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Murris F, Weyl A, Ouldamer L, Lorenzini J, Delvallee J, Martinez A, Ferron G, Chollet C, De Barros A, Chantalat E. Contribution of the cadaveric recirculation system in the anatomical study of lymphatic drainage of the ovary: applications in the management of ovarian cancer. Surg Radiol Anat 2024; 46:1155-1164. [PMID: 38900203 DOI: 10.1007/s00276-024-03406-w] [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: 03/11/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The present knowledge about lymphatic drainage of the ovary is based on carcinological studies, but it has only rarely been studied under physiological conditions. However, it is one of the preferential routes of dissemination in ovarian cancer, and understanding it is therefore vital for optimal carcinological management.Our purpose was to evaluate the feasibility of an innovative technique to study the lymphatic drainage territories of the ovary using a recirculation module on the cadaveric model. METHODS We injected patent blue into the cortex of twenty "revascularised" cadaver ovaries with the Simlife recirculation model. We observed the migration of the dye live and described the drainage territories of each ovary. RESULTS We observed a staining of the lymphatic vessels and migration of the dye in all the subjects, systematically ipsilateral to the injected ovary. We identified a staining of the lumbo-aortic territory in 65% of cases, with a preferential lateral-caval involvement (60%) for the right ovary and lateral-aortic territory (40%) for the left ovary. A common iliac involvement was observed in only 10% of cases. In 57% of cases, the staining of the lumbo-aortic territory was associated with a staining of the suspensory ligament. The pelvic territory was involved in 50% of cases, with an external iliac staining in 25% of cases and internal in 20%. CONCLUSION Our study provides for a better understanding of lymphatic drainage of the ovary using a new detection method, and allows the possibility of improving the teaching for operators with a realistic model. Continuation of this work could lead to considering more targeted and thus less morbid lymph node sampling for lymph node staging in early-stage ovarian cancer.
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Affiliation(s)
- Floriane Murris
- Département de chirurgie gynécologique, Chu Bretonneau Tours, Tours, 37000, France.
| | - Ariane Weyl
- Département de chirurgie gynécologique chu Rangueil Toulouse et laboratoire d'anatomie chu Rangueil Toulouse, Toulouse, 31000, France
| | - Lobna Ouldamer
- Département de chirurgie gynécologique, Chu Bretonneau Tours, Tours, 37000, France
| | | | - Julie Delvallee
- Département de chirurgie gynécologique, Chu Bretonneau Tours, Tours, 37000, France
| | - Alejandra Martinez
- Département de chirurgie gynécologique, IUCT Oncopole, Toulouse, 31000, France
| | - Gwenael Ferron
- Département de chirurgie gynécologique, IUCT Oncopole, Toulouse, 31000, France
| | - Charlotte Chollet
- Département de chirurgie gynécologique, IUCT Oncopole, Toulouse, 31000, France
| | - Amaury De Barros
- Département de neurochirurgie chu Pierre Paul Riquet Toulouse et laboratoire d'anatomie chu Toulouse, Toulouse, 31000, France
| | - Elodie Chantalat
- Département de chirurgie gynécologique chu Rangueil Toulouse et laboratoire d'anatomie chu Rangueil Toulouse, Toulouse, 31000, France
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Giancontieri P, Turetta C, Barchiesi G, Pernazza A, Pignataro G, D’Onghia G, Santini D, Tomao F. High-grade serous carcinoma of unknown primary origin associated with STIC clinically presented as isolated inguinal lymphadenopathy: a case report. Front Oncol 2024; 13:1307573. [PMID: 38370346 PMCID: PMC10870410 DOI: 10.3389/fonc.2023.1307573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/29/2023] [Indexed: 02/20/2024] Open
Abstract
Serous tubal intraepithelial carcinoma (STIC) is a precancerous lesion of high-grade serous ovarian carcinoma (HGSOC). Usually, it arises from the fimbrial end of the tube, and it is associated with metastatic potential. On average, the time to progress from STIC to HGSOC is 6.5 years. Therefore, whenever a STIC lesion is found, surgical staging and prophylactic salpingectomy are recommended in order to prevent ovarian cancer. We report a rare case of a 45-year-old female patient who clinically presented an isolated right inguinal lymphadenopathy. The remaining clinical examination was normal. Therefore, an excisional biopsy of the lymph node was performed. Pathological analysis revealed a high-grade serous carcinoma, most likely of gynecological origin. Due to histological evidence, a computed tomography (CT) scan was carried out. There was no CT evidence of ovarian disease, pelvic involvement, intra-abdominal lymphadenopathies, metastatic disease, or ascites. All tumor markers were negative. The patient underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy followed by surgical staging. Surprisingly, pathological examination showed a STIC lesion in the fimbria of the left fallopian tube. We aim to report the potential capability of STIC to spread particularly through lymphatic pathways rather than peritoneal dissemination.
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Affiliation(s)
- Paola Giancontieri
- Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Camilla Turetta
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Barchiesi
- Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Angelina Pernazza
- Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gemma Pignataro
- Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Daniele Santini
- Department of Radiological, Oncological and Anatomo-Pathological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Seon KE, Kim SW, Kim YT. Clinical relevance of sentinel lymph node biopsy in early ovarian cancer. Obstet Gynecol Sci 2023; 66:498-508. [PMID: 37821093 PMCID: PMC10663395 DOI: 10.5468/ogs.23114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023] Open
Abstract
The first-line treatment for early ovarian cancer typically involves primary debulking surgery aimed at maximal cytoreduction, alongside adjuvant chemotherapy if clinically indicated. Nodal assessment involving pelvic and para-aortic lymph node dissection is typically performed during the primary debulking surgery. However, the survival benefit of lymphadenectomy in patients with early ovarian cancer has not been well established, and the procedure is associated with longer operation time and higher perioperative complications. With the emergence of minimally invasive surgery as a potential alternative to laparotomy for early ovarian cancer, sentinel lymph node biopsy has been evaluated in this setting. In this review, we summarized the current literature regarding sentinel lymph node biopsy in patients with early ovarian cancer, focusing on the clinical relevance of this method, including its detection rate and diagnostic accuracy. Additionally, we discuss the current status of clinical trials investigating sentinel lymph node biopsy in early ovarian cancer cases.
