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Balafoutas D, Vlahos N. The role of minimally invasive surgery in gynaecological cancer: an overview of current trends. Facts Views Vis Obgyn 2024; 16:23-33. [PMID: 38551472 PMCID: PMC11198884 DOI: 10.52054/fvvo.16.1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Background The capabilities of minimally invasive surgery, either as conventional laparoscopy, or as robotic surgery, have increased to an extent that it enables complex operations in the field of gynaecological oncology. Objective To document the role of minimally invasive gynaecological surgery in cancer. Materials and methods A review of the literature that shaped international guidelines and clinical practice. Main outcome measures Current guidelines of major international scientific associations and trends in accepted clinical practice. Results In recent years, evidence on oncologic outcome has limited the role of minimally invasive techniques in cervical cancer, while the treatment of early endometrial cancer with laparoscopy and robotic surgery has become the international standard. In ovarian cancer, the role of minimally invasive surgery is still limited. Current evidence on perioperative morbidity underlines the necessity to implicate minimally invasive techniques whenever possible. Conclusion The optimal surgical route for the treatment of gynaecological cancer remains in many cases controversial. The role of minimally invasive surgery remains increasing in the course of time. What is new? This comprehensive review offers an entire perspective on the current role of minimally invasive surgery in gynaecological cancer therapy.
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Garcia NG, Moreno CS, Teixeira N, Lloret PE, Guibourg RL, Negre RR. Comparison of Laparoscopy and Laparotomy in the Management of Early-stage Ovarian Cancer. Gynecol Minim Invasive Ther 2023; 12:83-89. [PMID: 37416098 PMCID: PMC10321349 DOI: 10.4103/gmit.gmit_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 07/08/2023] Open
Abstract
Objectives The objective of this study was to assess the feasibility of minimally invasive surgery for early-stage ovarian cancer (EOC) by comparing the surgical and survival outcomes between laparoscopy and laparotomy. Materials and Methods This was a retrospective, single-center observational study that included all patients who underwent surgical staging for EOC by laparoscopy or laparotomy between 2010 and 2019. Results Forty-nine patients were included; of which 20 underwent laparoscopy, 26 laparotomy, and three conversion from laparoscopy to laparotomy. No significant differences were observed between the two groups regarding operative time, number of lymph nodes dissected, or intraoperative tumor rupture rate, while estimated blood loss and transfusion requirements were lower in the laparoscopy group. The complication rate tended to be higher in the laparotomy group. Patients in the laparoscopy group had a faster recovery, with earlier urinary catheter and abdominal drain removal, shorter hospital stay, and a trend toward earlier tolerance of oral diet and mobilization. At a mean follow-up of 45.7 months, 14 patients had disease recurrence, with no differences in the mean progression-free survival between the two groups (36 months for laparoscopy vs. 35.5 months for laparotomy, P = 0.22). Conclusion Laparoscopic surgery performed by a trained gynecological oncologist is a safe and effective surgical approach for comprehensive staging of EOC, with the additional benefits of a faster recovery compared to laparotomy.
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Affiliation(s)
- Nuria Ginjaume Garcia
- Department of Gynecologic Oncology, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - Cristina Soler Moreno
- Department of Gynecologic Oncology, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - Natalia Teixeira
- Department of Gynecologic Oncology, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - Pia Español Lloret
- Department of Gynecologic Oncology, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - Rocío Luna Guibourg
- Department of Gynecologic Oncology, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - Ramon Rovira Negre
- Department of Gynecologic Oncology, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
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Benabou K, Khadraoui W, Khader T, Hui P, Fernandez R, Azodi M, Menderes G. Port-Site Metastasis in Gynecological Malignancies. JSLS 2021; 25:JSLS.2020.00081. [PMID: 33879998 PMCID: PMC8035826 DOI: 10.4293/jsls.2020.00081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Minimally invasive oncologic surgery has become the standard of care in many gynecologic cancers. While laparoscopic surgery provides many benefits to patients, such as faster recovery, there are unique challenges associated with minimally invasive techniques. Port-site metastasis is a rare complication after laparoscopic oncologic surgery in management of gynecologic malignancies. Methods: We present the case of a 44-year-old female with isolated port-site recurrence following laparoscopic radical hysterectomy with node-negative, clinical stage IB1 cervical adenocarcinoma. In addition, we provide an updated review of the literature on management and oncologic outcomes of port-site metastasis. Conclusion: Port-site metastasis prevention necessitates a better understanding of underlying risk factors and pathophysiology in order to optimize outcomes. Future studies are needed on risk-reducing strategies and standardization of management for port-site metastasis.
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Affiliation(s)
- Kelly Benabou
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Wafa Khadraoui
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Tarek Khader
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Rodrigo Fernandez
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Gulden Menderes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Gao Q, Guo L, Wang B. The Pathogenesis and Prevention of Port-Site Metastasis in Gynecologic Oncology. Cancer Manag Res 2020; 12:9655-9663. [PMID: 33116825 PMCID: PMC7547761 DOI: 10.2147/cmar.s270881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022] Open
Abstract
Port-site metastasis (PSM) is a specific and challenging complication of laparoscopic gynecologic oncologic procedures. Research has demonstrated that PSM is associated with significant morbidity and poor outcome. The exact pathogenesis of PSM in gynecologic patients is not clear. Several preventive measures of PSM have been addressed in the relevant literature, and novel approaches to prevent this uncommon complication keep emerging. In this review, we summarized the potential mechanisms of PSM and discuss the controversies and merits of proposed preventive measures of PSM in gynecologic oncology. We undertook a literature search using the Medline database to identify studies on the pathogenesis and prevention of laparoscopic PSM. Hypotheses of PSM pathogeneses center on the immune response, pneumoperitoneum, wound contamination, and surgical method. Cogent evidence of effective prevention of PSM after laparoscopic surgery is lacking. Traditional preventive actions such as irrigation and tumor manipulation should be taken individually. Insufflation of hyperthermic CO2 and humidified CO2 leads to a better outcome in patients with a malignant tumor who undergo a laparoscopic procedure compared with normal CO2 pneumoperitoneum. Port-site resection shows no advantage in survival and results in more wound events. PSM prevention plays a crucial part in the overall care of patients with gynecologic malignancies who undergo laparoscopic procedures.
