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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] [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.
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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
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Agusti N, Bonaldo G, Kahn RM, Rosati A, Nachira D, Pan TL, Mburu A, Kochiashvili G, Paredes P, Hsu HC, Davies-Oliveira J, Ramirez PT. Cardiophrenic lymph nodes in advanced ovarian cancer. Int J Gynecol Cancer 2024; 34:150-158. [PMID: 38097346 DOI: 10.1136/ijgc-2023-004963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
Epithelial ovarian cancer most commonly presents at advanced stages, and prognosis is influenced by residual disease following cytoreduction. The significance of cardiophrenic lymph node resection at the time of cytoreductive surgery in advanced ovarian cancer remains a topic of debate. Enlarged cardiophrenic lymph nodes are detected through high-resolution imaging; however, the optimal imaging technique in determining feasibility of node resection remains uncertain. Similarly, the impact of excision of cardiophrenic lymph nodes on progression-free and overall survival remains elusive. The indications for resection of cardiophrenic lymph nodes are not addressed in standard ovarian cancer guidelines. Patients with cardiophrenic lymph nodes exceeding 1 cm in size may be considered for resection if complete intra-abdominal cytoreduction is feasible to no gross residual. The surgical approach might be either by open access or by video-assisted thoracoscopic surgery (minimally invasive approach), and major complications following cardiophrenic lymph nodes resection are low. Pathological cardiophrenic lymph nodes are associated with a poorer overall prognosis and can serve as a prognostic parameter; however, the therapeutic benefit of cardiophrenic lymph nodes resection remains inconclusive.
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Affiliation(s)
- Nuria Agusti
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Giulio Bonaldo
- Department of Women and Children's Health, Clinic of Gynecology and Obstetrics, University of Padova, Padova, Italy
| | - Ryan M Kahn
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Andrea Rosati
- Dipartimento per la salute della Donna e del Bambino e di Sanita Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A.Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa L Pan
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Anisa Mburu
- Department of Gynecology and Obstetrics, Aga Khan Hospital Mombasa, Mombasa, Kenya
| | - Gvantsa Kochiashvili
- Department of Gynecologic Oncology, Caucasus Medical Centre, Tbilisi, Georgia
- Department of Surgery, David Tvildiani Medical University, Tbilisi, Georgia
| | - Pilar Paredes
- Department of Nuclear Medicine, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | | | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
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Boerner T, Filippova OT, Chi AJ, Iasonos A, Zhou QC, Long Roche K, Zivanovic O, Park BJ, Huang J, Jones DR, Abu-Rustum NR, Gardner G, Sonoda Y, Chi DS. Video-assisted thoracic surgery in the primary management of advanced ovarian carcinoma with moderate to large pleural effusions: A Memorial Sloan Kettering Cancer Center Team Ovary Study. Gynecol Oncol 2020; 159:66-71. [PMID: 32792282 DOI: 10.1016/j.ygyno.2020.07.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. METHODS Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01-01/19. Differences between treatment groups were tested using standard statistical techniques. RESULTS One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8-51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5-87.8) vs. 37.4 months (95% CI: 33.3-45.2); p = .016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14-4.18; p = .019) and age ≥ 65 (HR 1.98, 95% CI: 1.16-3.40; p = .013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). CONCLUSIONS VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions.
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Affiliation(s)
- Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew J Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Bernard J Park
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA.
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Tozzi R, Ferrari F, Nieuwstad J, Campanile RG, Soleymani Majd H. Tozzi classification of diaphragmatic surgery in patients with stage IIIC-IV ovarian cancer based on surgical findings and complexity. J Gynecol Oncol 2019; 31:e14. [PMID: 31912672 PMCID: PMC7044006 DOI: 10.3802/jgo.2020.31.e14] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/12/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To introduce a systematic classification of diaphragmatic surgery in patients with ovarian cancer based on disease spread and surgical complexity. Methods For all consecutive patients who underwent diaphragmatic surgery during Visceral-Peritoneal debulking (VPD) in the period 2009–2017, we extracted: initial surgical finding, extent of liver mobilization and type of procedure. Combining these features, we aimed to classify the surgical procedures necessary to tackle different presentation of diaphragmatic disease. We also report histology, intra- and post-operative specific complication rate based on the classification. Results A total of 170 patients were included in this study, 110 (64.7%) had a peritonectomy, while 60 (35.3%) had a full thickness resection with pleurectomy. We identified 3 types of surgical procedures. Type I treated 28 out of 170 patients (16.5%) who only had anterior diaphragm disease, needed no liver mobilization, included peritonectomy and had no morbidity recorded. Type II pertained to 105 out of 170 patients (61.7%) who had anterior and posterior disease, needed partial and sometimes full liver mobilization, had a mix of peritonectomy and full thickness resection, and experienced 10% specific morbidity. Type III included 37 out of 170 patients (21.7%) who needed full mobilization of the liver, always had full thickness resection, and suffered 30% specific morbidity. Conclusion Diaphragmatic surgery can be classified in 3 types. The adoption of this classification can facilitate standardization of the surgery, comparison of data and define the expertise required. Finally, this classification can be a benchmark to establish the training required to treat diaphragmatic disease.
