1-6. Receiver operating characteristic analysis was performed to evaluate the predictive value of procalcitonin and CRP at each postoperative day. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Anastomotic leakage was detected in six patients (6.5%). Procalcitonin and CRP values were consistently higher in patients with anastomotic leakage at all postoperative days. The maximum area under the curve (AUC) for procalcitonin was observed at postoperative day 1 (AUC = 0.823) with a cutoff value of 3.8 ng/mL (83.3% sensitivity, 81.3% specificity). For CRP, the maximum AUC was found at postoperative day 3 (AUC = 0.833) with a cutoff level of 30.5 mg/dL (100% sensitivity, 80.4% specificity). CONCLUSIONS Procalcitonin and C-reactive protein are potential biomarkers for early detection of anastomotic leakage after ovarian cancer surgery with bowel resection. Further prospective studies with a larger sample size are needed to confirm these findings.
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Affiliation(s)
- José Luis Sánchez-Iglesias
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Morales-Coma
- Breast Pathology Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lucas Minig
- Department of Gynecologic Oncology, IMED Hospital, Valencia, Spain
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - Víctor Lago
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
- Department of Gynecologic Oncology, La Fe University Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University Hospital, Valencia, Spain
| | - Gemma Mancebo
- Gynecological Cancer Multidisciplinary Unit, Hospital del Mar, Barcelona, Spain
- Department of Gynecology, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jaime Siegrist
- Oncologic Gynecology Unit, Department of Gynecology, La Paz University Hospital, Madrid, Spain
| | | | - Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery, Hospital General Universitario de Castellon, Castellón, Spain
- Department of Medicine, Universidad Jaume I, Castellón, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery, Hospital General Universitario de Castellon, Castellón, Spain
- Department of Medicine, Universidad Jaume I, Castellón, Spain
| | - Paloma Cobas Lozano
- Department of Gynecologic Oncology, Hospital Universitario Donostia, OSI Donostialde, Donostia, Spain
| | - Arantza Lekuona Artola
- Department of Gynecologic Oncology, Hospital Universitario Donostia, OSI Donostialde, Donostia, Spain
| | | | - Úrsula Acosta
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Roser Ferrer-Costa
- Department of Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Melissa Bradbury
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Assumpció Pérez-Benavente
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Guijarro-Campillo AR, Padilla-Iserte P, Couso B, Erasun D, Utrilla-Layna J, Arencibia O, Boldo-Roda A, Gilabert-Estellés J, Veiga N, Lago V, Cárdenas-Rebollo JM, Domingo S. Accuracy of ICG compared with technetium-99 m for sentinel lymph node biopsy in vulvar cancer. Eur J Obstet Gynecol Reprod Biol 2024; 294:11-19. [PMID: 38183845 DOI: 10.1016/j.ejogrb.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Sentinel lymph node biopsy with radioactive tracer is the standard-of-care in lymph node status assessment in vulvar cancer. Indocyanine green fluorescence-ICG is a promising detection method, due to its advantages over technetium-99 m. In vulvar cancer, the procedure is controversial due to study heterogeneity and the small sample size in previous studies. This study evaluates ICG sentinel lymph node detection compared with the criterion-standard with technetium (dual modality method). METHODS Preoperative technetium and intraoperative ICG for sentinel lymph node have been prospectively evaluated in early-stage vulvar cancer. The primary endpoint was to determine accuracy in the detection rate for ICG compared with technetium. Secondary objectives included tracer modality relationship with obesity, tumor size and location. RESULTS In total, 75 patients participated at 8 centers; 38 had lateral and 37 had midline vulvar tumors. The overall sentinel lymph node detection rate was 85.3 % for technetium and 82.7 % for ICG. For lateral tumors, the detection rate was 84.2 % vs. 89.5 %, while it was 86.5 % vs. 75.7 % for middle tumors, using technetium and ICG, respectively. The median sentinel node harvest was 1.7 (range 1-4), with 24 % metastatic involvement. The sensitivity and positive predictive value for ICG based on the standard technique with technetium was 91.08 % (95 % CI, 83.76-95.84) and 94.8 % (95 % CI, 84.84-96.48), respectively. No significant differences were found comparing the two tracers in patients with midline lesions, obesity (body mass index ≥ 30) and tumor size ≥ 2-4 cm. CONCLUSION(S) ICG shows comparable performance parameters to the gold-standard of radioisotope localization.
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Affiliation(s)
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Bárbara Couso
- Department of Obstetrics and Gynecology, University Hospital of Ourense, Spain
| | - Diego Erasun
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Octavio Arencibia
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ana Boldo-Roda
- Department of Obstetrics and Gynecology, University Hospital La Plana, Villareal, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, University of Valencia, Spain
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Padilla-Iserte P, Domingo S. Correspondence on 'Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes' by Yoshida et al. Int J Gynecol Cancer 2024:ijgc-2024-005345. [PMID: 38395447 DOI: 10.1136/ijgc-2024-005345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Affiliation(s)
- Pablo Padilla-Iserte
- Department of Gynecologic Oncolgy, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncolgy, La Fe University and Polytechnic Hospital, Valencia, Spain
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11
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Guijarro-Campillo AR, Lago V, Pous-Serrano S, Domingo S. Conservative management of burst adbomen after interval cytoreduction surgery of ovarian carcinosarcoma. Int J Gynecol Cancer 2024:ijgc-2023-005013. [PMID: 38326227 DOI: 10.1136/ijgc-2023-005013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Affiliation(s)
| | - Victor Lago
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- CEU Cardenal Herrera University Library, Moncada, Comunidad Valenciana, Spain
| | | | - Santiago Domingo
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Lago V, Domingo S. Correspondence on "Sentinel lymph node biopsy in ovarian cancer: more questions than certainties" by Fagotti et al. Int J Gynecol Cancer 2023; 33:1989. [PMID: 37940338 DOI: 10.1136/ijgc-2023-005041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Affiliation(s)
- Victor Lago
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medicine, CEU Cardenal Herrera University, Moncada, Comunitat Valenciana, Spain
| | - Santiago Domingo
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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13
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Lago V, Pradillo Aramendi T, Segarra-Vidal B, Padilla-Iserte P, Matute L, Gurrea M, Pontones JL, Delgado F, Domingo S. Comparation between the Bricker ileal conduit vs double-barrelled wet colostomy after pelvic exenteration for gynaecological malignancies. Eur J Obstet Gynecol Reprod Biol 2023; 282:140-145. [PMID: 36716537 DOI: 10.1016/j.ejogrb.2023.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND After exhausting other therapeutic options, pelvic exenteration is performed in patients who suffer from relapsed gynaecologic tumours, with most of them requiring some sort of urinary diversion. MATERIAL AND METHODS The main objective of this study was to assess the short- and medium/long-term urinary complications associated with the Bricker ileal conduit versus double-barrelled wet colostomy after performing a pelvic exenteration for gynaecologic malignancies. RESULTS A total of 61 pelvic exenterations were identified between November 2010 and April 2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included in the urinary diversion analysis. Regarding the specific short-term urinary complications, no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific medium/long-term urinary complications. No differences in the rates of pyelonephritis (59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture (10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were found. CONCLUSIONS There are no significant differences in the rate of complications between double-barrelled wet colostomy and the Bricker ileal conduit. The long-term complications related to urinary diversion remained high regardless of the type of technique. In this context, the double-barrelled wet colostomy presents advantages such as the single stoma placement and the simplicity of the technique.
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Affiliation(s)
- Víctor Lago
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain; CEU Cardenal Herrera, Valencia, Spain.
