1
|
Taliento C, Morciano G, Nero C, Froyman W, Vizzielli G, Pavone M, Salvioli S, Tormen M, Fiorica F, Scutiero G, Scambia G, Giorgi C, Greco P, Pinton P. Circulating tumor DNA as a biomarker for predicting progression-free survival and overall survival in patients with epithelial ovarian cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2024:ijgc-2024-005313. [PMID: 38658022 DOI: 10.1136/ijgc-2024-005313] [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: 04/26/2024] Open
Abstract
OBJECTIVES Circulating tumor DNA (ctDNA) is emerging as a potential prognostic biomarker in multiple tumor types. However, despite the many studies available on small series of patients with ovarian cancer, a recent systematic review and meta-analysis is lacking. The objective of this study was to determine the association of ctDNA with progression-free-survival and overall survival in patients with epithelial ovarian cancer. METHODS An electronic search was conducted using PubMed (MEDLINE), Embase, CENTRAL (Cochrane Library), and CINAHL-Complete from January 2000 to September 15, 2023. To be included in the analysis the studies had to meet the following pre-specified inclusion criteria: (1) evaluable ctDNA; (2) progression-free-survival and overall survival reported as hazard ratio (HR); and (3) the patient population had epithelial ovarian cancer at the time of ctDNA detection. We evaluated the association of ctDNA with progression-free survival and overall survival. Secondary outcomes focused on sub-group analysis of genomic alterations and international Federation of Gynecology and Obstetrics (FIGO) stage. RESULTS A total of 26 studies reporting on 1696 patients with epithelial ovarian cancer were included. The overall concordance rate between plasma-based and tissue-based analyses was approximately 62%. We found that a high level of ctDNA in epithelial ovarian cancer was associated with worse progression-free survival (HR 5.31, 95% CI 2.14 to 13.17, p<0.001) and overall survival (HR 2.98, 95% CI 1.86 to 4.76, p<0.0001). The sub-group analysis showed a greater than threefold increase in the risk of relapse in patients with positive HOXA9 meth-ctDNA (HR 3.84, 95% CI 1.57 to 9.41, p=0.003). CONCLUSIONS ctDNA was significantly associated with worse progression-free survival and overall survival in patients with epithelial ovarian cancer. Further prospective studies are needed. PROSPERO REGISTRATION NUMBER CRD42023469390.
Collapse
Affiliation(s)
- Cristina Taliento
- Department of Medical Sciences, Obstetrics and Gynecology Unit, "S. Anna" University Hospital, University of Ferrara, Ferrara, Italy
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Giampaolo Morciano
- Department of Medical Sciences, Section of Experimental Medicine and Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Camilla Nero
- Department of Women and Child Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Dipartimento Scienze della Vita e Sanità Pubblica, Rome, Italy
| | - Wouter Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, University of Udine Medical Area Department, Udine, Italy
| | - Matteo Pavone
- Department of Women and Child Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- IHU Strasbourg, Institute of Image Guided Surgery, Strasbourg, France
| | - Stefano Salvioli
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Mara Tormen
- Department of Medical Sciences, Obstetrics and Gynecology Unit, "S. Anna" University Hospital, University of Ferrara, Ferrara, Italy
| | | | - Gennaro Scutiero
- Department of Medical Sciences, Obstetrics and Gynecology Unit, "S. Anna" University Hospital, University of Ferrara, Ferrara, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlotta Giorgi
- Department of Medical Sciences, Section of Experimental Medicine and Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Obstetrics and Gynecology Unit, "S. Anna" University Hospital, University of Ferrara, Ferrara, Italy
| | - Paolo Pinton
- Department of Medical Sciences, Section of Experimental Medicine and Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| |
Collapse
|
2
|
Kouhen F, Ghazi B, Nasser S, Sehouli J, El Ghanmi A. PARSGO and UM6SS: spearheading excellence in gynecological oncology in Morocco. Int J Gynecol Cancer 2024:ijgc-2024-005393. [PMID: 38658023 DOI: 10.1136/ijgc-2024-005393] [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: 04/26/2024] Open
Affiliation(s)
- Fadila Kouhen
- Radiotherapy Department, International University Hospital Sheikh Khalifa, Casablanca, Morocco
- Laboratory of Neurosciences and Oncogenetics, Neurooncology and oncogenetic Team, Mohammed VI Center for Research & Innovation, Casablanca, Morocco
- Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Bouchra Ghazi
- Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
- Immunopathology-Immunotherapy-Immunomonitoring Laboratory, Mohammed VI Center for Research & Innovation, Casablanca, Morocco
| | - Sara Nasser
- Department of Gynecology with Center of Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
- Pan-Arabian Research Society of Gynecological Oncology, Berlin, Germany
| | - Jalid Sehouli
- Pan-Arabian Research Society of Gynecological Oncology, Berlin, Germany
- Department of Gynecology with Center of Oncological Surgery, Charite Global Health Center, Berlin, Germany
| | - Adil El Ghanmi
- Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
- Pan-Arabian Research Society of Gynecological Oncology, Berlin, Germany
- Obstetrics and Gynecology Department, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| |
Collapse
|
3
|
Levin G, Pareja R, Viveros-Carreño D, Sanchez Diaz E, Yates EM, Zand B, Ramirez PT. Association of reviewer experience with discriminating human-written versus ChatGPT-written abstracts. Int J Gynecol Cancer 2024:ijgc-2023-005162. [PMID: 38627032 DOI: 10.1136/ijgc-2023-005162] [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: 04/24/2024] Open
Abstract
OBJECTIVE To determine if reviewer experience impacts the ability to discriminate between human-written and ChatGPT-written abstracts. METHODS Thirty reviewers (10 seniors, 10 juniors, and 10 residents) were asked to differentiate between 10 ChatGPT-written and 10 human-written (fabricated) abstracts. For the study, 10 gynecologic oncology abstracts were fabricated by the authors. For each human-written abstract we generated a ChatGPT matching abstract by using the same title and the fabricated results of each of the human generated abstracts. A web-based questionnaire was used to gather demographic data and to record the reviewers' evaluation of the 20 abstracts. Comparative statistics and multivariable regression were used to identify factors associated with a higher correct identification rate. RESULTS The 30 reviewers discriminated 20 abstracts, giving a total of 600 abstract evaluations. The reviewers were able to correctly identify 300/600 (50%) of the abstracts: 139/300 (46.3%) of the ChatGPT-generated abstracts and 161/300 (53.7%) of the human-written abstracts (p=0.07). Human-written abstracts had a higher rate of correct identification (median (IQR) 56.7% (49.2-64.1%) vs 45.0% (43.2-48.3%), p=0.023). Senior reviewers had a higher correct identification rate (60%) than junior reviewers and residents (45% each; p=0.043 and p=0.002, respectively). In a linear regression model including the experience level of the reviewers, familiarity with artificial intelligence (AI) and the country in which the majority of medical training was achieved (English speaking vs non-English speaking), the experience of the reviewer (β=10.2 (95% CI 1.8 to 18.7)) and familiarity with AI (β=7.78 (95% CI 0.6 to 15.0)) were independently associated with the correct identification rate (p=0.019 and p=0.035, respectively). In a correlation analysis the number of publications by the reviewer was positively correlated with the correct identification rate (r28)=0.61, p<0.001. CONCLUSION A total of 46.3% of abstracts written by ChatGPT were detected by reviewers. The correct identification rate increased with reviewer and publication experience.
Collapse
Affiliation(s)
- Gabriel Levin
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rene Pareja
- Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia
| | - David Viveros-Carreño
- Unidad Ginecología Oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
- Department of Gynecologic Oncology, Clínica Universitaria Colombia, Bogotá, Colombia
| | - Emmanuel Sanchez Diaz
- Universidad Pontificia Bolivariana Clinica Universitaria Bolivariana, Medellin, Colombia
| | - Elise Mann Yates
- Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| | - Behrouz Zand
- Gynecologic Oncology, Houston Methodist, Shenandoah, Texas, USA
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
4
|
Oliver-Perez MR, Caso-Maestro O, Conti-Nuño B, Bermejo R, Gil-Ibañez B, Tejerizo-Garcia A. Step by step abdominal wall closure in elective midline laparotomy. Int J Gynecol Cancer 2024:ijgc-2024-005500. [PMID: 38642922 DOI: 10.1136/ijgc-2024-005500] [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: 04/22/2024] Open
Affiliation(s)
- M Reyes Oliver-Perez
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense, Madrid, Spain
| | - Oscar Caso-Maestro
- Universidad Complutense, Madrid, Spain
- Department of Surgery, Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatrice Conti-Nuño
- Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rocio Bermejo
- Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Blanca Gil-Ibañez
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alvaro Tejerizo-Garcia
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense, Madrid, Spain
| |
Collapse
|
5
|
Milman T, Maeda A, Swift BE, Bouchard-Fortier G. Predictors and outcomes of same day discharge after minimally invasive hysterectomy in gynecologic oncology within the National Surgical Quality Improvement Program database. Int J Gynecol Cancer 2024; 34:602-609. [PMID: 38097349 DOI: 10.1136/ijgc-2023-004970] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To assess trends over time of same day discharge after minimally invasive hysterectomy in oncology, identify perioperative factors influencing same day discharge, and evaluate 30 day postoperative morbidity. METHODS A retrospective cohort of elective minimally invasive hysterectomies performed for gynecologic oncologic indications between January 2013 and December 2021 was identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Clinical and surgical characteristics, length of stay, and 30 day postoperative complications were captured. Clinical and surgical factors affecting same day discharge rate and impact of same day discharge on postoperative outcomes were evaluated using χ2 tests and logistic regression. RESULTS Patients undergoing minimally invasive hysterectomy (n=32 823) had a same day discharge rate of 34.5% over the 9 year period, increasing from 15.5% in 2013 to 55.1% in 2021. The rate of patients discharged on postoperative day 1 decreased from 76.4% to 41.4% over this period. On multivariable analysis, same day discharge decreased with: age 70-79 years (odds ratio (OR) 0.80) and ≥80 years (OR 0.42); body mass index 40-49.9 kg/m2 (OR 0.89) and ≥50 kg/m2 (OR 0.67); patient comorbidities, including hypertension (OR 0.85), chronic steroid use (OR 0.74), bleeding disorder (OR 0.54), anemia (OR 0.89), and hypoalbuminemia (OR 0.76); and surgical time >90th percentile (OR 0.40) (all p<0.05). Lymphadenectomy did not impact the same day discharge rate (unadjusted OR 1.03, p=0.22). Same day discharge had no effect on 30 day postoperative composite morbidity (OR 0.91, p=0.20), and was associated with fewer readmissions (OR 0.75, p=0.005). Age 70-79 years (OR 1.07, p=0.435) and age ≥80 years (OR 1.11, p=0.504) did not increase postoperative morbidity. However, body mass index categories 40-49.9 kg/m2 (OR 1.28, 95% CI 1.08 to 1.51) and ≥50 kg/m2 (OR 1.60, 95% CI 1.27 to 2.01) were associated with greater 30 day composite morbidity. CONCLUSION In this study, same day discharge following minimally invasive hysterectomy for oncologic indications was safe, and rates are rising among all age and body mass index categories. Quality improvement initiatives are needed at oncology centers to promote early discharge after minimally invasive gynecologic oncology surgery.