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Affiliation(s)
- Ki Eun Seon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Restaino S, Mauro J, Zermano S, Pellecchia G, Mariuzzi L, Orsaria M, Titone F, Biasioli A, Della Martina M, Andreetta C, Poletto E, Arcieri M, Buda A, Driul L, Vizzielli G. CUP-syndrome: Inguinal high grade serous ovarian carcinoma lymph node metastases with unknown primary origin – a case report and literature review. Front Oncol 2022; 12:987169. [PMID: 36300091 PMCID: PMC9589412 DOI: 10.3389/fonc.2022.987169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 01/19/2023] Open
Abstract
Objective High-grade serous ovarian carcinoma (HGSC) often presents lymph node involvement. According to the paths of lymphatic drainage, the most common site of nodal metastasis is in the aortic area. However, pelvic lymph nodes are also involved and inguinal metastases are less frequent. Methods Our report concerns the case of a 78-year-old woman with an inguinal lymph node relapse of HGSC, with the prior positivity of a right inguinal lymph node, after the primary surgery. Ovaries and tubes were negative on histological examination. A comprehensive search of the literature published from January 2000 to October 2021 was conducted on PubMed and Scopus. The papers were selected following the PRISMA guidelines. Nine retrospective studies were evaluated. Results Overall, 67 studies were included in the initial search. Applying the screening criteria, 36 articles were considered eligible for full-text reading of which, after applying the exclusion criteria, 9 studies were selected for the final analysis and included in the systematic review. No studies were included for a quantitative analysis. We divided the results according to the relapse location: loco-regional, abdominal, and extra-abdominal recurrence. Conclusions Inguinal node metastasis is a rare but not unusual occurrence in HGSC. A reasonable level of suspicion should be maintained in patients with inguinal adenopathy and high CA125 values, especially in women with a history of gynecologic surgery, even in the absence of negative imaging for an ovarian origin.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Jessica Mauro
- Department of Medicine, University of Udine, Udine, Italy
| | - Silvia Zermano
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Laura Mariuzzi
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Orsaria
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Francesca Titone
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
- Radiation Oncology Department, Academic Hospital of Udine, Udine, Italy
| | - Anna Biasioli
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Monica Della Martina
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Claudia Andreetta
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
- Oncology Department, University Hospital of Udine, Udine, Italy
| | - Elena Poletto
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
- Oncology Department, University Hospital of Udine, Udine, Italy
| | - Martina Arcieri
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Alessandro Buda
- Division of Gynecologic Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy
- *Correspondence: Lorenza Driul,
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Phung HT, Nguyen AQ, Van Nguyen T, Nguyen LT. Recurrent ovarian cancer presenting with isolated axillary lymph node metastasis: A rare case report. Ann Med Surg (Lond) 2022; 77:103640. [PMID: 35638064 PMCID: PMC9142611 DOI: 10.1016/j.amsu.2022.103640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Ovarian cancer with metastatic axillary lymph node is a very rare entity. This study aims to report a case of recurrent ovarian cancer presenting with isolated axillary lymph node metastasis. Case presentation We report a case of a 58-year-old patient with recurrent ovarian cancer in the axillary node and a suspected lesion in the ipsilateral breast. One year before recurrence, the patient was diagnosed with FIGO stage IIIC ovarian cancer and was treated with primary debulking and paclitaxel-carboplatin adjuvant chemotherapy. Biopsies of the breast lesion, right and left axillary lymph node yielded a fibroadenoma in the breast and a metastatic carcinoma in the axillary node. Immunohistochemistry stains of the left axillary node biopsy specimen was positive for CK7, P53 and PAX-8 markers, and negative for CK20 and GCDFP-15 markers. Immunohistochemistry results combined with a history of ovarian cancer helped confirm the ovarian origin of axillary lymph node metastasis. Clinical discussion Recurrent ovarian cancer presenting with isolated axillary lymph node metastasis is rare. Immunohistochemistry combined with medical history is essential for definitive diagnosis in this situation. PAX-8 and GCDFP-15 help to differentiate the origin from the breast or the ovary. Conclusion Oncologists and pathologists should recognize this rare clinical scenario for early diagnosis and treatment. Detailed medical history, imaging, and immunohistochemical studies on biopsy specimen should help reach accurate diagnosis. Recurrent ovarian cancer presenting with isolated axillary lymph node metastasis is extremely rare. The differential diagnosis of axillary lymph node metastasis from breast cancer is important because treatment and prognosis are completely different. Immunohistochemistry is helpful in identifying the ovarian origin and in ruling out breast and other primaries.
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Chalif J, Yao M, Gruner M, Kuznicki M, Vargas R, Rose PG, Michener C, DeBernardo R, Chambers L. Incidence and prognostic significance of inguinal lymph node metastasis in women with newly diagnosed epithelial ovarian cancer. Gynecol Oncol 2022; 165:90-96. [PMID: 35272875 DOI: 10.1016/j.ygyno.2022.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE(S) To assess incidence and oncologic outcomes in women with advanced epithelial ovarian cancer (EOC) with inguinal lymph node metastasis (ILNM) at diagnosis. METHODS An IRB-approved, retrospective single-institution cohort study was performed in women with stage III/IV EOC from 2009 to 2017. Patients with inguinal lymphadenopathy (defined as >1 cm in short axis) clinically or radiographically were identified. The impact of ILNM on progression-free survival (PFS) and overall survival (OS) were assessed. RESULTS Of the 562 women with advanced EOC, 18 (3.2%) had ILNM at diagnosis, accounting for 25.7% of all patients with stage IVB disease (n = 70). Five patients (27.7%) had a known genetic predisposition for EOC, including BRCA1 (11.1%, n = 2), BRCA2 (11.1%, n = 2) and BRIP1 (5.6%, n = 1). The majority of patients underwent optimal primary cytoreductive surgery (CRS), including debulking of inguinal nodal metastasis (83.3%, n = 15), with 50% (n = 9) having no gross residual disease after surgery. There was no difference in PFS (19.9 vs. 19.9 vs. 17.2 months, p = 0.84) or OS (137.2 vs. 52.9 vs. 67.6 months, p = 0.29) in women with stage III/IV with ILNM, stage III/IV without ILNM, and stage IVB disease without ILNM, respectively. Progression-free survival was improved in women with ILNM who underwent an optimal resection to no macroscopic disease vs. non-optimal resection (27.4 vs. 14.3 months, p = 0.019). Median overall survival at the time of analysis did not reach statistical significance (137.2 vs. 57.3 months, p = 0.24). CONCLUSION(S) In this retrospective cohort study, 3.2% of women with advanced EOC presented with ILNM at diagnosis. Although ILNM did not portend worse clinical outcomes compared to all Stage III/IV and Stage IVB patients, respectively, resection to no gross residual disease was associated with improved PFS.
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Affiliation(s)
- Julia Chalif
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America.
| | - Meng Yao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America
| | - Morgan Gruner
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
| | - Michelle Kuznicki
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
| | - Roberto Vargas
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
| | - Peter G Rose
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
| | - Chad Michener
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
| | - Robert DeBernardo
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
| | - Laura Chambers
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America; Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, United States of America
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Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations. J Clin Med 2022; 11:jcm11040953. [PMID: 35207226 PMCID: PMC8879527 DOI: 10.3390/jcm11040953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.