| | | | | | | | - Luis Matute
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Marta Gurrea
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - José Luis Pontones
- Urologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Francisco Delgado
- Urologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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15
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Angeles MA, Lago V, Bizzarri N, Chantalat E, Abatini C, Frasson M, Martinez A, Domingo S, Fagotti A, Ferron G. Tips and tricks for ileostomy closure after diverting ileostomy for gynecological cancer surgery. Int J Gynecol Cancer 2023:ijgc-2022-004085. [PMID: 36635050 DOI: 10.1136/ijgc-2022-004085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Victor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain.,CEU Cardenal Herrera University, Valencia, Spain
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Elodie Chantalat
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Carlo Abatini
- General Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Matteo Frasson
- Department of Colorectal Unit, Hospital La Fe, Valencia, Spain
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
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Guijarro-Campillo AR, Kumar V, Patil J, Janna R, Domingo S. Modified Martius technique for complex vesicovaginal fistula repair. Int J Gynecol Cancer 2023:ijgc-2022-004131. [PMID: 36650012 DOI: 10.1136/ijgc-2022-004131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Veerendra Kumar
- Department of Obstetrics and Gynecology, Kalyandurg Hospital, Kalyandurg, Andra Pradesh, India
| | - Jayaprakash Patil
- Department of Obstetrics and Gynecology, Kalyandurg Hospital, Kalyandurg, Andra Pradesh, India
| | - Rakesh Janna
- Department of Urology, Bellary Medical College, Bellary, Karnataka, India
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Department of Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Lago V, Montesinos-Albert M, Segarra-Vidal B, Cuenca SM, Hidalgo JJ, Padilla-Iserte P, Ferri B, Juarez I, Domingo S. ECO-LEAK technique: early detection of colorectal anastomotic leakage by transvaginal ultrasound. Int J Gynecol Cancer 2022; 33:631-632. [PMID: 36410772 DOI: 10.1136/ijgc-2022-003886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Victor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- CEU Cardenal Herrera University, Valencia, Spain
| | - Manel Montesinos-Albert
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Blanca Segarra-Vidal
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Susana Martínez Cuenca
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Juan José Hidalgo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Blanca Ferri
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Irene Juarez
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Punzón-Jiménez P, Lago V, Domingo S, Simón C, Mas A. Molecular Management of High-Grade Serous Ovarian Carcinoma. Int J Mol Sci 2022; 23:13777. [PMID: 36430255 PMCID: PMC9692799 DOI: 10.3390/ijms232213777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
High-grade serous ovarian carcinoma (HGSOC) represents the most common form of epithelial ovarian carcinoma. The absence of specific symptoms leads to late-stage diagnosis, making HGSOC one of the gynecological cancers with the worst prognosis. The cellular origin of HGSOC and the role of reproductive hormones, genetic traits (such as alterations in P53 and DNA-repair mechanisms), chromosomal instability, or dysregulation of crucial signaling pathways have been considered when evaluating prognosis and response to therapy in HGSOC patients. However, the detection of HGSOC is still based on traditional methods such as carbohydrate antigen 125 (CA125) detection and ultrasound, and the combined use of these methods has yet to support significant reductions in overall mortality rates. The current paradigm for HGSOC management has moved towards early diagnosis via the non-invasive detection of molecular markers through liquid biopsies. This review presents an integrated view of the relevant cellular and molecular aspects involved in the etiopathogenesis of HGSOC and brings together studies that consider new horizons for the possible early detection of this gynecological cancer.
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Affiliation(s)
- Paula Punzón-Jiménez
- Carlos Simon Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Victor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
- Department of Obstetrics and Gynecology, CEU Cardenal Herrera University, 46115 Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, 46010 Valencia, Spain
| | - Carlos Simón
- Carlos Simon Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, 46010 Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Aymara Mas
- Carlos Simon Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
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Lago V, Albert MM, Segarra-vidal B, Padilla-Iserte P, Matute L, Gurrea M, Domingo S. 2022-VA-1435-ESGO ECO-LEAK: A Novell strategy for anastomotic leakage diagnosis in gynecologic cancer patients. Diagnostics (Basel) 2022. [DOI: 10.1136/ijgc-2022-esgo.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Lago V, Segarra-Vidal B, Cappucio S, Angeles MA, Fotopoulou C, Muallem MZ, Manzanedo I, Iglesias JLS, Chacón E, Padilla-Iserte P, Fagotti A, Ferron G, Kluge L, Vargiu V, Del M, Scambia G, Minig L, Tejerizo Á, Segovia MG, Cascales-Campos PA, Hervás D, Domingo S. OVA-LEAK: Prognostic score for colo-rectal anastomotic leakage in patients undergoing ovarian cancer surgery. Gynecol Oncol 2022; 167:22-27. [PMID: 36058743 DOI: 10.1016/j.ygyno.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the present study was to define and validate an anastomotic leak prognostic score based on previously described and reported anastomotic leak risk factors (OVA-LEAK: https://n9.cl/ova-leakscore) and to establish if the use of OVA-LEAK score is better than clinical criteria (surgeon's choice) selecting anastomosis to be protected with a diverting ileostomy. MATERIAL & METHODS This is a retrospective, multicentre cohort study that included patients who underwent cytoreductive surgery for primary advanced or relapsed ovarian cancer with colorectal resection and anastomosis between January 2011 and June 2021. Data from patients already included in the previous predictive model were not considered in the present analysis. To validate the performance of our logistic regression model, we used the OVA-LEAK formula (Annex I: https://n9.cl/ova-leakscore) for estimating leakage probabilities in a new independent cohort. Then, receiver operating characteristic (ROC) analysis was performed and area under the curve (AUC) was used to measure the performance of the model. Additionally, the Brier score was also estimated. 95% confidence intervals (CI) for each of the estimated performance measures were also calculated. RESULTS 848 out of 1159 recruited patients were finally included in the multivariable logistic regression model validation. The AUC of the new cohort was 0.63 for predicting anastomotic leak. Considering a cut-off point of 22.1% to be 'positive' (to get a leak) this would provide a sensitivity of 0.45, specificity of 0.80, positive predictive value of 0.09 and negative predictive value of 0.97 for anastomotic leak. If we consider this cut-off point to select patients at risk of leak for bowel diversion, up to 22.5% of the sampled patients would undergo a diverting ileostomy and 47% (18/40) of the anastomotic leaks would be 'protected' with the stoma. Nevertheless, if we consider only the 'clinical criteria' for performing or not a diverting ileostomy, only 12.5% (5/40) of the leaks would be 'protected' with a stoma, with a rate of diverting ileostomy of up to 24.3%. CONCLUSIONS Compared with subjective clinical criteria, the use of a predictive model for anastomotic leak improves the selection of patients who would benefit from a diverting ileostomy without increasing the rate of stoma use.
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Affiliation(s)
- Víctor Lago
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain; CEU Cardenal Herrera, Spain.
| | - Blanca Segarra-Vidal
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Serena Cappucio
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Christina Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - Mustafa Zelal Muallem
- Department of Gynecology with Centre for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Israel Manzanedo
- Department of General and Digestive Surgery, Peritoneal Carcinomatosis Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Enrique Chacón
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid, Navarre, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Luisa Kluge
- Department of Gynecology with Centre for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Virginia Vargiu
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucas Minig
- Department of Gynecology, IMED Hospitales, Valencia, Spain
| | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - David Hervás
- Department of Applied Statistics and Operational Research and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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Pérez-García A, García-Granero Á, Thione A, Frasson M, Sánchez-García A, Salmerón-González E, Simón E, Domingo S, García-Granero E. Extended vertical rectus abdominis myocutaneous flap for reconstruction of large pelviperineal defects following oncologic resection. J Surg Oncol 2022; 126:1383-1388. [PMID: 36003058 DOI: 10.1002/jso.27068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/14/2022] [Accepted: 08/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap is insufficient. We present our experience with eVRAM flap for pelviperineal reconstruction following oncologic resection. METHODS A retrospective study was conducted, including all the patients who underwent reconstruction with eVRAM flap after complex pelvic resection, between 2012 and 2020. EVRAM flap was indicated when traditional VRAM was considered deficient to cover or reach the skin defect or to fill the dead space. RESULTS Forty-four patients were included in the study. Successful reconstruction with eVRAM flap was achieved in 40 patients. There were three flap failures, and one patient died in the second postoperative day because of multiple organ failure. Perineal wound complications occurred in 17 patients (38.6%), eight of them requiring surgical reoperation. Donor site problems were present in five patients (11.4%), and only one patient required surgical closure because of a major dehiscence. CONCLUSIONS The authors found the eVRAM flap to be a useful and reliable flap for reconstruction of complex pelviperineal wounds, with a low rate of donor site morbidity.
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Affiliation(s)
- Alberto Pérez-García
- Department of Plastic Surgery and Burns, La Fe University Hospital, Valencia, Spain
| | | | - Alessandro Thione
- Department of Plastic Surgery and Burns, La Fe University Hospital, Valencia, Spain
| | - Matteo Frasson
- Department of General Surgery, La Fe University Hospital, Valencia, Spain
| | | | | | - Eduardo Simón
- Department of Plastic Surgery and Burns, La Fe University Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University Hospital, Valencia, Spain
| | - E García-Granero
- Department of General Surgery, La Fe University Hospital, Valencia, Spain
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Quintana-Bertó R, Padilla-Iserte P, Gil-Moreno A, Oliver-Pérez R, Coronado PJ, Martín-Salamanca MB, Pantoja-Garrido M, Lorenzo C, Beric D, Gilabert-Estellés J, Sánchez L, Roldán-Rivas F, Díaz-Feijoo B, Rodríguez-Hernández JR, Marcos-Sanmartin J, Muruzábal JC, Cañada A, Domingo S. Preoperative sampling in endometrial cancer: evaluation of the histopathological agreement with definitive surgical specimen. Clin Transl Oncol 2022; 24:2388-2394. [PMID: 35984612 DOI: 10.1007/s12094-022-02893-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/16/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The main goal of this study is to assess the diagnostic agreement between preoperative biopsy and definitive histology of the surgical specimen to determine which sampling method is most suitable for diagnosis of early-stage endometrial cancer. METHODS We performed a retrospective multicentric study to assess the correlation between three endometrial sampling methods (hysteroscopy, pipelle and D&C) in patients who had undergone preoperative endometrial biopsy and received primary surgical treatment for endometrial cancer. The primary objective was the agreement rate between hysteroscopy (HSC), endometrial biopsy (pipelle) and dilatation and curettage (D&C). RESULTS A total of 1833 women who underwent preoperative sampling at 15 centers were included: 1042 biopsies were performed by HSC, 703 by pipelle and 88 by D&C. All three methods presented a moderate diagnostic concordance (κ = 0.40-0.61) with the definitive specimen's histology: HSC (κ = 0.47), pipelle sampling (κ = 0.48) and D&C (κ = 0.48). Likewise, a subgroup analysis was performed by histological subtype comparing HSC and endometrial biopsy, showing that neither is superior as a diagnostic method. CONCLUSIONS According to this study, the use of pipelle sampling could become an adequate diagnostic method in endometrial cancer due to its similar agreement to HSC, ease of use and affordability.