Collapse
Affiliation(s)
- Tal Milman
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Azusa Maeda
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | - Brenna E Swift
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Geneviève Bouchard-Fortier
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Obermair HM, Scasso S, Laufer J, Obermair A. Use of indocyanine green for ureteric illumination and visualization. Int J Gynecol Cancer 2024; 34:643-644. [PMID: 38253383 DOI: 10.1136/ijgc-2023-005042] [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: 01/24/2024] Open
Affiliation(s)
- Helena M Obermair
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Santiago Scasso
- Gynaecology Department, British Hospital, Montevideo, Uruguay
| | - Joel Laufer
- School of Medicine, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Kemah BL, Bhagat N, Pandya A, Sullivan R, Sundar SS. Training the gynecologic oncologists of the future - challenges and opportunities. Int J Gynecol Cancer 2024; 34:619-626. [PMID: 37989477 DOI: 10.1136/ijgc-2023-004557] [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] [Indexed: 11/23/2023] Open
Abstract
Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.
Collapse
Affiliation(s)
- Ben-Lawrence Kemah
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Health Research, Health Education and Research Organisation (HERO), Buea, Cameroon
| | - Nanak Bhagat
- Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Aayushi Pandya
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK
| | - Richard Sullivan
- Department of Cancer and Global Health, King's College London, London, UK
| | - Sudha S Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| |
Collapse
|
8
|
Sia TY, Wan V, Finlan M, Zhou QC, Iasonos A, Zivanovic O, Sonoda Y, Chi DS, Long Roche K, Jewell E, Tew WP, O'Cearbhaill RE, Cohen S, Makker V, Liu YL, Friedman CF, Kyi C, Zamarin D, Gardner G. Procedural interventions for oligoprogression during treatment with immune checkpoint blockade in gynecologic malignancies: a case series. Int J Gynecol Cancer 2024; 34:594-601. [PMID: 38296517 DOI: 10.1136/ijgc-2023-004842] [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] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility and outcomes of performing procedural interventions, defined as surgical resection, tumor ablation, or targeted radiation therapy, for oligoprogressive disease among patients with gynecologic malignancies who are treated with immune checkpoint blockade. METHODS Patients with gynecologic cancers treated with immune checkpoint blockade between January 2013 and October 2021 who underwent procedural interventions including surgical resection, interventional radiology ablation, or radiation therapy for oligoprogressive disease were identified. Procedures performed before immune checkpoint therapy initiation or ≥6 months after therapy completion were excluded. Long immunotherapy duration prior to intervention was defined as ≥6 months. Progression-free survival and overall survival were calculated from procedure date until disease progression or death, respectively. RESULTS During the study period, 886 patients met inclusion criteria and received immune checkpoint blockade therapy. Of these, 34 patients underwent procedural interventions for oligoprogressive disease; 7 underwent surgical resection, 3 underwent interventional radiology ablation, and 24 underwent radiation therapy interventions. Primary disease sites included uterus (71%), ovary (24%), and cervix (6%). Sites of oligoprogression included abdomen/pelvis (26%), bone (21%), lung (18%), distant lymph node (18%), brain (9%), liver (6%), and vagina (3%). Most tumors (76%) did not exhibit microsatellite instability or mismatch repair deficiency. Approximately half (53%) of the patients had long immune checkpoint therapy duration prior to intervention. Median progression-free survival following the procedure was 5.3 months (95% CI, 3.1-9.9), and median overall survival was 21.7 months (95% CI, 14.9-not estimable). Long versus short immune checkpoint therapy duration prior to procedure and length of immune checkpoint therapy had no effect on progression-free or overall survival. CONCLUSIONS Procedural interventions for patients with oligoprogression on immune checkpoint blockade therapy are feasible and demonstrate favorable outcomes. With expanding use of immune checkpoint therapy, it is important to investigate combined modalities to maximize therapeutic benefit for patients with gynecologic cancers.
Collapse
Affiliation(s)
- Tiffany Y Sia
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivian Wan
- Obstetrics & Gynecology, Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Michael Finlan
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Yukio Sonoda
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Dennis S Chi
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Kara Long Roche
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Jewell
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - William P Tew
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roisin E O'Cearbhaill
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Seth Cohen
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vicky Makker
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ying L Liu
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Claire F Friedman
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chrisann Kyi
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dmitriy Zamarin
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
9
|
Leitao MM, Iasonos A, Tomberlin M, Moukarzel LA, Price H, Bennetti G, Ramesh B, Chi DS, Long Roche K, Sonoda Y, Al-Niami A, Mueller JJ, Gardner GJ, Broach V, Jewell EL, Kim S, Feinberg J, Abu-Rustum NR, Zivanovic O. ARIA II: a randomized controlled trial of near-infrared Angiography during RectosIgmoid resection and Anastomosis in women with ovarian cancer. Int J Gynecol Cancer 2024:ijgc-2024-005395. [PMID: 38514101 DOI: 10.1136/ijgc-2024-005395] [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: 03/23/2024] Open
Abstract
BACKGROUND Ovarian cancer with extensive metastatic disease involving pelvic structures often requires rectosigmoid resection for complete gross resection; however, it is associated with increased surgical morbidity. There are limited data, and none in ovarian cancer, on near-infrared assessment of perfusion in rectosigmoid resections with anastomosis. PRIMARY OBJECTIVE To compare the rate of pelvic complications (pelvic abscesses, anastomotic leaks, and infections) within 30 days of surgery with and without near-infrared assessment of perfusion at time of rectosigmoid resection and re-anastomosis in patients undergoing cytoreductive surgery for ovarian cancer. STUDY HYPOTHESIS We hypothesize the use of near-infrared technology (intravenous indocyanine green and endoscopic near-infrared fluorescence imaging), compared with standard intra-operative assessment, to evaluate anastomotic perfusion at time of rectosigmoid resection and re-anastomosis will result in lower rates of post-operative pelvic complications. TRIAL DESIGN This is a planned multicenter randomized controlled trial. Patients who undergo rectosigmoid resection as part of their ovarian cytoreductive surgery will be randomized 1:1 to standard assessment of anastomosis with the surgeon's usual technique (control arm) or assessment with near-infrared angiography using indocyanine green and endoscopic fluorescence imaging (experimental arm). Randomization will occur after rectosigmoid resection has been completed and the surgeon declares their plan to create a diverting ostomy. Randomization will be stratified by plan for diverting ostomy. MAJOR INCLUSION/EXCLUSION CRITERIA Main inclusion criteria include patients with primary or recurrent ovarian, fallopian tube, or primary peritoneal cancer who are scheduled for cytoreductive surgery with suspected need for low-anterior rectosigmoid resection. PRIMARY ENDPOINT Rate of 30-day post-operative pelvic complications. SAMPLE SIZE 310 (155 per arm) ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Q2 2027 and Q4 2027, respectively. TRIAL REGISTRATION NCT04878094.