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Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Oxford University Hospital, Oxford, United Kingdom.
| | - Federico Ferrari
- Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Oxford University Hospital, Oxford, United Kingdom
| | - Joost Nieuwstad
- Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Oxford University Hospital, Oxford, United Kingdom
| | - Riccardo Garruto Campanile
- Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Oxford University Hospital, Oxford, United Kingdom
| | - Hooman Soleymani Majd
- Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Oxford University Hospital, Oxford, United Kingdom
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When Ovarian Cancer Is Not: Characterizing Nonovarian Cancer Pathology in a Laparoscopy-Based Triage System. Int J Gynecol Cancer 2018; 28:1485-1490. [PMID: 30036226 DOI: 10.1097/igc.0000000000001329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Establishing an accurate histologic diagnosis is essential for determining the appropriate course of therapy for ovarian cancer. This study sought to investigate and describe nonovarian cancer pathologies discovered during the systematic laparoscopic workup of presumed advanced ovarian cancer. METHODS A retrospective cohort of patients with presumed advanced ovarian cancer (based on elevated CA125 and/or imaging) presenting to our center without confirmed pathologic diagnosis were identified and characterized. Patients without ovarian cancer on final pathology were described and compared with those with confirmed epithelial ovarian cancer using standard statistical methods. RESULTS Nonovarian cancer was found in 26 (7.1%) of 365 cases over 3.5 years of study, and included benign ovarian pathology, and metastatic uterine, breast, and gastrointestinal cancers. Most nonovarian cancer cases could not be diagnosed with percutaneous biopsy, and instead used diagnostic laparoscopy or assessment at the time of laparotomy for diagnosis (58%). No patient received inappropriate treatment. Nonovarian cancer cases were more likely to be nonwhite (P = 0.003), have a better Eastern Cooperative Oncology Group performance status (P < 0.001), and have a lower CA125 value (P < 0.001), and were less likely to have pleural effusions (P = 0.04). CONCLUSIONS A systematic laparoscopic triage approach to advanced-stage ovarian cancer eliminates incorrect neoadjuvant chemotherapy administration and inappropriate laparotomy. This algorithm identified a population of women who are more likely to have nonovarian cancer pathology. Increasing screening efforts should be focused on conclusive diagnosis with the least invasive testing possible.
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Nuruzzaman HSM, Tan GHC, Nadarajah R, Teo M. Relevance of enlarged cardiophrenic lymph nodes in determining prognosis of patients with advanced ovarian cancer. BMJ Case Rep 2018; 2018:bcr-2017-221450. [PMID: 29331996 PMCID: PMC5778321 DOI: 10.1136/bcr-2017-221450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 11/04/2022] Open
Abstract
Ovarian cancer often presents at an advanced stage with widespread peritoneal and/or extra-abdominal metastases. Complete cytoreduction is the mainstay of treatment for disease confined to peritoneum. But in patients with distant metastases, the role and rationale is less obvious. One of the the most common sites of extra-abdominal disease is the cardiophrenic lymph node (CPLN). In this paper, we described the management of a patient with International Federation of Gynecology and Obstetrics (FIGO) stage IVB epithelial ovarian carcinoma and widespread peritoneal and extra-abdominal metastases to the CPLN, who underwent complete cytoreduction including excision of enlarged CPLN, following neoadjuvant chemotherapy. We examined the literature to determine the prognostic value of enlarged CPLN and their relevance in managing patients with advanced ovarian cancer and found it as an adverse prognostic factor. Transdiaphragmatic excision of CPLN is feasible without major complications. But as its correlation with overall or progression-free survival is not yet evident, large-scale prospective studies are warranted.
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Affiliation(s)
| | - Grace Hwei Ching Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ravichandran Nadarajah
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore, Singapore
| | - Melissa Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Prognostic importance of peritoneal lesion-to-primary tumour standardized uptake value ratio in advanced serous epithelial ovarian cancer. Eur Radiol 2017; 28:2107-2114. [PMID: 29260365 DOI: 10.1007/s00330-017-5194-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Using preoperative PET/CT, we evaluated the prognostic value of preoperative [18F]FDG uptake ratio between various metastatic lesions and primary tumour in patients with advanced serous epithelial ovarian cancer (EOC). METHODS We retrospectively reviewed patients with International Federation of Gynecology and Obstetrics (FIGO) stage III, IV serous EOC who underwent preoperative [18F]FDG PET/CT scans. Clinico-pathological variables and PET/CT parameters such as maximum standardized uptake value of the ovarian cancer (SUVovary), pelvic or para-aortic LN (SUVLN), peritoneal (SUVperit) and distant extra-peritoneal (SUVdist) metastatic lesions, and the metastatic lesion-to-ovarian cancer standardized uptake value ratio were assessed. RESULTS Clinico-pathological data were retrospectively reviewed for 97 eligible patients. The median progression-free survival (PFS) was 18 months (range, 6-90 months) and 59 (60.8 %) patients experienced recurrence. In multivariate regression analysis, older age (p = 0.035, hazard ratio (HR) 1.032, 95 % CI 1.002-1.062), and high SUVperit/SUVovary (p = 0.046, HR 1.755, 95 % CI 1.011-3.047) were independent risk factors of recurrence. Patient group categorized by SUVperit/SUVovary showed significant difference in PFS (Log-Rank test, p = 0.001). CONCLUSIONS In patients with advanced serous EOC, preoperative SUVperit/SUVovary measured by [18F]FDG PET/CT provides significant incremental performance for prediction of recurrence. KEY POINTS • PET/CT data from advanced serous epithelial ovarian cancer patients were analysed. • Prognostic value of SUV ratio between metastatic and primary tumour was investigated. • SUV perit /SUV ovary provides incremental performance for prediction of recurrence.