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Affiliation(s)
- Raquel Quintana-Bertó
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Av. Abril Martorell, 106, 46026, Valencia, Spain.
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Av. Abril Martorell, 106, 46026, Valencia, Spain
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Reyes Oliver-Pérez
- Gynecologic Oncology-Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Pluvio J Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC University Complutense, Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, Seville, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology. Hospital, Nuestra Señora de la Calendaria, Tenerife, Spain
| | - Duska Beric
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, Alicante, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of València, València, Spain
| | - Lourdes Sánchez
- Gynaecology and Obstetrics Department, University General Hospital of Ciudad Real, Castilla-La Mancha, Spain
| | - Fernando Roldán-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | - Juan Carlos Muruzábal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Antonio Cañada
- Department of Biostatistics, Health Research Institute La Fe, València, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Av. Abril Martorell, 106, 46026, Valencia, Spain
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Quintana-Bertó R, Padilla-Iserte P, Gil-Moreno A, Oliver-Pérez R, Coronado PJ, Martín-Salamanca MB, Pantoja-Garrido M, Lorenzo C, Cazorla E, Gilabert-Estellés J, Sánchez L, Roldán-Rivas F, Díaz-Feijoo B, Rodríguez-Hernández JR, Marcos-Sanmartin J, Muruzábal JC, Cañada A, Domingo S. Oncological safety of hysteroscopy in endometrial cancer. Int J Gynecol Cancer 2022; 32:ijgc-2022-003586. [PMID: 35882425 DOI: 10.1136/ijgc-2022-003586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE It has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The goal of this study was to assess the oncological safety comparing hysteroscopy to Pipelle blind biopsy in the presurgical diagnosis of patients with endometrial cancer. METHODS We performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis. RESULTS A total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76). CONCLUSION Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.
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Affiliation(s)
- Raquel Quintana-Bertó
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Reyes Oliver-Pérez
- Gynecologic Oncology-Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute, Madrid, Spain
| | - Pluvio J Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC University Complutense, Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, Seville, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Nuestra Señora de la Calendaria, Tenerife, Spain
| | - Eduardo Cazorla
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, Torrevieja, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of València, València, Spain
| | - Lourdes Sánchez
- Gynaecology and Obstetrics Department, University General Hospital of Ciudad Real, Castilla la Mancha, Spain
| | - Fernando Roldán-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | - Juan Carlos Muruzábal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Antonio Cañada
- Department of Biostatistics, Health Research Institute La Fe València Spain, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
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Díaz-Feijoo B, Agusti N, Sebio R, Sisó M, Carreras-Dieguez N, Domingo S, Díaz-Cambronero O, Torne A, Martinez-Palli G, Arguís MJ. A multimodal prehabilitation program for the reduction of post-operative complications after surgery in advanced ovarian cancer under an ERAS pathway: a randomized multicenter trial (SOPHIE). Int J Gynecol Cancer 2022; 32:ijgc-2022-003652. [PMID: 35793862 DOI: 10.1136/ijgc-2022-003652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Multimodal prehabilitation programs that combine exercise training, nutritional support, and optimize psychological status have demonstrated efficacy in reducing post-operative complications in non-gynecological abdominal surgeries; however, the benefit in advanced ovarian cancer is unclear. PRIMARY OBJECTIVE To compare the post-operative complications of a multimodal prehabilitation program in patients undergoing cytoreductive surgery for advanced ovarian cancer with standard pre-operative care. STUDY HYPOTHESIS Multimodal prehabilitation reduces post-operative complications in patients undergoing cytoreductive surgery for advanced ovarian cancer and subsequently reduces the length of hospital stay and time to initiation of adjuvant therapy. TRIAL DESIGN This prospective, multi-institutional, randomized clinical trial will randomize candidates for surgery to either the standard of care or multimodal prehabilitation consisting of (1) 2- or 3-weekly supervised high-intensity resistance training sessions and promotion of physical activity through a mobile phone application; (2) respiratory physiotherapy; (3) nutrition counseling with supplementation as needed; and (4) weekly psychological and cognitive behavioral sessions. Baseline, pre-operative and 1 month post-operative data will be collected. An independent blinded evaluator will collect intra- and post-operative surgical data. MAJOR INCLUSION/EXCLUSION CRITERIA Women with advanced ovarian cancer International Federation of Gynecology and Obstetrics (2014) stage III or IV scheduled to undergo primary debulking surgery, interval debulking surgery,or secondary or tertiary cytoreductive surgery will be included. Women are eligible if they are able to undergo a minimum of 2 weeks of prehabilitation prior to surgery. Patients with <75% adherence to the total program will be excluded. PRIMARY ENDPOINT Post-operative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery according to the Comprehensive Complication Index. SAMPLE SIZE 146 patients will be included, 73 in each group. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Accrual should be completed in December 2024 with results reported soon thereafter. TRIAL REGISTRATION NUMBER NCT04862325.
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Affiliation(s)
- Berta Díaz-Feijoo
- Hospital Clinic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Department of Gynecologic Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Nuria Agusti
- Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Gynecologic Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raquel Sebio
- Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Rehabilitation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marina Sisó
- Hospital Clinic de Barcelona, Barcelona, Spain
- Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Núria Carreras-Dieguez
- Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Gynecologic Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Santiago Domingo
- Gynaecology, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Oscar Díaz-Cambronero
- Department of Anesthesiology and Critical Care, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Aureli Torne
- Hospital Clinic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Department of Gynecologic Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Graciela Martinez-Palli
- Hospital Clinic de Barcelona, Barcelona, Spain
- Anaesthesiology and Intensive Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ma José Arguís
- Hospital Clinic de Barcelona, Barcelona, Spain
- Anaesthesiology and Intensive Care, Hospital Clinic de Barcelona, Barcelona, Spain
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Domingo S, Solé-Marcé C, Moline T, Ferrer B, Cortés-Hernández J. POS0135 DOWNREGULATION OF miR-885-5p AS A KEY EFFECTOR IN CUTANEOUS LUPUS ERYTHEMATOSUS PATHOGENESIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSkin involvement is common in systemic lupus erythematosus (SLE), with up to 70% of patients developing skin lesions at some point during the course of their disease. Moreover, cutaneous lesions are the first sign of systemic disease in 20% of SLE patients [1]. Skin requires a regulated and undisrupted miRNA profile for a correct development and function. Studies show that miRNAs play a pathogenic role in autoimmune skin diseases such as Psoriasis [2]. Understanding of the role of deregulated miRNAs in CLE may enhance our knowledge about CLE pathogenesis which is currently not understood.ObjectivesIdentify differentially expressed miRNAs in skin lesions to determine their role in CLE pathogenesis.MethodsPaired skin biopsies from CLE lesional (n=20) and non-lesional skin (n=20) were obtained. MiRNA microarray screening was performed using TaqMan MicroRNA Array. Validation was performed in a new cohort of FFPE skin samples by qRT-PCR (n=20). In situ hybridization was performed to identify the skin cell type involved in selected miRNAs. Next, in vitro experiments using primary skin and immune cells were performed in order to discover their role in CLE pathogenesis. A microarray screening and luciferase assay were performed to find miR-885-5p altered gene expression, molecular pathways and target genes.ResultsMiR-885-5p