Collapse
Affiliation(s)
- Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Morgan Tomberlin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lea A Moukarzel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hannah Price
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gabrielle Bennetti
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bhavani Ramesh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Kara Long Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Ahmed Al-Niami
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Jennifer J Mueller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Ginger J Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Vance Broach
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Elizabeth L Jewell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Sarah Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Jacqueline Feinberg
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Oliver Zivanovic
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of OB/GYN, Weill Cornell Medical College of Cornell University, New York, New York, USA
| |
Collapse
|
10
|
Perrone AM, Mezzapesa F, Bernante P, Balsamo F, Garelli S, De Iaco P. Synergizing health: combined gynecological and bariatric robotic surgery for endometrial cancer in obese women. Int J Gynecol Cancer 2024:ijgc-2023-005121. [PMID: 38471674 DOI: 10.1136/ijgc-2023-005121] [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: 03/14/2024] Open
Affiliation(s)
- Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Mezzapesa
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Bernante
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Metabolic and Bariatric Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
| | - Francesca Balsamo
- Division of Metabolic and Bariatric Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
| | - Silvia Garelli
- Endocrinology and Diabetes Prevention and Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| |
Collapse
|
11
|
Lavoue V, Ouldamer L, Huchon C. Correspondence on "Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods" by Navarro Santana et al. Int J Gynecol Cancer 2024:ijgc-2024-005315. [PMID: 38460970 DOI: 10.1136/ijgc-2024-005315] [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: 03/11/2024] Open
Affiliation(s)
- Vincent Lavoue
- Service de Gynécologie, CHU de Rennes - Hôpital Sud, Rennes, France
| | | | | |
Collapse
|
12
|
Fotopoulou C, Eriksson AG, Baiocchi G, Zivanovic O. Surgery for gynecological cancers in the era of personalized medicine: a novel paradigm. Int J Gynecol Cancer 2024; 34:351. [PMID: 38438173 DOI: 10.1136/ijgc-2024-005299] [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: 03/06/2024] Open
Affiliation(s)
| | - Ane Gerda Eriksson
- Department of Gynecologic Oncology, Norwegian Radium Hospital, OSLO, Oslo, Norway
| | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, São Paulo, Brazil
| | - Oliver Zivanovic
- Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, Pennsylvania, USA
| |
Collapse
|
13
|
Kahn RM, Chang SJ, Chi DS. Extra-abdominal cytoreductive techniques in ovarian cancer: how far can (should) we go? Int J Gynecol Cancer 2024; 34:379-385. [PMID: 38438179 DOI: 10.1136/ijgc-2023-004630] [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] [Indexed: 03/06/2024] Open
Abstract
Complex surgery is an essential component in the management of advanced ovarian cancer. Furthermore, achieving complete gross resection in cytoreductive surgery appears to be associated with significant survival benefits in patients with advanced ovarian cancer. The goal of this review is to demonstrate the advancement of surgical techniques in gynecologic oncology surgery, including resection of disease within the intrathoracic and inguinal regions. This progress has expanded the option of surgery to more patients, especially those who would have previously been deemed inoperable. In this review we describe the most notable studies and reports of surgical resection of ovarian cancer involving cardiophrenic/supradiaphragmatic lymph nodes, mediastinum, lung pleura or parenchyma, and the inguinal region. We also describe the growing role that video-assisted thoracic surgery has played in advanced ovarian cancer diagnosis and management. The studies, series, and reports described demonstrate that comprehensive surgical procedures outside of the abdomen or pelvis can be both safe and feasible in properly selected patients. They also suggest that resection of disease outside of the abdomen or pelvis may benefit appropriately selected patients. Future studies are necessary to identify which patients may benefit most from upfront surgery versus neoadjuvant chemotherapy when ovarian cancer metastasis is present in the thoracic or inguinal regions.
Collapse
Affiliation(s)
- Ryan M Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Suk-Joon Chang
- Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea (the Republic of)
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
14
|
Pinheiro de Senna Nogueira Batista B, Chang EIF. Surgical options for lymphedema after gynecological cancer treatment: current trends and advances. Int J Gynecol Cancer 2024; 34:436-446. [PMID: 38438177 DOI: 10.1136/ijgc-2023-004607] [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] [Indexed: 03/06/2024] Open
Abstract
Lower leg lymphedema is an important complication after gynecological treatment that can severely affect the quality of life of long-term survivors of these malignancies. As a chronic and progressive disease, affected patients will require life-long therapy centered on compression. Although conventional compressive treatments can be effective, they are extremely burdensome and time-consuming for most patients and adherence is challenging. With advances in the field of reconstructive microsurgery, new procedures have been developed in the past decades to help these patients in their continuous care and have been offered at many oncological centers around the world as a first line of treatment. We performed a PubMed search using the Mesh terms 'Lymphedema/surgery' and 'Lower extremity' yielding a total of 508 articles. Of these, 35 articles were included for analysis. Articles that failed to provide a comprehensive analysis of outcomes following surgical treatment, studies examining treatment for upper limb lymphedema, primary lymphedema, or lower extremity lymphedema resulting from non-gynecologic etiologies, and studies that failed to have a minimum of 6 months follow-up were excluded. A comprehensive review of these 35 articles including over 1200 patients demonstrated large variability on the outcomes reported; however, an overall benefit from these procedures was found. Surgical options including lymphovenous anastomosis, vascularized lymph node transfers, and excisional procedures can be performed in patients with lower leg lymphedema, depending on staging and findings in indocyanine green lymphography. Surgical treatment of lymphedema is an effective option that can improve symptoms and quality of life of patients suffering from lymphedema following gynecologic cancers.
Collapse
|
15
|
Allanson E, Hari A, Ndaboine E, Cohen PA, Bristow R. Medicolegal, infrastructural, and financial aspects in gynecologic cancer surgery and their implications in decision making processes: Quo Vadis? Int J Gynecol Cancer 2024; 34:451-458. [PMID: 38438180 DOI: 10.1136/ijgc-2023-004585] [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] [Indexed: 03/06/2024] Open
Abstract
Surgical decision making is complex and involves a combination of analytic, intuitive, and cognitive processes. Medicolegal, infrastructural, and financial factors may influence these processes depending on the context and setting, but to what extent can they influence surgical decision making in gynecologic oncology? This scoping review evaluates existing literature related to medicolegal, infrastructural, and financial aspects of gynecologic cancer surgery and their implications in surgical decision making. Our objective was to summarize the findings and limitations of published research, identify gaps in the literature, and make recommendations for future research to inform policy.
Collapse
Affiliation(s)
- Emma Allanson
- Division of Obstetrics and Gynaecology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Anjali Hari
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Edgard Ndaboine
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Mwanza, Tanzania
| | - Paul A Cohen
- Division of Obstetrics and Gynaecology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Robert Bristow
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| |
Collapse
|
16
|
Ng JS, Ilancheran A. The role of surgery in gestational trophoblastic disease: an overview. Int J Gynecol Cancer 2024; 34:409-415. [PMID: 38438170 DOI: 10.1136/ijgc-2023-004584] [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] [Indexed: 03/06/2024] Open
Abstract
Gestational trophoblastic disease comprises a group of rare, and potentially malignant, conditions that arise from abnormal trophoblastic proliferation. When there is invasion and evidence of metastatic disease, gestational trophoblastic neoplasia is used. While chemotherapy is the mainstay of treatment for gestational trophoblastic neoplasia, the role of surgery has come full circle in recent years. Before the introduction of highly effective systemic treatment options, surgery was the default treatment. Surgery for gestational trophoblastic neoplasia often yielded unsatisfactory results and mortality remained high. In recent years, the role of adjuvant surgery in the management of gestational trophoblastic neoplasia has been examined with great interest. We aim to provide an overview of the various surgical approaches employed in managing gestational trophoblastic neoplasia, including their indications, techniques, and outcomes. Additionally, we discuss whether there is a role to do less in surgery for gestational trophoblastic neoplasia and describe our experience with a modified surgical technique for its treatment. By summarizing the current evidence, this article highlights the significant contributions of surgery to the holistic management of patients with gestational trophoblastic neoplasia and provides a framework on which to base management and treatment programs.
Collapse
Affiliation(s)
- Joseph S Ng
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore
- Gynecologic Cancer Program, National University Cancer Institute, Singapore
| | - Arunachalam Ilancheran
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore
- Gynecologic Cancer Program, National University Cancer Institute, Singapore
| |
Collapse
|
17
|
Peters I, Marchetti C, Scambia G, Fagotti A. New windows of surgical opportunity for gynecological cancers in the era of targeted therapies. Int J Gynecol Cancer 2024; 34:352-362. [PMID: 38438181 DOI: 10.1136/ijgc-2023-004580] [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] [Indexed: 03/06/2024] Open
Abstract
Precision medicine through molecular profiling has taken a prominent role in the treatment of solid tumors and it is widely expected that this will continue to expand. With respect to gynecological cancers, a major change has particularly been observed in the treatment landscape of epithelial ovarian, endometrial, and cervical cancers. Regarding the former, maintenance therapy with either poly(ADP-ribose) polymerase inhibitors (PARPi) and/or bevacizumab has become an indispensable treatment option following the traditional combination of cytoreductive surgery and platinum-based chemotherapy. Considering endometrial cancer, the molecular classification system has now been incorporated into virtually every guideline available and molecular-directed treatment strategies are currently being researched, presumably leading to a further transformation of its treatment paradigm. After all, treatment with immune-checkpoint inhibitors that target the programmed cell death 1 (PD-1) receptor has already been shown to significantly improve disease outcomes in these patients, especially in those with mismatch repair deficient, microsatellite stability-high (MMRd-MSI-H) disease. Similarly, in recurrent/metastatic cervical cancer patients, these agents elicited improved survival rates when being added to platinum-based chemotherapy with or without bevacizumab. Interestingly, implications of these targeted therapies for surgical management have been touched on to a minor extent, but are at least as intriguing. This review therefore aims to address the wide-ranging opportunities the molecular tumor characteristics and their corresponding targeted therapies have to offer for the surgical management of epithelial ovarian, endometrial, and cervical cancers, both in the primary and recurrent setting.