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Hacker NF, Rao A. Surgery for advanced epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:71-87. [PMID: 27884789 DOI: 10.1016/j.bpobgyn.2016.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Cytoreductive surgery for patients with advanced epithelial ovarian cancer has been practised since the pioneering work of Tom Griffiths in 1975. Further research has demonstrated the prognostic significance of the extent of metastatic disease pre-operatively, and of complete cytoreduction post-operatively. Patients with advanced epithelial ovarian cancer should be referred to high volume cancer units, and managed by multidisciplinary teams. The role of thoracoscopy and resection of intrathoracic disease is presently investigational. In recent years, there has been increasing use of neoadjuvant chemotherapy and interval cytoreductive surgery in patients with poor performance status, which is usually due to large volume ascites and/or large pleural effusions. Neoadjuvant chemotherapy reduces the post-operative morbidity, but if the tumour responds well to the chemotherapy, the inflammatory response makes the surgery more difficult. Post-operative morbidity is generally tolerable, but increases in older patients, and in those having multiple, aggressive surgical procedures, such as bowel resection or diaphragmatic stripping. Primary cytoreductive surgery should be regarded as the gold standard for most patients until a test is developed which would allow the prediction of platinum resistance pre-operatively.
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Affiliation(s)
- Neville F Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales, Kensington NSW 2031, Australia.
| | - Archana Rao
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick NSW 2031, Australia.
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Role of Video-Assisted Thoracoscopy in Advanced Ovarian Cancer: A Literature Review. Int J Gynecol Cancer 2016; 26:801-6. [DOI: 10.1097/igc.0000000000000680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractTools that accurately predict the presence of metastatic ovarian cancer in the pleura are limited. Thus, we sought to summarize the current literature on video-assisted thoracoscopic surgery (VATS) and its applicability in patients with advanced ovarian cancer. A total of 187 patients with suspected ovarian cancer who underwent the VATS procedure were identified for this analysis. The median patient age was 59.4 years (range, 20.3–83 years). The median operative time for VATS was 32 minutes (range, 5–65 minutes). In 89 patients (48%), VATS revealed macroscopic disease in the pleural cavity. After VATS, 44 patients underwent neoadjuvant chemotherapy, and the remaining 143 patients underwent primary cytoreductive surgery. Video-assisted thoracoscopic surgery led to a change in disease stage or management in 76 patients (41%). Among patients with pleural effusions, VATS revealed pleural disease in 57% of patients, and 73% of patients with positive pleural cytology had evidence of pleural disease at the time of VATS. In addition, 23.5% of patients with negative pleural cytology had evidence of pleural disease at the time of VATS. Prospective trials are needed to accurately evaluate the impact of VATS on disease-free and overall survival in patients with advanced ovarian cancer. Video-assisted thoracoscopic surgery can help determine which patients are ideal candidates for surgical cytoreduction.