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Deng T, Huang Q, Wan T, Luo X, Feng Y, Huang H, Liu J. The impact of lymph node dissection on survival in patients with clinical early-stage ovarian cancer. J Gynecol Oncol 2021; 32:e40. [PMID: 33825356 PMCID: PMC8039180 DOI: 10.3802/jgo.2021.32.e40] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To estimate the impact of lymph node dissection on survival in patients with apparent early-stage epithelial ovarian cancer (EOC). Methods We conducted a retrospective review of patients with clinical stage I–II EOC. All patients underwent primary surgery at Sun Yat-sen University Cancer Center between January 2003 and December 2015. Demographic features and clinicopathological information as well as perioperative adverse events were investigated, and survival analyses were performed. Results A total of 400 ovarian cancer patients were enrolled, and patients were divided into 2 groups: 81 patients did not undergo lymph node resection (group A), and 319 patients underwent lymph node dissection (group B). In group B, the median number of removed nodes per patient was 25 (21 pelvic and 4 para-aortic nodes). In groups A and B, respectively, the 5-year progression-free survival (PFS) rates were 83.3% and 82.1% (p=0.305), and the 5-year overall survival (OS) rates were 93.1% and 90.9% (p=0.645). The recurrence rate in the retroperitoneal lymph nodes was not associated with lymph node dissection (p=0.121). The median operating time was markedly longer in group B than in group A (220 minutes vs. 155 minutes, p<0.001), and group B had a significantly higher incidence of lymph cysts at discharge (32.9% vs. 0.0%, p<0.001). Conclusion In patients with early-stage ovarian cancer, lymph node dissection was not associated with a gain in OS or PFS and was associated with an increased incidence of perioperative adverse events.
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Affiliation(s)
- Ting Deng
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Qidan Huang
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ting Wan
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaoling Luo
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yanling Feng
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - He Huang
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jihong Liu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
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Abu-Rustum NR, Angioli R, Bailey AE, Broach V, Buda A, Coriddi MR, Dayan JH, Frumovitz M, Kim YM, Kimmig R, Leitao MM, Muallem MZ, McKittrick M, Mehrara B, Montera R, Moukarzel LA, Naik R, Pedra Nobre S, Plante M, Plotti F, Zivanovic O. IGCS Intraoperative Technology Taskforce. Update on near infrared imaging technology: beyond white light and the naked eye, indocyanine green and near infrared technology in the treatment of gynecologic cancers. Int J Gynecol Cancer 2020; 30:670-683. [PMID: 32234846 DOI: 10.1136/ijgc-2019-001127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - Arthur E Bailey
- Research and Development, Stryker Endoscopy, San Jose, California, USA
| | - Vance Broach
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Michelle R Coriddi
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Joseph H Dayan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Michael Frumovitz
- Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yong Man Kim
- Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Rainer Kimmig
- Gynecology and Obstetrics, University Hospital of Duisburg-Essen, Essen, Germany
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Matt McKittrick
- Research and Development, Stryker Endoscopy, San Jose, California, USA
| | - Babak Mehrara
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Roberto Montera
- Universita Campus Bio-Medico di Roma Facolta di Medicina e Chirurgia, Roma, Lazio, Italy
| | - Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Raj Naik
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK
| | - Silvana Pedra Nobre
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Marie Plante
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - Francesco Plotti
- Universita Campus Bio-Medico di Roma Facolta di Medicina e Chirurgia, Roma, Lazio, Italy
| | - Oliver Zivanovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Tato-Varela S, Kuhn W. Impact of retroperitoneal lymph node dissection in ovarian cancer - time for paradigm shift? Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0020. [PMID: 31398143 DOI: 10.1515/hmbci-2019-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 01/12/2023]
Abstract
Ovarian cancer is the second most common malignant neoplasm of the genital tract. Staging procedures for ovarian cancer include longitudinal laparotomy, hysterectomy, bilateral salpingo-oophorectomy and infragastric omentectomy as well as systematic pelvic and para-aortic lymphadenectomy. In general, the goal of this primary procedure is to achieve the maximum cytoreduction of all abdominal diseases; a residual disease <1 cm defines optimal cytoreduction, however, a maximal effort should be made to remove all gross disease as this offers superior survival outcomes. The role of lymphadenectomy in ovarian cancer has been the focus of gynecological oncologists during recent years. The core issue of the controversy is whether the removal of lymph nodes should be performed only to stage the disease or if the removal itself improves survival. To further comprehend the issue, one must take into account that several studies have shown that systematic lymphadenectomy is associated with a risk of vascular injury, lymph cyst formation, pulmonary embolism and increased post-operative mortality even when performed by surgeons with extensive experience. We present an extensive review of the available literature on the matter, hoping to provide some insight into the true need for such a procedure.
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Affiliation(s)
- Sara Tato-Varela
- Department of Gynecology and Obstetrics, Donau-Isar Klinikum Hospital, Perlasberger Straße 41, 94469Deggendorf, Lower Bavaria, Germany
| | - Walther Kuhn
- Department of Gynecology and Obstetrics, Donau-Isar Klinikum Hospital, Deggendorf, Lower Bavaria, Germany
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Bacalbasa N, Balescu I, Balalau C, Ionescu O, Stoica C. Normal Size Ovary Carcinoma Syndrome with Inguinal Ovarian Cancer Lymph Node Metastases - A Case Report and Literature Review. ACTA ACUST UNITED AC 2018; 32:385-389. [PMID: 29475925 DOI: 10.21873/invivo.11250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022]
Abstract
Inguinal lymph node mass as the first sign in patients with ovarian cancer represents a rare situation, with only few cases being reported so far. We present the case of a 46-year-old patient who presented for the apparition of bilateral inguinal tumoral masses in the absence of any other pathological signs. The biopsy revealed the presence of an adenocarcinoma with probable genital origin; however, neither the gynaecological examination nor the computed tomography demonstrated the presence of any suspect lesion. The patient was submitted to a positron emission computed tomography which revealed a high capitation in both adnexal areas as well as at the level of the inguinal lymph nodes. The patient was submitted to surgery, the frozen section of the adnexas confirming the ovarian origin of the tumor. Complete cytoreduction to no residual disease was successfully performed. At one-year follow-up the patient is free of any recurrent disease.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Balescu
- Department of General Surgery "Ponderas" Academic Hospital, Bucharest, Romania
| | - Cristian Balalau
- Department of Obstetrics and Gynecology "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Sf. Pantelimon" Clinical Hospital, Bucharest, Romania
| | - Olivia Ionescu
- Department of Obstetrics and Gynecology "Fichtelgebirge", Clinic, Marktredwitz, Germany
| | - Claudia Stoica
- Department of General Surgery "Ilfov" Clinical County Hospital, Bucharest, Romania
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Metwally IH, Zuhdy M, Hassan A, Alghandour R, Megahed N. Ovarian cancer with metastatic inguinal lymphadenopathy: A case series and literature review. J Egypt Natl Canc Inst 2017; 29:109-114. [PMID: 28258913 DOI: 10.1016/j.jnci.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 01/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Ovarian cancer is the 4th commonest cancer among Egyptian women. It can spread through 3 different lymphatic pathways to para-aortic/paracaval lymph nodes, to pelvic lymph nodes and only occasionally through the round ligament of the uterus to the inguinal nodes. These rare cases are staged IVb on FIGO system. PRESENTATION We present a series of 4 cases of ovarian cancer metastasizing to inguinal nodes. The literature review revealed only 17 published similar cases. Management controversies as well as prognosis are discussed in our study. CONCLUSION Inguinal metastasis from ovarian cancer seems more frequent than previously thought. Examination of inguinal region should be mandatory in all cases diagnosed with ovarian cancer.