Collapse
Affiliation(s)
- Inge Peters
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Claudia Marchetti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
18
|
Manning-Geist B, Obermair A, Broach VA, Leitao MM, Zivanovic O, Abu-Rustum NR. Update on near infrared imaging technology: indocyanine green and near infrared technology in the treatment of gynecologic cancers. Int J Gynecol Cancer 2024; 34:416-420. [PMID: 38438171 PMCID: PMC10962647 DOI: 10.1136/ijgc-2023-004583] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Beryl Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andreas Obermair
- University of Queensland Queensland Centre for Gynaecological Cancer Research, Herston, Queensland, Australia
| | - Vance A Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
19
|
Armbrust R, Davies-Oliveira J, Sehouli J. Health-related quality of life metrics as endpoints in surgical trials: hype or hope? Int J Gynecol Cancer 2024; 34:447-450. [PMID: 38438183 DOI: 10.1136/ijgc-2023-005127] [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] [Indexed: 03/06/2024] Open
Abstract
The management of gynecological cancer has evolved considerably over the past decades in almost every field of treatment. Surgery plays a major role in the treatment algorithm. However, these invasive interventions can have profound implications for the quality of life (QoL) of affected individuals. The routine implementation of QoL measurements in clinical trials has become common, reflecting a new research 'standard', despite the fact that all available QoL instruments were not designed nor validated prospectively for surgical trials. This review seeks to address whether patient reported outcomes and QoL measurements rightfully take center stage in current surgical trials, leading to direct implementation for the benefit of patient care, or are they simply more of a researcher's hope. We will also provide an 'action plan' to better implement QoL measurements in future surgical trials.
Collapse
Affiliation(s)
- Robert Armbrust
- Gynecology with Center of Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Jalid Sehouli
- Gynecology with Center of Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| |
Collapse
|
20
|
Can B, Akgöl S, Adıgüzel Ö, Kaya C. A new, less invasive approach for retroperitoneal pelvic and para-aortic lymphadenectomy combining the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique and single-port laparoscopy. Int J Gynecol Cancer 2024:ijgc-2023-005093. [PMID: 38316443 DOI: 10.1136/ijgc-2023-005093] [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: 02/07/2024] Open
Affiliation(s)
- Behzat Can
- Gynecological Oncology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Sedat Akgöl
- Gynecological Oncology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Özgür Adıgüzel
- Gynecological Oncology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Cihan Kaya
- Obstetrics and Gynecolgy, Acıbadem Health Care Group, Acıbadem Bakirköy Hospital, Istanbul, Turkey
| |
Collapse
|
21
|
Basabe MS, Suki TS, Munsell MF, Iniesta MD, Garcia Lopez JE, Hillman RT, Cain K, Huepenbecker S, Mena G, Taylor JS, Ramirez PT, Meyer LA. Evaluation of a tiered opioid prescription algorithm in an ERAS pathway: exploring opportunities for further refinement. Int J Gynecol Cancer 2023; 34:ijgc-2023-004948. [PMID: 38123191 DOI: 10.1136/ijgc-2023-004948] [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] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Opioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription. OBJECTIVE To evaluate the intervention by investigating opioid use post-discharge for women undergoing abdomino-pelvic surgery, and patient adherence to opioid disposal education. METHODS We analyzed post-discharge opioid consumption among 558 patients. Eligible patients included those who underwent elective gynecologic surgery, were not taking scheduled opioids pre-operatively, and received discharge opioids according to a tiered prescribing algorithm. A survey assessing discharge opioid consumption and disposal safety knowledge was distributed on post-discharge day 21. Over-prescription was defined as >20% of the original prescription left over. Descriptive statistics were used for analysis. RESULTS The survey response rate was 61% and 59% in the minimally invasive surgery and open surgery cohorts, respectively. Overall, 42.8% of patients reported using no opioids after hospital discharge, 45.2% in the minimally invasive surgery and 38.6% in the open surgery cohort. Furthermore, 74.9% of respondents were over-prescribed, with median age being statistically significant for this group (p=0.004). Finally, 46.4% of respondents expressed no knowledge regarding safe disposal practices, with no statistically significant difference between groups (p>0.99). CONCLUSION Despite implementation of the tiered discharge opioid algorithm aimed to personalize opioid prescriptions to estimated need, we still over-prescribed opioids. Additionally, despite targeted education, nearly half of all patients who completed the survey did not know how to dispose of their opioid tablets. Additional efforts are needed to further refine the algorithm to reduce over-prescription of opioids and improve disposal education.
Collapse
Affiliation(s)
- M Sol Basabe
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina S Suki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria D Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan E Garcia Lopez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert Tyler Hillman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katherine Cain
- Department of Pharmacy Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
22
|
Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer 2023; 33:1837-1842. [PMID: 37898483 DOI: 10.1136/ijgc-2023-004723] [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] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility of uterine transposition as a method of preserving fertility and ovarian function after pelvic radiation. METHODS This prospective multicenter observational study included patients with non-gynecologic pelvic cancers who underwent pelvic radiation as part of their cancer treatment between June 2017 and June 2019. For inclusion in the study, patients were required to have normal menstrual cycles and hormone levels (follicle-stimulating hormone, luteinizing hormone, and estrogen) before treatment. Uterine transposition to the upper abdomen was performed prior to irradiation. Clinical examinations and Doppler ultrasonography were used to evaluate the gonadal vasculature post-surgery. The uterus was repositioned into the pelvis 2-4 weeks after radiation therapy or at the time of rectosigmoid resection in patients with rectal cancer who had undergone neoadjuvant treatment. Cancer treatment and follow-up were performed according to standard guidelines. RESULTS Eight patients (seven with rectal cancer and one with pelvic liposarcoma) underwent uterine transposition at a median age of 30.5 years (range 19-37). The uterus was successfully preserved in six patients, accompanied by normal menses, hormonal levels, and vaginal intercourse after treatment. One patient with rectal cancer died of carcinomatosis 4 months after uterine transposition. One patient presented with uterine necrosis 4 days after uterine transposition, and the uterus was removed; however, one ovary was preserved. Cervical ischemia was the most common post-surgical complication in three (37.5%) patients. Three patients attempted to conceive, and two (66%) were spontaneously successful and delivered healthy babies at 36 and 38 weeks by cesarean section without complications. CONCLUSIONS Uterine transposition is a feasible procedure for preserving gonadal and uterine function in patients requiring pelvic radiotherapy for non-gynecological cancer, with the potential for achieving spontaneous pregnancy and successful delivery.
Collapse
Affiliation(s)
- Reitan Ribeiro
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Paraná, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | - Rene Pareja
- Department of Gynecology Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia, Medellin, Colombia
| |
Collapse
|
23
|
Chen Y, Zheng Y, Yang F. Primary debulking surgery for advanced epithelial ovarian cancer with isolated enlarged para-aortic lymph node by robotic transumbilical single port approach. Int J Gynecol Cancer 2023; 33:1976-1977. [PMID: 37597853 DOI: 10.1136/ijgc-2023-004729] [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: 08/21/2023] Open
Affiliation(s)
- Yu Chen
- Department of Gynecologic Oncology, Sichuan University West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Chengdu, China
| | - Ying Zheng
- Department of Gynecologic Oncology, Sichuan University West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Chengdu, China
| | - Fan Yang
- Department of Gynecologic Oncology, Sichuan University West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Chengdu, China
| |
Collapse
|
24
|
Neveu J, Tremblay E, Mercier F, Garneau S, Cormier B. Developing a hyperthermic intraperitoneal chemotherapy (HIPEC) gynecologic oncology program: a Canadian experience. Int J Gynecol Cancer 2023; 33:1957-1965. [PMID: 38011988 PMCID: PMC10803971 DOI: 10.1136/ijgc-2023-004788] [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: 08/17/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for epithelial ovarian cancer following cytoreductive surgery. The intraperitoneal spread of the disease makes the peritoneal cavity an ideal target for drug delivery. HIPEC has shown promising results in improving overall survival in epithelial ovarian cancer patients when performed during interval cytoreductive surgery. Recent studies have provided level 1 evidence supporting increased overall survival in stage III ovarian cancer patients treated with HIPEC during interval cytoreduction. Meta-analyses have further confirmed the survival improvement in women receiving HIPEC. Despite its inclusion in guidelines, many centers have been hesitant to implement HIPEC programs due to perceived obstacles, such as increased morbidity, cost, and resource requirements. Studies have shown that morbidity rates are acceptable in selected patients, and the addition of HIPEC to cytoreductive surgery is cost effective. Therefore, the main barrier to implementing HIPEC programs is related to resource requirements and logistics, but with proper preparation, these challenges can be overcome. Establishing a successful HIPEC program requires institutional support, a knowledgeable and dedicated team, adequate resources and equipment, and proper training and audit. This review aims to provide evidence based information to guide the development of successful HIPEC programs, including preoperative, anesthetic, and surgical considerations. It also reviews the different equipment and protocols for the perfusion and common postoperative events.