was found downregulated in CLE lesional skin (-4.45 fold, pvalue<0,01, respectively). Results were confirmed in a validation cohort. In situ hybridization revealed miR-885-5p was located in the epidermal keratinocytes in CLE non-lesional skin. Healthy keratinocytes presented an increased miR-885-5p expression compared with other relevant cell types such as fibroblasts (p<0.001) or PBMCs (p<0.001). Moreover stimulation with IFNα and UVB promoted a marked long-lasting downregulation of miR-885-5p (IFNα, 24h -67 fold (p<0.001); UVB, 24h -70 fold (p<0.001)).Gene microarray of anti-miR-885-5p keratinocytes showed that the unique gene that was upregulated in all anti-miR-885-5p conditions was PSMB5. In vitro experiments demonstrated that PSMB5 is a direct target of miR-885-5p (74% of reduction p<0.001) and it is involved in epidermal inflammation by enhancing NFKB and inflammatory cytokines IL-1β, TNFα and CXCL8. In addition, we observed immune recruitment in UVB stimulated anti-miR885-5p keratinocytes and we found that this immune migration is mediated via miR-885-5p direct binding of TRAF1 and subsequent chemokine CCL5, CCL20, CXCL8 and S100A7 secretion.ConclusionOur findings demonstrate that CLE lesions present a downregulation of miR-885-5p that is strongly implicated in CLE pathogenesis. Moreover, miRNA applicability as therapeutics makes the discovered miRNAs promising candidates for novel therapy in CLE, as there is a need to develop new therapies for refractory cases and to avoid current treatment significant side effects.References[1]Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. 2013; 27(3):391-404.[2]Sonkoly E et al. MicroRNAs: novel regulators involved in the pathogenesis of psoriasis? PLoS One. 2007. 11;2(7):e610.Disclosure of InterestsNone declared
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Domingo S, Balasubbaiah Y, Nyndala S, Garcia I, Barahona M. Surgical training and cervical screening in rural India hospitals. Int J Gynecol Cancer 2022; 32:1475-1476. [PMID: 35387892 DOI: 10.1136/ijgc-2022-003534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Santiago Domingo
- Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | | | - Irene Garcia
- Gynecology, RDT Hospital, Anantapur, Andhra Pradesh, India
| | - Manel Barahona
- Hospital Universitario de Puerto Real, Puerto Real, Andalucía, Spain
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Machado-Lopez A, Alonso R, Lago V, Jimenez-Almazan J, Garcia M, Monleon J, Lopez S, Barcelo F, Torroba A, Ortiz S, Domingo S, Simon C, Mas A. Integrative Genomic and Transcriptomic Profiling Reveals a Differential Molecular Signature in Uterine Leiomyoma versus Leiomyosarcoma. Int J Mol Sci 2022; 23:ijms23042190. [PMID: 35216305 PMCID: PMC8877247 DOI: 10.3390/ijms23042190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
The absence of standardized molecular profiling to differentiate uterine leiomyosarcomas versus leiomyomas represents a current diagnostic challenge. In this study, we aimed to search for a differential molecular signature for these myometrial tumors based on artificial intelligence. For this purpose, differential exome and transcriptome-wide research was performed on histologically confirmed leiomyomas (n = 52) and leiomyosarcomas (n = 44) to elucidate differences between and within these two entities. We identified a significantly higher tumor mutation burden in leiomyosarcomas vs. leiomyomas in terms of somatic single-nucleotide variants (171,863 vs. 81,152), indels (9491 vs. 4098), and copy number variants (8390 vs. 5376). Further, we discovered alterations in specific copy number variant regions that affect the expression of some tumor suppressor genes. A transcriptomic analysis revealed 489 differentially expressed genes between these two conditions, as well as structural rearrangements targeting ATRX and RAD51B. These results allowed us to develop a machine learning approach based on 19 differentially expressed genes that differentiate both tumor types with high sensitivity and specificity. Our findings provide a novel molecular signature for the diagnosis of leiomyoma and leiomyosarcoma, which could be helpful to complement the current morphological and immunohistochemical diagnosis and may lay the foundation for the future evaluation of malignancy risk.
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Affiliation(s)
- Alba Machado-Lopez
- Igenomix Foundation, INCLIVA Biomedical Research Institute, 46980 Valencia, Spain; (A.M.-L.); (R.A.)
| | - Roberto Alonso
- Igenomix Foundation, INCLIVA Biomedical Research Institute, 46980 Valencia, Spain; (A.M.-L.); (R.A.)
- Research and Development Department, Igenomix SL, 46980 Paterna, Spain; (J.J.-A.); (M.G.)
| | - Victor Lago
- Gynecologic Oncology Department, University Hospital La Fe, 46026 Valencia, Spain; (V.L.); (S.D.)
| | - Jorge Jimenez-Almazan
- Research and Development Department, Igenomix SL, 46980 Paterna, Spain; (J.J.-A.); (M.G.)
| | - Marta Garcia
- Research and Development Department, Igenomix SL, 46980 Paterna, Spain; (J.J.-A.); (M.G.)
| | - Javier Monleon
- Department of Obstetrics and Gynecology, Hospital Universitario La Fe, 46026 Valencia, Spain;
| | - Susana Lopez
- Department of Pathology, Hospital Universitario La Fe, 46026 Valencia, Spain;
| | - Francisco Barcelo
- Department of Gynecology and Obstetrics, Gynecology Oncology Unit, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Amparo Torroba
- Pathology Service, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Sebastian Ortiz
- Department of Pathology, Complejo Hospitalario de Cartagena, 30202 Murcia, Spain;
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, 46026 Valencia, Spain; (V.L.); (S.D.)
| | - Carlos Simon
- Igenomix Foundation, INCLIVA Biomedical Research Institute, 46980 Valencia, Spain; (A.M.-L.); (R.A.)
- Department of Obstetrics and Gynecology, Universidad de Valencia, 46010 Valencia, Spain
- Department of Obstetrics and Gynecology, BIDMC, Harvard University, Boston, MA 02215, USA
- Correspondence: (C.S.); (A.M.); Tel.: +34-963-90-53-10 (C.S. and A.M.)
| | - Aymara Mas
- Igenomix Foundation, INCLIVA Biomedical Research Institute, 46980 Valencia, Spain; (A.M.-L.); (R.A.)
- Correspondence: (C.S.); (A.M.); Tel.: +34-963-90-53-10 (C.S. and A.M.)
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Lago V, Marina T, Laseca Modrego M, Gil-Ibañez B, Rodriguez JR, Domingo J, Minig L, Padilla-Iserte P, Arencibia Sánchez O, Sala Ferichola M, Munmanny M, Martín Salamanca B, Iacoponi S, Cabrera S, Coronado P, Utrilla-Layna J, Bataller Á, Fiol G, Corbalán S, Espinosa E, Gil-Moreno A, Domingo S. Fertility sparing treatment in patients with endometrial cancer (FERT-ENC): a multicentric retrospective study from the Spanish Investigational Network Gynecologic Oncology Group (SPAIN-GOG). Arch Gynecol Obstet 2022; 306:821-828. [PMID: 35122158 DOI: 10.1007/s00404-021-06375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The primary objective was to evaluate the response rate of conservative treatment for endometrial cancer, and the secondary objective was to assess oncological, fertility and obstetric outcomes in patients who underwent fertility preservation treatment. MATERIAL AND METHODS This multicentre, observational, retrospective study evaluated endometrial cancer patients who underwent fertility-sparing treatment in Spanish centres between January 2010 and January 2020. Seventy-three patients with stage IA endometrioid adenocarcinoma of the uterus were included in the study. RESULTS The levonorgestrel intrauterine device (LNG-IUD) was the most common fertility-sparing treatment (53.4%), followed by megestrol acetate (20.5%) and medroxyprogesterone acetate (16.4%). During the 24-month follow-up period, the rate of complete response to fertility-sparing management was 74% (n = 54), and 8.2% (n = 6) of patients presented a partial response. Additionally, 13 (17.8%) patients presented with persistent disease and six (8.2%) relapsed after response. The LNG-IUD was associated with a higher complete response rate than the other methods (87.2 vs. 58.8%; p = 0.01). Surgical treatment (at least hysterectomy) was performed in 44 (60.3%) patients as the end of fertility-sparing treatment. Four (5.5%) patients presented relapse after surgery, associated with final FIGO stage III (p = 0.036), myometrial invasion > 50% (p = 0.018) and final tumour grade 2-3 (p = 0.018). The mean follow-up period was 57.8 (range 6-159) months. The 5-year relapse-free survival and overall survival rates were 92.6% [95% CI (81.3, 97.2)] and 93.5% [95% CI (80.7, 97.9)], respectively. During follow-up, three patients (4.1%) died of the disease after completion of surgical treatment. Up to 50.7% of patients included in the study attempted to get pregnant. Of these, the rate of pregnancy was 81.1% (n = 30/37), and reproductive techniques were used for this purpose in 78.4% of cases. CONCLUSIONS Fertility-sparing management presented a high response rate in patients with endometrial cancer. LNG-IUD was associated with a better response rate compared to the other treatment options. Moreover, in patients using this management method, pregnancy could be achieved using reproductive techniques.