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Diaphragmatic peritonectomy vs. full thickness resection with pleurectomy during Visceral-Peritoneal Debulking (VPD) in 100 consecutive patients with stage IIIC–IV ovarian cancer: A surgical-histological analysis. Gynecol Oncol 2016; 140:430-5. [DOI: 10.1016/j.ygyno.2015.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 01/10/2023]
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Role of Transdiaphragmatic Thoracic Exploration in Bulky Stage IIIC Ovarian Cancer Patients Who Underwent Diaphragmatic Surgery. Int J Gynecol Cancer 2015. [DOI: 10.1097/igc.0000000000000516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sala E. Ovarian cancer: imaging in treatment selection and planning with FIGO update. Cancer Imaging 2015. [PMCID: PMC4601816 DOI: 10.1186/1470-7330-15-s1-o38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sala E. Ovarian cancer: imaging in treatment selection and planning with FIGO update. Cancer Imaging 2014. [PMCID: PMC4242770 DOI: 10.1186/1470-7330-14-s1-o18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pölcher M, Zivanovic O, Chi DS. Cytoreductive Surgery for Advanced Ovarian Cancer. WOMENS HEALTH 2014; 10:179-90. [DOI: 10.2217/whe.14.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The amount of the largest diameter of visible residual tumor after cytoreductive surgery remains one of the strongest prognostic factors In advanced ovarian cancer. The Implementation of a more aggressive surgical approach to Increase the proportion of patients without visible residual tumor Is, therefore, a rational concept. Thus, the surgical management of advanced ovarian, primary peritoneal and fallopian tube cancers now Incorporates more comprehensive surgical procedures. However, these more extensive surgical procedures are associated with an Increased risk of morbidity, which may have a negative Impact on the oncologic outcome. In addition, It Is unclear whether all patients benefit from a comprehensive surgical Intervention In the same way or If there are patients whose disease course will not be Influenced by this approach. The methodologic analysis of surgical effectiveness Is complex and controversial owing to a lack of prospective surgical trials. This review acknowledges controversies and alms to discuss novel developments In the field of cytoreductive surgery for patients with ovarian, primary peritoneal and fallopian tube cancers. The focus of the review Is to discuss the role of surgery at Initial diagnosis. The role of secondary and tertiary surgery In the recurrent setting Is beyond the scope of this review.
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Affiliation(s)
- Martin Pölcher
- Red Cross Women's Hospital Munich, Department of Gynecologic Oncology & Minimally-Invasive Surgery, Munich, Germany
| | - Oliver Zivanovic
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dennis S Chi
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Hacker N. State of the art of surgery in advanced epithelial ovarian cancer. Ann Oncol 2013; 24 Suppl 10:x27-32. [DOI: 10.1093/annonc/mdt465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdominopelvic cytoreduction rates and recurrence sites in stage IV ovarian cancer: Is there a case for thoracic cytoreduction? Gynecol Oncol 2013; 131:27-31. [DOI: 10.1016/j.ygyno.2013.07.093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/11/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022]
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Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer. Gynecol Oncol 2012; 126:397-402. [DOI: 10.1016/j.ygyno.2012.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/23/2012] [Accepted: 05/14/2012] [Indexed: 12/20/2022]
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Abstract
Ovarian cancer affects approximately 21,880 women and accounts for over 13,000 deaths annually in the United States. Although survival rates have improved over the past several decades, directly as a result of advances in chemotherapy and surgery, ovarian cancer continues to have high mortality rates. Understanding the multiple roles of surgery throughout the disease course is the focus of this review.
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Whitworth JM, Schneider KE, Fauci JM, Bryant AS, Cerfolio RJ, Straughn JM. Outcomes of patients with gynecologic malignancies undergoing video-assisted thoracoscopic surgery (VATS) and pleurodesis for malignant pleural effusion. Gynecol Oncol 2012; 125:646-8. [DOI: 10.1016/j.ygyno.2012.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/13/2012] [Accepted: 02/20/2012] [Indexed: 01/31/2023]
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Mironov O, Sala E, Mironov S, Pannu H, Chi DS, Hricak H. Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery. J Gynecol Oncol 2011; 22:260-8. [PMID: 22247803 PMCID: PMC3254845 DOI: 10.3802/jgo.2011.22.4.260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/03/2011] [Accepted: 06/28/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. METHODS This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT ≤30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. RESULTS In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. CONCLUSION In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.
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Affiliation(s)
- Oleg Mironov
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Evis Sala
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Svetlana Mironov
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Harpreet Pannu
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Dennis S. Chi
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
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Prognostic significance of mediastinal 18F-FDG uptake in PET/CT in advanced ovarian cancer. Eur J Nucl Med Mol Imaging 2011; 39:474-80. [PMID: 22109667 DOI: 10.1007/s00259-011-1984-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 10/21/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the prognostic significance of increased mediastinal (18)F-FDG uptake in PET/CT for the staging of advanced ovarian cancer. METHODS We retrospectively evaluated patients managed for FIGO stage III/IV ovarian cancer between 1 January 2006 and 1 June 2009. Patients were included if they had undergone (18)F-FDG PET/CT and surgery for initial staging. Exclusion criteria were age younger than 18 years, inability to undergo general anaesthesia, recurrent ovarian cancer, and borderline or nonepithelial malignancy. Whole-body PET/CT was performed after intravenous (18)F-FDG injection. The location of abnormal hot spots and (18)F-FDG maximal standard uptake values (SUV(max)) were recorded. We compared the complete cytoreduction and survival rates in groups defined based on mediastinal (18)F-FDG uptake and SUV(max) values. Kaplan-Meier curves of overall survival and disease-free survival were compared using the log-rank test. Hazard ratios with their 95% confidence intervals were computed. Adjusted hazard ratios were obtained using a multivariate Cox model. RESULTS We included 53 patients, of whom 17 (32%) had increased mediastinal (18)F-FDG uptake. Complete cytoreduction was achieved in 14 (87.5%) of the 16 patients managed with primary surgery and in 21 (75%) of the 28 patients managed with interval surgery. Complete cytoreduction was achieved significantly more often among patients without increased mediastinal (18)F-FDG uptake (80.6% vs. 35.3%; p = 0.001). Disease-free survival was comparable between the two groups. By univariate analysis, overall mortality was significantly higher among patients with increased mediastinal (18)F-FDG uptake (hazard ratio 5.70, 95% confidence interval 1.74-18.6). The only factor significantly associated with overall survival by multivariate analysis was complete cytoreduction (adjusted hazard ratio 0.24, 95% confidence interval 0.07-0.89). CONCLUSION Increased mediastinal (18)F-FDG uptake was common in patients with advanced ovarian cancer. However, complete cytoreduction, which was significantly more frequent among patients without mediastinal (18)F-FDG uptake, was the only factor independently associated with survival.
