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Zhang J, Li M, Feng L, Zhai Y, Wang L, Chen Y. Laparoscopic versus laparotomic surgical treatment in apparent stage I ovarian cancer: a multi-center retrospective cohort study. World J Surg Oncol 2024; 22:62. [PMID: 38389046 PMCID: PMC10882876 DOI: 10.1186/s12957-024-03345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Laparoscopic treatment shows non-inferior survival outcomes and better surgical outcomes in apparent stage I ovarian cancer (OC) in some studies but has not been well defined. METHODS We conducted a retrospective study of patients with apparent stage I OC treated in two hospitals between 2012 and 2022. The surgical and oncologic outcomes were evaluated between patients receiving laparoscopic and laparotomic surgery. RESULTS We identified 37 patients with apparent stage I OC, including 15 (40.5%) serous carcinomas, 9 (24.3%) mucinous cancers, 3 (8.1%) endometroid cancers, 2 clear cell carcinomas, and 8 (21.6%) non-epithelial cancers. Sixteen patients received laparoscopic surgery and the other 21 patients underwent laparotomic surgery. The median age (44.5 vs. 49.0 years), mean mass size (10.5 vs. 11.3 cm), and median follow-up time (43.5 vs. 75.0 months) showed no statistically significant differences between patients in laparoscopic and laparotomic groups (all P > 0.05). All the patients underwent comprehensive surgical staging surgery, and the mean surgical time (213.5 vs. 203.3 min, P = 0.507), number of lymph nodes sampling (18.6 vs. 17.5, P = 0.359), proportion of upstaging (12.5% vs. 19.0%, P = 0.680), and postoperative complications (no Accordion Severity Grading System grade ≥ 3) were comparable between two surgical groups. Moreover, patients in the laparoscopic group had significantly less intraoperative blood loss (231.3 vs. 352.4 mL, P = 0.018), shorter interval between surgery and postoperative adjuvant chemotherapy (7.4 vs. 9.5 days, P = 0.004), shorter length of hospital stay (9.9 vs. 13.8 days, P < 0.001) than those treated with laparotomic surgery. During a median follow-up of 54.0 months, 9 (24.3%) relapsed and 1 (2.7%) died, with a 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rate of 70.6% and 100%, respectively. However, the 5-year RFS (93.3% vs. 58.8%, P = 0.084) and DSS (100% vs. 100%, P = 0.637) rates did not significantly differ between the two groups. CONCLUSION Laparoscopic surgical treatment had less intraoperative blood loss, earlier postoperative adjuvant chemotherapy administration, shorter hospitalization time, and non-inferior survival outcomes in apparent stage I OC when compared with laparotomic surgery.
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Affiliation(s)
- Jing Zhang
- Department of Gynecology, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), No. 376 Shunde Road, Xiangdu District, Xingtai, Hebei Province, 054000, People's Republic of China.
| | - Meiyan Li
- Department of Gynecology, Handan Central Hospital, Handan, Hebei Province, People's Republic of China
| | - Lan Feng
- Department of Gynecology, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), No. 376 Shunde Road, Xiangdu District, Xingtai, Hebei Province, 054000, People's Republic of China
| | - Yinjun Zhai
- Department of Intervention, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), Xingtai, Hebei Province, People's Republic of China
| | - Lin Wang
- Department of Gynecology, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), No. 376 Shunde Road, Xiangdu District, Xingtai, Hebei Province, 054000, People's Republic of China
| | - Yuancao Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), Xingtai, Hebei Province, People's Republic of China
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Droste A, Anic K, Hasenburg A. Laparoscopic Surgery for Ovarian Neoplasms - What is Possible, What is Useful? Geburtshilfe Frauenheilkd 2022; 82:1368-1377. [PMID: 36467976 PMCID: PMC9715350 DOI: 10.1055/a-1787-9144] [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: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
The use of minimally invasive surgical techniques is becoming increasingly important in gynecologic oncology due to technical advances and the increasing level of surgical expertise. In addition to laparoscopic approaches for the treatment of benign neoplasms, minimally invasive surgical methods have also become established in some areas for treating gynecologic malignancies. For tumor entities such as endometrial and cervical carcinoma, there are conclusive studies emphasizing the role of laparoscopy in surgical therapy. By contrast, due to a lack of prospective data with survival analyses, no clear conclusions can be drawn on the significance of laparoscopy in the surgical treatment of ovarian carcinoma. However, some smaller, mostly retrospective case-control studies and cohort studies open the way for a discussion, positing the possibility that laparoscopic surgical procedures, particularly for early ovarian carcinoma, are technically feasible and of a quality equivalent to that of conventional longitudinal laparotomy, and may also be associated with lower perioperative morbidity. In this article we discuss the most important aspects of using minimally invasive surgical techniques for ovarian carcinoma based on the current literature. In particular we look at the relevance of laparoscopy as a primary approach for surgical staging of early ovarian carcinoma, and we evaluate the role of diagnostic laparoscopy in assessing the operability of advanced ovarian carcinoma.