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Affiliation(s)
- Islam H Metwally
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Egypt.
| | - Mohammad Zuhdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Egypt
| | - Amr Hassan
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Egypt
| | - Reham Alghandour
- Medical Oncology Department, Oncology Center Mansoura University (OCMU), Egypt
| | - Nirmeen Megahed
- Pathology Department, Faculty of Medicine, Mansoura University, Egypt
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Understanding Lymphatic Drainage Pathways of the Ovaries to Predict Sites for Sentinel Nodes in Ovarian Cancer. Int J Gynecol Cancer 2016; 25:1405-14. [PMID: 26397066 PMCID: PMC5106084 DOI: 10.1097/igc.0000000000000514] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental digital content is available in the text. Objective In ovarian cancer, detection of sentinel nodes is an upcoming procedure. Perioperative determination of the patient’s sentinel node(s) might prevent a radical lymphadenectomy and associated morbidity. It is essential to understand the lymphatic drainage pathways of the ovaries, which are surprisingly up till now poorly investigated, to predict the anatomical regions where sentinel nodes can be found. We aimed to describe the lymphatic drainage pathways of the human ovaries including their compartmental fascia borders. Methods A series of 3 human female fetuses and tissues samples from 1 human cadaveric specimen were studied. Immunohistochemical analysis was performed on paraffin-embedded transverse sections (8 or 10 μm) using antibodies against Lyve-1, S100, and α-smooth muscle actin to identify the lymphatic endothelium, Schwann, and smooth muscle cells, respectively. Three-dimensional reconstructions were created. Results Two major and 1 minor lymphatic drainage pathways from the ovaries were detected. One pathway drained via the proper ligament of the ovaries (ovarian ligament) toward the lymph nodes in the obturator fossa and the internal iliac artery. Another pathway drained the ovaries via the suspensory ligament (infundibulopelvic ligament) toward the para-aortic and paracaval lymph nodes. A third minor pathway drained the ovaries via the round ligament to the inguinal lymph nodes. Lymph vessels draining the fallopian tube all followed the lymphatic drainage pathways of the ovaries. Conclusions The lymphatic drainage pathways of the ovaries invariably run via the suspensory ligament (infundibulopelvic ligament) and the proper ligament of the ovaries (ovarian ligament), as well as through the round ligament of the uterus. Because ovarian cancer might spread lymphogenously via these routes, the sentinel node can be detected in the para-aortic and paracaval regions, obturator fossa and surrounding internal iliac arteries, and inguinal regions. These findings support the strategy of injecting tracers in both ovarian ligaments to identify sentinel nodes.
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Expression and Function of CD44 in Epithelial Ovarian Carcinoma. Biomolecules 2015; 5:3051-66. [PMID: 26569327 PMCID: PMC4693269 DOI: 10.3390/biom5043051] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 12/12/2022] Open
Abstract
CD44, a cell surface glycoprotein, has been increasingly implicated in the pathogenesis and progression of epithelial ovarian cancer, the deadliest gynecologic malignancy in women. Here, we review recent reports on the expression and function of CD44 in epithelial ovarian carcinoma. Further functional data for CD44 in peritoneal adhesion and metastatic progression and its association with stem cells is highlighted. Recent studies utilizing CD44 for therapeutic targeting are also discussed.
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Yang XJ, Zheng FY, Xu YS, Ou RY. Ovarian cancer initially presenting with isolated ipsilateral superficial inguinal lymph node metastasis: a case study and review of the literature. J Ovarian Res 2014; 7:20. [PMID: 24506831 PMCID: PMC3926675 DOI: 10.1186/1757-2215-7-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
Isolated superficial inguinal metastases without any extended intra-abdominal spread is a rare event in patients with ovarian carcinoma. Here we report an isolated superficial inguinal metastasis in a patient with primary ovarian cancer. A 54-year-old Chinese patient with primary ovarian cancer, had an isolated painless enlarged right groin swelling (3×2cm) as the only manifestation, preoperative pathology confirmed metastatic adenocarcinoma. Gynecologic examination, transvaginal ultrasonography of the abdominopelvic cavity revealed a 5-cm mixed, right adnexal mass. At exploratory laparotomy, there was little intra-abdominal tumor dissemination but 100 ml of faint yellow peritoneal fluid and a 5-cm right ovarian tumor with intact capsule. Staging operation was performed and postoperative pathology confirmed adenocarcinoma located within right ovarian, with no evidence of involvement of other sites. Then the patient received adjuvant chemotherapy for Stage IVB. Five years later, the patient is currently still alive without evidence of recurrent disease. This case indicate that ovarian carcinoma isn't a disease localized only within the intra-peritoneal cavity, isolated superficial inguinal lymph node metastasis might occur in rare cases via potential lymphatic and (or) hematogenous route under special conditions. We propose the need to investigate the possible mechanisms, risk factors, metastatic patterns, the biology and natural history of such patients in a large-scale and multicenter analysis. Furthermore, efforts should be made for earlier and differential diagnosis and finally prolong survival time for such patients.