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Affiliation(s)
- Qianqian Gao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Ling Guo
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Bo Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
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Cutaneous Metastases in Ovarian Cancer. Cancers (Basel) 2019; 11:cancers11091292. [PMID: 31480743 PMCID: PMC6788186 DOI: 10.3390/cancers11091292] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022] Open
Abstract
Skin metastases in ovarian cancer are uncommon, but their incidence may be increasing due to improved survival rates. Skin metastases can be divided into umbilical metastases, which are known as Sister Joseph nodules (SJNs) and are associated with peritoneal metastasis, and non-SJN skin metastases, which usually develop within surgical scars and in the vicinity of superficial lymphadenopathy. As most skin metastases develop after specific conditions, recognition of preceding metastatic diseases and prior treatments is necessary for early diagnosis of skin lesions. The prognosis of skin metastases in ovarian cancer varies widely since they are heterogeneous in the site of lesion and the time of appearance. Patients with SJNs at initial diagnosis and patients with surgical scar recurrences without concomitant metastases may have prolonged survival with a combination of surgery and chemotherapy. In patients who developed skin recurrences as a late manifestation, symptoms should be treated with external beam radiotherapy and immune response modifiers. Immune checkpoint blockade can enhance anti-tumor immunity and induce durable clinical responses in multiple tumor types, including advanced chemoresistant ovarian cancer. With the use of radiation therapy, which enhances the systemic anti-tumor immune response, immune checkpoint blockade may be a promising therapeutic strategy for distant metastasis, including skin metastasis.
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Laparoscopic Assessment to Determine the Likelihood of Achieving Optimal Cytoreduction in Patients Undergoing Primary Debulking Surgery for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer. Am J Clin Oncol 2019; 41:938-942. [PMID: 29624506 DOI: 10.1097/coc.0000000000000413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the safety and efficacy of laparoscopic assessment to determine the likelihood of achieving optimal cytoreduction (OC) in patients undergoing primary debulking surgery (PDS) for ovarian cancer. METHODS All patients who underwent diagnostic laparoscopy and PDS at our institution from January 2008 to December 2013 were identified. We determined the likelihood of achieving optimal cytoreduction by laparoscopic assessment based on tumor site, pattern of spread, and disease burden. Sensitivity was defined as the number of patients who achieved optimal cytoreduction after laparoscopic assessment divided by the number of patients with disease deemed resectable by laparoscopy. RESULTS We identified 55 patients during study period. Twenty-one of the 55 patients (38%) were early stage disease. Six (10.9%) patients had disease deemed unresectable and 49 (89.1%) had disease deemed resectable at the time of laparoscopy. OC was achieved in 48 of 49 (97.9%) patients. The sensitivity of laparoscopy in predicting OC was 98% (95% confidence interval, 89.3%-99.9%). The operation was completed laparoscopically in 23 of 49 patients (47%); in 26 of 49 (53%), PDS was performed by laparotomy. There were no port site metastases reported. The rate of postoperative complications was 16%. With a median follow-up of 30 months, the median overall survival was not reached and the 75th percentile for overall survival was 37 months. CONCLUSIONS Laparoscopy was shown to have a high sensitivity in predicting OC and is a feasible tool in triaging patients with ovarian cancer. Laparoscopy is not associated with adverse surgical outcomes.
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Rationale of Laparoscopic Surgery in Gynaecological Oncology: Time to Address the Issue! INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tan Z, Li A, Chen L, Xu X, Fu C. Port-Site Metastasis of Uterine Carcinosarcoma after Laparoscopy. J Korean Med Sci 2017; 32:1891-1895. [PMID: 28960047 PMCID: PMC5639075 DOI: 10.3346/jkms.2017.32.11.1891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 05/19/2016] [Indexed: 11/20/2022] Open
Abstract
We report a case of port-site metastasis after laparoscopic surgery for early stage uterine carcinosarcoma (UCS) and review the related literature. A 53-year-old woman with suspected uterine malignance underwent a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, infra-colic omentectomy, and pelvic lymphadenectomy resulting pathologically in a stage IA UCS. Twelve months later she developed a palpable abdominal-wall mass at the trocar site without other synchronous metastases. A mass resection was performed and it was pathologically diagnosed with port-site metastasis of UCS. When performing surgery for UCS, specimens should be carefully removed in case small pieces of the occult disseminated metastatic tissues are trapped between the outer surface of the trocar sleeve and the abdominal wall incisional canal. Despite the low incidence, a laparotomy might be considered rather than laparoscopy to prevent port-site metastasis and more gynecological oncology clinical practices might be relevant to the management of port-site metastasis.
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Affiliation(s)
- Zhen Tan
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
- PLA Center of General Surgery, Chengdu Military General Hospital, Chengdu, China
| | - Ang Li
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Long Chen
- Graduates Management Unit, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - XiaoWen Xu
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - ChuanGang Fu
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Isolated port site recurrence of node-negative clinical stage IB1 cervical adenocarcinoma. Gynecol Oncol Rep 2017; 20:54-57. [PMID: 28331901 PMCID: PMC5348602 DOI: 10.1016/j.gore.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 01/02/2023] Open
Abstract
Introduction Port site metastasis after laparoscopic surgery for cervical cancer is a rare phenomenon. Methods We present a case report of isolated port site recurrence 4 years following laparoscopic surgery in a patient with node-negative, clinical stage IB1 cervical adenocarcinoma. Results A 44 year-old woman presented with a necrotic cervical lesion. A biopsy of the mass revealed invasive endocervical adenocarcinoma. She underwent a robotic-assisted radical hysterectomy, bilateral salpingectomy, and pelvic lymph node dissection with bilateral oophoropexy. All lymph nodes were placed in an Endocatch bag prior to removal via the 12 mm assistant port. There was no clinical evidence of metastatic disease and final pathology revealed negative surgical margins and lymph nodes. Four years later, she re-presented with a soft tissue mass in her abdominal wall underlying the site of the prior laparoscopic assistant port. This was confirmed by transcutaneous biopsy to be metastatic adenocarcinoma of endocervical origin. Further work-up revealed no other evidence of metastatic disease. The recurrence was excised and all margins were negative. Conclusion This is the first case report describing an isolated port site recurrence in a patient who underwent robotic-assisted laparoscopic surgery for early-stage cervical adenocarcinoma with negative margins and negative lymph nodes. The mechanism underlying this isolated recurrence remains unknown. Port-site metastasis is a rare complication after laparoscopic surgery. Port-site recurrence can occur in early stage, node-negative cervical cancer. Surveillance of port sites at post-operative follow-up visits is imperative. The mechanism underlying this isolated recurrence remains unknown.