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Affiliation(s)
- Annika Droste
- 611615Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany,Korrespondenzadresse Dr. med. univ. Annika Droste Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für
Geburtshilfe und FrauengesundheitLangenbeckstraße 155131
MainzGermany
| | - Katharina Anic
- 611615Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
| | - Annette Hasenburg
- 611615Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
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Fusegi A, Kanao H, Ishizuka N, Nomura H, Tanaka Y, Omi M, Aoki Y, Kurita T, Yunokawa M, Omatsu K, Matsuo K, Miyasaka N. Oncologic Outcomes of Laparoscopic Radical Hysterectomy Using the No-Look No-Touch Technique for Early Stage Cervical Cancer: A Propensity Score-Adjusted Analysis. Cancers (Basel) 2021; 13:cancers13236097. [PMID: 34885205 PMCID: PMC8657300 DOI: 10.3390/cancers13236097] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/04/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Minimally invasive radical hysterectomy is contraindicated in early stage cervical cancer cases because of poor prognosis. The no-look no-touch technique (NLNT) eliminates intraoperative tumor spillage and may improve survival outcomes. We evaluated oncologic outcomes of laparoscopic radical hysterectomy performed using NLNT. We compared the outcomes of abdominal radical hysterectomy and NLNT using inverse probability of treatment weighting. We found no significant differences in disease-free survival between the groups, even in patients with tumor sizes ≥ 2 cm. We also studied NLNT’s non-inferiority to abdominal radical hysterectomy by evaluating heterogeneity between the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial and those of our study. We did not observe significant heterogeneity, although there was a trend toward a lower hazard ratio in our study compared with the non-inferiority margin in the LACC trial. Laparoscopic radical hysterectomy using NLNT is a plausible alternative surgical treatment for early stage cervical cancer. Abstract We evaluated oncologic outcomes of laparoscopic radical hysterectomy using the no-look no-touch technique (NLNT). We analyzed patients with early stage (IA2, IB1, and IIA1, FIGO2008) cervical cancer treated between December 2014 and December 2019. The primary endpoint was disease-free survival (DFS). We compared the outcomes of the abdominal radical hysterectomy (ARH) and NLNT groups using a Cox model with inverse probability of treatment weighting (IPTW), according to propensity scores. We also evaluated NLNT’s non-inferiority to ARH using an evaluation of heterogeneity between the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial and our study. ARH and NLNT were performed in 118 and 113 patients, respectively. The median follow-up duration was 3.2 years. After IPTW adjustment, the 3-year DFS rates (NLNT 92.4%; ARH 94.0%) and overall survival rates did not differ significantly between the groups. Furthermore, the 3-year DFS rates for patients with tumor sizes ≥ 2 cm in the NLNT (85.0%) and ARH (90.3%) groups did not differ significantly. No significant heterogeneity was observed between the LACC trial and our study (I2 = 60.5%, p = 0.111), although there was a trend toward a lower hazard ratio in our study. Laparoscopic radical hysterectomy using NLNT provides a favorable prognosis for early stage cervical cancer.
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Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
- Correspondence: ; Tel.: +81-3-3520-0111
| | - Naoki Ishizuka
- Clinical Research Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Yuji Tanaka
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Tomoko Kurita
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Mayu Yunokawa
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Kohei Omatsu
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
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Lv H, Zhou T, Rong F. Proteomic analysis of the influence of CO 2 pneumoperitoneum in cervical cancer cells. J Cancer Res Ther 2021; 17:1253-1260. [PMID: 34850775 DOI: 10.4103/jcrt.jcrt_638_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective The effect of CO2 pneumoperitoneum (CDP) on the oncology outcomes of patients undergoing laparoscopic radical hysterectomy for cervical cancer remains unclear. In this study, we investigated the effects of CDP on the proliferation of cervical cancer cells and examined the molecular mechanism. Materials and Methods We established an in vitro CDP model to study the effects of CDP on the proliferation of cervical cancer cells by Cell Counting Kit-8 (CCK-8) assay, xenografted tumor assay. Tandem mass tag-based quantitative proteomics were used to study the proteomic changes in HeLa cells after CDP treatment. Western blot assay was used to detect the expressions of PI3K/Akt signaling pathway proteins. Results CDP increased cell proliferation after a short period of inhibition in vitro and promoted tumorigenesis in vivo. Proteomic analysis showed that the expression levels of 177 and 309 proteins were changed significantly 24 and 48 h after CDP treatment, respectively. The acidification caused by CO2 inhibited the proliferation of cervical cancer cells by inhibiting the phosphorylation of PI3K and Akt. Conclusions CDP promoted the proliferation of human cervical cancer cells after a short time of inhibition. The mechanism of which is related to the inhibition of phosphorylation of the PI3K/Akt signaling pathway.
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Affiliation(s)
- Hongtao Lv
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| | - Fengnian Rong
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
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Zimmermann JSM, Radosa JC, Radosa MP, Sklavounos P, Schweitzer PA, Solomayer EF. Survey of current practices and opinions of German Society of Gynecologic Endoscopy members regarding the treatment of ovarian neoplasia by robotic surgery. Arch Gynecol Obstet 2020; 303:1305-1313. [PMID: 33201376 PMCID: PMC8286217 DOI: 10.1007/s00404-020-05876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE As data on this topic are sparse and contradictory, we aimed to ascertain the opinions of the members of the German Society of Gynecologic Endoscopy (AGE) regarding the use of robotic surgery in the treatment of ovarian malignancies. METHODS In 2015, an anonymous questionnaire was sent to AGE members to assess their views on the treatment of ovarian malignancies by robotic surgery according to T stage and the current treatment practices in their facilities. RESULTS Of the 228 respondents, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [n = 218 (96%)] respondents reported treating < 10% of their patients using robotic surgery. Respondents felt that T1 and borderline ovarian tumors, but not T2 (51%) or T3/4 (76%) tumors, should and could be treated by robot surgery. 162 (71%) respondents considered the currently available data on this subject to be insufficient, and 42% indicated their willingness to participate in clinical studies on the applicability of robotic surgery to the treatment of T1/2 ovarian tumors. CONCLUSION The majority of AGE members surveyed considered robotic surgery to be an option for the treatment of T1 ovarian malignancies and borderline ovarian tumors. However, prospective randomized studies are needed to determine the relevance of robotic surgery in this context.