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Fleury AC, Kushnir CL, Giuntoli II RL, Spirtos NM. Upper abdominal cytoreduction and thoracoscopy for advanced epithelial ovarian cancer: unanswered questions and the impact on treatment. BJOG 2011; 119:202-6. [DOI: 10.1111/j.1471-0528.2011.03197.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Song YJ, Lim MC, Kang S, Seo SS, Kim SH, Han SS, Park SY. Extended cytoreduction of tumor at the porta hepatis by an interdisciplinary team approach in patients with epithelial ovarian cancer. Gynecol Oncol 2011; 121:253-7. [PMID: 21277009 DOI: 10.1016/j.ygyno.2010.12.350] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 12/14/2010] [Accepted: 12/17/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to describe the development and experience in resection of tumor at the porta hepatis in patients with ovarian cancer by an interdisciplinary team approach. METHODS From August 2007 to June 2009, 11 women (2 primary and 9 recurrent ovarian cancers) underwent extended cytoreductive surgery including resection of tumor at the porta hepatis by hepatobiliary surgeons. RESULTS Tumor resection at the porta hepatis was required in 7.1% of the patients (11/155) during the study period. The median tumor size of the porta hepatis was 2.0cm (range, 0.7-4cm). All visible tumors at the porta hepatis were completely resected with co-operation of hepatobiliary surgeons. Optimal cytoreduction was achieved in all patients. There was no significant morbidity related to tumor resection of the porta hepatis and mortality associated with surgery. Five of 11 patients had recurrent disease at median 8months (range, 1-13) after the surgery with a median follow-up of 8months (range, 3-21months). CONCLUSION Tumor resection at the porta hepatis is feasible with acceptable morbidities in patients with ovarian cancer by an interdisciplinary team approach with hepatobiliary surgeons. Long term follow up is needed to know the impact on survival.
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Affiliation(s)
- Yong Jung Song
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea.
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Mironov O, Ishill NM, Mironov S, Vargas HA, Zheng J, Moskowitz CS, Sonoda Y, Papas RS, Chi DS, Hricak H. Pleural effusion detected at CT prior to primary cytoreduction for stage III or IV ovarian carcinoma: effect on survival. Radiology 2010; 258:776-84. [PMID: 21193598 DOI: 10.1148/radiol.10100162] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer. MATERIALS AND METHODS The institutional review board waived informed consent for this HIPAA-compliant study of 203 patients with International Federation of Obstetrics and Gynecology stage III (n = 172) or IV (n = 31) epithelial ovarian cancer who underwent CT before primary cytoreductive surgery between 1997 and 2004 (mean age, 61 years; range, 37-96 years). Two radiologists retrospectively evaluated chest and/or abdominal CT images for pleural malignancy and the presence, size, and laterality of pleural effusions. To evaluate survival, Kaplan-Meier methods were used, with log-rank P values for comparisons. Multivariate analyses were conducted by using Cox proportional hazards regression. κ Statistics were calculated for interreader agreement. RESULTS Median survival was 50 months (95% confidence interval [CI]: 45, 55 months) for patients with stage III disease and 41 months (95% CI: 27, 58 months) for patients with stage IV disease. Readers 1 and 2 found pleural effusions in 40 and 41 stage III and 20 and 21 stage IV patients, respectively. At multivariate analysis, after controlling for stage, age at surgery, preoperative serum CA-125 level, debulking status, and ascites, moderate-to-large pleural effusion on CT images was significantly associated with worse overall survival (reader 1: hazard ratio = 2.27 [95% CI: 1.31, 3.92], P < .01; reader 2: hazard ratio = 2.25 [95% CI: 1.26, 4.01], P = .02). Preoperative CA-125 level, debulking status, and ascites were also significant survival predictors (P ≤ .03 for all for both readers). Readers agreed substantially in distinguishing small from moderate-to-large effusions (κ = 0.764). CONCLUSION Moderate-to-large pleural effusion on preoperative CT images in patients with stage III or IV epithelial ovarian cancer was independently associated with poorer overall survival after controlling for age, preoperative CA-125 level, surgical stage, ascites, and cytoreductive status.