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Fagotti A, Perelli F, Pedone L, Scambia G. Current Recommendations for Minimally Invasive Surgical Staging in Ovarian Cancer. Curr Treat Options Oncol 2016; 17:3. [PMID: 26739150 DOI: 10.1007/s11864-015-0379-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OPINION STATEMENT Minimally invasive surgery (MIS) currently is performed to stage and treat ovarian cancer at different stages of disease; however, the higher level of evidence from existing studies is IIB. Despite the absence of randomized controlled trials, MIS represents a safe and adequate procedure for treating and staging early ovarian cancer, and its use has increased significantly in clinical practice. Major concerns are related to minimizing tumor disruption or dissemination, removing the adnexal mass intact, adequate retroperitoneal staging, and fertility-sparing surgery for young patients. The main goal for patients with advanced ovarian cancer is to determine the best therapeutic strategy by evaluating the risks and benefits of primary debulking surgery versus neoadjuvant chemotherapy followed by interval debulking surgery. The use of staging laparoscopy in patients with advanced epithelial ovarian cancer appears to be the most researched and accepted approach. Regarding other types and stages of ovarian cancer, although the evidence is very promising, clinical trials performed by expert gynecologic oncology surgeons in referral centers are still needed to prove the efficacy of such an approach in these patients. In particular, MIS has provided an opportunity to remove localized recurrences, with both retroperitoneal and intraperitoneal diffusion.
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Affiliation(s)
- Anna Fagotti
- Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Federica Perelli
- Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luigi Pedone
- Obstetrics and Gynecology, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Obstetrics and Gynecology, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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Menderes G, Black JD, Azodi M. The role of minimally invasive interval debulking surgery in advanced epithelial ovarian cancer. Expert Rev Anticancer Ther 2016; 16:899-901. [PMID: 27477495 DOI: 10.1080/14737140.2016.1219658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gulden Menderes
- a Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Gynecologic Oncology , Yale School of Medicine , New Haven , CT , USA
| | - Jonathan D Black
- a Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Gynecologic Oncology , Yale School of Medicine , New Haven , CT , USA
| | - Masoud Azodi
- a Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Gynecologic Oncology , Yale School of Medicine , New Haven , CT , USA
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12
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Lu Q, Qu H, Liu C, Wang S, Zhang Z, Zhang Z. Comparison of Laparoscopy and Laparotomy in Surgical Staging of Apparent Early Ovarian Cancer: 13-year Experience. Medicine (Baltimore) 2016; 95:e3655. [PMID: 27196468 PMCID: PMC4902410 DOI: 10.1097/md.0000000000003655] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/24/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to compare the safety and morbidity of laparoscopic versus laparotomic comprehensive staging of apparent early stage ovarian cancer.In this retrospective study, the outcomes of patients with apparent stage I ovarian cancer who underwent laparoscopic or laparotomic comprehensive surgical staging from January 2002 to January 2014 were evaluated. The long-term survival of patients with early ovarian cancer was compared.Forty-two patients were treated by laparoscopy, and 50 were treated by laparotomy. The median operative time was 200 minutes in the laparoscopy group and 240 minutes in the laparotomy group (P >0.05). The median length of hospital stay was 3 days in the laparoscopy group and 7 days in the laparotomy group (P <0.05). Following laparoscopic and laparotomic staging, the cancer was upstaged for 9 (21.4%) and 10 (20.0%) women, respectively. The median follow-up time was 82 months in the laparoscopic and laparotomic groups, respectively. Excluding the upstaged patients, no recurrence was observed in the present study, and the overall survival and 5-year survival rates were 100% in both the laparoscopy and laparotomy groups.Laparoscopic and laparotomic comprehensive staging of early ovarian cancer were similar in terms of staging adequacy, accuracy and survival rate. Laparoscopic staging was associated with a significantly reduced hospital stay. Prospective randomized trials are required to evaluate the overall oncologic outcomes.
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Affiliation(s)
- Qi Lu
- From the Department of Obstetrics and Gynecology, Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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Manvelyan V, Khemarangsan V, Huang KG, Adlan AS, Lee CL. Port-site metastasis in laparoscopic gynecological oncology surgery: An overview. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Wu Y, Dai Z, Wang X. Hand-assisted laparoscopic surgery and its applications in gynecology. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Peña-Fernández M, Solar-Vilariño I, Rodríguez-Álvarez MX, Zapardiel I, Estévez F, Gayoso-Diz P. Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors. Ecancermedicalscience 2015; 9:606. [PMID: 26715943 PMCID: PMC4679209 DOI: 10.3332/ecancer.2015.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to ascertain the incidence of and the risk factors associated with morbidity in laparoscopy performed on patients with cervical cancer and endometrial cancer. Methods This was an observational study of a cohort of 128 women, 89 with endometrial cancer and 39 with cervical cancer from January 2000 to December 2011. We used the Student’s t-test or the Mann-Whitney U test for continuous variables, and the Chi-square or Fisher’s exact test for categorical variables. Results Complications were found in 44 patients (34.4%). After a multivariate analysis, among the risk factors associated with the presence of complications as the only type of surgery was found to be statistically significant (p = 0.043), more frequent in the most complex procedures such as Wertheim operation, trachelectomy, and para-aortic lymphadenectomy. Type of surgery (p = 0.003) and tumour type (p = 0.003) were risk factors associated with conversion to laparotomy. It was more frequent among the most complex procedures and cervical cancer cases. Regarding the need for transfusion, significant differences were observed in terms of surgery duration (p < 0.001), more frequent in longer surgery. Conclusion Morbidity in laparoscopic surgical oncology is related to the surgery complexity, where the basal characteristics of the patient are not a factor of influence in the development of complications.
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Affiliation(s)
- Maite Peña-Fernández
- Department of Gynecology and Obstetrics, Santiago de Compostela University Clinical Teaching Hospital, Spain
| | - Inés Solar-Vilariño
- Department of Gynecology and Obstetrics, Santiago de Compostela University Clinical Teaching Hospital, Spain
| | - María Xosé Rodríguez-Álvarez
- Clinical Epidemiology and Biostatistics Unit, Santiago de Compostela University Clinical Teaching Hospital and Santiago Health Research Institute, Spain
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Francisco Estévez
- Department of Gynecology and Obstetrics, POVISA Hospital, Vigo, Spain
| | - Pilar Gayoso-Diz
- Clinical Epidemiology and Biostatistics Unit, Santiago de Compostela University Clinical Teaching Hospital and Santiago Health Research Institute, Spain
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Kharod S, Yeung A, Fredenburg K, Greenwalt J. Cervical cancer with a rare umbilical metastases in prior surgical site. Int J Surg Case Rep 2015; 17:8-11. [PMID: 26519808 PMCID: PMC4701796 DOI: 10.1016/j.ijscr.2015.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/10/2015] [Indexed: 11/17/2022] Open
Abstract
We describe the case of an unusual port-site cervical cancer metastasis. We perform a review of the current published literature of port-site metastases. We demonstrate that our patient’s case is unlike others previously described.