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Affiliation(s)
- J S M Zimmermann
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany.
| | - J C Radosa
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - M P Radosa
- Department of Gynecology and Obstetrics, Klinikum Bremen Nord, Bremen, Germany
| | - P Sklavounos
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - P A Schweitzer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - E F Solomayer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
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Xu Y, Jiang W, Xie S, Xue F, Zhu X. The Role of Inhaled Anesthetics in Tumorigenesis and Tumor Immunity. Cancer Manag Res 2020; 12:1601-1609. [PMID: 32184663 PMCID: PMC7061426 DOI: 10.2147/cmar.s244280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022] Open
Abstract
Inhaled anesthetics are widely used for induction and maintenance of anesthesia during surgery, including isoflurane, sevoflurane, desflurane, haloflurane, nitrous oxide (N2O), enflurane and xenon. Nowadays, it is controversial whether inhaled anesthetics may influence the tumor progression, which urges us to describe the roles of different inhaled anesthetics in human cancers. In the review, the relationships among the diverse inhaled anesthetics and patient outcomes, immune response and cancer cell biology were discussed. Moreover, the mechanisms of various inhaled anesthetics in the promotion or inhibition of carcinogenesis were also reviewed. In summary, we concluded that several inhaled anesthetics have different immune functions, clinical outcomes and cancer cell biology, which could contribute to opening new avenues for selecting suitable inhaled anesthetics in cancer surgery.
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Affiliation(s)
- Yichi Xu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenxiao Jiang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Shangdan Xie
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fang Xue
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Zheng L, Zhou D, Lu L, Liu Z, Fang L. Effects of CO 2 pneumoperitoneum on proliferation, apoptosis, and migration of gastrointestinal stromal tumor cells. Surg Endosc 2019; 33:3384-3395. [PMID: 30604263 DOI: 10.1007/s00464-018-06633-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of the study was to investigate the proliferation and migration capability of human gastrointestinal stromal tumor line GIST-T1 after exposure to different pressures and times of CO2 pneumoperitoneum. METHODS We established simulated CO2 pneumoperitoneum environment in vitro and divided the human GIST cell GIST-T1 into open control group, 8 mmHg CO2 pneumoperitoneum treatment group and 15 mmHg CO2 pneumoperitoneum treatment group. Each group was divided into two subgroups respectively cultured for 1 h and 3 h. pH value of cell culture, cell growth curve, and cell cycle distribution of each group was measured. By application of scratch healing tests and Transwell chamber experiments, mobility ratio and number of cells through 8 µm membranes were measured to assess the migration ability of cells in each group after intervention. RESULTS Cell culture pH value of each subgroup in CO2 group decreased significantly after exposed in CO2 pneumoperitoneum (P < 0.01). The proliferation of GIST-T1 cells in 15 mmHg CO2 group was significantly inhibited early (1-2 days) (P < 0.05) and the proliferation of GIST-T1 cells in 8 mmHg CO2 1 h subgroup and 15 mmHg CO2 1 h subgroup was increased significantly late (4-6 days) (P < 0.05) after the interventions of CO2 pneumoperitoneum. The percentage of cells in G0-G1 phase increased, the percentage of S phase cells decreased (P < 0.01) in 1-h subgroup and 3-h subgroup of 15 mmHg CO2 group 24 h after exposure to CO2. The percentage of cells in S phase increased in 1-h subgroup of 8 mmHg CO2 group and decreased in 3-h subgroup of 15 mmHg CO2 group 72 h after exposure to CO2. In the Transwell chamber experiment, the cell number through 8-µm membrane increased significantly (P < 0.01) in 3-h subgroup of CO2 group compared to that in 3-h subgroup of control group. CONCLUSIONS The routine pressure and duration of CO2 pneumoperitoneum used in clinic did not promote the proliferation of gastrointestinal stromal tumors, but had a potential risk of increasing postoperative recurrence and distant metastasis.
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Affiliation(s)
- Lijun Zheng
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Donglei Zhou
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Liesheng Lu
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Zhongchen Liu
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Lin Fang
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China.
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Report of the survey on current opinions and practice of German Society for Gynecologic Endoscopy (AGE) members regarding the laparoscopic treatment of ovarian malignancies. Arch Gynecol Obstet 2018. [PMID: 29520665 DOI: 10.1007/s00404-018-4709-5] [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] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this survey was to assess the opinions of members of the German Society of Gynecologic Endoscopy (AGE) regarding the laparoscopic treatment of ovarian malignancies and current practice at their institutions. METHODS Between February and October 2015, the AGE sent an anonymous online survey via mail to its members. The questionnaire solicited participants' opinions about the laparoscopic treatment of ovarian cancers according to T stage and borderline tumors, and information about current practice at their institutions. Participants were also asked their opinions on currently available data on this issue. RESULTS Of 228 AGE members who completed the survey, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [212 (93%)] respondents stated that < 10% of all ovarian cancer cases were currently treated laparoscopically at their institutions. Most participants indicated that T1 (a, b, c) tumors [145 (64%)] and ovarian borderline tumors [206 (90%)], but not T2 [48 (21%)] or T3/4 [9 (4%) ovarian tumors] should or could be treated laparoscopically. One hundred seventy-two (75%) participants considered currently available data on this topic to be insufficient and 152 (66%) stated that they would take part in a clinical trial assessing a laparoscopic approach to T1/2 ovarian cancer. CONCLUSION According to this survey, to the opinion of the majority of AGE members, laparoscopy might be a considerable option for the treatment of early ovarian malignancies and borderline tumors and should be evaluated further in future studies.
