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Moukarzel LA, Chi DS. Posterior pelvic exenteration, a crucial component in the surgeon’s toolbox for optimizing surgical cytoreduction for advanced ovarian cancer. J Gynecol Oncol 2022; 33:e41. [PMID: 35320890 PMCID: PMC9024179 DOI: 10.3802/jgo.2022.33.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lea A. Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tsonis O, Gkrozou F, Vlachos K, Paschopoulos M, Mitsis MC, Zakynthinakis-Kyriakou N, Boussios S, Pappas-Gogos G. Upfront debulking surgery for high-grade serous ovarian carcinoma: current evidence. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1707. [PMID: 33490219 PMCID: PMC7812243 DOI: 10.21037/atm-20-1620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
High-grade serous ovarian carcinoma (HGSOC) is a leading cause of mortality among women worldwide. Currently, there is no clear consensus over the regime these patients should receive. The main two options are upfront debulking surgery with adjuvant chemotherapy or neoadjuvant chemotherapy followed by interval debulking surgery (IDS). The former approach is proposed to be accompanied by lower chemoresistance rates but could lead to severe surgical comorbidities and lower quality of life (QoL). Optimizing patient’s selection for upfront debulking surgery might offer higher progression-free and overall survival rates. Further studies need to be conducted in order to elucidate the predictive factors, which are favorable for patients undergoing upfront debulking surgery in cases of high-grade serous ovarian cancer.
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Affiliation(s)
- Orestis Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospitals Birmingham, Birmingham, UK
| | - Konstantinos Vlachos
- Department of General Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Michail C Mitsis
- Department of General Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK.,AELIA Organization, Thessaloniki, Greece
| | - George Pappas-Gogos
- Department of General Surgery, University Hospital of Ioannina, Ioannina, Greece
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Sebastian A, Thomas A, Varghese G, Yadav B, Chandy R, Peedicayil A. Outcome of Bowel Resection in Women with Advanced Ovarian Carcinoma. Indian J Surg Oncol 2018; 9:511-518. [PMID: 30538381 DOI: 10.1007/s13193-018-0790-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/13/2018] [Indexed: 12/20/2022] Open
Abstract
To evaluate the mortality and morbidity related to bowel resection in women with advanced ovarian carcinoma. Retrospective case series of 47 women with stage III and IV carcinoma ovary who underwent bowel resection, over the period of 5 years from Jan 2011 to Dec 2015. The risk factors for perioperative morbidity and death were determined by regression analysis. The disease free and overall survival were determined by Kaplan-Meier plots. In this cohort, 64% (30/47) had primary debulking, 21% (10/47) had interval debulking, and 15% (7/47) had secondary debulking. The mean period of follow-up was 23 months (1 to 45 months). There were no anastomotic leaks. The commonest morbidities were relaparotomy (8.5%), surgical site infection (12%), and paralytic ileus (19%). The overall morbidity was 42.6% (20/47). The 30-day mortality was 4.2% (2/47). The recurrence rate was 51% (20/47). The overall mortality from ovarian cancer in this cohort was 40% (19/47) during the follow-up period. Stage and histology seemed to be important risk factors for morbidity. Low BMI and sub-optimal debulking were significant risk factors for recurrence and death in univariate analysis. Bowel resection, in optimally selected cases of advanced carcinoma ovary, is often required for optimal cytoreduction. It carries a reasonable peri-operative mortality and morbidity and improves overall survival.