Introduction Port-site metastasis of cervical cancer is a relatively rare occurrence, and has been reported in the published literature as a pre-terminal event. Presentation of case We present the case of a 52-year-old female who was diagnosed with cervical cancer after presenting to our institution’s hospital with urinary symptoms not relieved by multiple treatments with antibiotics. To fully evaluate the extent of disease, positron emission tomography-computed tomography imaging was obtained, showing an area of mildly increased fluorodeoxyglucose uptake in her umbilicus. While undergoing external-beam radiotherapy treatment for her cervical cancer, she began to experience pain in the umbilicus associated with a mass. A biopsy was taken, revealing metastatic cervical cancer at the site of a previous port-site incision for a cholecystectomy that the patient underwent 18 months before the finding. Discussion Port-site metastasis have been reported following kidney, bladder, and colon cancer resections, with reports of cervical cancer cases being exceedingly rare. Several hypotheses have emerged as potential explanations for port-site metastasis. Conclusion To our knowledge, this represents the first reported case of a port-site metastasis to an incision site created for an unrelated laparoscopic surgery, performed well in advance of the diagnosis of cervical cancer.
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Affiliation(s)
- Shivam Kharod
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Anamaria Yeung
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States.
| | - Kristianna Fredenburg
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Julie Greenwalt
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
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Seror J, Bats AS, Bensaïd C, Douay-Hauser N, Ngo C, Lécuru F. Risk of port-site metastases in pelvic cancers after robotic surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:599-603. [DOI: 10.1016/j.ejso.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 12/02/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
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Hindman NM, Kang S, Parikh MS. Common postoperative findings unique to laparoscopic surgery. Radiographics 2015; 34:119-38. [PMID: 24428286 DOI: 10.1148/rg.341125181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls.
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Affiliation(s)
- Nicole M Hindman
- From the Departments of Radiology (N.M.H., S.K.) and Surgery (M.S.P.), NYU School of Medicine, 660 First Ave, New York, NY 10016
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Furukawa N, Nishioka K, Noguchi T, Kajihara H, Horie K. Port-site metastasis of mucinous borderline ovarian tumor after laparoscopy. Case Rep Oncol 2014; 7:804-9. [PMID: 25566056 PMCID: PMC4280454 DOI: 10.1159/000369994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We report a case of port-site metastasis after laparoscopic surgery for borderline mucinous ovarian tumors (mBOTs) without spillage and review the related literature. The patient was a 50-year-old nulligravida who presented with abdominal distension. Magnetic resonance imaging showed a 20 × 10-cm multilocular mass with various signal intensities. The wall and septa of the mass were neither thick nor enhanced. A laparoscopy was performed. An intact left ovarian tumor was observed. The weight of the tumor was 1,540 g. The final diagnosis was stage IA intestinal-type mBOT, so the patient did not undergo adjuvant therapy. Twenty-six months after surgery, the patient presented with a 3 × 5-cm palpable mass on the umbilicus. Biopsy of the mass revealed mucinous adenocarcinoma and computed tomography showed a 3.5 × 4.0-cm mass at the umbilicus without additional metastases. A laparotomy was performed and no metastasis in the peritoneal cavity was observed by gross examination. An umbilical mass resection, hysterectomy, right salpingo-oophorectomy, appendectomy, and partial omentectomy were performed. Hematoxylin and eosin-stained sections of the umbilical mass revealed glands of varying size infiltrating the stroma, immunohistologic staining for cytokeratin 7 was positive, and cytokeratin 20 was negative, but no other metastases were observed. The patient was diagnosed with port-site metastasis and invasive recurrence of mBOT. She underwent six cycles of adjuvant paclitaxel and carboplatin therapy. Large ovarian tumors should be carefully extracted without spillage of the tumor contents to prevent port-site metastasis, despite the low incidence.
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Affiliation(s)
- Naoto Furukawa
- Department of Obstetrics and Gynecology Nara Medical University, Kashihara, Yamato Takada, Japan
| | - Kazuhiro Nishioka
- Department of Obstetrics and Gynecology Yamato Takada Municipal Hospital, Yamato Takada, Japan
| | - Taketoshi Noguchi
- Department of Obstetrics and Gynecology Yamato Takada Municipal Hospital, Yamato Takada, Japan
| | - Hirotaka Kajihara
- Department of Obstetrics and Gynecology Yamato Takada Municipal Hospital, Yamato Takada, Japan
| | - Kiyoshige Horie
- Department of Obstetrics and Gynecology Yamato Takada Municipal Hospital, Yamato Takada, Japan
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Minimally invasive surgery for gynecological cancers: Experience of one institution. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Effect of carbon dioxide pneumoperitoneal pressure on the ultrastructure of implanted endometriotic lesions in a rat model. Eur J Obstet Gynecol Reprod Biol 2013; 171:319-24. [DOI: 10.1016/j.ejogrb.2013.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 06/13/2013] [Accepted: 08/23/2013] [Indexed: 11/15/2022]
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Lönnerfors C, Bossmar T, Persson J. Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies. Acta Obstet Gynecol Scand 2013; 92:1361-8. [DOI: 10.1111/aogs.12245] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/12/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Celine Lönnerfors
- Department of Obstetrics and Gynecology; Skåne University Hospital and Lund University; Lund Sweden
| | - Thomas Bossmar
- Department of Obstetrics and Gynecology; Skåne University Hospital and Lund University; Lund Sweden
| | - Jan Persson
- Department of Obstetrics and Gynecology; Skåne University Hospital and Lund University; Lund Sweden
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Jernigan AM, Auer M, Fader AN, Escobar PF. Minimally invasive surgery in gynecologic oncology: a review of modalities and the literature. ACTA ACUST UNITED AC 2012; 8:239-50. [PMID: 22554172 DOI: 10.2217/whe.12.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Minimally invasive surgery is one of the newest and most exciting areas of development in procedural medicine. This field shows tremendous potential to increase therapeutic benefit while minimizing some of the painful or dangerous side effects of surgical interventions. Minimally invasive surgery has strong historic ties to the field of gynecology and has come a long way as technology and techniques have improved. This has increasingly allowed the application of laparoscopy to more complex procedures and the treatment of gynecologic malignancies. Three laparoscopic approaches, traditional laparoscopy, robotic assisted laparoscopy and laparoendoscopic single-site surgery are reviewed here. We discuss the basic approaches to these three laparoscopic techniques, and then review their applications in gynecologic oncology. We also touch on the evidence behind outcomes associated with their use.