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Banys-Paluchowski M, Yeganeh B, Luettges J, Maibach A, Langenberg R, Krawczyk N, Paluchowski P, Maul H, Gebauer G. Isolated subcutaneous implantation of a borderline ovarian tumor: A case report and review of the literature. World J Clin Oncol 2016; 7:270-274. [PMID: 27081651 PMCID: PMC4826974 DOI: 10.5306/wjco.v7.i2.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/22/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopy-related tumor implantations of gynecological malignancies into the subcutaneous tissue are rarely diagnosed. We report an interesting case of a 46-year-old female who presented with an abdominal subcutaneous metastasis of a borderline ovarian tumor. The patient received a laparoscopic unilateral adnexectomy for a solid-cystic tumor of the right ovary. Histopathological workup showed a papillary borderline tumor of mucinous type. Nine days later she underwent a hysterectomy, left adnexectomy, appendectomy and omentectomy. Exploration of the peritoneum revealed no intraperitoneal implants. Further exploration showed a non-invasive implant of a borderline tumor in the subcutaneous tissue above the fascia that had no contact to the peritoneum. It is hypothesized that tumor cells may have been implanted during a previous laparoscopy, the most recent of which had been fourteen years prior to her current presentation. Various risk factors for port-site malignancies have been identified. Tumor manipulation and extraction of tumor tissue without a protective bag may contribute to development of trocar-site metastasis.
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Lin F, Pan L, Li L, Li D, Mo L. Effects of a simulated CO2 pneumoperitoneum environment on the proliferation, apoptosis, and metastasis of cervical cancer cells in vitro. Med Sci Monit 2014; 20:2497-503. [PMID: 25436974 PMCID: PMC4260668 DOI: 10.12659/msm.891179] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate the growth curve, cell colony formation, cell cycle, apoptosis, anti-anoikis, and ability of invasion, adhesion, and migration of cervical cancer cells after exposure to a model of a simulated CO2 pneumoperitoneum environment with different pressures and at different times. MATERIAL AND METHODS The cervical cancer cells were cultured in groups with 8 and 16 mmHg of 100% CO2 for 1, 2, 3, and 4 h in a model of a simulated environment of CO2 pneumoperitoneum. The cells in the control group were cultured in a standard environment. The growth curve was drawn through constant survival cell counts for 7 days, and the group with most obvious change was selected for subsequent experiments to detect cell colony formation, cell cycle apoptosis, and anti-anoikis, and the ability of invasion, adhesion, and migration. RESULTS After a brief inhibition, the proliferation of cervical cancer cells was markedly increased and had no relationship with different CO2 pressures. Compared with the control group, the early apoptosis rate in the experimental group was higher, and the ability of invasion, migration, and adhesion decreased significantly. CONCLUSIONS Cervical cancer cells stimulated by a CO2 pneumoperitoneum environment in vitro have an increased the ability to proliferate after a short period of inhibition and have reduced abilities of invasion, migration, and adhesion.
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Affiliation(s)
- Fei Lin
- Department of Anesthesiology, Tumor Hospital of Guangxi Medical University, Nanning, China (mainland)
| | - Linghui Pan
- Department of Anesthesiology, Tumor Hospital of Guangxi Medical University, Nanning, China (mainland)
| | - Li Li
- Department of Gynecologic Oncology, Tumor Hospital of Guangxi Medical University, Nanning, China (mainland)
| | - Danrong Li
- Department of Gynecologic Oncology, Tumor Hospital of Guangxi Medical University, Nanning, China (mainland)
| | - Lingzhao Mo
- Department of Gynecologic Oncology, Tumor Hospital of Guangxi Medical University, Nanning, China (mainland)
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Comparison of Laparoscopy and Laparotomy in the Surgical Management of Early-Stage Ovarian Cancer. Int J Gynecol Cancer 2014; 24:352-7. [DOI: 10.1097/igc.0000000000000033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe aim of this study is to investigate the safety and efficacy of laparoscopy in the treatment of early-stage ovarian cancer (EOC).MethodsWe retrospectively analyzed the clinical data of patients who underwent laparoscopy (35 patients) or laparotomy (40 patients) for the comprehensive surgical staging of EOC in Zhujiang Hospital during the period of 2002 to 2010 and compared the 2 surgical approaches in operative time, intraoperative blood loss, number of dissected lymph nodes, tumor rupture rate, length of hospital stay, time of gastrointestinal function recovery, wound healing condition, complication rate, upstaging rate, rate of postoperative chemotherapy, and postoperative follow-up condition.ResultsThe laparoscopy group had significantly shorter hospital stay and time of first postoperative flatus and had significantly lower rate of poor wound healing than the laparotomy group. The 2 groups did not show significant differences in operative time, intraoperative blood loss, number of dissected lymph nodes, tumor rupture rate, complication rate, upstaging rate, and rate of postoperative chemotherapy.ConclusionsLaparoscopy is safe and effective for the comprehensive surgical staging of EOC and has the advantages of shorter hospital stay, faster recovery of gastrointestinal function, and good wound healing.