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Affiliation(s)
- Víctor Lago
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
| | - Tiermes Marina
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.,Obstetrics and Gynecology Department, Clinic University Hospital, Barcelona, Spain
| | - María Laseca Modrego
- Gynecologic Oncology Department, Maternal and Child University Hospital of the Canarias, Canari Island, Spain
| | - Blanca Gil-Ibañez
- Gynecologic Oncology Department, University Hospital, 12 de Octubre, Madrid, Spain
| | - José Ramón Rodriguez
- Obstetrics and Gynecology Department, Clinic and University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Lucas Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | | | - Octavio Arencibia Sánchez
- Gynecologic Oncology Department, Maternal and Child University Hospital of the Canarias, Canari Island, Spain
| | - Manuela Sala Ferichola
- Obstetrics and Gynecology Department, General University Hospital of Alicante, Alicante, Spain
| | - Merixell Munmanny
- Obstetrics and Gynecology Department, Clinic University Hospital, Barcelona, Spain
| | | | - Sara Iacoponi
- Gynecologic Oncology Department, Hospital Quironsalud Madrid, Madrid, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Department, University Hospital Vall d´Hebron, Barcelona, Spain
| | - Pluvio Coronado
- Obstetrics and Gynecology Department, Clinic University Hospital San Carlos, Madrid, Spain
| | | | - Águeda Bataller
- Obstetrics and Gynecology Department, University Hospital of La Rivera, Alzira, Spain
| | - Gabriel Fiol
- Gynecologic Oncology Department, University Hospital Torrecárdenas, Almeria, Spain
| | - Shiana Corbalán
- Obstetrics and Gynecology Department, University Hospital Los Arcos, Murcia, Spain
| | | | - Antonio Gil-Moreno
- Gynecologic Oncology Department, University Hospital Vall d´Hebron, Barcelona, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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Lago V, Sala Climent L, Segarra-Vidal B, Frasson M, Flor B, Domingo S. Ghost ileostomy: prevention, diagnosis, and early treatment of colorectal anastomosis leakage in advanced ovarian cancer. Int J Gynecol Cancer 2021; 32:109-110. [PMID: 34785523 DOI: 10.1136/ijgc-2021-003060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Victor Lago
- Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | | | - Matteo Frasson
- Department of Colorectal Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Blas Flor
- Department of Colorectal Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Domingo S, Marina T. Left upper abdomen: surgical anatomy. Int J Gynecol Cancer 2021; 31:1190-1191. [PMID: 34341135 DOI: 10.1136/ijgc-2020-002332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Santiago Domingo
- Gynecologic Oncology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Tiermes Marina
- Gynecologic Oncology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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Díaz-Feijoo B, Acosta Ú, Torné A, Gil-Ibáñez B, Hernández A, Domingo S, Gil-Moreno A. Laparoscopic Debulking of Enlarged Pelvic Nodes during Surgical Para-aortic Staging in Locally Advanced Cervical Cancer: A Retrospective Comparative Cohort Study. J Minim Invasive Gynecol 2021; 29:103-113. [PMID: 34217852 DOI: 10.1016/j.jmig.2021.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE To evaluate laparoscopic pelvic lymph node debulking during extraperitoneal aortic lymphadenectomy in diagnosis, therapeutic planning, and prognosis of patients with locally advanced cervical cancer and enlarged lymph nodes on imaging before chemoradiotherapy. DESIGN Retrospective, multicenter, comparative cohort study. SETTING The study was carried out at 11 hospitals with specialized gynecologic oncology units in Spain. PATIENTS Total of 381 women with locally advanced cervical cancer and International Federation of Gynecology and Obstetrics 2018 stage IIIC 1r (radiologic) and higher who received primary treatment with chemoradiotherapy. INTERVENTIONS Patients underwent pelvic lymph node debulking and para-aortic lymphadenectomy (group 1), only para-aortic lymphadenectomy (group 2), or no lymph node surgical staging (group 3). On the basis of pelvic node histology, group 1 was subdivided as negative (group 1A) or positive (group 1B). MEASUREMENTS AND MAIN RESULTS False positives and negatives of imaging tests, disease-free survival, overall survival, and postoperative complications were evaluated. In group 1, pelvic lymph node involvement was 43.3% (71 of 164), and aortic involvement was 24.4% (40 of 164). In group 2, aortic nodes were positive in 29.7% (33 of 111). Disease-free survival and overall survival were similar in the 3 groups (p = .95) and in groups 1A and 1B (p = .25). No differences were found between groups 1 and 2 in intraoperative (3.7% vs 2.7%, p = .744), early postoperative (8.0% vs 6.3%, p = .776), or late postoperative complications (6.1% vs 2.7%, p = .252). Fewer early and late complications were attributed to radiotherapy in group 1A than in the others (p = .022). CONCLUSION Laparoscopic pelvic lymph node debulking during para-aortic staging surgery in patients with locally advanced cervical cancer with suspicious nodes allows for the confirmation of metastatic lymph nodes without affecting survival or increasing surgical complications. This information improves the selection of patients requiring boost irradiation, thus avoiding overtreatment of patients with negative nodes.
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Affiliation(s)
- Berta Díaz-Feijoo
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic de Barcelona, Institut d ́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine - University of Barcelona (Drs. Díaz-Feijoo and Torné).
| | - Úrsula Acosta
- Service of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (Drs. Acosta and Gil-Moreno), Barcelona
| | - Aureli Torné
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic de Barcelona, Institut d ́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine - University of Barcelona (Drs. Díaz-Feijoo and Torné)
| | - Blanca Gil-Ibáñez
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre (Dr. Gil-Ibáñez), Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz (Dr. Hernández)
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia (Dr. Domingo), Spain
| | - Antonio Gil-Moreno
- Service of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (Drs. Acosta and Gil-Moreno), Barcelona; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC (Dr. Gil-Moreno), Madrid
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Cabrera S, Barahona-Orpinell M, Almansa-González C, Padilla-Iserte P, Bebia V, Martí L, Tejerizo-García Á, Domingo S, Gil-Moreno A. Combined use of ICG and technetium does not improve sentinel lymph node detection in endometrial cancer: Results of the COMBITEC study. Gynecol Oncol 2021; 162:32-37. [PMID: 33992451 DOI: 10.1016/j.ygyno.2021.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There is scarce evidence available about the benefit of combining technetium (99mTc) and indocyanine green (ICG) for sentinel lymph node (SLN) biopsy in endometrial cancer. The aim of this study was to compare the overall and bilateral pelvic detection rates of SLNs in two retrospective cohorts: ICG exclusive vs. combined ICG+99mTc. METHODS The COMBITEC study (COMBined ICG and Technetium for SLN detection in Endometrial Cancer) consisted of a multicentre retrospective study (February 2015-June 2020) including patients diagnosed with endometrial atypical hyperplasia or early-stage endometrial carcinoma who underwent SLN biopsy by cervical injection of ICG with or without 99mTc in four different referral centers in Spain. RESULTS A total of 180 patients were included, 51% (n = 92) in ICG group and 49% (n = 88) in ICG+99mTc group. Eighty-seven percent of the patients presented endometrioid histology, and over 99% of the procedures were performed by a minimally invasive approach. Both groups were comparable regarding their basal characteristics, except for a higher body mass index in ICG+99mTc group and a bigger proportion of robotic-assisted procedures in ICG group. Overall detection rate was 92.8% without significant differences between groups (ICG: 94.6% vs ICG+99mTc: 90.9%, p = .34). No significant differences were observed neither in bilateral pelvic nor aortic mapping rate. When 99mTc was used, surgical procedures were significantly longer. In 7.3% of mapped patients, at least one positive SLN was found (ICG: 10.3% vs ICG+99mTc: 3.9%, p = .109). Empty node packet rates and number of SLNs retrieved per patient were also similar between cohorts. CONCLUSION Combining preoperative 99mTc to intraoperative ICG did not improve SLN detection in endometrial cancer, but resulted in longer procedures.
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Affiliation(s)
- Silvia Cabrera
- Gynecologic Oncology Unit, University Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus and Autonomous University of Barcelona (UAB), Spain.