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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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Single-port-access, hand-assisted laparoscopic surgery for benign large adnexal tumors versus single-port pure laparoscopic surgery for adnexal tumors. Surg Endosc 2011; 26:693-703. [DOI: 10.1007/s00464-011-1939-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 09/10/2011] [Indexed: 10/16/2022]
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Affiliation(s)
- G Faust
- Department of Oncology, Leicester Royal Infirmary, Leicester, UK
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Suh DH, Kim JW. Laparoscopic surgery is a current tide of widely accepted standard procedure for endometrial cancer. J Gynecol Oncol 2010; 21:67-9. [PMID: 20613892 PMCID: PMC2895717 DOI: 10.3802/jgo.2010.21.2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 06/22/2010] [Indexed: 11/30/2022] Open
Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Martínez A, Querleu D, Leblanc E, Narducci F, Ferron G. Low incidence of port-site metastases after laparoscopic staging of uterine cancer. Gynecol Oncol 2010; 118:145-50. [PMID: 20451983 DOI: 10.1016/j.ygyno.2010.03.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 03/14/2010] [Accepted: 03/17/2010] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the incidence of clinically detected port-site metastases (PSM) in patients with endometrial and cervical cancer treated at two gynecologic oncology services with extensive experience. METHODS All eligible uterine cancer patients laparoscopically staged at Centre Oscar Lambret in Lille and Institut Claudius Regaud in Toulouse, France, were reviewed. MEDLINE database was searched to identify articles on PSM after laparoscopic procedures for cervical and endometrial cancer. RESULTS During the study period, 1216 laparoscopic procedures for uterine cancer were performed. 921 patients underwent laparoscopic staging for cervical cancer and 295 for endometrial cancer. The overall incidence of PSM in our institutions was 0.4% per procedure (5 patients), and the incidence of PSM after laparoscopy for cervical and endometrial cancer was 0.43% and 0.33%, respectively. Excluding patients with peritoneal carcinomatosis, the rate of port-site recurrence in our series lowered to 0.16%, and the rate of isolated PSM to 0%. The median time to the development of PSM was 8 months (range 6-48), the median overall survival from diagnosis for all patients was 26 months (range 7-30), and median survival from recurrence was 5 months (range 1-20). CONCLUSION Although PSM is recognized as a complication of laparoscopy for ovarian cancer. PSM is a rare complication of laparoscopic staging for endometrial and cervical cancer. The majority of patients with PSM presented with associated synchronous disease. The incidence of isolated PSM can be maintained virtually to 0% by an adequate operative technique. We believe that PSM in patients with uterine cancer cannot be used as an argument against laparoscopic staging in uterine cancer.
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Affiliation(s)
- A Martínez
- Department of Surgical Oncology, Claudius Regaud Cancer Center, 20-24 Rue Pont-Saint-Pierre, Toulouse, France.
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Sert B. Robotic port-site and pelvic recurrences after robot-assisted laparoscopic radical hysterectomy for a stage IB1 adenocarcinoma of the cervix with negative lymph nodes. Int J Med Robot 2010; 6:132-5. [DOI: 10.1002/rcs.295] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Staging and surgical treatment. Cancer Treat Res 2009. [PMID: 19763430 DOI: 10.1007/978-0-387-98094-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
BACKGROUND Endometrial cancer is the most common gynecologic malignancy in the United States. Surgical staging is an integral component in the treatment of this disease. Minimally invasive surgical techniques have been utilized with increasing frequency in its management. METHODS This article reviews the use of minimally invasive surgery for the treatment of endometrial cancer. RESULTS Prospective trials and retrospective analyses have demonstrated the safety and feasibility of laparoscopy in performing hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy for surgical staging in endometrial cancer. The use of minimally invasive techniques does not appear to have an adverse impact on survival, and it improves quality of life in the postoperative period. Robotic surgery has been used in the management of this disease with promising preliminary results. CONCLUSIONS Laparoscopy is a safe and effective approach for surgical staging of selected patients with endometrial cancer. Further studies and cost-benefit analyses are required to determine if the use of robotics improves outcomes over standard laparoscopy and can extend the benefits of minimally invasive surgery to a larger proportion of patients with this common gynecologic malignancy.
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Affiliation(s)
- Marcia M Humphrey
- Gynecologic Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Nezhat FR, Ezzati M, Chuang L, Shamshirsaz AA, Rahaman J, Gretz H. Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol 2009; 200:83.e1-6. [PMID: 19019337 DOI: 10.1016/j.ajog.2008.08.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 03/26/2008] [Accepted: 08/07/2008] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the role of laparoscopy for staging of early ovarian cancers. STUDY DESIGN Case series conducted at the University Hospital with 36 patients who had presumed early-stage adnexal cancers. Laparoscopic staging/restaging was performed. RESULTS Cases included 20 invasive epithelial tumors, 11 borderline tumors, and 5 nonepithelial tumors. Mean number of peritoneal biopsies, paraaortic nodes, and pelvic nodes were 6, 12.23, and 14.84, respectively. Eighty-three percent of the patients had laparoscopic omentectomy. On final pathology, 7 patients were upstaged. Postoperative complications included 1 small bowel obstruction, 2 pelvic lymphoceles, and 1 lymphocele cyst. Mean duration of follow-up is 55.9 months. Three patients had recurrences. All patients are alive without evidence of the disease. CONCLUSION This represents 1 of the largest series and longest follow-ups of laparoscopic staging for early-stage adnexal tumors. Laparoscopic staging of these cancers appears to be feasible and comprehensive without compromising survival when performed by gynecologic oncologists experienced with advanced laparoscopy.
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33
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Relapse and survival in early-stage ovarian cancer. Arch Gynecol Obstet 2008; 280:71-7. [DOI: 10.1007/s00404-008-0877-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
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Zivanovic O, Sonoda Y, Diaz JP, Levine DA, Brown CL, Chi DS, Barakat RR, Abu-Rustum NR. The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease. Gynecol Oncol 2008; 111:431-7. [PMID: 18929404 DOI: 10.1016/j.ygyno.2008.08.024] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/13/2008] [Accepted: 08/26/2008] [Indexed: 01/18/2023]
Abstract
BACKGROUND The aim was to describe the rate of laparoscopic trocar-related subcutaneous tumor implants in women with underlying malignant disease. METHODS An analysis of a prospective database of all patients undergoing transperitoneal laparoscopic procedures for malignant conditions performed by the gynecologic oncology service. RESULTS Between July 1991 and April 2007, laparoscopic procedures were performed in 1694 patients with a malignant intraabdominal condition and in 505 breast cancer patients undergoing risk-reducing, diagnostic or therapeutic laparoscopic procedures without intraabdominal disease. Port-site metastases were documented in 20 of 1694 patients (1.18%) who underwent laparoscopic procedures for a malignant intraabdominal condition. Of these, 15 patients had a diagnosis of epithelial ovarian or fallopian tube carcinoma, 2 had breast cancer, 2 had cervical cancer, and 1 had uterine cancer. Nineteen of 20 patients (95%) had simultaneous carcinomatosis or metastases to other sites at the time of port-site metastasis. Patients who developed port-site metastases within 7 months from the laparoscopic procedure had a median survival of 12 months whereas patients who developed port-site metastasis >7 months had a median survival of 37 months (P=0.004). No port-site recurrence was documented in patients undergoing risk-reducing, diagnostic or therapeutic laparoscopic procedures for breast cancer without intraabdominal disease. CONCLUSION The rate of port-site tumor implantation after laparoscopic procedures in women with malignant disease is low and almost always occurs in the setting of synchronous, advanced intraabdominal or distant metastatic disease. The presence of port-site implantation is a surrogate for advanced disease and should not be used as an argument against laparoscopic surgery in gynecologic malignancies.