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Ueshima E, Yamaguchi M, Ueha T, Muradi A, Okada T, Idoguchi K, Sofue K, Akisue T, Miwa M, Fujii M, Sugimoto K. Inhibition of growth in a rabbit VX2 thigh tumor model with intraarterial infusion of carbon dioxide-saturated solution. J Vasc Interv Radiol 2014; 25:469-76. [PMID: 24480085 DOI: 10.1016/j.jvir.2013.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intraarterial infusion of CO2-saturated solution in rabbit VX2 thigh tumors. MATERIALS AND METHODS Fourteen Japanese white rabbits had VX2 tumors implanted in the right femoral muscle 3 weeks before intraarterial infusion. Rabbits were divided into control and CO2 groups (n = 7 each). Fifty milliliters of solution (saline solution and CO2-saturated solution for the control and CO2 groups, respectively) was administered via a 24-gauge catheter in the ipsilateral iliac artery close to the feeding artery of the VX2 tumor. All rabbits were killed for tumor harvest on day 3 after the procedure. Tumor volume was evaluated with in vivo direct caliper measurement and contrast-enhanced computed tomography (CT). Tumor apoptotic changes were examined by DNA fragmentation assay and immunoblot analysis. The tumor growth ratio and apoptotic cell rate were analyzed. RESULTS Body weight was equally increased in both groups, but the mean tumor growth ratio was significantly decreased in the CO2 group compared with the control group (-9.5% ± 7.9 vs 27.2% ± 6.6 and 4.1% ± 4.4 vs 35.7% ± 4.5 measured by calipers and contrast-enhanced CT, respectively; P < .01). Apoptotic activity in the CO2 group was higher than in the control group (number of apoptotic cells per area, 215.0 ± 58.7 vs 21.8 ± 5.4; adjusted relative density of cleaved caspase-3, 0.23 ± 0.07 vs 0.04 ± 0.01; P < .01). CONCLUSIONS Intraarterial infusion of CO2-saturated solution inhibits rabbit VX2 thigh tumor growth by activation of apoptotic cell death through cleaved caspase-3 upregulation.
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Affiliation(s)
- Eisuke Ueshima
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Masato Yamaguchi
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Akhmadu Muradi
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan
| | - Takuya Okada
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Idoguchi
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Masahiko Fujii
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Sugimoto
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Brockbank E, Harry V, Kolomainen D, Mukhopadhyay D, Sohaib A, Bridges J, Nobbenhuis M, Shepherd J, Ind T, Barton D. Laparoscopic staging for apparent early stage ovarian or fallopian tube cancer. First case series from a UK cancer centre and systematic literature review. Eur J Surg Oncol 2013; 39:912-7. [DOI: 10.1016/j.ejso.2013.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/30/2013] [Accepted: 05/08/2013] [Indexed: 01/29/2023] Open
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Borley J, Yazbek J, Farthing A. Supporting the wider use of laparoscopy in the treatment of ovarian masses. J OBSTET GYNAECOL 2013; 33:434-7. [PMID: 23815190 DOI: 10.3109/01443615.2013.783004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with ovarian masses which have a moderate risk of malignancy are frequently treated by open laparotomy, despite the Royal College of Obstetricians and Gynaecologists (RCOG) guidance indicating that laparoscopic oophorectomy may be performed in selected cases. The reluctance to perform laparoscopic surgery in these cases is normally due to the perception that survival is affected if the mass is subsequently diagnosed as being malignant, the risk of rupture impacting on FIGO stage and the need for additional staging surgery. However, there is no good evidence to support these views. Preoperative diagnosis of ovarian masses is limited and thus a significant number of patients are subjected to open surgery, where they may have benefitted from the advantages of laparoscopic surgery. We argue that in the absence of a definitive preoperative test, there are advantages to the laparoscopic approach in patients who have a moderate risk of malignancy and further high level evidence should be encouraged in this field.
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Affiliation(s)
- J Borley
- Imperial College NHS Trust, London, UK
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Zanatta A, Rosin MMS, Gibran L. Laparoscopy as the most effective tool for management of postmenopausal complex adnexal masses when expectancy is not advisable. J Minim Invasive Gynecol 2012; 19:554-61. [PMID: 22818540 DOI: 10.1016/j.jmig.2012.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
Abstract
Postmenopausal women with adnexal masses suspicious for malignancy must undergo surgery for histopathologic confirmation. The low positive predictive value for malignancy of the currently available preoperative examinations results in 5 to 220 surgeries performed for each case of pelvic malignancy detected, depending on the evaluation method and patient selection. Although extensively reviewed as an effective tool for the investigation and treatment of adnexal masses, laparoscopy is still underused for this purpose in postmenopausal women. Some reasons are uncertainty about the incidental diagnosis of a malignant lesion during laparoscopy, concern about the effect of laparoscopy over the course of a pelvic malignant lesion, and inadequate referral of patients at high risk to specialized centers with oncologic gynecologists. Identification of patients at low risk might also be inadequate, causing them to undergo unnecessary laparotomy. Herein we demonstrate through a comprehensive literature review that laparoscopy is a highly effective tool for investigation and treatment of suspected adnexal masses in postmenopausal women, both in general medical settings without oncologic backup and in specialized centers. The indications for laparoscopy in this context can be further expanded without oncologic harm if patients at low and high risk are appropriately selected for surgery at general and specialized settings, respectively.