Collapse
Affiliation(s)
- Joannie Neveu
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
- H Bliss Murphy Cancer Center, Health Sciences Center General Hospital, St John's, Newfoundland and Labrador, Canada
| | - Elizabeth Tremblay
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département d'obstétrique et gynécologie, Université de Montréal, Montréal, Québec, Canada
| | - Frederic Mercier
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département de chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Sébastien Garneau
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département d'anesthésie, Université de Montréal, Montréal, Québec, Canada
| | - Beatrice Cormier
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département d'obstétrique et gynécologie, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
25
|
Leitao M. Uterine transposition: a simple yet revolutionary means of fertility preservation for women with cancer. Int J Gynecol Cancer 2023; 33:1843-1844. [PMID: 37989481 DOI: 10.1136/ijgc-2023-005122] [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: 11/23/2023] Open
Affiliation(s)
- Mario Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
26
|
Ditto A, Chiarello G, Leone Roberti Maggiore U, Martinelli F, Bogani G, Raspagliesi F. Low pressure laparoscopic procedure in morbidly obese patients with endometrial carcinoma using a new subcutaneous abdominal wall-retraction device: a surgical challenge. Int J Gynecol Cancer 2023; 33:1974-1975. [PMID: 37586758 DOI: 10.1136/ijgc-2023-004577] [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: 08/18/2023] Open
Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
27
|
Dostalek L, Freitag P, Slovackova M, Zima T, Komarc M, Fricova L, Fucik T, Nemejcova K, Cibula D, Brynda D, Slama J. HPV testing as an effective triage strategy in the follow-up after fertility-sparing treatment for glandular lesions of the uterine cervix. Int J Gynecol Cancer 2023:ijgc-2023-004920. [PMID: 38054269 DOI: 10.1136/ijgc-2023-004920] [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: 12/07/2023] Open
Abstract
OBJECTIVE The management and surveillance of glandular pre-cancerous lesions of the uterine cervix present distinct challenges compared with squamous lesions, primarily attributed to the lower effectiveness of diagnostic methods such as cytology or colposcopy. This study aimed to investigate the long-term safety of fertility-sparing treatment for adenocarcinoma in situ and microinvasive adenocarcinoma of the cervix, while identifying factors associated with recurrence, with a particular emphasis on the role of human papillomavirus (HPV) testing. METHODS We retrospectively reviewed data from all patients with histopathologically confirmed adenocarcinoma in situ or microinvasive cervical adenocarcinoma who received treatment at a single center between 2002 and 2023. The study involved the examination of consecutive surgical specimens and the follow-up details. Factors associated with recurrence were assessed in a subgroup of patients with available long-term follow-up data (at least 6 months). RESULTS In total, 143 patients (112 with adenocarcinoma in situ and 31 with adenocarcinoma) were included in the analysis. Among the 86 patients who underwent fertility-sparing treatment, the recurrence rate was 9% (12% for adenocarcinoma in situ and 4% for adenocarcinoma) during a median follow-up period of 56.6 months (range 7-179). No patients who were HPV negative experienced recurrence during the follow-up period. In contrast, among patients who were HPV positive, the recurrence rate was 38%. Additionally, HPV 16/18 positivity displayed a notable association with a higher risk of recurrence compared with the other high-risk genotypes, although this difference did not reach statistical significance (83% vs 10%; p=0.083, log-rank). CONCLUSION Our retrospective study demonstrated a significant association between the risk of recurrence and HPV status during the follow-up period. Consequently, long-term follow-up utilizing HPV testing and genotyping appears to be a secure alternative to a hysterectomy.
Collapse
Affiliation(s)
- Lukas Dostalek
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Pavel Freitag
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Miroslava Slovackova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Tomas Zima
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
| | - Lenka Fricova
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Tomas Fucik
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Kristyna Nemejcova
- Department of Pathology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - David Cibula
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Daniel Brynda
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jiri Slama
- Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| |
Collapse
|
28
|
Nasser S, Bilir E, David A, Gultekin M, Sehouli J. Building research competency across low and middle resource settings: an ENGOT initiative and NOGGO mentorship program at the ESGO 2022 in Berlin. Int J Gynecol Cancer 2023:ijgc-2023-005019. [PMID: 38016756 DOI: 10.1136/ijgc-2023-005019] [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: 11/30/2023] Open
Affiliation(s)
- Sara Nasser
- Department of Gynecology with Center of Oncological Surgery, Charité Universitatsmedizin Berlin, Berlin, Germany
- Gynecologic Oncology, Pan-Arabian Research Society of Gynecological Oncology, Berlin, Germany
| | - Esra Bilir
- Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
- Department of Global Health, Koc University Graduate School of Health Sciences, Istanbul, Turkey
| | - Atallah David
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Murat Gultekin
- Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Charité Universitatsmedizin Berlin, Berlin, Germany
| |
Collapse
|
29
|
Borghi C, Biagioli E, Mauro J, Roberto A, Borghese M, Buda A. Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2023:ijgc-2023-004863. [PMID: 38011989 DOI: 10.1136/ijgc-2023-004863] [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: 11/29/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate the effect of different types of neoadjuvant chemotherapy regimens, in terms of optimal pathological response and oncological outcomes, in patients with locally advanced cervical cancer. METHODS A systematic search of the literature was performed. MEDLINE through PubMed and Embase databases were searched from inception to June 2023. The study was registered in PROSPERO (ID number CRD42023389806). All women with a pathological diagnosis of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 classification stages IB2-IVA), any age or histology, who underwent intravenous neoadjuvant chemotherapy before radical surgery, and articles only in English language, were included. We conducted a meta-analysis for optimal pathological response after surgery and survival outcomes. The risk of bias was assessed using the Newcastle-Ottawa scale and the Risk of Bias 2 (RoB) tools. The review methods and results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS 25 studies with a total number of 1984 patients fulfilled the eligibility criteria of our review and were included for data extraction and efficacy analysis. When compared with a two-drug regimen, the three-drug combination including cisplatin, paclitaxel, and ifosfamide or anthracyclines showed superior efficacy in terms of optimal pathological response with an odds ratio of 0.38 (95% CI 0.24 to 0.61, p<0.0001), with no difference in disease-free survival (hazard ratio (HR) 0.72, 95% CI 0.50 to 1.03, I2=0%, p=0.07) and higher overall survival (HR 0.63, 95% CI 0.41 to 0.97, I2=0%, p=0.03). CONCLUSIONS The three-drug combination of cisplatin, paclitaxel, and ifosfamide or anthracyclines showed a higher rate of complete or optimal partial response, with the triple regimens having an advantage over the platinum-based schedules in terms of overall survival. Neoadjuvant chemotherapy followed by radical surgery should not be considered a standard of care in locally advanced cervical cancer.
Collapse
Affiliation(s)
- Chiara Borghi
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
| | - Elena Biagioli
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Jessica Mauro
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
- University of Udine, Udine, Italy
| | - Anna Roberto
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Martina Borghese
- Division of Obstetrics and Gynecology, Ospedale Santa Croce, Cuneo, Piemonte, Italy
| | - Alessandro Buda
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
| |
Collapse
|
30
|
Montesinos-Albert M, Giroux PA, Hudry D, Pasquesoone C, Narducci F, Martinez-Gomez C. Complex abdominal wall reconstruction for an isolated parietal recurrence of ovarian cancer. Int J Gynecol Cancer 2023:ijgc-2023-004855. [PMID: 37989478 DOI: 10.1136/ijgc-2023-004855] [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: 11/23/2023] Open
Affiliation(s)
| | | | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | | | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | | |
Collapse
|
31
|
Castillo MH, Marrufo C. Total uterine inversion due to pedunculated vaginal tumor. Int J Gynecol Cancer 2023:ijgc-2023-004712. [PMID: 37989479 DOI: 10.1136/ijgc-2023-004712] [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: 11/23/2023] Open
Affiliation(s)
| | - Carlos Marrufo
- Oncology Gynecology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| |
Collapse
|
32
|
Gil-Ibanez B, Davies-Oliveira J, Lopez G, Díaz-Feijoo B, Tejerizo-Garcia A, Sehouli J. Impact of gynecological cancers on health-related quality of life: historical context, measurement instruments, and current knowledge. Int J Gynecol Cancer 2023; 33:1800-1806. [PMID: 37696648 DOI: 10.1136/ijgc-2023-004804] [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] [Indexed: 09/13/2023] Open
Abstract
Gynecologic cancers, comprising 14.4% of newly diagnosed cancer cases in women globally, are substantial causes of both mortality and morbidity, with a profound impact on the quality of life (QoL) of survivors. Over the past few decades, advancements in interdisciplinary and interprofessional care have contributed to an increase in the average life expectancy of gynecological cancer patients. However, the disease and its treatments have a profound impact on patients, leading to physical changes and psychological consequences, including psychosocial and psychosexual effects, which negatively affect their QoL.The primary objective of management strategies is to minimize harm while improving survival rates and enhancing QoL during the survivorship stage. QoL measures play a crucial role in enhancing our comprehension of how cancer and its treatments affect individuals. Consequently, various measurement instruments, such as the EORTC QLQ 30, PROMIS-29, FACT-G, and QOL-CS, have been developed to assess health-related quality of life (HRQoL). Pre- and post-treatment HRQoL measurements have been shown to be predictive factors for post-operative complications and prognostic factors for overall survival and progression-free survival in gynecological oncology patients. Patient-reported outcomes related to HRQoL are essential tools for measuring patient outcomes and enabling patient-centered clinical decision-making.This article focuses on HRQoL, providing a historical context, summarizing measurement instruments, and discussing the current understanding of the impact of gynecological cancers on HRQoL.