| | | | | | | | - Vicente Bebia
- Gynecologic Oncology Unit, University Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus and Autonomous University of Barcelona (UAB), Spain
| | - Lola Martí
- Gynecologic Oncology Unit, University Hospital of Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Santiago Domingo
- Gynecologic Oncology Unit, University Hospital La Fe, Valencia, Spain
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, University Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus and Autonomous University of Barcelona (UAB), Spain; CIBERONC, Barcelona, Spain
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Rodríguez-Ortega A, Alegre A, Lago V, Carot-Sierra JM, Ten-Esteve A, Montoliu G, Domingo S, Alberich-Bayarri Á, Martí-Bonmatí L. Machine Learning-Based Integration of Prognostic Magnetic Resonance Imaging Biomarkers for Myometrial Invasion Stratification in Endometrial Cancer. J Magn Reson Imaging 2021; 54:987-995. [PMID: 33793008 DOI: 10.1002/jmri.27625] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Estimation of the depth of myometrial invasion (MI) in endometrial cancer is pivotal in the preoperatively staging. Magnetic resonance (MR) reports suffer from human subjectivity. Multiparametric MR imaging radiomics and parameters may improve the diagnostic accuracy. PURPOSE To discriminate between patients with MI ≥ 50% using a machine learning-based model combining texture features and descriptors from preoperatively MR images. STUDY TYPE Retrospective. POPULATION One hundred forty-three women with endometrial cancer were included. The series was split into training (n = 107, 46 with MI ≥ 50%) and test (n = 36, 16 with MI ≥ 50%) cohorts. FIELD STRENGTH/SEQUENCES Fast spin echo T2-weighted (T2W), diffusion-weighted (DW), and T1-weighted gradient echo dynamic contrast-enhanced (DCE) sequences were obtained at 1.5 or 3 T magnets. ASSESSMENT Tumors were manually segmented slice-by-slice. Texture metrics were calculated from T2W and ADC map images. Also, the apparent diffusion coefficient (ADC), wash-in slope, wash-out slope, initial area under the curve at 60 sec and at 90 sec, initial slope, time to peak and peak amplitude maps from DCE sequences were obtained as parameters. MR diagnostic models using single-sequence features and a combination of features and parameters from the three sequences were built to estimate MI using Adaboost methods. The pathological depth of MI was used as gold standard. STATISTICAL TEST Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy, positive predictive value, negative predictive value, precision and recall were computed to assess the Adaboost models performance. RESULTS The diagnostic model based on the features and parameters combination showed the best performance to depict patient with MI ≥ 50% in the test cohort (accuracy = 86.1% and AUROC = 87.1%). The rest of diagnostic models showed a worse accuracy (accuracy = 41.67%-63.89% and AUROC = 41.43%-63.13%). DATA CONCLUSION The model combining the texture features from T2W and ADC map images with the semi-quantitative parameters from DW and DCE series allow the preoperative estimation of myometrial invasion. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alejandro Rodríguez-Ortega
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alberto Alegre
- Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Víctor Lago
- Gynecologic Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Miguel Carot-Sierra
- Universitat Politècnica de València. Department of Applied Statistics, Operations Research and Quality, Valencia, Spain
| | - Amadeo Ten-Esteve
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Guillermina Montoliu
- Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - Luis Martí-Bonmatí
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Gil-Moreno A, Alonso-Alconada L, Díaz-Feijoo B, Domingo S, Vilar A, Hernández A, Gilabert J, Llueca A, Torné A, de Santiago J, Carbonell-Socias M, Lago V, Arias E, Sampayo V, Siegrist J, Chipirliu A, Sánchez-Iglesias JL, Pérez-Benavente A, Padilla-Iserte P, Santacana M, Matias-Guiu X, Abal M, Lopez-Lopez R. M-TRAP: Safety and performance of metastatic tumor cell trap device in advanced ovarian cancer patients. Gynecol Oncol 2021; 161:681-686. [PMID: 33795131 DOI: 10.1016/j.ygyno.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite radical surgery and chemotherapy, most patients with ovarian cancer die due to disease progression. M-Trap is an implantable medical device designed to capture peritoneal disseminated tumor cells with the aim to focalize the disease. This trial analyzed the safety and performance of the device. METHODS This first-in-human prospective, multi-center, non-blinded, single-arm study enrolled 23 women with high-grade serous advanced ovarian cancer. After primary or interval debulking surgery, 3 M-Trap devices were placed in the peritoneum of the abdominal cavity. 18-months post-implantation or at disease progression, devices were initially removed by laparoscopy. The primary safety endpoint was freedom from device and procedure-related major adverse events (MAEs) through 6-months post-implantation compared to an historical control. The primary performance endpoint was histopathologic evidence of tumor cells capture. RESULTS Only one major adverse event was attributable to the device. 18 women were free of device and procedure related MAEs (78.3%). However, the primary safety endpoint was not achieved (p = 0.131), primarily attributable to the greater surgical complexity of the M-Trap patient population. 62% of recurrent patients demonstrated tumor cell capture in at least one device with a minimal tumor cell infiltration. No other long-term device-related adverse events were reported. The secondary performance endpoint demonstrated a lack of disease focalization. CONCLUSIONS The M-Trap technology failed to meet its primary safety objective, although when adjusted for surgical complexity, the study approved it. Likewise, the devices did not demonstrate the anticipated benefits in terms of tumor cell capture and disease focalization in recurrent ovarian cancer.
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Affiliation(s)
- Antonio Gil-Moreno
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain.
| | | | - Berta Díaz-Feijoo
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana Vilar
- Department of Gynecology, University Hospital of Santiago de Compostela, Spain
| | - Alicia Hernández
- Department of Gynecology, University Hospital La Paz, Madrid, Spain
| | - Juan Gilabert
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Antoni Llueca
- Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, Castelló de la Plana, Spain
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | - Melchor Carbonell-Socias
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Víctor Lago
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Efigenia Arias
- Department of Gynecology, University Hospital of Santiago de Compostela, Spain
| | - Victoria Sampayo
- Department of Gynecology, University Hospital of Santiago de Compostela, Spain
| | - Jaime Siegrist
- Department of Gynecology, University Hospital La Paz, Madrid, Spain
| | - Anca Chipirliu
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Jose Luis Sánchez-Iglesias
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Assumpció Pérez-Benavente
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Maria Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - Miguel Abal
- Nasasbiotech, S.L., A Coruña, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), CIBERONC, Santiago de Compostela, Spain
| | - Rafael Lopez-Lopez
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), CIBERONC, Santiago de Compostela, Spain.
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Lago V, Montero B, López S, Padilla-Iserte P, Matute L, Marina T, Gurrea M, Montoliu G, Bello P, Domingo S. Ultrastaging protocol in sentinel lymph node for apparent early stage ovarian cancer. Gynecol Oncol 2021; 161:408-413. [PMID: 33712275 DOI: 10.1016/j.ygyno.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the present study is to determine the role of sentinel lymph node (SLN) ultrastaging in apparent early-stage ovarian cancer. METHODS We previously demonstrated the feasibility of SLN in early-stage ovarian cancer in a pilot study and in a clinical trial (NCT03452982). The SLN of the 30 patients involved in both were processed following an ultrastaging protocol. The cost of ultrastaging processing was also reported. RESULTS A SLN was detected in up to 91.3% and 90% in the pelvic and para-aortic region, respectively. In all cases, a SLN was detected at least in one field, pelvic or para-aortic. The mean time from injection to SLN resection was 53.3 ± 20.3 min. Two of 30 (6.6%) patients had a contralateral SLN in the para-aortic field, but no patients had contralateral SLN within the pelvic field after injection. The mean number of harvested SLN was 2.1 ± 1.4 (range: 0-5) and 2.7 ± 1.5 (range: 0-7) in the pelvic and para-aortic region, respectively. Two patients were upgraded to stage IIIA1 because of lymph node metastasis. In the first case, based on single sections and haematoxylin and eosin (H&E) examination, a pelvic SLN micrometastasis (1 mm) was found on the first H&E section. By using the ultrastaging protocol, the size of the metastasis was increased to 2.1 mm (macrometastasis). In the same patient, the ultrastaging study of the inframesenteric para-cava SLNs found isolated tumour cells in the subcapsular and interfollicular lymph nodes sinus in one of the two SLN harvested (in one of the sections at the fourth and fifth ultrastage levels). The other upstaged case was a para-aortic macrometastasis in a patient in whom the SLN was not identified in the para-aortic field because of the absence of migration from the infundibulo-pelvic stump injection. The cost of ultrastaging in each patient depended on the total number of SLN retrieved, averaging 96.8 € (range: 0-230.5) and 124.5 € (range: 0-322.7€) for pelvic and para-aortic SLN, respectively. CONCLUSIONS A uniform protocol for ultrastaging is essential for lower-volume metastasis detection and to provide reproducible information between upcoming studies, as evidence about SLN in ovarian cancer is growing.
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Affiliation(s)
- Víctor Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain; Woman's Health Research Group, Medical Research Institute La Fe (IISLAFE), Valencia, Spain; Spanish Clinical Research Network, SCReN-IIS La Fe (PT17/0017/0035), Valencia, Spain.
| | - Beatriz Montero
- Department of Pathology, University Hospital La Fe, Valencia, Spain
| | - Susana López
- Department of Pathology, University Hospital La Fe, Valencia, Spain
| | | | - Luis Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Tiermes Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Marta Gurrea
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | | | - Pilar Bello
- Department of Nuclear Medicine, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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Padilla-Iserte P, Lago V, Tauste C, Díaz-Feijoo B, Gil-Moreno A, Oliver R, Coronado P, Martín-Salamanca MB, Pantoja-Garrido M, Marcos-Sanmartin J, Gilabert-Estellés J, Lorenzo C, Cazorla E, Roldán-Rivas F, Rodríguez-Hernández JR, Sánchez L, Muruzábal JC, Hervas D, Domingo S. Impact of uterine manipulator on oncological outcome in endometrial cancer surgery. Am J Obstet Gynecol 2021; 224:65.e1-65.e11. [PMID: 32693096 DOI: 10.1016/j.ajog.2020.07.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data available to indicate whether oncological outcomes might be influenced by the uterine manipulator, which is used at the time of hysterectomy for minimally invasive surgery in patients with endometrial cancer. The current evidence derives from retrospective studies with limited sample sizes. Without substantial evidence to support its use, surgeons are required to make decisions about its use based only on their personal choice and surgical experience. OBJECTIVE To evaluate the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparent early-stage endometrial cancer. STUDY DESIGN We performed a retrospective multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent early-stage endometrial cancer, treated with minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objective was to determine recurrence-free survival, overall survival, and the pattern of recurrence. RESULTS A total of 2661 women from 15 centers were included; 1756 patients underwent hysterectomy with a uterine manipulator and 905 without it. Both groups were balanced with respect to histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics stage, and adjuvant therapy. The rate of recurrence was 11.69% in the uterine manipulator group and 7.4% in the no-manipulator group (P<.001). The use of the uterine manipulator was associated with a higher risk of recurrence (hazard ratio, 2.31; 95% confidence interval, 1.27-4.20; P=.006). The use of uterine manipulator in uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics [FIGO] I-II) was associated with lower disease-free survival (hazard ratio, 1.74; 95% confidence interval, 0.57-0.97; P=.027) and higher risk of death (hazard ratio, 1.74; 95% confidence interval, 1.07-2.83; P=.026). No differences were found regarding the pattern of recurrence between both groups (chi-square statistic, 1.74; P=.63). CONCLUSION In this study, the use of a uterine manipulator was associated with a worse oncological outcome in patients with uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.