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Affiliation(s)
- Alysson Zanatta
- Department of Gynecologic Endoscopy, Hospital Pérola Byington, Centro de Referência da Saúde da Mulher, S~ao Paulo/SP, Brazil.
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Rate of port-site metastasis is uncommon in patients undergoing robotic surgery for gynecological malignancies. Int J Gynecol Cancer 2011; 21:936-40. [PMID: 21633306 DOI: 10.1097/igc.0b013e3182174609] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To describe the rate of port-site metastasis in patients who underwent robotic surgery for suspected gynecological malignancy. METHODS Using a prospective database, we identified all patients who underwent robotic surgery performed by the Gynecologic Oncology service at 1 institution between December 2006 and March 2010. Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about port-site metastasis. RESULTS One hundred eighty-one patients met the inclusion criteria. The median age was 55.4 years (range, 19-82 years), and the median body mass index was 29.6 kg/m² (range, 17.9-70.7 kg/m²). Port-site metastases were detected in 2 patients (1.1%) at 3 weeks (patient 1) and 11 months (patient 2) after surgery. Patient 1 underwent surgery for an adnexal mass, and pathological examination revealed gallbladder adenocarcinoma metastatic to the ovary. She had a recurrence in the right lateral abdominal wall robotic trocar site with concurrent metastases in the gallbladder fossa and liver. Patient 2 was diagnosed with adenocarcinoma of unclear (cervical vs endometrial) origin. Imaging showed metastases in pelvic and para-aortic lymph nodes. She underwent laparoscopy and was found intraoperatively to have gross disease on the right ovary. The patient underwent right salpingo-oophorectomy and chemoradiation. She had residual disease in the cervix and subsequently underwent robotic hysterectomy and left salpingo-oophorectomy. Pathological examination revealed endometrial cancer. She had a recurrence at the transumbilical trocar site concurrent with retroperitoneal lymphadenopathy and carcinomatosis. There were no cases of isolated port-site metastasis. CONCLUSIONS The rate of port-site metastasis after robotic surgery in women with gynecological cancer is low and similar to the rate for laparoscopic procedures.
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Comparisons of Surgical Outcomes, Complications, and Costs Between Laparotomy and Laparoscopy in Early-Stage Ovarian Cancer. Int J Gynecol Cancer 2011; 21:251-6. [PMID: 21270608 DOI: 10.1097/igc.0b013e318208c71c] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives:The purpose of this study was to compare the surgical outcomes, complications, and costs between laparoscopic staging and laparotomic staging for early-stage ovarian cancer.Methods:We evaluated 113 patients who underwent laparoscopy (n = 26) or laparotomy (n = 87) for staging. We retrospectively analyzed patients' demographics and operative variables, including operative time, estimated blood loss, lymph node count, hospital stay, complications, postoperative pain, and return to normal activity. In addition, costs for laparoscopy and laparotomy groups were also compared.Results:The mean operation time was longer in laparoscopy group compared to laparotomy group (227.6 minutes vs 184.6 minutes, P = 0.016). The laparoscopy group had less intraoperative blood loss, less transfusion requirement, shorter postoperative hospital stay, earlier general diet intake, shorter time to adjuvant chemotherapy, and lower postoperative pain score after 6, 24, and 48 hours compared with the laparotomy group. The mean number of lymph node retrievals was comparable between the groups. The incidence of operative complications was lower in the laparoscopy group (7.7%) relative to the laparotomy group (23.0%). The total average cost for staging completed via laparotomy was $1237 and that via laparoscopy was $1998, with significant difference.Conclusions:Complete surgical staging by laparoscopy was achieved in all cases with comparable operative time and less operative complications compared with laparotomy for selected patients with early-stage ovarian cancer. However, the operation costs for laparoscopy were significantly higher than the operation costs for laparotomic staging surgery.
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Nezhat FR, DeNoble SM, Liu CS, Cho JE, Brown DN, Chuang L, Gretz H, Saharia P. The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers. JSLS 2010; 14:155-68. [PMID: 20932362 PMCID: PMC3043561 DOI: 10.4293/108680810x12785289143990] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe our experience with laparoscopic primary or interval tumor debulking in patients with presumed advanced ovarian, fallopian tube, or peritoneal cancers. METHODS This is a retrospective analysis of a prospective case series. Women with presumed advanced (FIGO stage IIC or greater) ovarian, fallopian tube, or primary peritoneal cancers deemed appropriate candidates for laparoscopic debulking by the primary surgeon(s) were recruited. RESULTS The study comprised 32 patients who underwent laparoscopic evaluation. Seventeen underwent total laparoscopic primary or interval cytoreduction, with 88.2% optimal cytoreduction. Eleven underwent diagnostic laparoscopy and conversion to laparotomy for cytoreduction, with 72.7% optimal cytoreduction. Four patients had biopsies, limited cytoreduction, or both. In the laparoscopy group, 9 patients have no evidence of disease (NED), 6 are alive with disease (AWD), and 2 have died of disease (DOD), with mean follow-up time of 19.7 months. In the laparotomy group, 3 patients are NED, 5 are AWD, and 3 are DOD, with mean follow-up of 25.8 months. Estimated blood loss and length of hospital stay were less for the laparoscopy group (P=0.008 and P=0.03), while operating time and complication rates were not different. Median time to recurrence was 31.7 months for the laparoscopy group and 21.5 months for the laparotomy group (P=0.3). CONCLUSIONS Laparoscopy can be used for diagnosis, triage, and debulking of patients with advanced ovarian, fallopian tube, or primary peritoneal cancer and is technically feasible in a well-selected population.