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Affiliation(s)
- Oliver Zivanovic
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Mettler L, Schollmeyer T, Boggess J, Magrina JF, Oleszczuk A. Robotic assistance in gynecological oncology. Curr Opin Oncol 2008; 20:581-9. [DOI: 10.1097/cco.0b013e328307c7ec] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Semaan AY, Abdallah RT, Mackoul PJ. The role of laparoscopy in the treatment of early ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 2008; 139:121-6. [PMID: 18433977 DOI: 10.1016/j.ejogrb.2008.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/10/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022]
Abstract
Laparoscopic management of early ovarian cancer (EOC) has constituted a controversial issue since it was first described. Recent data reinforced the arguments supporting the use of laparoscopy in the management of EOC. Advances in laparoscopy have enabled surgeons to meet the International Federation of Gynecology and Obstetrics' criteria for staging of EOC. Although most study results are encouraging, the sample size is still too small to be able to draw definite conclusions. Frequently cited concerns such as accuracy of staging, intraabdominal tumor rupture and port site metastasis should not be used as arguments against laparoscopic management of EOC. Clinical evidence is clearly in favor of a larger role for laparoscopy in the management of EOC. This should encourage studies with larger sample sizes to confirm the validity of laparoscopic management of EOC.
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Affiliation(s)
- Assaad Y Semaan
- The George Washington University, Department of Obstetrics and Gynecology, Washington, DC 20037, USA.
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37
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Are C, Brennan MF, D’Angelica M, Fong Y, Guillonneau B, Jarnagin WR, Park B, Strong VE, Touijer K, Weiser M, Abu-Rustum NR. Current Role of Therapeutic Laparoscopy and Thoracoscopy in the Management of Malignancy: A Review of Trends from a Tertiary Care Cancer Center. J Am Coll Surg 2008; 206:709-18. [DOI: 10.1016/j.jamcollsurg.2007.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 10/29/2007] [Accepted: 11/05/2007] [Indexed: 01/21/2023]
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39
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Puntambekar SP, Palep RJ, Puntambekar SS, Wagh GN, Patil AM, Rayate NV, Agarwal GA. Laparoscopic total radical hysterectomy by the Pune technique: Our experience of 248 cases. J Minim Invasive Gynecol 2007; 14:682-9. [DOI: 10.1016/j.jmig.2007.05.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 04/03/2007] [Accepted: 05/18/2007] [Indexed: 10/22/2022]
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Ghezzi F, Cromi A, Uccella S, Bergamini V, Tomera S, Franchi M, Bolis P. Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer. Gynecol Oncol 2007; 105:409-13. [PMID: 17275077 DOI: 10.1016/j.ygyno.2006.12.025] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 11/28/2006] [Accepted: 12/22/2006] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the results of laparoscopic staging of apparent early ovarian cancer (EOC) with those obtained with comprehensive surgical staging via laparotomy. METHODS Consecutive patients undergoing comprehensive laparoscopic staging for presumed EOC (LPS group; N=15) were compared with historical controls selected from consecutive women who have had conventional staging with open surgery (LPT group; N=19). RESULTS No difference was found in demographics and preoperative variables between the two groups. There were no significant differences between the two groups with regard to median number of lymph nodes and likelihood of identifying metastatic disease. No conversion to laparotomy and no intraoperative complication occurred in the LPS group. Operative time was significantly longer in the LPS group when compared with the LPT group (377+/-47 vs. 272+/-81 min, P=0.002). One patient in the LPS group had a retroperitoneal haematoma recognized in the postoperative period, and this required laparotomy and ligature of the hypogastric arteries to achieve haemostasis. Minor postoperative complications occurred in 1 (6.7%) patient in the LPS group and in 8 (42.1%) patients in the LPT group (P=0.047). Hospital stay was significantly shorter in the LPS group [3 (2-12) vs. 7 (4-14) days, P=0.001]. Median (range) follow-up time was 16 (4-33) and 60 (32-108) months in the LPS and LPT group, respectively. Eleven (73.3%) patients in the LPS group and 13 (68.4%) in the LPT group received adjuvant treatment. There were no recurrences in the LPS group whereas 4 (7.1%) recurrences occurred in the LPT group. Overall survival was 100% in both groups. CONCLUSION Our results suggest that laparoscopic comprehensive surgical staging of EOC is as safe and adequate as the standard surgical staging performed via laparotomy.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Piazza Biroldi 1, 21100 Varese, Italy.
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41
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Abstract
The role of minimally invasive surgery in the management of gynecologic cancers continues to expand. Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy has emerged as a safe, reasonable option for women with early-stage cervical cancer desiring fertility preservation. Similarly, laparoscopically assisted radical vaginal hysterectomy has been systematically described, is feasible, and can be offered to women with early-stage cervical cancer who do not desire future childbearing. In the treatment of early-stage endometrial cancer, the surgical approach of laparoscopic hysterectomy, peritoneal washings, and pelvic and para-aortic lymph node dissection, with or without an omentectomy, is being compared with the same surgery performed via laparotomy in the cooperative Gynecologic Oncology Group LAP 2 study, which has completed accrual, and appears to be a reasonable surgical option. In ovarian cancer, minimally invasive surgery has been incorporated to manage early-stage, advanced-stage, and recurrent disease, as well as second-look procedures. Hand-assisted laparoscopy has also recently been described in managing larger volume primary and recurrent gynecologic cancers. Extraperitoneal laparoscopy for para-aortic and pelvic lymph node dissections has been shown to yield adequate nodal counts and to be safe and feasible in the management of gynecologic cancers.