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Affiliation(s)
- Oleg Mironov
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065, USA
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[Assessment and impact of intrathoracic disease in advanced ovarian cancer]. Bull Cancer 2010; 97:523-5. [PMID: 20478765 DOI: 10.1684/bdc.2010.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As seventy-five percent of patients with ovarian cancer are diagnosed at an advanced stage (FIGO stage III/IV), optimal surgery is then difficult to perform. The aim of our study is to assess the interest of thoracoscopy in the management of ovarian carcinoma with pleural effusion.
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Diaz JP, Abu-Rustum NR, Sonoda Y, Downey RJ, Park BJ, Flores RM, Chang K, Leitao MM, Barakat RR, Chi DS. Video-assisted thoracic surgery (VATS) evaluation of pleural effusions in patients with newly diagnosed advanced ovarian carcinoma can influence the primary management choice for these patients. Gynecol Oncol 2010; 116:483-8. [DOI: 10.1016/j.ygyno.2009.09.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/22/2009] [Accepted: 09/27/2009] [Indexed: 01/02/2023]
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Ibeanu OA, Bristow RE. Predicting the Outcome of Cytoreductive Surgery for Advanced Ovarian Cancer. Int J Gynecol Cancer 2010; 20 Suppl 1:S1-11. [DOI: 10.1111/igc.0b013e3181cff38b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Cohen-Mouly S, Badia A, Bats AS, Barthes F, Bensaïd C, Riquet M, Lécuru F. Role of Video-Assisted Thoracoscopy in Patients With Ovarian Cancer and Pleural Effusion. Int J Gynecol Cancer 2009; 19:1662-5. [DOI: 10.1111/igc.0b013e3181a84595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives:To evaluate the feasibility of video-assisted thoracoscopy (VAT) for staging advanced ovarian cancer, to measure the performance of preoperative computed tomography (CT) for diagnosing pleural metastases, to assess the correlation between pleural and abdominal involvement, and to measure the impact of VAT on patient management.Methods:We retrospectively evaluated 16 VAT procedures in 15 patients with advanced ovarian malignancies and pleural effusions. The reason for VAT was either to evaluate unilateral or bilateral pleural effusions (n = 15) or to evaluate pleural metastases after neoadjuvant chemotherapy (n = 1). Preoperative CT was performed routinely, and findings were compared with those of VAT. The rates of involvement of the hepatic pedicle, mesentery, and right side of the diaphragm were compared with the rate of pleural involvement.Results:The right side of the chest was examined 12 times; and the left side, 4 times. There were no complications; 1 procedure was stopped because of ventilatory intolerance. Video-assisted thoracoscopy identified metastases smaller than 1 cm in 5 patients and larger than 1 cm in 2 additional patients; there was no evidence of pleural involvement in 6 patients. Computed tomography had 14% sensitivity and 25% specificity for pleural status determination, using VAT biopsy as the reference standard. Pleural involvement did not correlate with involvement of the hepatic pedicle, mesentery, or right side of the diaphragm.Conclusions:Video-assisted thoracoscopy performs better than CT for evaluating pleural involvement in ovarian cancer. Video-assisted thoracoscopy supplies accurate data on thoracic involvement, which does not seem predictable from the peritoneal involvement. Video-assisted thoracoscopy may impact patient management.
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Silver DF, Bou Zgheib N. Extended left colon resections as part of complete cytoreduction for ovarian cancer: tips and considerations. Gynecol Oncol 2009; 114:427-30. [PMID: 19555997 DOI: 10.1016/j.ygyno.2009.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 05/26/2009] [Accepted: 05/29/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Colectomy is a common part of cytoreductive surgery. The most common segment of the colon resected is the rectosigmoid. Extended left-sided colectomies are rarely performed. With increased emphasis on the importance of maximal cytoreductive surgery it is becoming more important to understand the outcomes related to such a procedure. The purpose of this report is to evaluate the quality of life issues related to extended left colectomies. METHODS Data on all patients who underwent cytoreductive surgery between April 2007 and April 2009 was prospectively recorded. Nineteen patients underwent extended left colon resections. The data from these cases was evaluated with particular attention directed at the quality of life issues surrounding postoperative bowel function, and tolerance of postoperative chemotherapy. RESULTS Nine underwent resection of the left hemicolon plus the hepatic flexure. Six underwent resection of the left hemicolon, hepatic flexure, and the ascending colon. Four underwent subtotal colectomies. Temporary diverting loop ileostomies were performed on 18 of the 19 patients each of whom consented for intraperitoneal chemotherapy. No delays in chemotherapy were observed. Median number of bowel movements at 6, 9 and 12 months were 2, 2 and 1, respectively. No fecal incontinence was observed. Patients expressed satisfaction with their bowel surgery and denied any significant decrease in their quality of life due to their bowel function. CONCLUSION Extended left colon resection is a reasonable technique to include in patients requiring maximal cytoreduction. Quality of life related to bowel function is acceptable and chemotherapy is not delayed.