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Affiliation(s)
- Farr R Nezhat
- Division of Gynecologic Oncology and Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Columbia University Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Medical Center, New York, New York 10019, USA.
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Liu CS, Nagarsheth NP, Nezhat FR. Laparoscopy and Ovarian Cancer: A Paradigm Change in the Management of Ovarian Cancer? J Minim Invasive Gynecol 2009; 16:250-62. [DOI: 10.1016/j.jmig.2009.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 12/29/2008] [Accepted: 01/08/2009] [Indexed: 11/26/2022]
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Medeiros LRF, Rosa DD, Bozzetti MC, Rosa MI, Edelweiss MI, Stein AT, Zelmanowicz A, Ethur AB, Zanini RR. Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer. Cochrane Database Syst Rev 2008:CD005344. [PMID: 18843688 DOI: 10.1002/14651858.cd005344.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the past ten years laparoscopy has become an increasingly common approach for the surgical removal of early stage ovarian tumours. There remains uncertainty about the value of this intervention. This review has been undertaken to assess the available evidence of the benefits and harms of laparoscopic surgery for the management of early stage ovarian cancer compared to laparotomy. OBJECTIVES To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy. SEARCH STRATEGY Trials were identified by searching the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2007, MEDLINE (January 1990 to November 2007), EMBASE (1990 to November 2007), LILACS (1990 to November 2007), BIOLOGICAL ABSTRACTS (1990 to November 2007) and Cancerlit (1990 to November 2007). We also searched our own publication archives, based on prospective handsearching of relevant journals from November 2007. Reference lists of identified studies, gynaecological cancer handbooks and conference abstract were also scanned. SELECTION CRITERIA Studies including patients with histologically proven stage I ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO).Studies comparing laparoscopic surgery with laparotomy for early stage ovarian cancer were only available from 1990. It was anticipated that a very small number of randomised controlled trials (RCTs) were conducted studying the management of early stage ovarian cancer. Therefore, non-randomised comparative studies, cohort studies and case-controls studies, but not studies with historical controls, were also considered. DATA COLLECTION AND ANALYSIS Data extraction was performed independently by five review authors (LRM, DDR, MIR, MCB and MIE) who assessed study quality and quality of extracted data. Extracted data included trial characteristics, characteristics of the study participants, interventions and outcomes. The quality of non RCTs was assessed using appropriate quality evaluations tools from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and from the Newcastle-Ottawa tool for observational studies (NOS). MAIN RESULTS No RCTs were identified. Three observational studies were identified. AUTHORS' CONCLUSIONS This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice.
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Affiliation(s)
- Lídia R F Medeiros
- Social Medicine/Epidemiology, Federal University of Rio Grande do Sul, Jose de Alencar 1244, 1009 Menino Deus, Porto Alegre, Rio Grande do Sul, Brazil, 90880-480.
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Hao YX, Zhong H, Zhang C, Zeng DZ, Shi Y, Tang B, Yu PW. Effects of simulated carbon dioxide and helium peumoperitoneum on proliferation and apoptosis of gastric cancer cells. World J Gastroenterol 2008; 14:2241-5. [PMID: 18407602 PMCID: PMC2703853 DOI: 10.3748/wjg.14.2241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/05/2008] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effects of carbon dioxide (CO(2)) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS The gastric cancer cells MKN-45 were exposed to a CO(2) and helium environment maintained at different pressures (0, 5, 10 and 15 mmHg). The cells were exposed to simulated pneumoperitoneum environment for 4 h, and pH of the culture media was measured after it was moved to normal conditions for 0, 2, 4, 6 and 8 h. Proliferation viability of MKN-45 was examined by 3-[4,5Dimethylthiazol-2-yl],5-diphenyltetrazolium bromide or triazolyl blue (MTT) assay after it was moved to normal conditions. Apoptotic ratio was measured by Annexin V-FITC/PI double labelled staining. RESULTS The pH of media was acid and recovered to normal after 4 h in the CO(2) group while it was basic in the helium group. There was no difference between CO(2) groups (under 10 mmHg ) and control group (P > 0.05) in the proliferative viability of the cells. The cultured cells exposed to 15 mmHg CO(2) environment grew more slowly than control group from 4 to 7 d (P < 0.01 ) while there was no difference from 1 to 3 d (P > 0.05). The proliferative viability in helium group was not obviously different from the control group (P > 0.05). The apoptotic ratio of the cultured cells was markedly higher than that of the control group (P < 0.01) at 10 and 15 mmHg CO(2) insufflation pressure. In helium group, the apoptotic ratio was not obviously different from the control group (P > 0.05). CONCLUSION There is no obvious effect in the proliferation and apoptosis of MKN-45 cells under 10 mmHg CO(2) insufflation pressure and helium in any pressure. Fifteen mmHg CO(2) insufflation pressure can inhibit the proliferation of the cells and improve apoptosis.
