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Uccella S, Bosco M, Mezzetto L, Garzon S, Maggi V, Giacopuzzi S, Antonelli A, Pinali L, Zorzato PC, Festi A, Polati E, Montemezzi S, De Manzoni G, Franchi MP, Veraldi GF. Major vessel resection for complete cytoreduction in primary advanced and recurrent ovarian malignancies: A case series and systematic review of the literature - pushing the boundaries in oncovascular surgery. Gynecol Oncol 2023; 179:42-51. [PMID: 37922861 DOI: 10.1016/j.ygyno.2023.10.021] [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] [Received: 08/02/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Oncovascular surgery (the removal of major blood vessels infiltrated by cancer) is challenging but can be key to achieve complete cytoreduction in patient with advanced ovarian cancer. The aim of this study was to review the literature on oncovascular surgery in ovarian cancer and to report the details of all the cases performed at our institution. METHODS We retrospectively reviewed the database of ovarian cancer patients who underwent debulking surgery at the Department of Obstetrics and Gynecology of Verona University between January 2021 and 2023. Patients with at least one major vessel resection during cytoreduction were identified. We then systematically review the literature searching Pubmed and Embase from inception to January 2023 to report all cases of surgery for ovarian cancer with concomitant major vessel resection. RESULTS Five patients with advanced/recurrent ovarian cancer underwent major vascular resection at our institution. Vascular involvement was preoperatively identified in all cases and no case of vascular resection was performed after accidental injury. The major vessels removed were the inferior vena cava (n = 2), the common iliac veins (n = 2), the external iliac arteries (n = 2), the left common iliac artery (n = 1), and the left external iliac vein (n = 1). All patients underwent other non-gynecological cytoreductive procedures prior to vessel removal and had R0 obtained. Three (60%) patients experienced one or more postoperative complications. The literature search identified a total of seven cases of major vessels resection in ovarian cancer surgery. A single or multiple major vessels were removed in two (28.6%) and five (72.4%) cases, respectively. All the seven patients underwent vascular reconstruction. Four (57.1%) patients reported postoperative complications. Overall, 66.7% of the 12 total identified patients were free from disease at the last follow-up [median 15.5 months (range 5-25)]. CONCLUSIONS Oncovascular surgery is feasible in selected patients with ovarian cancer, provided that a multidisciplinary approach with customized care is available.
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Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Luca Mezzetto
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria Integrata, University of Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Veronica Maggi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Lucia Pinali
- Radiology Department, Verona University Hospital, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Anna Festi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Enrico Polati
- Department of Anaesthesia and Intensive Care B, University of Verona, DAI Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | | | - Giovanni De Manzoni
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Gian Franco Veraldi
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria Integrata, University of Verona, Italy
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Llueca A, Serra A, Climent MT, Maiocchi K, Villarin A, Delgado K, Mari-Alexandre J, Gilabert-Estelles J, Carrasco P, Segarra B, Gomez L, Hidalgo JJ, Escrig J, Laguna M. Postoperative Intestinal Fistula in Primary Advanced Ovarian Cancer Surgery. Cancer Manag Res 2021; 13:13-23. [PMID: 33442290 PMCID: PMC7797294 DOI: 10.2147/cmar.s280511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background Advanced ovarian cancer (AOC) requires an aggressive surgery with large visceral resections in order to achieve an optimal or complete cytoreduction and increase the patient’s survival. However, the surgical aggressiveness in the treatment of AOC is not exempt from major complications, such as the gastrointestinal fistula (GIF), which stands out among others due to its high morbidity and mortality. Methods We evaluated the clinicopathological features in patients with AOC and their association with GI. Data for 107 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. Clinicopathological features, including demographic, surgical procedures and follow-up data, were analyzed in relation to GIF. Results GIF was present in 11% of patients in the study, 5 (4.5%) and 7 (6.4%) of colorectal and small bowel origin, respectively. GIF was significantly associated with peritoneal cancer index (PCI) >20, more than 2 visceral resections, and multiple digestive resections. Overall and disease-free survival were also associated with GIF. Multivariate analysis identified partial bowel obstruction and operative bleeding as independent prognostic factors for survival. The presence of GIF is positively associated with poor prognosis in patients with AOC. Conclusion Given the importance of successful cytoreductive surgery in AOC, the assessment of the amount of tumor and the aggressiveness of the surgery to avoid the occurrence of GIF become a priority in patients with AOC.
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Affiliation(s)
- Antoni Llueca
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Anna Serra
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Maria Teresa Climent
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Radiology, University General Hospital of Castellon, Castellón, Spain
| | - Josep Mari-Alexandre
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan Gilabert-Estelles
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain.,Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain
| | - Paula Carrasco
- Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Blanca Segarra
- University of Texas MD Anderson Cancer Center, Gynecology Oncology, Houston, Texas, USA
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | | | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Manuel Laguna
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
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Bogani G, Leone Roberti Maggiore U, Chiappa V, Ditto A, Martinelli F, Sabatucci I, Mosca L, Lorusso D, Raspagliesi F. The addition of lymphadenectomy to secondary cytoreductive surgery in comparison with bulky node resection in patients with recurrent ovarian cancer. Int J Gynaecol Obstet 2018; 143:319-324. [DOI: 10.1002/ijgo.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/07/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Umberto Leone Roberti Maggiore
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
- Obstetrics and Gynecology; IRCCS AOU San Martino; Italy/Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI); University of Genoa; Genoa Italy
| | | | - Antonino Ditto
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Fabio Martinelli
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Ilaria Sabatucci
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Lavinia Mosca
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Domenica Lorusso
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
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