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Affiliation(s)
- David F Silver
- Department of Obstetrics and Gynecology, St. Luke's Hospital, Bethlehem, PA, USA.
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Lim MC, Lee HS, Jung DC, Choi JY, Seo SS, Park SY. Pathological Diagnosis and Cytoreduction of Cardiophrenic Lymph Node and Pleural Metastasis in Ovarian Cancer Patients Using Video-Assisted Thoracic Surgery. Ann Surg Oncol 2009; 16:1990-6. [DOI: 10.1245/s10434-009-0486-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 01/21/2009] [Accepted: 03/09/2009] [Indexed: 12/26/2022]
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Terauchi F, Kobayashi Y, Nagashima T, Moritake T, Nishi H, Fujito A, Isaka K. Pilot Study on Transdiaphragmatic Thoracoscopic-Assisted Pleural Biopsy and Intrathoracic Washing Cytology for Stage IIIc Ovarian Cancer With Diaphragmatic Metastases. Int J Gynecol Cancer 2009; 19:300-3. [DOI: 10.1111/igc.0b013e31819c5521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose:The significance of investigations of thoracic cavities as well as pleural biopsy and intrathoracic washing cytology through transdiaphragmatic thoracoscopy for stage IIIc ovarian cancer with diaphragmatic metastases was assessed as a prospective pilot study.Subjects and Methods:Eligibility criteria were established to include patients with stage IIIc ovarian cancer in whom pleural effusions were not detected preoperationally, but prominent diaphragmatic metastases were observed when the abdomen was opened and those who submitted consent. Transdiaphragmatic thoracoscopy was performed after diaphragm stripping. Then, biopsy of the lesion suspected to be disseminated or the plural membrane of the thoracic opening was performed followed by washing cytology using physiological saline.Results:Ten subjects were enrolled. Disseminated lesions were observed on plural membranes, and positive results were obtained in biopsy and washing cytology in 3 subjects. In addition, positive results were seen with biopsy alone in 2 subjects and with washing cytology alone in 2 subjects. Hence, a total of 7 subjects (70.0%) were up-staged to the level of stage IV. Postoperational complications were not observed in any of these cases.Conclusions:It was suggested that stage IIIc ovarian cancer with prominent diaphragmatic metastasis may advance to the level of stage IV from a clinical point of view even if carcinomatous pleural effusions are not detected pre-operationally. Therefore, it is thought that this operational method is useful in the management of progressive ovarian cancer.
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Intra-thoracic cytoreduction of stage IV peritoneal malignancy: A case series. Gynecol Oncol 2008; 111:533-6. [DOI: 10.1016/j.ygyno.2008.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 06/11/2008] [Accepted: 06/18/2008] [Indexed: 11/19/2022]
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Aletti GD, Podratz KC, Cliby WA, Gostout BS. Stage IV ovarian cancer: disease site-specific rationale for postoperative treatment. Gynecol Oncol 2008; 112:22-7. [PMID: 18947860 DOI: 10.1016/j.ygyno.2008.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 09/08/2008] [Accepted: 09/11/2008] [Indexed: 01/29/2023]
Abstract
OBJECTIVES We aimed to define the site-specific patterns of treatment failure in stage IV ovarian cancer. METHODS Data from all consecutive Mayo Clinic patients with stage IV epithelial ovarian cancer, from 1994 through 2003, were collected and analyzed. Statistical analyses included the chi(2) test and Kaplan-Meier curves with log-rank tests. RESULTS Review of our patient database identified 109 patients with stage IV ovarian cancer: mean age, 62 years (range, 36-83 years); 5-year overall survival, 15%. Most patients (74%) had intraperitoneal disease at the time of relapse, 36% had pleural effusion, and 49% had extraperitoneal metastases. At the time of death 75% had intraperitoneal localizations, 51% had pleural effusion, and 46% had extraperitoneal metastases. Patients with pleural effusion were more likely to have pleural disease at relapse and at last follow-up. Extrapleural disease at the time of diagnosis predicted extrapleural disease at relapse and at last follow-up. Most patients classified as having stage IV disease by pleural cytology only, as opposed to all other patients, had intraperitoneal disease at relapse (88% vs 58.7%, P=.001) and last follow-up (88.5% vs 59.6%, P=.001). Patients having stage IV disease by pleural cytology only had survival benefit when disease was optimally debulked in the abdomen and pelvis (median survival, 3.1 years vs 1.3 years; P=.001). Patients with multiple unresectable liver metastases had poor prognosis (median survival, 1.2 years) owing to progression of liver disease. CONCLUSIONS Clinical trials for stage IV ovarian cancer should reflect the site-specific risks for recurrence according to disease location at diagnosis.