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Affiliation(s)
| | | | | | - Rong-Ying Ou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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Kleppe M, Van Gorp T, Slangen BFM, Kruse AJ, Brans B, Pooters INA, Van de Vijver KK, Kruitwagen RFPM. Sentinel node in ovarian cancer: study protocol for a phase 1 study. Trials 2013; 14:47. [PMID: 23414057 PMCID: PMC3577513 DOI: 10.1186/1745-6215-14-47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/01/2013] [Indexed: 11/18/2022] Open
Abstract
Background The concept of sentinel lymph node surgery is to determine whether the cancer has spread to the very first lymph node or sentinel node. If the sentinel node does not contain cancer, then there is a high likelihood that the cancer has not spread to other lymph nodes. The sentinel node technique has been proven to be effective in different types of cancer. In this study we want to determine whether a sentinel node procedure in patients with ovarian cancer is feasible when the tracers are injected into the ovarian ligaments. Methods/Design Patients with a high likelihood of having an ovarian malignancy in whom a median laparotomy and a frozen section analysis is planned and patients with endometrial cancer in whom a staging laparotomy is planned will be included. Before starting the surgical staging procedure, blue dye and radioactive colloid will be injected into the ligamentum ovarii proprium and the ligamentum infundibulo-pelvicum. In the analysis we calculate the percentage of patients in whom it is feasible to identify sentinel nodes. Other study parameters are the anatomical localization of the sentinel node(s) and the incidence of false negative lymph nodes. Trial registration Approval number: NL40323.068.12 Name: Medical Ethical Committee Maastricht University Hospital, University of Maastricht Affiliation: Maastricht University Hospital Board Chair Name: Medisch Ethische Commissie azM/UM
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Affiliation(s)
- Marjolein Kleppe
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, PO Box 5800 6202 AZ, Maastricht, The Netherlands
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Oshita T, Itamochi H, Nishimura R, Numa F, Takehara K, Hiura M, Tanimoto H, Noma J, Hayase R, Murakami A, Fujimoto H, Kanamori Y, Kitada F, Shitsukawa K, Nagaji M, Minagawa Y, Fujiwara M, Kigawa J. Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai Gynecology Study Group. Int J Clin Oncol 2012; 18:1107-13. [DOI: 10.1007/s10147-012-0483-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 09/25/2012] [Indexed: 11/29/2022]
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Gil-Moreno A, Magrina JF, Pérez-Benavente A, Díaz-Feijoo B, Sánchez-Iglesias JL, García A, Cabrera-Díaz S, Puig O, Martínez-Gómez X, Xercavins J. Location of aortic node metastases in locally advanced cervical cancer. Gynecol Oncol 2012; 125:312-4. [PMID: 22333995 DOI: 10.1016/j.ygyno.2012.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/02/2012] [Accepted: 02/04/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND To assess the location of aortic node metastasis in patients with locally advanced cervical cancer undergoing extraperitoneal aortic lymphadenectomy to define the extent of the aortic lymphadenectomy. MATERIAL AND METHODS Between August 2001 and December 2010, 100 consecutive patients with primary locally advanced cervical cancer underwent extraperitoneal laparoscopic aortic and common iliac lymphadenectomy. The location of aortic node metastases, inframesenteric or infrarenal was noted. RESULTS The mean number±standard deviation (SD) of aortic nodes removed was 15.9 ± 7.8 (range 4-62). The mean number ± SD of inframesenteric (including common iliac) nodes removed was 8.8 ± 4.5 (range 2-41) and the mean number ± SD of infrarenal nodes removed was 7.8 ± 4.1 (range 2-21). Positive aortic nodes were observed in 16 patients, and in 5 (31.2%) of them the infrarenal nodes were the only nodes involved, with negative inframesenteric nodes. CONCLUSION Inframesenteric aortic nodes are negative in the presence of positive infrarenal nodes in about one third of patients with locally advanced cervical cancer and aortic metastases.
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Affiliation(s)
- A Gil-Moreno
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Laparoscopically guided minilaparotomy: a minimally invasive approach for the treatment of gynaecologic diseases in morbidly obese patients. Eur J Obstet Gynecol Reprod Biol 2011; 160:210-4. [PMID: 22136884 DOI: 10.1016/j.ejogrb.2011.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/23/2011] [Accepted: 11/07/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Obese patients are at greater risk of gynaecologic surgery. Laparotomy is generally performed, even though this approach is regarded as highly invasive, whereas laparoscopy, though minimally invasive, is relatively contraindicated because of the high conversion rates to laparotomy. In light of this, we propose laparoscopically guided transverse minilaparotomy (LGTM) as a minimally invasive alternative technique. The rationale of diagnostic laparoscopy is to evaluate the feasibility of a minimally invasive approach. We have evaluated the feasibility and compared the outcomes with a historical group treated with laparotomy (LPTM), in morbidly obese patients (MOP) subjected to gynaecologic surgery. STUDY DESIGN From November 2004, MOPs with body mass index (BMI) ≥ 40 kg/m² and admitted for gynaecologic surgery (early stage endometrial cancer and benign disease) were enrolled in this observational study and submitted to LGTM. Patients with a uterine size greater than the umbilical transverse line and with indication for vaginal surgery were excluded operative data and outcome were prospectively recorded. RESULTS LGTM was feasible in 34 cases (87%) out of 39. In two women, the procedure was aborted due to intraperitoneal and ovarian malignant disease spread diagnosed at laparoscopy. In three cases, conversion was necessary due to severe adhesions in one case; laparoscopically unrecognized disease spread in the parametria in the second, and in the remaining case a right common iliac vein injury during lymphadenectomy. When compared to LPTM, haemoglobin drop and postoperative stay were significantly reduced with LGTM. Complications were higher in the control group: due to a significantly higher incidence of wound dehiscence (OR 0.27, 95% CI 0.05-1.32, p<0.05). CONCLUSIONS LGTM is feasible in the vast majority of MOPs and achieves significantly better results when compared to the standard approach.
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Lymph node metastasis in stages I and II ovarian cancer: A review. Gynecol Oncol 2011; 123:610-4. [DOI: 10.1016/j.ygyno.2011.09.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/06/2011] [Accepted: 09/10/2011] [Indexed: 12/13/2022]
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Classe JM, Cerato E, Boursier C, Dauplat J, Pomel C, Villet R, Cuisenier J, Lorimier G, Rodier JF, Mathevet P, Houvenaeghel G, Leveque J, Lécuru F. [Retroperitoneal lymphadenectomy and survival of patients treated for an advanced ovarian cancer: the CARACO trial]. ACTA ACUST UNITED AC 2011; 40:201-4. [PMID: 21482037 DOI: 10.1016/j.jgyn.2011.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 12/15/2022]
Abstract
The standard management for advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by platinum based chemotherapy. However, retroperitoneal lymph node resection remains controversial. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of the disease and the histological type. Several published cohorts suggest the survival benefit of pelvic and para-aortic lymphadenectomy. A recent large randomized trial have demonstrated the potential benefit for surgical removal of bulky lymph nodes in term of progression-free survival but failed to show any overall survival benefit because of a critical methodology. Further randomised trials are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease. CARACO is a French ongoing trial, built to bring a reply to this important question. A huge effort for inclusion of the patients, and involving new teams, are mandatory.