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Leng J, Lang J, Jiang Y, Liu D, Li H. Impact of different pressures and exposure times of a simulated carbon dioxide pneumoperitoneum environment on proliferation and apoptosis of human ovarian cancer cell lines. Surg Endosc 2006; 20:1556-9. [PMID: 16897289 DOI: 10.1007/s00464-005-0560-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Accepted: 02/23/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed too evaluate the proliferation and apoptosis of human ovarian cancer cell lines HO8910 and SKOV3 after exposure to a simulated laparoscopic carbon dioxide (CO2) pneumoperitoneum environment at different pressures and lengths of exposure time. METHODS The effects of the simulated laparoscopic CO2 pneumoperitoneum environment at different CO2 pressures (0-16 mmHg) and exposure times (1-4 h) on tumor cell growth and apoptosis were assessed by 3-[4,5-Dimethylthiazol]-2; 5-diphenyltetrazolium bromide (MTT) chromometry and proliferative index (PI) staining or Annexin V and PI double-staining flow cytometry. Cells cultured in a standard environment were used as the control group. RESULTS In this study, HO8910 cell growth tended to slow down with the increase in CO2 pressure and exposure time. A significantly lower PI was observed at 72 h of culture after exposure to both 8 and 16 mmHg of pressure, as compared with the control and 0 mmHg pressure group (p < 0.05). The PI of SKOV3 cells tended to decline after exposure. Significantly lower PI was observed in the group with exposure to 16 mmHg for 4 h over a 72-h period, as compared with the control groups exposed to 0 mmHg (p < 0.05). The inhibition of cell growth was associated with an increase in the proportion of cells at stage G1. The apoptotic index and the percentage of apoptotic cells tended to increase with an increase in pressure and a prolonged time of exposure. CONCLUSIONS The results suggest inhibited cell proliferation and increased cell apoptosis of human ovarian cancer cells were positively related to CO2 pressure and exposure time.
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Affiliation(s)
- J Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, CAM & PUMC, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
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Gaetje R, Kissler S, Eckerdt F, Baudendistel B, Kaufmann M, Oppelt P. Influence of surgical trauma on tumor establishment in a rat ovarian cancer model. ACTA ACUST UNITED AC 2004. [DOI: 10.1007/s10397-004-0065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND. Stress response to laparoscopic surgery: a review. Surg Endosc 2004; 18:1022-8. [PMID: 15136930 DOI: 10.1007/s00464-003-9169-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Accepted: 11/08/2003] [Indexed: 01/10/2023]
Abstract
BACKGROUND Laparoscopic surgery is associated with reduced surgical trauma, and therefore with a less acute phase response, as compared with open surgery. Impairment of the immune system may enhance surgical infections, port-site metastases, and sepsis. The objectives of this review was to assess immunologic consequences of benign laparoscopic surgery and to highlight controversial aspects. METHODS A literature search on stress response to nonmalignant laparoscopic and open surgery was conducted using the MEDLINE and Cochrane databases. Cross-references from the reference list of major articles on the subject were used, as well as manuscripts published between 1993 and 2002. RESULTS Local (i.e., peritoneal) immune function is affected by carbon dioxide pneumoperitoneum. The production of tumor necrosis factor and the phagocytotic capacity of peritoneal macrophages are less lowered. The systemic stress response, as determined by delayed-type hypersensitivity response and leukocyte antigen expression on lymphocytes, shows a preservation of immune function after laparoscopic surgery, as compared with conventional surgery. CONCLUSIONS Intraperitoneal carbon dioxide insufflation attenuates peritoneal immunity, but laparoscopic surgery is associated with a lower systemic stress response than open surgery.
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Affiliation(s)
- M Buunen
- Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Abu-Rustum NR, Sonoda Y, Chi DS, Teoman H, Dizon DS, Venkatraman E, Barakat RR. The effects of CO2 pneumoperitoneum on the survival of women with persistent metastatic ovarian cancer. Gynecol Oncol 2003; 90:431-4. [PMID: 12893213 DOI: 10.1016/s0090-8258(03)00330-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The effects of CO(2) pneumoperitoneum on the survival of women with metastatic ovarian cancer have not been documented. We sought to describe the survival of women with persistent stage III-IV ovarian cancer as documented by positive second-look laparoscopy or laparotomy and to see whether the laparoscopic approach with CO(2) pneumoperitoneum has a negative effect on overall survival. METHODS We conducted a retrospective review of all patients with FIGO stage III-IV invasive epithelial ovarian cancer who were found to have persistent disease at second-look surgery. All patients underwent primary surgery followed by intravenous chemotherapy and were clinically without evidence of disease prior to second-look surgery. Second-look laparoscopy began to be utilized regularly in 1994. The selection of the second-look surgical approach depended on the surgeon's discretion. CO(2) pneumoperitoneum was utilized for all laparoscopic cases with the maximum intra-abdominal pressure maintained at 15 mm Hg. Patients received a variety of additional intravenous, intraperitoneal, or oral chemotherapy following positive second-look surgery. RESULTS Between 6/1/91 and 6/30/02, 289 patients were found to have persistent ovarian/peritoneal cancer at second look. Second-look operations included 131 (45%) transperitoneal laparoscopies and 139 (48%) laparotomies. Nineteen (7%) patients underwent laparoscopy followed immediately by laparotomy. The mean age, stage distribution, histology, grade, and size of residual disease at second look did not differ between the two groups. The median overall survival for patients who underwent laparoscopy, 41.1 months (95% CI, 33.2-58.1), did not significantly differ from that of the laparotomy group, 38.8 months (95% CI, 31.9-44.2) (P = 0.742). CONCLUSIONS Transperitoneal laparoscopy with CO(2) pneumoperitoneum does not appear to reduce the overall survival of women with persistent metastatic intra-abdominal carcinoma of ovarian/peritoneal origin. The overall survival appears to be independent of the second-look surgical approach.
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Affiliation(s)
- Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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