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Affiliation(s)
- Ajit Sebastian
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
| | - Anitha Thomas
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
| | - Gigi Varghese
- 2Department of Colorectal Surgery, CMC Hospital, Vellore, 632004 India
| | - Bijesh Yadav
- 3Department of Biostatistics, CMC Hospital, Vellore, 632004 India
| | - Rachel Chandy
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
| | - Abraham Peedicayil
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
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Derlatka P, Sienko J, Grabowska-Derlatka L, Palczewski P, Danska-Bidzinska A, Bidzinski M, Czajkowski K. Results of optimal debulking surgery with bowel resection in patients with advanced ovarian cancer. World J Surg Oncol 2016; 14:58. [PMID: 26923029 PMCID: PMC4770554 DOI: 10.1186/s12957-016-0800-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/16/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The surgical treatment of patients with advanced-stage ovarian cancer is based on maximal cytoreduction with widening the debulking on the extra-ovarian tissues and infiltrated organs. The purpose of the study was to assess the outcome after optimal cytoreduction with partial bowel resection and to find the risk factors of relapse. Another goal was the quantitative and qualitative assessment of intra- and postoperative complications in the studied group. METHODS The analysis of debulking procedures with intestinal resection and postoperative period in 33 ovarian cancer patients, The International Federation of Gynecology and Obstetrics (FIGO) stages III and IV, was performed. RESULTS The optimal cytoreduction defined as less than 1.0 cm residual disease was achieved in all patients including the following: 26 patients (78.8%) with no macroscopic residual disease, 4 patients (12.1%) with the largest residual tumor less than 0.5, and 3 patients (9.1%) with 0.5 cm to less than 1.0 cm residual disease. The rectosigmoid resection was the most common surgical procedure (n = 27). The risk of relapse was significantly higher in subjects who had the macroscopic residual tumor left during the primary operation (57.1 vs. 11.5%, P = 0.035). A primary bowel tumor size was another predictor of relapse. The maximum tumor diameter was significantly larger (14.9 ± 6.7 cm vs. 10.3 ± 4.7 cm, P = 0.047) in patients who developed the relapse. CONCLUSIONS As presented in the article, our outcomes and other authors' observations indicate that debulking surgery with bowel resection in patients with advanced ovarian cancer brings good results. Complications connected with bowel surgery are to be accepted. The interesting thing is that a primary bowel tumor size was a predictor of relapse.
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Affiliation(s)
- Pawel Derlatka
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St, 00-315, Warsaw, Poland.
| | - Jacek Sienko
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St, 00-315, Warsaw, Poland.
| | | | - Piotr Palczewski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.
| | - Anna Danska-Bidzinska
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St, 00-315, Warsaw, Poland.
| | - Mariusz Bidzinski
- The Faculty of Health Science, The Jan Kochanowski University in Kielce, Kielce, Poland.
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St, 00-315, Warsaw, Poland.
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Lee T. Gastrointestinal Stromal Tumor (GIST) Presenting as a Huge Pelvic Mass. Geburtshilfe Frauenheilkd 2013; 73:70-73. [PMID: 24771887 DOI: 10.1055/s-0032-1328039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 10/05/2012] [Accepted: 10/28/2012] [Indexed: 01/07/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors that can arise anywhere in the tubular gastrointestinal tract. These tumors occasionally present as a pelvic mass, leading to a misdiagnosis of gynecological disease. A 47-year-old woman presented with a pelvic mass measuring 30 cm in diameter and highly elevated CA-125 levels. She underwent exploratory laparotomy with resection of the pelvic mass. The mass mimicking ovarian malignancy was found in the sigmoid colon and was correctly diagnosed as a GIST at surgery. It should be noted that preoperative diagnosis of GIST is uncommon, due to its rarity and the varying clinical presentation. However, non-gynecological tumors should be included in the differential diagnosis of a pelvic mass with atypical presentation. Gynecologists need to be cognizant of extra-ovarian pathology in patients presenting with an atypical pelvic mass.
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Affiliation(s)
- Th Lee
- Department of Obstetrics and Gynecology, Kosin University College of Medicine, Busan, Republic of Korea
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A surgeon's help with the management of bowel problems related to gynecology is truly needed - comparison of two periods spanning 24 years. Taiwan J Obstet Gynecol 2013; 51:612-5. [PMID: 23276566 DOI: 10.1016/j.tjog.2012.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Colorectal surgeons are frequently on call to provide help to gynecologists who are managing bowel problems that occur either during or following gynecological surgery. This is a retrospective analysis of a single surgeon's experiences associated with such instances. The analysis focuses on whether there have been any changes in referral patterns, surgical techniques and/or results. MATERIALS AND METHODS From July 1984 to June 2008, 282 patients were operated on by a single colorectal surgeon, for problems that were related to gynecology. These consisted of 137 patients operated on during the first 12-year period, from July 1984 to June 1996. During this first period, 85 patients were operated on for cervical cancer related problems, 39 patients were operated on for problems related to other gynecological malignancies and nine patients were operated on for iatrogenic bowel injury during surgery. During the second 12-year period, from July 1996 to June 2008, 145 patients were operated on. Of these, 85 patients were operated on for cervical cancer related problems, 44 patients were operated on for problems related to other gynecological malignancies and eight patients were operated on for iatrogenic bowel injury during surgery. RESULTS During the first 12-year period, six operations were pelvic exenterations for primary gynecological malignancies or recurrences. One hundred and one patients received stomas during their first operation. Twenty-five patients encountered various complications. Postoperative death occurred in five patients. During the second 12-year period, 12 operations were pelvic exenterations for primary gynecological malignancies or recurrences. Eighty-seven patients received stomas during their first operation. Thirty-seven patients encountered various complications. Postoperative death occurred in six patients. CONCLUSION Gynecological problems frequently involve the colon or rectum. Cervical cancer related problems remain the most common type necessitating help from a colorectal surgeon. In spite of advances in surgical management, stomas are still frequently unavoidable in order to cure a patient or improve the patient's quality of life. Appropriate management of problems by a colorectal surgeon in relation to gynecology is important and in the best interests of the patient.