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Affiliation(s)
- J-M Classe
- Département de chirurgie oncologique, centre René-Gauducheau-ICO, boulevard Jean-Monod, Nantes-Saint-Herblain, France.
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Abstract
ObjectiveTo examine whether the intraoperative combined injection technique is feasible in locating the sentinel node(s) of the ovary.Methods/MaterialsIn 16 patients with high-risk uterine cancer and normal postmenopausal ovaries, technetium isotope and blue dye were injected in the right or left ovary during laparotomy, respectively. During the operation, the pelvic and para-aortic lymphatic areas were searched, and the number, method of detection, and location(s) of the hot and/or blue node(s) were recorded.ResultsOne to 3 sentinel nodes per patient were identified in all but 1 patient (15 of 16, 94%). The sentinel nodes (n = 30) were all located in the para-aortic area. The sentinel nodes of the left ovary were mainly (9 of 14, 64%) located above the inferior mesenteric artery level, as the most sentinel nodes of the right ovary (15 of 16, 94%) were found below the inferior mesenteric artery level (P = 0.001). There were no contralateral or bilateral sentinel nodes.ConclusionsThe combined intraoperative injection technique with radioisotope and blue dye is fast enough to identify the ovarian sentinel node(s). The stained nodes were consistently located on a certain lymphatic area. The sentinel node concept for the early ovarian cancer deserves more attention.
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Mujezinović F, Takač I. Pelvic lymph node dissection in early ovarian cancer: success of retrieval of lymph nodes by individual lymph node groups in respect to pelvic laterality. Eur J Obstet Gynecol Reprod Biol 2010; 151:208-11. [DOI: 10.1016/j.ejogrb.2010.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/28/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
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Ayhan A, Basaran A, Güler TÖ. Effects of Oxidized Regenerated Methylcellulose on Lymphocyst Formation and Peritoneum in Gynecologic Cancer Patients. Int J Gynecol Cancer 2010; 20:23-7. [DOI: 10.1111/igc.0b013e3181be698f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Benedetti Panici P, Basile S, Angioli R. Pelvic and aortic lymphadenectomy in cervical cancer: the standardization of surgical procedure and its clinical impact. Gynecol Oncol 2009; 113:284-90. [PMID: 19157526 DOI: 10.1016/j.ygyno.2008.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/23/2008] [Accepted: 12/02/2008] [Indexed: 01/28/2023]
Abstract
Cervical cancer ranks as the second most frequent cancer in women in the world, and nodal metastasis seems to be the first step of tumor spread in most cases. Since lymph node involvement is a major prognostic factor in cervical carcinoma, lymphatic spread of cervical cancer has been one of the most studied surgical topics in gynecologic oncology. Traditionally, lymph nodes stations have been accurately analyzed, improving surgical techniques of nodal dissection, which have been more and more intensive during years with the aim of improving survival. Oppositely, on the basis of recent acquisitions in cancer immunology and new anti-cancer immunotherapies and vaccines, the importance of lymph nodes has been recently reconsidered. Unfortunately, lymph node status is still difficult to be assessed pre-operatively with a high level of accuracy, and intra-operatively by sentinel node techniques, which remain inadequate for many aspects according to several gynecologic oncologists. The absence of definitive evidence of survival advantage given by extensive lymphadenectomy in all cervical cancer cases indicates that nodal dissection should be performed on the objective risk of node metastasis in each case. To date, the mainstay of detecting lymph node metastasis is still the histologic evaluation, therefore a proper resection of mostly involved lymph nodes remains a crucial surgical step when treating cervical cancer.
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Fujimoto T, Nanjyo H, Fukuda J, Nakamura A, Mizunuma H, Yaegashi N, Sugiyama T, Kurachi H, Sato A, Tanaka T. Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence. Gynecol Oncol 2008; 112:342-7. [PMID: 19062082 DOI: 10.1016/j.ygyno.2008.10.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/20/2008] [Accepted: 10/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the relationship between histopathological prognostic factors and sites of initial recurrence in endometrioid uterine cancer. METHODS A total of 355 patients (Stage I, n=227; II, n=38; III, n=90) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy followed by adjuvant chemotherapy who were at risk for recurrence. Relapse-free survival (RFS) and disease-related survival (DRS) were analyzed using the log-rank testing. Multivariate Cox regression analysis and logistic regression analysis were used to determine and estimate independent prognostic factors. RESULTS Lymph-vascular space invasion (LVSI), architectural grade (AG), myometrial invasion, and PLN metastasis (PLNM) were identified as independent prognostic factors for RFS. AG (p=0.0043) related with local recurrence. Among patients who received adjuvant chemotherapy, patients with G3 tumor had higher ratio of recurrence (16/45) compared with G1/2 tumor (11/102) (p=0.0004). Meanwhile, PLNM related with distant recurrence (p=0.0008). There was a statistically significant difference in RFS according to the number of positive PLN sites (group 0: n=313, 1: n=16, > or =2: n=26), five-year RFS in each group was 91.9%, 81.3%, and 41.2%, respectively. CONCLUSIONS Sites of initial recurrence were related with AG and PLNM in patients with endometrioid uterine cancer. Current chemotherapy alone may not be an effective adjuvant therapy to prevent recurrence in patients with G3 tumor and > or =2 positive PLN sites. Prospective clinical trial needs to be conducted to establish the strategy of adjuvant therapy with these patients.
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Affiliation(s)
- Toshio Fujimoto
- Department of Obstetrics and Gynecology, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
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Salet-Lizée D, Alsary S. [Not Available]. ACTA ACUST UNITED AC 2008; 145S4:12S45-9. [PMID: 22793985 DOI: 10.1016/s0021-7697(08)74722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.
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Salet-Lizée D, Alsary S. [Not Available]. ACTA ACUST UNITED AC 2008; 145:12S45-9. [PMID: 22794072 DOI: 10.1016/s0021-7697(08)45009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.