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Affiliation(s)
- Giovanni D Aletti
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Are C, Brennan MF, D’Angelica M, Fong Y, Guillonneau B, Jarnagin WR, Park B, Strong VE, Touijer K, Weiser M, Abu-Rustum NR. Current Role of Therapeutic Laparoscopy and Thoracoscopy in the Management of Malignancy: A Review of Trends from a Tertiary Care Cancer Center. J Am Coll Surg 2008; 206:709-18. [DOI: 10.1016/j.jamcollsurg.2007.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 10/29/2007] [Accepted: 11/05/2007] [Indexed: 01/21/2023]
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Juretzka MM, Abu-Rustum NR, Sonoda Y, Downey RJ, Flores RM, Park BJ, Hensley ML, Barakat RR, Chi DS. The impact of video-assisted thoracic surgery (VATS) in patients with suspected advanced ovarian malignancies and pleural effusions. Gynecol Oncol 2007; 104:670-4. [PMID: 17150248 DOI: 10.1016/j.ygyno.2006.10.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 10/04/2006] [Accepted: 10/05/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We previously reported our initial experience of patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent video-assessed thoracic surgery (VATS) before planned abdominal exploration. The objective of this study was to report the surgical findings and management of patients who underwent VATS in an update of our experience. METHODS We performed a retrospective review of all patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS for assessment of extent of intrathoracic disease at our institution between 6/01 and 8/05. RESULTS Twenty-three patients with a median age of 61 years (range, 36-79) were identified. VATS was performed for right-sided effusions in 17 patients (74%), and a median of 1350 ml (400-3700 ml) of pleural fluid was drained. VATS demonstrated macroscopic disease in 15 (65%) patients, with nodules >1 cm in 11/15 (73%), and nodules <1 cm in 4/15 (27%). Macroscopic intrathoracic disease was found in 4/10 (40%) patients with negative cytology. Intrathoracic cytoreduction was performed in 3/11 patients (27%) with intrathoracic disease >1 cm. After VATS, 12/23 patients (52%) underwent primary surgical management, with cytoreduction to < or =1 cm achieved in 11/12 patients (92%). The other eleven patients received primary chemotherapy after undergoing diagnostic laparoscopy alone (4/11) or no further abdominal exploration (7/11). Nine of these patients proceeded to interval cytoreduction, while 2 had pathology demonstrating upper gastrointestinal and lymphoma primaries at the time of VATS. Final diagnosis of primary site of disease included: ovary, 14 (61%); endometrial, 2 (9%); dual ovarian/endometrial primaries, 1 (4%); fallopian tube, 1 (4%); primary peritoneal, 1 (4%); other, 4 (17%). Overall, findings at VATS altered primary surgical management in 11/23 (48%) patients. CONCLUSIONS Sixty-five percent of patients with suspected advanced ovarian cancer and moderate to large pleural effusions had gross intrathoracic disease identified at VATS, with the majority (11/15, 73%) having disease >1 cm in diameter. Use of VATS allows for assessment of intrathoracic disease and may help identify candidates for primary cytoreductive surgery and possible intrathoracic cytoreduction versus neoadjuvant chemotherapy.
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Affiliation(s)
- Margrit M Juretzka
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Eitan R, Levine DA, Abu-Rustum N, Sonoda Y, Huh JN, Franklin CC, Stevens TA, Barakat RR, Chi DS. The clinical significance of malignant pleural effusions in patients with optimally debulked ovarian carcinoma. Cancer 2005; 103:1397-401. [PMID: 15726548 DOI: 10.1002/cncr.20920] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to determine the impact of malignant pleural effusions on survival in patients with optimally debulked, advanced epithelial ovarian carcinoma. METHODS The authors conducted a retrospective review of all patients with advanced epithelial ovarian carcinoma who underwent optimal primary cytoreduction at their institution between January 1987 and August 2000. Survival rates were compared between patients with optimally debulked Stage IIIC epithelial ovarian carcinoma and patients with optimally debulked Stage IV epithelial ovarian carcinoma (according to the International Federation of Gynecology and Obstetrics [FIGO] staging system) based on cytology-proven malignant pleural effusions. RESULTS Ninety-nine patients were identified, and 97 of those patients were evaluable. The group with Stage IIIC disease included 76 patients, and the group with Stage IV disease included 21 patients. The median age at diagnosis was 55 years (range, 26-88 years). The majority of patients received platinum-based chemotherapy after undergoing optimal primary cytoreduction. Age, tumor grade and histology, and the percentage of patients with ascites were similar in the two groups. The median survival rate was 58 months for patients who had Stage IIIC disease and 30 months for patients who had Stage IV disease (P = 0.016). CONCLUSIONS Although both groups underwent optimal cytoreduction in the abdomen/pelvis and were treated in a similar fashion, the median survival rate of patients with malignant pleural effusions was significantly shorter than the survival of patients without effusions. Many factors that led to or were manifested by pleural effusions, such as undetected bulky residual intrathoracic disease, may have been the cause for this survival difference. In the patients with effusions, one or more of these contributing factors may have led to the observed decreased survival rate, warranting further investigation.
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Affiliation(s)
- Ram Eitan
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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