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Affiliation(s)
- Alan C Schlaerth
- Memorial Sloan-Kettering Cancer Center, Gynecology Service, Department of Surgery, 1275 York Avenue, New York, New York 10021, USA
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Deffieux X, Castaigne D, Pomel C. Role of laparoscopy to evaluate candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer. Int J Gynecol Cancer 2006; 16 Suppl 1:35-40. [PMID: 16515565 DOI: 10.1111/j.1525-1438.2006.00323.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The objective of this study was to evaluate the role of laparoscopy in selecting candidates for complete cytoreduction surgery in epithelial ovarian carcinoma. We performed an explorative laparoscopy in 15 women presenting with advanced ovarian carcinoma, and for whom the preoperative evaluation was considered unsatisfactory, to define the possibility of achieving a complete cytoreduction. We focused on three sites of carcinomatosis: bowel, liver pedicle, and right diaphragmatic dome. Laparoscopic evaluation was successful in all 15 patients. Four patients were considered to have unresectable carcinomatosis because of extensive involvement of the small bowel and therefore had no laparotomy. These women underwent neoadjuvant chemotherapy in the following 2 weeks. Eleven patients were considered to have resectable peritoneal carcinomatosis (PC). Ten women had no macroscopic residual tumor after surgery. A modified posterior exenteration was performed in five patients. The laparoscopic exploration had underestimated the liver pedicle involvement in two patients, but only one had an infracentimetric residual tumor after surgery. Laparoscopy is a reliable method of exploring PC in advanced-stage ovarian cancer. Laparoscopy may obviate the need for unnecessary laparotomy in many cases and may, therefore, contribute to a better quality of life for patients found to have unresectable disease.
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Affiliation(s)
- X Deffieux
- Department of Surgical Oncology, Gustave Roussy Institute Comprehensive Cancer Center, Villejuif, France.
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Juretzka MM, Crawford CL, Lee C, Wilton A, Schuman S, Chi DS, Sonoda Y, Barakat RR, Abu-Rustum NR. Laparoscopic findings during adnexal surgery in women with a history of nongynecologic malignancy. Gynecol Oncol 2006; 101:327-30. [PMID: 16360202 DOI: 10.1016/j.ygyno.2005.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 10/24/2005] [Accepted: 10/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the results of laparoscopic management of adnexal masses in women with a history of nongynecologic malignancy. METHODS We conducted a retrospective review of 262 patients with history of prior nongynecologic malignancy who underwent laparoscopy for management of an adnexal mass between 1/1992 and 6/2004. RESULTS Median patient age at laparoscopy was 55 years (range, 20-91 years), and median BMI was 25 kg/m2 (range, 14-41 kg/m2). Of the 262 patients, 145 (55.3%) had prior abdominal/pelvic surgery. Prior cancer history included breast (202, 77.1%), lymphoma/leukemia (16, 6.1%), colorectal (8, 3.0%), lung (7, 2.7%), multiple myeloma (5, 1.9%), head/neck (5, 1.9%), genitourinary (5, 1.9%), upper gastrointestinal (4, 1.5%), and other (10, 3.8%). Median ovarian mass diameter measured on radiologic imaging was 3.8 cm (range, 0.2-13.5 cm); median CA-125 was 17.0 U/mL (range, 1-7000 U/mL). In all, 49 (18.7%) patients had malignancy identified at laparoscopy, with 30/49 (61.2%) diagnosed with metastatic malignancy to the ovary and 19/49 (38.8%) having a new primary ovarian malignancy. Median tumor diameter and CA-125 were significantly higher in women found to have a malignancy (4.7 vs. 3.7 cm, and 35 vs. 14 U/mL, respectively). Overall, conversion to laparotomy occurred in 34 (12.9%) cases. Twenty-one of 49 (42.9%) patients with malignancy were converted to laparotomy compared with 13/213 (6.1%) when benign disease was noted (P < 0.001). CONCLUSIONS Approximately 1 in 5 patients with a history of nongynecologic malignancy who were selected for laparoscopic management of an adnexal mass was found to have malignancy, with 60% being metastatic from other primaries. The majority of cases were managed laparoscopically even if malignancy was identified.
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Affiliation(s)
- Margrit M Juretzka
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Kehoe SM, Abu-Rustum NR. Transperitoneal laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic cancers. Curr Treat Options Oncol 2006; 7:93-101. [PMID: 16455020 DOI: 10.1007/s11864-006-0044-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laparoscopy, a minimally invasive surgery, may benefit select patients more than traditional abdominal approaches. The benefits of this procedure include low morbidity, shorter length of hospital stay, less blood loss, no significant increase in complications, and a shorter postoperative recovery period; this allows patients to begin adjuvant therapy more quickly. Laparoscopy has been used in gynecologic oncology since the early 1990s and has continued to grow and develop. Complex gynecologic oncology procedures can be performed with a low rate of complication and a low rate of conversion to laparotomy. The literature supports the fact that laparoscopy can be performed with short-term benefit with no increase in morbidity. Although the data are limited and emerging, the risk of cancer recurrence does not appear to increase because of this minimal access approach. Currently, advanced laparoscopic techniques are used to evaluate and treat cervical, endometrial, and ovarian malignancies. Specifically, transperitoneal laparoscopic lymphadenectomy including pelvic and paraaortic nodes is a feasible and efficacious procedure in the management of certain gynecologic malignancies.
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Affiliation(s)
- Siobhan M Kehoe
- Memorial Sloan-Kettering Cancer Center, Gynecology Service, Department of Surgery, 1275 York Avenue, New York, NY 10021, USA
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Prado S, Yazigi R, Garrido J, Gonzalez M, Torres R, Oddo D. Recurrent ovarian dysgerminoma after laparoscopy. Int J Gynecol Cancer 2006; 16 Suppl 1:397-9. [PMID: 16515632 DOI: 10.1111/j.1525-1438.2006.00336.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To our knowledge, recurrent dysgerminoma at the site of tumor removal by laparoscopy in a patient with stage IA disease has not been previously reported. A woman with ovarian dysgerminoma treated by laparoscopy and tumor removed through the cul-de-sac recurred the 17 months later at the site of tumor removal. She was successfully treated with etoposide, bleomycin, and cisplatin chemotherapy with complete response. This case illustrates the potential for surgical site implant of an ovarian dysgerminoma; surgeons should follow strict guidelines when performing laparoscopic procedures for ovarian malignancies in order to prevent this type of incident.
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Affiliation(s)
- S Prado
- Division of Gynecologic Oncology, National Cancer Institute, Santiago, Chile.