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Padilla-Iserte P, Quintana R, Marina T, Lago V, Matute L, Domingo S. Uterine manipulator in endometrial cancer: a video is worth a thousand words. Int J Gynecol Cancer 2020; 31:147. [PMID: 33277343 DOI: 10.1136/ijgc-2020-002011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Raquel Quintana
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Tiermes Marina
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Victor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Matute
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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Sancho-Muriel J, Cholewa H, Primo V, García-Granero Á, Millán M, Domingo S, Valverde Navarro A, García-Granero E, Frasson M. Martius flap and sphincteroplasty as treatment for recurrent anovaginal fistula associated with anal incontinence-a video vignette. Colorectal Dis 2020; 22:1200-1201. [PMID: 32216038 DOI: 10.1111/codi.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023]
Affiliation(s)
- J Sancho-Muriel
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - H Cholewa
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - V Primo
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Á García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - M Millán
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - S Domingo
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - A Valverde Navarro
- Department of Anatomy and Embryology, University of Valencia, Valencia, Spain
| | - E García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - M Frasson
- Colorectal Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
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Marina T, Lago V, Padilla P, Matute L, Domingo S. Vesicovaginal Fistula Repair by Modified Martius Flap: A Step-by-Step Surgical Technique Video. Ann Surg Oncol 2020; 28:1002-1006. [PMID: 32797377 DOI: 10.1245/s10434-020-09020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fistula repair in the perineal region represents a major challenge for surgeons. It is important for the medical community to facilitate and disclose these techniques. OBJECTIVE The aim of this article was to show a stepwise approach for a direct repair and use of a Martius flap for a vesicovaginal fistula. METHODS We show a single case performed in a patient who presented with a vesicovaginal fistula diagnosed after surgery, which did not respond to conservative management. The procedure consists of the following steps: intraoperative cystoscopy, anatomical direct repair of the fistulous tract between the bladder and vagina, and modified Martius flap. CONCLUSIONS Martius flap is a repair technique used for complex fistula in the perineal region. It is a simple, safe, and reproducible procedure with good long-term functional and esthetic results.
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Affiliation(s)
- Tiermes Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - Víctor Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Pablo Padilla
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Luis Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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Sozzi G, Petrillo M, Berretta R, Capozzi VA, Paci G, Musicò G, Di Donna MC, Vargiu V, Bernardini F, Lago V, Domingo S, Fagotti A, Scambia G, Chiantera V. Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience. Arch Gynecol Obstet 2020; 302:707-714. [PMID: 32648028 DOI: 10.1007/s00404-020-05684-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the incidence, predictors and clinical outcome of pancreatic fistulas in patients receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer. METHODS Data of women who underwent splenectomy during cytoreduction for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Surgical, post-operative and follow-up data were analysed. RESULTS Overall, 260 patients were included in the study. Pancreatic resection was performed in 45 (17.6%) women, 23 of whom received capsule resection alone, while 22 required tail resection. Hyperthermic intraperitoneal chemotherapy (HIPEC) was administered in 28 (10.8%) patients. In the overall population, a pancreatic fistula was detected in 32 (12.3%) patients, and pancreatic resection (p-value = 0.033) and HIPEC administration (p-value = 0.039) were associated with fistula development. In multivariate analysis, HIPEC (OR = 2.573; p-value = 0.058) was confirmed as a risk factor for fistula development in women receiving splenectomy alone, while concomitant cholecystectomy (OR = 2.680; p-value = 0.012) was identified as the only independent predictor of the occurrence of pancreatic fistulas in those receiving additional distal pancreatectomy. Although the median length of hospital stay was higher in women with pancreatic leakage (p-value = 0.008), the median time from surgery to adjuvant treatment was not significantly increased. CONCLUSION HIPEC was identified as a risk factor for pancreatic fistulas in patients who underwent splenectomy alone, while concomitant cholecystectomy was the only independent predictor of fistula in those receiving additional pancreatectomy. The development of pancreatic leakage was not associated with increased post-operative mortality or delay in the initiation of chemotherapy.
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Affiliation(s)
- Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy.
| | - Marco Petrillo
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy.,Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Roberto Berretta
- Department of Gynaecology and Obstetrics, University of Parma, Parma, Italy
| | | | - Giuseppe Paci
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Giulia Musicò
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | | | - Virginia Vargiu
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Bernardini
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Victor Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Anna Fagotti
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sanchez-Iglesias JL, Chiva L, Olloqui A, Matute L, García-Granero A, Cárdenas-Rebollo JM, Domingo S. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol 2020; 158:603-607. [PMID: 32571682 DOI: 10.1016/j.ygyno.2020.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - J L Sanchez-Iglesias
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Chiva
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - L Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - A García-Granero
- Department of General Surgery, University Hospital Son Espases, Palma de Mallorca, Spain; Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain
| | - J M Cárdenas-Rebollo
- Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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Lago V, Tiermes M, Padilla-Iserte P, Matute L, Gurrea M, Domingo S. Protective Maneuver to Avoid Tumor Spillage during Laparoscopic Radical Hysterectomy: Vaginal Cuff Closure. J Minim Invasive Gynecol 2020; 28:174-175. [PMID: 32540498 DOI: 10.1016/j.jmig.2020.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/23/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of a protective maneuver to avoid tumor exposure during laparoscopic radical hysterectomy. DESIGN This video illustrates the vaginal cuff closure technique in cervical cancer surgery. SETTING The Oncologic Gynecology Department at the University Hospital La Fe. INTERVENTIONS After the Laparoscopic Approach to Cervical Cancer trial [1], the laparoscopic approach to the surgical treatment of cervical cancer has been questioned: laparotomic surgery has been associated with a better cancer outcome. This publication has changed the current approach recommendation for performing radical hysterectomy from minimally invasive surgery to open surgery. There are some theories that might justify these findings. In minimally invasive surgery, the use of a uterine manipulator can condition the spread owing to erosion and friction caused on the tumor, even leading to the perforation of the tumor. In addition, intraperitoneal colpotomy can lead to pelvic peritoneum contamination by the tumor. To close the gap between laparoscopy and laparotomy, some protective maneuvers, such as vaginal cuff closure, have been proposed [2,3]. These strategies aim to reduce the possibility of manipulation or exposure of the tumor to the pelvis during colpotomy in laparoscopic radical hysterectomy. These protective maneuvers have been shown to decrease the relapse rate in retrospective studies [4]. However, prospective trials are needed to elucidate and confirm these findings. In this video, we explain step-by-step the technique of vaginal cuff closure before a radical hysterectomy performance for uterine cervical cancer. First, the nodal status is established by laparoscopic sentinel lymph node dissection and frozen section study. Bilateral pelvic lymphadenectomy is completed according to the size of the tumor. In the case of negative nodal status, the vaginal cuff is closed: Approximately 2 to 3 cm from the tumor (depending on its size), a circumferential incision of the vaginal mucosa is performed, followed by the dissection of the vaginal wall, which should be sufficient to allow a tension-free vaginal closure. The vaginal cuff is then closed with a running suture. A laparoscopic radical hysterectomy is then completed, and the surgical specimen is removed without any manipulation of the tumor. CONCLUSION Avoiding manipulation of the tumor during cancer surgery is crucial. A vaginal cuff closure technique appears to be an easy protective maneuver that prevents tumor exposure and manipulation during laparoscopic radical hysterectomy.
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Affiliation(s)
- Víctor Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain (all authors)..
| | - Marina Tiermes
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain (all authors)
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain (all authors)
| | - Luis Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain (all authors)
| | - Marta Gurrea
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain (all authors)
| | - Santiago Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain (all authors)
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Lago V, Bello P, Montero B, Matute L, Padilla-Iserte P, Lopez S, Marina T, Agudelo M, Domingo S. Sentinel lymph node technique in early-stage ovarian cancer (SENTOV): a phase II clinical trial. Int J Gynecol Cancer 2020; 30:1390-1396. [PMID: 32448808 PMCID: PMC7497563 DOI: 10.1136/ijgc-2020-001289] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022] Open
Abstract
Objective Early-stage ovarian cancer might represent an ideal disease scenario for sentinel lymph node application. Nevertheless, the published experience seems to be limited. Our objective was to assess the feasibility and safety concerns of sentinel lymph node biopsy in patients with clinical stage I–II ovarian cancer. Methods We conducted a prospective cohort study of 20 patients with histologically confirmed ovarian cancer. 99mTc and indocyanine green were injected into both the utero-ovarian and infundibulopelvic ligament stump, if they were present, during surgical staging. An intraoperative gamma probe and near-infrared fluorescence imaging were used to detect the sentinel lymph nodes. Inclusion criteria included: >18 years of age, suspicious adnexal mass (unilateral or bilateral) at ultrasound and CT imaging or confirmed ovarian tumor after previous surgery (unilateral or bilateral salpingo-oophorectomy with or without hysterectomy). Adverse events were recorded through postoperative day 30. The primary trial end point was to report adverse events related to the technique, including the use of 99mTc and ICG intraperitoneally, as well as the feasibility of the technique. Results A total of 20 patients were included in the analysis. Sentinel lymph nodes were detected in 14/15 (93%) pelvic and all 20 (100%) para-aortic regions. Five patients did not have utero-ovarian injection because of prior hysterectomy. The mean time from injection to sentinel lymph node resection was 53±15 min (range; 30–80). The mean number of harvested sentinel lymph nodes was 2.2±1.5 (range; 0–5) lymph nodes in the pelvis and 3.3±1.8 (range; 1–7) lymph nodes in the para-aortic region. There were no adverse intraoperative events, nor any within the 30 days of follow-up related with the technique. Conclusion Sentinel lymph node mapping in early-stage ovarian cancer is feasible without major intraoperative or < 30 days safety concerns. (NCT03452982). Trial registration number ClinicalTrials.gov, NCT03452982.