Collapse
Affiliation(s)
- Blanca Gil-Ibanez
- Gynecologic Oncology and Minimally Invasive Surgery Unit, Gynecology and Obstetrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- i+12 Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jennifer Davies-Oliveira
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Gregorio Lopez
- Gynecologic Oncology and Minimally Invasive Surgery Unit, Gynecology and Obstetrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- i+12 Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institutd'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Alvaro Tejerizo-Garcia
- Gynecologic Oncology and Minimally Invasive Surgery Unit, Gynecology and Obstetrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- i+12 Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, European Competence Center of Ovarian Cancer, Charité, University of Berlin, Berlin, Germany
| |
Collapse
|
33
|
Xue FS, He N, Cheng Y. Correspondence on 'Thoracic epidural analgesia as part of an enhanced recovery program in gynecologic oncology: a prospective cohort study' by Pandraklakis et al. Int J Gynecol Cancer 2023; 33:1836. [PMID: 37890876 DOI: 10.1136/ijgc-2023-004979] [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: 10/29/2023] Open
Affiliation(s)
- Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nong He
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
34
|
Mitric C, Kosa SD, Kim SR, Nelson G, Laframboise S, Bouchard-Fortier G. Cost impact analysis of enhanced recovery after minimally invasive gynecologic oncology surgery. Int J Gynecol Cancer 2023; 33:1786-1793. [PMID: 37524497 DOI: 10.1136/ijgc-2023-004528] [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] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The implementation of a peri-operative care program based on enhanced recovery after surgery principles for minimally invasive gynecologic oncology surgery led to an improvement in same day discharge from 29% to 75% at our center. This study aimed to determine the program's economic impact. METHODS Our initial enhanced recovery quality improvement program enrolled consecutive patients undergoing minimally invasive hysterectomy at a single center during a 12-month period and compared them to a pre-intervention cohort. The primary outcome was overall costs. The secondary outcomes were surgical and post-operative visit costs. The surgical visit costs included pre-operative and operating room, post-operative stay, pharmacy, and interventions costs. The 30-day post-operative visit costs included clinic and emergency room, and readmission costs. The costs for every visit were collected from the case-cost department and expressed in 2020 Canadian dollars (CAD). RESULTS A total of 96 and 101 patients were included in the pre- and post-intervention groups, respectively. The median total cost per patient for post-intervention was $7252 compared with $8381 pre-intervention (p=0.02), resulting in a $1129 cost reduction per patient. The total cost for the program implementation was $134 per patient for a total cost of $13 106. The median post-operative stay cost was $816 post-intervention compared with $1278 pre-intervention (p<0.05). Statistically significant savings for the post-intervention group were also found for operative visit, operating room costs, and pharmacy (p<0.05). On multivariate analysis, surgical approach was the only factor associated with operating room costs, whereas both surgical approach and group (pre- vs post-intervention) impacted the total and post-operative stay costs (p<0.05). CONCLUSION In addition to increasing the same day discharge rate after minimally invasive gynecologic oncology surgery, an enhanced recovery-based peri-operative care program led to significant reductions in cost.
Collapse
Affiliation(s)
- Cristina Mitric
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Daisy Kosa
- Department of Health Research Methods, Evidence, and Impacts, McMaster University, Hamilton, Ontario, Canada
| | - Soyoun Rachel Kim
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephane Laframboise
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Geneviève Bouchard-Fortier
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Odajima S, Tanabe H, Koike Y, Onishi J, Ichikawa T, Yokosu K, Takaneka S, Okamoto A. Short- and long-term morbidity of total parietal peritonectomy for advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:1771-1777. [PMID: 37875321 DOI: 10.1136/ijgc-2023-004742] [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] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE Total parietal peritonectomy is gradually being recognized as a surgical option for advanced ovarian cancer; however, evidence regarding its efficacy and safety remains insufficient. Herein, we aimed to assess the short- and long-term post-operative safety profiles of total parietal peritonectomy. METHODS We reviewed the medical records of post-operative morbidity and mortality of patients who underwent cytoreductive surgery with total parietal peritonectomy for stage III and IV ovarian cancer between April 2018 and January 2023. RESULTS Fifty patients were enrolled in the study: 31 who underwent primary cytoreductive surgery and 19 who underwent interval cytoreductive surgery. The median age of all patients was 57 (range, 23-74) years. The median follow-up period was 22 (range, 3-59) months. Of 44 patients (88%) with stage IIIC/IV, 38 patients (76%) had high-grade serous carcinoma. The complete resection rates were 94%, 91%, and 100% in all patients, the primary cytoreductive surgery group, and the interval cytoreductive surgery group, respectively. There were 63 post-operative complication events overall, including 17 (27%) major complication events in 15 patients within 1 year post-operatively. Ten major complications occurred within 30 days of surgery, mainly in the primary cytoreductive surgery group (9 cases). Regarding complication type, the most frequent major event was pleural effusion (3 cases, 7%). After 30 days, there were a total of 17 all-grade complication events, of which ileus and hydronephrosis were major complications in 3 cases each (18%). There were no mortalities related to cytoreductive surgery. The scheduled adjuvant chemotherapy could be completed in 96% of patients. CONCLUSIONS Total parietal peritonectomy is a feasible procedure for managing advanced ovarian cancer. Short- and long-term complications may include pleural effusion and ileus/hydronephrosis, respectively.
Collapse
Affiliation(s)
- Suguru Odajima
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hiroshi Tanabe
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuki Koike
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Junki Onishi
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Teppei Ichikawa
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Kota Yokosu
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shin Takaneka
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| |
Collapse
|
36
|
Li J, Duan J, Zhu M, Jiang W. Transabdominal resection of the metastatic lymph nodes at the level of the celiac trunk. Int J Gynecol Cancer 2023:ijgc-2023-004871. [PMID: 37813477 DOI: 10.1136/ijgc-2023-004871] [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: 10/17/2023] Open
Affiliation(s)
- Jun Li
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jie Duan
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Menghan Zhu
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wei Jiang
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| |
Collapse
|
37
|
Noll F, Odetto D, Zamora L, Saadi JM. Latin American video workshop: a new strategy to learn surgery in gynecology oncology. Int J Gynecol Cancer 2023; 33:1655. [PMID: 37247939 DOI: 10.1136/ijgc-2023-004644] [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: 05/31/2023] Open
Affiliation(s)
- Florencia Noll
- Gynecologic oncology, Sanatorio Allende, Cordoba, Argentina
| | - Diego Odetto
- Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Zamora
- Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jose Martin Saadi
- Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
38
|
Tsibulak I, Fotopoulou C. Tumor biology and impact on timing of surgery in advanced epithelial ovarian cancer. Int J Gynecol Cancer 2023; 33:1627-1632. [PMID: 37553165 DOI: 10.1136/ijgc-2023-004676] [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] [Indexed: 08/10/2023] Open
Abstract
Recent advances in epithelial ovarian cancer research have led to a shift in treatment strategy from the traditional 'organ-centric' to a personalized tumor biology-based approach. Nevertheless, we are still far behind an individualized approach for cytoreductive surgery in advanced ovarian cancer; the gold standard of primary treatment in combination with systemic agents. The impact of tumor biology on treatment sequence is still understudied. It is obvious, that response to platinum-based therapy is crucial for the success of neoadjuvant chemotherapy. While high-grade serous and endometrioid tumors are commonly characterized by an excellent response, other subtypes are considered poor responders or even resistant to platinum. Undoubtedly, neoadjuvant chemotherapy may filter poor responders, but to date, we still do not have appropriate alternatives to platinum-based chemotherapy in the neoadjuvant and first-line setting and 'adjusting' systemic treatment in cases of poor response to neoadjuvant chemotherapy remains elusive. Primary cytoreduction is still considered the gold standard for fit patients with operable tumor dissemination patterns, especially for those ovarian cancer subtypes that show poor response to platinum. Of note, even in high-grade serous ovarian cancer, approximately 20% of tumors are platinum resistant and the benefit of neoadjuvant chemotherapy in this subgroup is limited. Interestingly, these tumors are associated with the mesenchymal molecular subtype, which in turn correlates with high risk for residual disease after cytoreductive surgery and is characterized by the worst survival outcome among high-grade ovarian cancers. This leads to the question, how to best tailor surgical radicality at the onset of patients' presentation to avoid associated morbidity and with a moderate benefit. Here, we give an overview of recent advances of interaction between tumor biology and surgery in ovarian cancer.