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Nawa A, Suzuki K, Kato S, Fujiwara S, Kajiyama H, Shibata K, Ino K, Nakamura S, Kikkawa F. Carbon beam therapy in recurrent ovarian cancer. Ann Oncol 2008; 19:192-4. [DOI: 10.1093/annonc/mdm553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Benedetti Panici P, Perniola G, Angioli R, Zullo MA, Manci N, Palaia I, Bellati F, Plotti F, Calcagno M, Basile S. Bulky lymph node resection in patients with recurrent epithelial ovarian cancer: impact of surgery. Int J Gynecol Cancer 2007; 17:1245-51. [PMID: 17425680 DOI: 10.1111/j.1525-1438.2007.00929.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to evaluate the role of systematic lymphadenectomy, feasibility, complications rate, and outcome in epithelial ovarian cancer (EOC) patients with recurrent bulky lymph node disease. A prospective observational study of EOC patients with pelvic/aortic lymph node relapse was conducted between January 1995 and June 2005. After a clinical and laparoscopic staging, secondary cytoreduction, including systematic lymphadenectomy, were performed. The eligibility criteria were as follows: disease-free interval ≥6 months, radiographic finding suggestive of bulky lymph node recurrence, and patients' consent to be treated with chemotherapy. Forty-eight EOC patients with lymph node relapse were recruited. Twenty-nine patients were amenable to cytoreductive surgery. Postoperatively, all patients received adjuvant treatment. The median numbers of resected aortic and pelvic nodes were 15 (2–32) and 17 (8–47), respectively. The median numbers of resected aortic and pelvic positive lymph nodes were 4 (1–18) and 3 (1–17), respectively. The mean size of bulky nodes was 3.3 cm. Four patients (14%) experienced one severe complication. No treatment-related deaths were observed. After a median follow-up of 26 months, among cytoreduced patients, 18 women were alive with no evidence of disease, nine were alive with disease. Among the 11 patients not amenable to surgery, five women were alive with persistent disease, six patients died of disease, at a median follow-up of 18 months. Estimated 5-year overall survival and disease-free interval for operated women were 87% and 31%, respectively. In conclusion, patients with bulky lymph node relapse can benefit from systematic lymphadenectomy in terms of survival. The procedure is feasible with an acceptable morbidity rate
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Affiliation(s)
- P Benedetti Panici
- Department of Obstetrics and Gynecology, University La Sapienza of Rome, Rome, Italy.
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Ushijima K. Management of retroperitoneal lymph nodes in the treatment of ovarian cancer. Int J Clin Oncol 2007; 12:181-6. [PMID: 17566840 DOI: 10.1007/s10147-007-0672-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Indexed: 10/23/2022]
Abstract
The mechanisms and clinical significance of lymph node involvement in ovarian cancer have been revealed since the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new clinical staging including retroperitoneal lymph node status. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of disease progression and the histological type. Thus, it is difficult to specify a single node as the sentinel node. As a surgical approach, systemic lymphadenectomy is necessary to obtain accurate clinical stage, and it has obvious diagnostic value. Nevertheless, a recent large randomized trial in patients with advanced ovarian cancer revealed that systemic lymphadenectomy had no impact on survival compared with removing only macroscopic lymph nodes. Other factors, such as chemosensitivity, histological grade, and the size of residuals have also influenced survival in ovarian cancer. From the viewpoint of adverse effects and survival benefit, the efficacy of lymphadenectomy remains controversial. Therefore, further accumulation of clinical data is needed to establish the indications for lymph node dissection; when this procedure is done, it should be performed by experienced gynecologic oncologists at selected institutions.
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Affiliation(s)
- Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
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Todo Y, Okamoto K, Hayashi M, Minobe S, Nomura E, Hareyama H, Takeda M, Ebina Y, Watari H, Sakuragi N. A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy. Gynecol Oncol 2007; 104:623-8. [PMID: 17097721 DOI: 10.1016/j.ygyno.2006.10.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/14/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to verify whether a preoperative scoring system to estimate the risk of lymph node metastasis (LNM) in endometrial carcinoma is clinically useful for tailoring the indication of lymphadenectomy. STUDY DESIGN LNM score was set up using volume index, serum CA125 level, and tumor grade/histology, which were found to be independent risk factors for LNM in a pilot study. Based on the LNM score before a validation study was started, the estimated rates of LNM (para-aortic LNM) were 3.4% (0.0%) in a low risk group, 7.7% (5.8%) in an intermediate group, 44.4% (30.6%) in a high risk group and 70.0% (50.0%) in an extremely high risk group. The validation study was carried out using data for 211 patients with endometrial carcinoma for whom three risk factors were preoperatively confirmed. Logistic regression analysis was used to determine whether these factors remain valid. The actual rate of LNM was investigated according to the LNM score. RESULTS Volume index, serum CA125 level, and tumor grade/histology were found to be independent risk factors for LNM in the cohort of this study. The actual rates of LNM (para-aortic LNM) were 3.2% (1.0%) in the low risk group, 15.3% (11.9%) in the intermediate group, 30.2% (23.8%) in the high risk group and 78.6% (57.1%) in the extremely high risk group. CONCLUSION The actual rate of LNM for each score was fairly consistent with the estimated rate of LNM. Para-aortic lymphadenectomy may not be necessary in cases of a low risk group. A large prospective multicenter clinical trial needs to be conducted to establish the clinical usefulness of our preoperative scoring system.
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Affiliation(s)
- Yukiharu Todo
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-8638, Japan.
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Oei AL, Verheijen RH, Seiden MV, Benigno BB, Lopes A, Soper JT, Epenetos AA, Massuger LF. Decreased intraperitoneal disease recurrence in epithelial ovarian cancer patients receiving intraperitoneal consolidation treatment with yttrium-90-labeled murine HMFG1 without improvement in overall survival. Int J Cancer 2007; 120:2710-4. [PMID: 17354223 DOI: 10.1002/ijc.22663] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study analyzes the site of disease recurrence in ovarian cancer patients to assess the influence of a single intraperitoneal (IP) administration of yttrium-90-labeled murine monoclonal antibody HMFG1 ((90)Y-muHMFG1) on the pattern of disease recurrence. In a large phase III trial ovarian cancer patients in complete clinical remission with FIGO stage Ic-IV were randomized between standard treatment plus a single IP (90)Y-labeled muHMFG1 versus standard treatment alone after negative second-look laparoscopy. Case report forms of all patients with disease recurrence were reviewed to determine site and date of recurrent disease. In total 447 patients were included in the study with a median follow-up of 3.5 years. Relapse was seen in 104/224 in the active and 98/223 in the control arm. Significantly fewer IP (p < 0.05) and more extraperitoneal (p < 0.05) relapses occurred in the active treatment arm. Time to IP recurrence was significantly longer (p = 0.0019) and time to extraperitoneal recurrence was significantly shorter for the active treatment arm (p < 0.001). The impact of IP radioimmunotherapy on IP relapse-free survival could only be seen in the subgroup of patients with residual disease after primary surgery (HR, 0.31; 95% CI, 0.18 to 0.53; p = 0.002). Although, there is no survival benefit for IP radioimmunotherapy as consolidation treatment for epithelial ovarian cancer, we found an improved control of IP disease, that was offset by increased extraperitoneal recurrences.