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Naik R, Galaal K, Alagoda B, Katory M, Mercer-Jones M, Farrel R. Surgical training in gastrointestinal procedures within a UK gynaecological oncology subspecialty programme. BJOG 2009; 117:26-31. [DOI: 10.1111/j.1471-0528.2009.02415.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bidzinski M, Derlatka P, Kubik P, Ziolkowska-Seta I, Dańska-Bidzinska A, Gmyrek L, Sobiczewski P, Panek G. The evaluation of intra- and postoperative complications related to debulking surgery with bowel resection in patients with FIGO stage III-IV ovarian cancer. Int J Gynecol Cancer 2007; 17:993-7. [PMID: 17367325 DOI: 10.1111/j.1525-1438.2007.00896.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The surgical treatment of advanced ovarian cancer is based on the maximal debulking with widening the operation range to the infiltrated organs. The aims are as follows: (1) the assessment of the quantity and quality of intra- and postoperative complications in patients with advanced ovarian cancer in which partial bowel resection was performed and (2) the evaluation of intra- and postoperative complications related to surgery with bowel resection and anastomosis, compared to Hartmann's procedure. The analysis of debulking procedures with intestinal resection and postoperative period in 39 ovarian cancer patients, FIGO stage III-IV, was performed. During 39 operations, the most frequent type of resection was the sigmoidectomy or proctosigmoidectomy (29 patients). In the remaining patients, left- and right-side hemicolectomy or partial enterectomy was done. Twenty-four anastomosis and 15 Hartmann's procedures were performed. There were no differences between surgery with anastomosis and Hartmann's procedure in aspect of quantity of complications, blood loss, and the time of surgery. There were no statistically significant differences in overall survival and progression-free survival in both groups. We conclude that the percentage of complications related to debulking surgery with intestinal resection in advanced ovarian cancer patients might be accepted. The quantity of complications related to surgery with anastomosis and to Hartmann's procedure is similar. If possible, the surgery with anastomosis should be performed.
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Affiliation(s)
- M Bidzinski
- Department of Gynecological Oncology, The Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW This review examines the current role of intestinal surgery in advanced ovarian cancer. Institutions differ considerably in surgical procedures and therapeutic outcomes for this disease. Moreover, therapeutic outcomes are influenced by the inclusion criteria for surgical procedures and the degree of surgical completion. We discuss the role of intestinal surgery and suggest surgical indications for intestinal surgery in advanced ovarian cancer. RECENT FINDINGS Prognosis in advanced ovarian cancer is better when there is a smaller postoperative tumor mass. However, it is necessary to investigate the effects of intestinal surgery on residual tumor mass and its prognostic benefits. Here, recent reports were reviewed to ascertain the usefulness and safety of intestinal surgery for advanced ovarian cancer and examine surgical indications and institutional requirements. SUMMARY By performing aggressive intestinal surgery such as combined bowel resection, optimal cytoreductive surgery can be performed in 70-98% of cases. The morbidity associated with intestinal surgery is acceptably low. Prognostic benefits for intestinal surgery are clear in patients with operable ovarian cancer with no residual disease. Women with suspected ovarian cancer should therefore be referred to centers with experienced tumor surgeons.
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Affiliation(s)
- Osamu Takahashi
- Department of Obstetrics and Gynecology, Akita City Hospital, Kawamoto, Akita, Japan.
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