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Cao LP, Ding GP, Que RS, Zheng S. Influence of CO2 pneumoperitoneum on intracellular pH and signal transduction in cancer cells. J Zhejiang Univ Sci B 2005; 6:650-5. [PMID: 15973767 PMCID: PMC1389799 DOI: 10.1631/jzus.2005.b0650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECT The authors studied the influence of CO(2) pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. METHOD They set up a simulation of pneumoperitoneum under different CO(2) pressure, and then measured the variation of intracellular pH (pHi) at different time and the activity of protein kinase C (PKC) and protein phosphatase 2a (PP2a) at the end of the pneumoperitoneum. After 1 week, the concentration of cancer cells in the culture medium was calculated. RESULT When the pressure of CO(2) pneumoperitoneum was 0, 10, 20, 30 mmHg respectively, the average pHi was 7.273, 7.075, 6.783, 6.693 at the end of the pneumoperitoneum; PKC activity was 159.4, 168.5, 178.0, 181.6 nmol/(g.min) and PP2a was 4158.3, 4066.9, 3984.0, 3878.5 nmol/(g.min) respectively. After 1 week, the cancer cells concentration was 2.15 x 10(5), 2.03 x 10(5), 2.20 x 10(5), 2.18 x 10(5) L(-1). CONCLUSION CO(2) pneumoperitoneum could promote acidosis in cancer cells, inducing the activation of protein kinase C and deactivation of protein phosphatase 2a, but it could not accelerate the mitosis rate of the cancer cells.
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Affiliation(s)
- Li-Ping Cao
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Fagotti A, Fanfani F, Ludovisi M, Lo Voi R, Bifulco G, Testa AC, Scambia G. Role of laparoscopy to assess the chance of optimal cytoreductive surgery in advanced ovarian cancer: a pilot study. Gynecol Oncol 2005; 96:729-35. [PMID: 15721418 DOI: 10.1016/j.ygyno.2004.11.031] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether laparoscopy can be considered as adequate and reliable as standard laparotomy in predicting optimal cytoreduction (RT < or = 1 cm) in patients with advanced ovarian cancer. METHODS From March to November 2003, 95 patients with suspected advanced ovarian or peritoneal cancer have been evaluated. Thirty-one cases were excluded due to an anesthesiological class of risk ASA III-IV (51.6%) and for the presence of a large size mass reaching the xiphoid (48.4%). Sixty-four patients completed the study. All patients were submitted to preoperative clinico-radiological evaluation and then to both laparoscopy and standard longitudinal laparotomy, sequentially. Some specific preoperatively defined parameters were analyzed during each procedure in order to obtain the most accurate evaluation on the possibility to get an optimal cytoreduction. RESULTS The overall accuracy rate of laparoscopy in assessing optimal cytoreduction was 90%. The negative predictive value (NPV) of the clinical-radiologic evaluation corresponded to 73%, whereas in no case was the judgment of unresectable disease obtained by laparoscopy changed by the laparotomic approach (NPV 100%). On the contrary, an optimal debulking was achievable in 34 of 39 cases (87%) selected as completely resectable by explorative laparoscopy. CONCLUSIONS Laparoscopy can be considered super imposable to standard longitudinal laparotomy in identifying not optimally resectable advanced ovarian cancer patients.
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Affiliation(s)
- Anna Fagotti
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Campobasso, Rome, Italy
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Chi DS, Abu-Rustum NR, Sonoda Y, Ivy J, Rhee E, Moore K, Levine DA, Barakat RR. The safety and efficacy of laparoscopic surgical staging of apparent stage I ovarian and fallopian tube cancers. Am J Obstet Gynecol 2005; 192:1614-9. [PMID: 15902166 DOI: 10.1016/j.ajog.2004.11.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of laparoscopic staging of ovarian or fallopian tube cancers to staging via laparotomy for epithelial ovarian carcinoma. STUDY DESIGN We performed a case-control study of all patients with apparent stage I adnexal cancers who had laparoscopic staging from October 2000 to March 2003. The control group consisted of all patients with apparent stage I epithelial ovarian carcinoma who had staging via laparotomy during the same time period. RESULTS Staging was laparoscopic in 20 patients and via laparotomy in 30. There were no differences in mean age and body mass index. There were also no differences in omental specimen size and number of lymph nodes removed. Estimated blood loss and hospital stay were lower for laparoscopy, but operating time was longer. There were no conversions to laparotomy or complications in the laparoscopic group, compared with 3 minor complications in the laparotomy group. CONCLUSION In this preliminary analysis, it appears that patients with apparent stage I ovarian or fallopian tube cancer can safely and adequately undergo laparoscopic surgical staging.
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Affiliation(s)
- Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Abu-Rustum NR. CO2 pneumoperitoneum or the Bookwalter: Choose your access and exposure. Gynecol Oncol 2005; 97:1-3. [PMID: 15790429 DOI: 10.1016/j.ygyno.2005.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Indexed: 10/25/2022]
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Frumovitz M, Ramirez PT, Greer M, Gregurich MA, Wolf J, Bodurka DC, Levenback C. Laparoscopic training and practice in gynecologic oncology among Society of Gynecologic Oncologists members and fellows-in-training. Gynecol Oncol 2004; 94:746-53. [PMID: 15350368 DOI: 10.1016/j.ygyno.2004.06.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2004] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the proportion of Society of Gynecologic Oncologists (SGO) members performing laparoscopic procedures and to determine SGO members' and fellows' opinions regarding indications for and the adequacy of training in laparoscopy. METHODS Surveys were mailed to SGO members and fellows-in-training in December 2002. Anonymous responses were collected by mail or through a Web site. The survey was mailed twice and was estimated to take 5 min to complete. The data were analyzed using frequency distributions and nonparametric tests. RESULTS Three hundred thirty-six SGO members (45%) and fifty-seven fellows (49%) responded. Among SGO members, 272 (84%) currently performed laparoscopic surgeries. Reasons cited for performing laparoscopy were decreased length of hospital stay (74%), improved patient quality of life (57%), patient preference (48%), improved cosmesis (46%), and better visualization (18%). Among those who did not perform laparoscopy, 50% cited increased operating time as their main reason. When asked to indicate the laparoscopic procedure most commonly performed in their practice, 69% reported diagnosis of an adnexal mass; 11%, prophylactic bilateral salpingo-oophorectomies; and 10%, laparoscopically assisted vaginal hysterectomy and lymph node staging for uterine cancer. Only 3% of SGO respondents performed more than 50% of their procedures laparoscopically, and all respondents reported converting from laparoscopy to laparotomy less than 25% of the time. Most respondents had limited laparoscopic training during their fellowships: 39% received none, and 46% received limited (less than five procedures per month) training. Nevertheless, 78% of SGO respondents rated their laparoscopic skills as either very good or good. Among fellows, only 25% believed they were receiving very good or good laparoscopic training. Eighty percent of SGO respondents believe that at least six procedures per month were necessary for adequate training, yet only 33% of fellows performed that many procedures. CONCLUSIONS Most SGO respondents used laparoscopy for selective indications, and most developed their laparoscopic skills after their fellowship training. SGO respondents believed laparoscopic instruction is an important part of training, but most fellows perceived their laparoscopic training as inadequate.
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Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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