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Affiliation(s)
- Angèle L Oei
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Panici PB, Plotti F, Zullo MA, Muzii L, Manci N, Palaia I, Ruggiero A, Angioli R. Pelvic lymphadenectomy for cervical carcinoma: Laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol 2006; 103:859-64. [PMID: 16806442 DOI: 10.1016/j.ygyno.2006.05.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 05/07/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. METHODS Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. RESULTS 168 patients entered the study. The mean operative times were: 63+/-7.6, 54+/-6.7 and 75+/-8.4 min (TPL vs EPL P<0.001; EPL vs LPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P=ns). The average hospitalizations were: 5.6+/-0.9, 3.2+/-0.4 and 3.1+/-0.3 days (TPL vs EPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. CONCLUSIONS EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay.
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Córdoba O, Gil-Moreno A, de la Torre J, Martínez-Palones JM, Díaz B, Xercavins J. Extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence of fallopian tube carcinoma. Int J Gynecol Cancer 2006; 16:991-3. [PMID: 16803474 DOI: 10.1111/j.1525-1438.2006.00595.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The endoscopic retroperitoneal approach is a minimally invasive method for surgical staging of cervical cancer. A 57-year-old woman had an intraoperative diagnosis of carcinoma of the left fallopian tube and undergone a retroperitoneal pelvic and para-aortic lymphadenectomy with no peritonization during surgical staging. Small suspicious nodes in the serous membrane of the sigmoid colon and peritoneal washings were positive for malignancy. A total of 12 nodes were obtained, all of which were negative. She received six cycles of paclitaxel and platinum-based chemotherapy and showed a complete clinical response. Thirty-two months after surgery, the abdominal computed tomography scan showed a left para-aortic lymph node, 19 mm in diameter, which was successfully removed through an extraperitoneal laparoscopic approach. The extraperitoneal laparoscopic approach of the para-aortic region is a feasible procedure after previous transperitoneal lymphadenectomy and chemotherapy.
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Affiliation(s)
- O Córdoba
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
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Manci N, Bellati F, Graziano M, Pernice M, Muzii L, Angioli R, Benedetti Panici P. Ovarian cancer, diagnosed with PET, with bilateral inguinal lymphadenopathy as primary presenting sign. Gynecol Oncol 2006; 100:621-2. [PMID: 16246401 DOI: 10.1016/j.ygyno.2005.09.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 09/15/2005] [Accepted: 09/16/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ovarian cancer groin lymph nodes metastases are rare. Only one case of disease spread isolated to the groins has been reported in the English literature. We report the case of a patient with bilateral inguinal lymphadenopathy due to tumor metastases and in which tumor origin was diagnosed using [(18)F]fluorodeoxyglucose positron emission tomography (PET). CASE REPORT This is the first case of bilateral groin lymph nodes as sole site of metastases from ovarian cancer. Primary origin was identified using PET. CONCLUSIONS In rare cases, the ovaries can directly metastasis to the groin even in a relatively initial tumor growth phase. PET may play a role in the diagnosis of occult ovarian tumors.
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Affiliation(s)
- Natalina Manci
- Institute of Gynecology, Perinatology and Child Health, University La Sapienza di Roma, Viale Regina Elena 324, 00161 Rome, Italy.
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Horn LC, Einenkel J, Höckel M, Kölbl H, Kommoss F, Lax SF, Riethdorf L, Schnürch HG, Schmidt D. Pathologisch-anatomische Aufarbeitung und Befundung von Lymphknoten bei gynäkologischen Malignomen. DER PATHOLOGE 2005; 26:266-72. [PMID: 15915329 DOI: 10.1007/s00292-005-0764-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The nodal status is one of the strongest prognostic factors in gynecologic malignancies. Metastatic involvement of regional and distant lymph nodes represents the selection basis for adjuvant therapy in a large number of solid neoplasms. The number of resected lymph nodes is one of the most important parameters in the quality control of the surgical procedure, in particular with respect to radicality. The present paper provides recommendations for gross dissection, laboratory procedures and reporting for lymph node biopsies, lymph node dissections and sentinel lymph node biopsies (SLN) for cancers of the vulva, vagina, uterine cervix, endometrium, Fallopian tubes and the ovaries, submitted for the evaluation of metastatic disease. The pathologic oncology report should include information about the number and size of resected lymph nodes, the number of involved lymph nodes with the maximum size of metastases and the presence of paranodal infiltration. In addition, the detection of isolated tumor cells should be reported, particularly with respect to the detection method (immunostains or molecular methods). In cases of metastatic disease and carcinoma of unknown primary (CUP-syndrome), information should be given regarding the primary tumor.
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Affiliation(s)
- L-C Horn
- Abteilung für Gynäko- & Perinatalpathologie, Institut für Pathologie der Universität Leipzig.
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Hornung R, Urs E, Serenella E, Edward W, Ursula S, Urs H, Daniel F. Analysis of potential prognostic factors in 111 patients with ovarian cancer. Cancer Lett 2004; 206:97-106. [PMID: 15019165 DOI: 10.1016/j.canlet.2003.10.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Revised: 10/17/2003] [Accepted: 10/21/2003] [Indexed: 01/03/2023]
Abstract
The aim of this study was to assess the correlation of survival with clinical, surgical, histopathological, and biochemical parameters in patients with ovarian cancer. Age, surgical and histopathological data, the concentrations of estrogen and progesterone receptors, Her-2 neu, p53, U-PA, PAI-1, and Cathepsin D, DNA-and S-phase indexes of 111 ovarian cancer patients have been analyzed and correlated to survival. Progesterone receptors were correlated with prolonged survival. FIGO staging at the time of diagnosis is an independent prognostic factor for the patient's survival. Endometrioid and serous ovarian cancers have a better prognosis than mucinous and clear cell ovarian cancers. Survival of optimally debulked patients was substantially longer than that of not optimally debulked patients. This study shows, that an accurate clinical and surgical staging with an according histopathological assessment combined with optimal cytoreduction is of importance for the prognosis of ovarian cancer patients.
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MESH Headings
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/metabolism
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/metabolism
- Cathepsin D/metabolism
- Cystadenocarcinoma, Serous/diagnosis
- Cystadenocarcinoma, Serous/metabolism
- Female
- Humans
- Middle Aged
- Neoplasm Staging
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/metabolism
- Plasminogen Activator Inhibitor 1/metabolism
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- S Phase
- Survival Rate
- Tumor Suppressor Protein p53/metabolism
- Urokinase-Type Plasminogen Activator/metabolism
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Affiliation(s)
- R Hornung
- Department of Obstetrics and Gynecology, University Hospital, Frauenklinikstrasse 10, Zurich 8091, Switzerland.
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