Collapse
Affiliation(s)
- Irina Tsibulak
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Imperial College London Faculty of Medicine, London, London, UK
| |
Collapse
|
39
|
Chen Y, Zheng Y, Chen S, Peng S. An advantageous technique for fertility sparing staging surgery of epithelial ovarian cancer with a single umbilical incision. Int J Gynecol Cancer 2023; 33:1471-1472. [PMID: 36822656 DOI: 10.1136/ijgc-2023-004284] [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: 02/25/2023] Open
Affiliation(s)
- Yu Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Sijing Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shiyi Peng
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| |
Collapse
|
40
|
Veiga N, Muruzábal JC, Aguirre S, Lapeña S, Tarrio O, Vicaría I. Laparoscopic transperitoneal para-aortic lymphadenectomy in double inferior vena cava vascular anomalies. Int J Gynecol Cancer 2023; 33:1475-1476. [PMID: 37137524 DOI: 10.1136/ijgc-2023-004361] [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: 05/05/2023] Open
Affiliation(s)
- Nadia Veiga
- Ginecología, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Sara Aguirre
- Ginecología, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sonia Lapeña
- Ginecología, Hospital Universitario de Navarra, Pamplona, Spain
| | - Orencio Tarrio
- Ginecología, Hospital Universitario de Navarra, Pamplona, Spain
| | - Iván Vicaría
- Radiología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| |
Collapse
|
41
|
Capozzi VA, Rotondella I, De Finis A, Scarpelli E, Ghi T, Berretta R. Rectovaginal fistula repair by Martius flap after exclusive chemoradiation in a patient with advanced cervical cancer. Int J Gynecol Cancer 2023; 33:1473-1474. [PMID: 36958754 DOI: 10.1136/ijgc-2023-004365] [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: 03/25/2023] Open
Affiliation(s)
- Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Isabella Rotondella
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Alessandra De Finis
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Elisa Scarpelli
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| |
Collapse
|
42
|
Mohr S, Imboden S, Siegenthaler F, Mueller MD. Complementary use of indocyanine green and technetium to enhance sentinel lymphadenectomy in vulvar cancer. Int J Gynecol Cancer 2023:ijgc-2023-004562. [PMID: 37648407 DOI: 10.1136/ijgc-2023-004562] [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: 09/01/2023] Open
Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Michael David Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
43
|
Lindemann K, Kleppe A, Eyjólfsdóttir B, Heimisdottir Danbolt S, Wang YY, Heli-Haugestøl AG, Walcott SL, Mjåland O, Navestad GA, Hermanrud S, Juul-Hansen KE, Kongsgaard U. Prospective evaluation of an enhanced recovery after surgery (ERAS) pathway in a Norwegian cohort of patients with suspected or advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:1279-1286. [PMID: 37451690 PMCID: PMC10423533 DOI: 10.1136/ijgc-2023-004355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/18/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE This prospective cohort study evaluated the introduction of an enhanced recovery after surgery (ERAS) pathway in a tertiary gynecologic oncology referral center. Compliance and clinical outcomes were studied in two separate surgical cohorts. METHODS Patients undergoing laparotomy for suspected or verified advanced ovarian cancer at Oslo University Hospital were prospectively included in a pre- and post-implementation cohort. A priori, patients were stratified into: cohort 1, patients planned for surgery of advanced disease; and cohort 2, patients undergoing surgery for suspicious pelvic tumor. Baseline characteristics, adherence to the pathway, and clinical outcomes were assessed. RESULTS Of the 439 included patients, 235 (54%) underwent surgery for advanced ovarian cancer in cohort 1 and 204 (46%) in cohort 2. In cohort 1, 53% of the patients underwent surgery with an intermediate/high Aletti complexity score. Post-ERAS, median fasting times for solids (13.1 hours post-ERAS vs 16.0 hours pre-ERAS, p<0.001) and fluids (3.7 hours post-ERAS vs 11.0 hours pre-ERAS, p<0.001) were significantly reduced. Peri-operative fluid management varied less and was reduced from median 15.8 mL/kg/hour (IQR 10.8-22.5) to 11.5 mL/kg/hour (IQR 9.0-15.4) (p<0.001). In cohort 2 only there was a statistically significant reduction in length of stay (mean (SD) 4.3±1.5 post-ERAS vs 4.6±1.2 pre-ERAS, p=0.026). Despite stable readmission rates, there were significantly more serious complications reported in cohort 1 post-ERAS. CONCLUSIONS ERAS increased adherence to current standards in peri-operative management with significant reduction in fasting times for both solids and fluids, and peri-operative fluid administration. Length of stay was reduced in patients with suspicious pelvic tumor. Despite serious complications being common in patients with advanced disease undergoing debulking surgery, a causal relationship with the ERAS protocol could not be established. Implementing ERAS and continuous performance auditing are crucial to advancing peri-operative care of patients with ovarian cancer.
Collapse
Affiliation(s)
- Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Kleppe
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | | | | | - Yun Yong Wang
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Sara L Walcott
- Department of Clinical Service, Oslo University Hospital, Oslo, Norway
| | - Odd Mjåland
- Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - Gerd-Anita Navestad
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - Silje Hermanrud
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - Knut Erling Juul-Hansen
- Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo, Norway
| | - Ulf Kongsgaard
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo, Norway
| |
Collapse
|
44
|
Inci MG, Sehouli J, Schnura E, Lee M, Roll S, Reinhold T, Klews J, Kaufner L, Niggemann P, Groeben H, Toelkes J, Reisshauer A, Liebl M, Daehnert E, Zimmermann M, Knappe-Drzikova B, Rolker S, Nunier B, Algharably E, Pirmorady Sehouli A, Zwantleitner L, Krull A, Heitz F, Ataseven B, Chekerov R, Harter P, Schneider S. The KORE-INNOVATION trial, a prospective controlled multi-site clinical study to implement and assess the effects of an innovative peri-operative care pathway for patients with ovarian cancer: rationale, methods and trial design. Int J Gynecol Cancer 2023; 33:1304-1309. [PMID: 37208019 DOI: 10.1136/ijgc-2023-004531] [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] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Advanced ovarian cancer is managed by extensive surgery, which could be associated with high morbidity. A personalized pre-habilitation strategy combined with an 'enhanced recovery after surgery' (ERAS) pathway may decrease post-operative morbidity. PRIMARY OBJECTIVE To analyze the effects of a combined multi-modal pre-habilitation and ERAS strategy on severe post-operative morbidity for patients with ovarian cancer (primary diagnosis or first recurrence) undergoing cytoreductive surgery. STUDY HYPOTHESIS A personalized multi-modal pre-habilitation algorithm entailing a physical fitness intervention, nutritional and psycho-oncological support, completed by an ERAS pathway, reduces post-operative morbidity. TRIAL DESIGN This is a prospective, controlled, non-randomized, open, interventional two-center clinical study. Endpoints will be compared with a three-fold control: (a) historic control group (data from institutional ovarian cancer databases); (b) prospective control group (assessed before implementing the intervention); and (c) matched health insurance controls. INCLUSION CRITERIA Patients with ovarian, fallopian, or primary peritoneal cancer undergoing primary surgical treatment (primary ovarian cancer or first recurrence) can be included. The intervention group receives an additional multi-level study treatment: (1) standardized frailty assessment followed by (2) a personalized tri-modal pre-habilitation program and (3) peri-operative care according to an ERAS pathway. EXCLUSION CRITERIA Inoperable disease or neoadjuvant chemotherapy, simultaneous diagnosis of simultaneous primary tumors, in case of interference with the overall prognosis (except for breast cancer); dementia or other conditions that impair compliance or prognosis. PRIMARY ENDPOINT Reduction of severe post-operative complications (according to Clavien- Dindo Classification (CDC) III-V) within 30 days after surgery. SAMPLE SIZE Intervention group (n=414, of which approximately 20% insure with the participating health insurance); historic control group (n=198); prospective control group (n=50), health insurance controls (for those intervention patients who are members of the participating health insurance). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS The intervention phase started in December 2021 and will continue until June 2023. As of March 2023, 280 patients have been enrolled in the intervention group. The expected completion of the entire study is September 2024. TRIAL REGISTRATION NCT05256576.
Collapse
Affiliation(s)
- Melisa Guelhan Inci
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Eva Schnura
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH Klinik fur Gynakologie & Gynakologische Onkologie, Essen, Germany
| | - Marlene Lee
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Julia Klews
- Business Division - Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lutz Kaufner
- Department of Anesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Phil Niggemann
- Department of Anesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Harald Groeben
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Julia Toelkes
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Anett Reisshauer
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Max Liebl
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Enrico Daehnert
- Business Division - Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuela Zimmermann
- Business Division - Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Akkon University of Humanities, Berlin, Germany
| | - Barbora Knappe-Drzikova
- Nutrition and Diabetes advisor (DDG) and Dietitian for parental nutrition therapy (VDD), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanne Rolker
- Nutrition and Diabetes advisor (DDG) and Dietitian for parental nutrition therapy (VDD), Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Björn Nunier
- Department of Ergo-, Logo-, and Physiotherapy, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Engi Algharably
- Institute for Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adak Pirmorady Sehouli
- Department of Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Lena Zwantleitner
- Fachbereich Versorgungsmanagement, Techniker Krankenkasse, Hamburg, Germany
| | - Andrea Krull
- Eierstockkrebs Schwerpunkt, Verein Gynäkologische Krebserkrankungen Deutschland e.V, Neumünster, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH Klinik fur Gynakologie & Gynakologische Onkologie, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH Klinik fur Gynakologie & Gynakologische Onkologie, Essen, Germany
- Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Lippe, Detmold, Germany
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH Klinik fur Gynakologie & Gynakologische Onkologie, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH Klinik fur Gynakologie & Gynakologische Onkologie, Essen, Germany
| |
Collapse
|
45
|