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Affiliation(s)
- Victor Lago
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain .,Woman's Health Research Group, Medical Research Institute La Fe (IISLAFE), Valencia, Spain.,Spanish Clinical Research Network, SCReN-IIS La Fe (PT17/0017/0035), Valencia, Spain
| | - Pilar Bello
- Nuclear Medicine Department, University Hospital La Fe, Valencia, Spain
| | - Beatriz Montero
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Luis Matute
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | | | - Susana Lopez
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Tiermes Marina
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Marc Agudelo
- Nuclear Medicine Department, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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Vazquez S, Padilla-Iserte P, Marina T, Lago V, Matute L, Domingo S. Creatsas modified vaginoplasty as reconstructive treatment of vaginal stenosis due to vaginal or pelvic radiotherapy. Int J Gynecol Cancer 2020; 30:1249. [PMID: 32376742 DOI: 10.1136/ijgc-2020-001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sheila Vazquez
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Tiermes Marina
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Victor Lago
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Matute
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Díaz-Feijoo B, Torné A, Tejerizo Á, Benito V, Hernández A, Ruiz R, Domingo S, Luna-Guibourg R, Llueca A, Coronado P, Gilabert-Estelles J, Bebia V, Gil-Ibáñez B, Gil-Moreno A. Prognostic Value and Therapeutic Implication of Laparoscopic Extraperitoneal Paraaortic Staging in Locally Advanced Cervical Cancer: A Spanish Multicenter Study. Ann Surg Oncol 2020; 27:2829-2839. [PMID: 32152774 DOI: 10.1245/s10434-020-08329-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the impact of laparoscopic extraperitoneal paraaortic staging in therapeutic planning and prognosis of patients with locally advanced cervical cancer (LACC) as compared with imaging staging. METHODS Retrospective multicenter study of stage IB2 and IIA2 to IVA (FIGO 2009) LACC patients who were candidates for primary chemoradiotherapy. The study (surgical) group included 634 patients undergoing laparoscopic/robotic extraperitoneal paraaortic staging treated with extended-field radiotherapy (EFRT) if lymph node involvement was confirmed. The control (imaging) group included 288 patients treated with EFRT when lymph node involvement was suspected on positron emission tomography-computed tomography scans and/or magnetic resonance imaging. RESULTS In the study group, a median of 13 (range 9-17) lymph nodes were removed, with a rate of positive paraaortic nodes of 18%, with metastatic size ≤ 5 mm in 20.4% of cases. Paraaortic EFRT was administered to 18% of patients in the study group and in 58% of controls. In 34% of patients from the surgical group, EFRT was modified according to surgical findings with respect to imaging staging. The median follow-up in the study and control groups was 3.7 and 4.8 years, respectively. In both groups, the overall survival and cancer-specific disease-free survival were similar. The time interval between diagnosis and starting EFRT was 18 days longer in the study group, without differences in overall survival as compared with controls (hazard ratio 1.00, 95% confidence interval 0.998-1.005; p = 0.307). CONCLUSIONS Laparoscopic extraperitoneal paraaortic staging in LACC patients is safe and modified therapeutic planning, allowing better selection of candidates for EFRT.
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Affiliation(s)
- Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Hospital Universitario, Madrid, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Rubén Ruiz
- Service of Gynecology and Obstetrics, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rocío Luna-Guibourg
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Llueca
- Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, Castelló de la Plana, Spain
| | - Pluvio Coronado
- Women's Health Institute, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicente Bebia
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Blanca Gil-Ibáñez
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain
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Lago V, Marina T, Delgado Oliva F, Padilla-Iserte P, Matute L, Domingo S. Double-barrel wet colostomy after total pelvic exenteration. Int J Gynecol Cancer 2020; 30:1650-1651. [PMID: 32079710 DOI: 10.1136/ijgc-2019-000993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Victor Lago
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Tiermes Marina
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Francisco Delgado Oliva
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Valenciana, Spain
| | - Pablo Padilla-Iserte
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Matute
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Affiliation(s)
- Víctor Lago
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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Lago V, Bello P, Matute L, Padilla-Iserte P, Marina T, Agudelo M, Domingo S. Sentinel Lymph Node Technique in Apparent Early Ovarian Cancer: Laparoscopic Technique. J Minim Invasive Gynecol 2019; 27:1019-1020. [PMID: 31628986 DOI: 10.1016/j.jmig.2019.09.790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/22/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To demonstrate the feasibility of laparoscopic sentinel lymph node technique in presumed early-stage ovarian cancer. DESIGN Video illustrating the laparoscopic performance of the sentinel lymph node technique in ovarian cancer. SETTING The Oncologic Gynecology Department at the University Hospital La Fe. PATIENTS Candidates for the technique presented an apparent early stage ovarian cancer. The technique was performed in the context of a clinical trial called SENTOV (NCT03452982). INTERVENTIONS To date, lymphadenectomy is recommended after the diagnosis of apparent early-stage ovarian cancer as part of the surgical staging. Minimally invasive surgery can be considered for the purpose of restaging [1]. Up to 14% of the patients are upstaged because of positive lymph nodes after pelvic and para-aortic lymphadenectomy [2]. Regarding low-grade tumors, a lower rate of lymph node involvement has been reported [3]. Sentinel lymph node technique has been reported to be feasible in a recent pilot study [4]. Two clinical trials (Sentinel Lymph Node in Early Ovarian Cancer and Sentine Lymph Node in Early Ovarian Cancer) are currently ongoing to clarify the use of sentinel lymph node technique in early ovarian cancer. The injection points were at the infundibulopelvic and ovarian ligament stumps. Two hundred microliters of saline solution containing 37 MBq of technetium-99m nanocolloid followed by 0.5 mL of indocyanine green (ICG) was injected subperitoneally. We used a 27 G needle at each injection point. Immediately after injection and also at 15 and 30 minutes after injection, the operative field was checked guided by the acoustic signal of the gamma probe and the near-infrared camera. We performed a minimum dissection looking for the sentinel lymph node or nodes in the pelvic and para-aortic region. Any lymph node with a remarkable radioactivity count as high as 10 times the background and/or dyed with ICG was considered a sentinel lymph node and was harvested separately. A systematic surgical staging was performed after the sentinel lymph node procedure was completed. Because of its small size, the ICG molecule is not caught in the lymph node valve system and keeps migrating when performing lymphography. An exhaustive direct view of the dye path is required to avoid misleading detection of the real sentinel lymph node. This theoretical problem is resolved by the use of the 99mTC-nanocolloid. This tracer gets trapped into the lymph node valve system because of its molecular size and does not keep migrating as does ICG. As such, a combination of both methods is proposed. CONCLUSION Laparoscopic performance of sentinel lymph node technique in ovarian cancer seems to achievable. Between 2017 and 2019, this procedure was performed in 30 patients (13 laparoscopic), in the context of our pilot experience [4] and the Sentinel Lymph Node in Early Ovarian Cancer clinical trial (NCT03452982).
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Affiliation(s)
- Víctor Lago
- Department of Gynecologic Oncology, University Hospital La Fe (Drs. Lago, Matute, Padilla-Iserte, Marina, and Domingo).
| | - Pilar Bello
- Department of Nuclear Medicine, University Hospital La Fe (Drs. Bello and Agudelo), Valencia, Spain
| | - Luis Matute
- Department of Gynecologic Oncology, University Hospital La Fe (Drs. Lago, Matute, Padilla-Iserte, Marina, and Domingo)
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe (Drs. Lago, Matute, Padilla-Iserte, Marina, and Domingo)
| | - Tiermes Marina
- Department of Gynecologic Oncology, University Hospital La Fe (Drs. Lago, Matute, Padilla-Iserte, Marina, and Domingo)
| | - Marc Agudelo
- Department of Nuclear Medicine, University Hospital La Fe (Drs. Bello and Agudelo), Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, University Hospital La Fe (Drs. Lago, Matute, Padilla-Iserte, Marina, and Domingo)
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