Chiva L, Gonzalez-Rodriguez M, Tendobi C. Elikia: a hope for cervical cancer in the Democratic Republic of Congo. Int J Gynecol Cancer 2023; 33:1316-1317. [PMID: 36650013 DOI: 10.1136/ijgc-2022-004220] [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: 01/19/2023] Open
Affiliation(s)
- Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Celine Tendobi
- Obstetrics and Gynecology, Hospital Monkole, Kinshasa, Congo (the Democratic Republic of the)
| |
Collapse
|
46
|
Hablase R, Das N, Lutchman Singh K. Rare presentation of endometrial cancer with uterine inversion. Int J Gynecol Cancer 2023; 33:848. [PMID: 37127327 DOI: 10.1136/ijgc-2022-004088] [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: 05/03/2023] Open
Affiliation(s)
- Radwa Hablase
- Department of Gynaecological Oncology, Swansea Bay University Health Board, Swansea, UK
| | - Nagindra Das
- Department of Gynaecological Oncology, Swansea Bay University Health Board, Swansea, UK
| | - Kerryn Lutchman Singh
- Department of Gynaecological Oncology, Swansea Bay University Health Board, Swansea, UK
| |
Collapse
|
47
|
Steenbeek MP, van Bommel MHD, intHout J, Peterson CB, Simons M, Roes KCB, Kets M, Norquist BM, Swisher EM, Hermens RPMG, Lu KH, de Hullu JA. TUBectomy with delayed oophorectomy as an alternative to risk-reducing salpingo-oophorectomy in high-risk women to assess the safety of prevention: the TUBA-WISP II study protocol. Int J Gynecol Cancer 2023:ijgc-2023-004377. [PMID: 37045546 DOI: 10.1136/ijgc-2023-004377] [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: 04/14/2023] Open
Abstract
BACKGROUND Risk-reducing salpingectomy with delayed oophorectomy has gained interest for individuals at high risk for tubo-ovarian cancer as there is compelling evidence that especially high-grade serous carcinoma originates in the fallopian tubes. Two studies have demonstrated a positive effect of salpingectomy on menopause-related quality of life and sexual health compared with standard risk-reducing salpingo-oophorectomy. PRIMARY OBJECTIVE To investigate whether salpingectomy with delayed oophorectomy is non-inferior to the current standard salpingo-oophorectomy for the prevention of tubo-ovarian cancer among individuals at high inherited risk. STUDY HYPOTHESIS We hypothesize that postponement of oophorectomy after salpingectomy, to the age of 40-45 (BRCA1) or 45-50 (BRCA2) years, compared with the current standard salpingo-oophorectomy at age 35-40 (BRCA1) or 40-45 (BRCA2) years, is non-inferior in regard to tubo-ovarian cancer risk. TRIAL DESIGN In this international prospective preference trial, participants will choose between the novel salpingectomy with delayed oophorectomy and the current standard salpingo-oophorectomy. Salpingectomy can be performed after the completion of childbearing and between the age of 25 and 40 (BRCA1), 25 and 45 (BRCA2), or 25 and 50 (BRIP1, RAD51C, and RAD51D pathogenic variant carriers) years. Subsequent oophorectomy is recommended at a maximum delay of 5 years beyond the upper limit of the current guideline age for salpingo-oophorectomy. The current National Comprehensive Cancer Network (NCCN) guideline age, which is also the recommended age for salpingo-oophorectomy within the study, is 35-40 years for BRCA1, 40-45 years for BRCA2, and 45-50 years for BRIP1, RAD51C, and RAD51D pathogenic variant carriers. MAJOR INCLUSION/EXCLUSION CRITERIA Premenopausal individuals with a documented class IV or V germline pathogenic variant in the BRCA1, BRCA2, BRIP1, RAD51C, or RAD51D gene who have completed childbearing are eligible for participation. Participants may have a personal history of a non-ovarian malignancy. PRIMARY ENDPOINT The primary outcome is the cumulative tubo-ovarian cancer incidence at the target age: 46 years for BRCA1 and 51 years for BRCA2 pathogenic variant carriers. SAMPLE SIZE The sample size to ensure sufficient power to test non-inferiority of salpingectomy with delayed oophorectomy compared with salpingo-oophorectomy requires 1500 BRCA1 and 1500 BRCA2 pathogenic variant carriers. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Participant recruitment is expected to be completed at the end of 2026 (total recruitment period of 5 years). The primary outcome is expected to be available in 2036 (minimal follow-up period of 10 years). TRIAL REGISTRATION NUMBER NCT04294927.
Collapse
Affiliation(s)
| | | | - Joanna intHout
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Christine B Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Kit C B Roes
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Marleen Kets
- Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Barbara M Norquist
- Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA
| | | | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Karen H Lu
- Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | |
Collapse
|
48
|
Chacon E, Gómez-Hidalgo NR, Lago V, Boria F, Minguez JA, Chiva L. Principles of urinary reconstruction in gynecologic oncology. Int J Gynecol Cancer 2023; 33:638-639. [PMID: 37011922 DOI: 10.1136/ijgc-2023-004407] [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: 04/05/2023] Open
Affiliation(s)
- Enrique Chacon
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Victor Lago
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Felix Boria
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | - Jose Angel Minguez
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis Chiva
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Madrid, Spain
| |
Collapse
|
49
|
Kasius JC, Trozzi R, Pijnenborg J, Baert T, Laenen A, Van Rompuy AS, Zapardiel I, Vizzielli G, Knez J, Fanfani F, Amant F. Improving Endometrial cancer assessment by combining the new techniqUe of GENomic profiling with surgical Extra uterIne disEase assessment (EUGENIE). Int J Gynecol Cancer 2023; 33:823-826. [PMID: 36977506 DOI: 10.1136/ijgc-2023-004289] [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: 03/30/2023] Open
Abstract
BACKGROUND The molecular classification of endometrial cancer revolutionized our knowledge of its biology but so far has not affected our surgical approach. The exact risk of extra-uterine metastasis and hence the type of surgical staging for each of the four molecular subgroups are currently unknown. PRIMARY OBJECTIVE To determine the association between molecular classification and disease stage. STUDY HYPOTHESIS Each endometrial cancer molecular subgroup has a specific pattern of spread and this pattern of spread could guide the extent of surgical staging. TRIAL DESIGN Prospective, multicenter study MAJOR INCLUSION/EXCLUSION CRITERIA: Participants eligible for inclusion in this study must meet all the following criteria: women ≥18 years with primary endometrial cancer, any histology and stage. PRIMARY ENDPOINT Number and site of metastasis in each endometrial cancer molecular subgroup. SAMPLE SIZE 1000 patients will be enrolled. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS The trial will last 6 years: 4 years of accrual, and 2 years of follow-up of all patients. Results on staging and oncological outcomes are expected in 2027 and 2029, respectively. TRIAL REGISTRATION The study has been accepted by UZ Leuven Ethical Committee. Belg. Reg. nr: B3222022000997.
Collapse
Affiliation(s)
- Jenneke C Kasius
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), 22660 1100 DD, Amsterdam, The Netherlands
| | - Rita Trozzi
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Johanna Pijnenborg
- Department of Obstetrics & Gynecology, Radboudumc, Nijmegen, The Netherlands
| | - Thaïs Baert
- Division of Gynecologic Oncology; Department of Obstetrics and gynecology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Anne-Sophie Van Rompuy
- Department of Pathology, Katholieke Universiteit Leuven UZ Leuven, Leuven, Flanders, Belgium
- Laboratory of Translational Cell & Tissue Research, Department of Imaging and Pathology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Ignacio Zapardiel
- Gynecologic Oncology, La Paz University Hospital, Madrid, University, Spain
| | - Giuseppe Vizzielli
- Department of Medical Area (DAME), University of Udine, Udine, Friuli-Venezia Giulia, Italy
- Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda sanitaria universitaria Friuli Centrale, Udine, Friuli-Venezia Giulia, Italy
| | - Jure Knez
- Department for Gynaecological Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Francesco Fanfani
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Frédéric Amant
- Division of Gynecologic Oncology; Department of Obstetrics and gynecology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Center for Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| |
Collapse
|
50
|
Raffone A, Fanfani F, Raimondo D, Rovero G, Renzulli F, Travaglino A, De Laurentiis U, Santoro A, Zannoni GF, Casadio P, Scambia G, Seracchioli R, Mollo A. Predictive factors of sentinel lymph node failed mapping in endometrial carcinoma patients: a systematic review and meta-analysis. Int J Gynecol Cancer 2023:ijgc-2022-004014. [PMID: 36914172 DOI: 10.1136/ijgc-2022-004014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 03/16/2023] Open
Abstract
OBJECTIVE In endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20-25% of cases, with several factors affecting the likelihood of detection. However, pooled data about predictive factors of failure are lacking. The aim of this systematic review and meta-analysis was to assess the predictive factors of sentinel lymph node failed mapping in endometrial cancer patients undergoing sentinel lymph node biopsy. METHODS A systematic review and a meta-analysis was performed searching all studies assessing predictive factors of sentinel lymph node failed mapping in apparent uterine-confined endometrial cancer patients undergoing sentinel lymph node biopsy through the cervical injection of indocyanine green. The associations between sentinel lymph node failed mapping and predictive factors of failure were assessed, calculating the odds ratio (OR) with 95% confidence intervals. RESULTS Six studies with a total of 1345 patients were included. Compared with patients with sentinel lymph node bilateral successful mapping, patients with sentinel lymph node failed mapping showed: OR 1.39 (p=0.41) for body mass index >30 kg/m2; OR 1.72 (p=0.24) for menopausal status; OR 1.19 (p=0.74) for adenomyosis; OR 0.86 (p=0.55) for prior pelvic surgery; OR 2.38 (p=0.26) for prior cervical surgery; OR 0.96 (p=0.89) for prior Cesarean section; OR 1.39 (p=0.70) for lysis of adhesions during surgery before sentinel lymph node biopsy; OR 1.77 (p=0.02) for indocyanine green dose <3 mL; OR 1.28 (p=0.31) for deep myometrial invasion; OR 1.21 (p=0.42) for International Federation of Gynecology and Obstetrics (FIGO) grade 3; OR 1.89 (p=0.01) for FIGO stages III-IV; OR 1.62 (p=0.07) for non-endometrioid histotype; OR 1.29 (p=0.25) for lymph-vascular space invasion; OR 4.11 (p<0.0001) for enlarged lymph nodes; and OR 1.71 (p=0.022) for lymph node involvement. CONCLUSION Indocyanine green dose <3 mL, FIGO stage III-IV, enlarged lymph nodes, and lymph node involvement are predictive factors of sentinel lymph node failed mapping in endometrial cancer patients.
Collapse
Affiliation(s)
- Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Rovero
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Federica Renzulli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy.,Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Campania, Italy
| | - Umberto De Laurentiis
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Angela Santoro
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Campania, Italy
| |
Collapse
|