1
|
Channawi A, Pop FC, Khaled C, Gomez MG, Moreau M, Polastro L, Veys I, Liberale G. Prognostic Impact of Mesenteric Lymph Node Status on Digestive Resection Specimens During Cytoreductive Surgery for Ovarian Peritoneal Metastases. Ann Surg Oncol 2024; 31:605-613. [PMID: 37865938 PMCID: PMC10695887 DOI: 10.1245/s10434-023-14405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The most common mode of ovarian cancer (OC) spread is intraperitoneal dissemination, with the peritoneum as the primary site of metastasis. Cytoreductive surgery (CRS) with chemotherapy is the primary treatment. When necessary, a digestive resection can be performed, but the role of mesenteric lymph nodes (MLNs) in advanced OC remains unclear, and its significance in treatment and follow-up evaluation remains to be determined. This study aimed to evaluate the prevalence of MLN involvement in patients who underwent digestive resection for OC peritoneal metastases (PM) and to investigate its potential prognostic value. METHODS This retrospective, descriptive study included patients who underwent CRS with curative intent for OC with PM between 1 January 2007 and 31 December 2020. The study assessed MLN status and other clinicopathologic features to determine their prognostic value in relation to overall survival (OS) and progression-free survival (PFS). RESULTS The study enrolled 159 women with advanced OC, 77 (48.4%) of whom had a digestive resection. For 61.1% of the patients who underwent digestive resection, MLNs were examined and found to be positive in 56.8%. No statistically significant associations were found between MLN status and OS (p = 0.497) or PFS ((p = 0.659). CONCLUSIONS In anatomopathologic studies, MLNs are not systematically investigated but are frequently involved. In the current study, no statistically significant associations were found between MLN status and OS or PFS. Further prospective studies with a systematic and standardized approach should be performed to confirm these findings.
Collapse
Affiliation(s)
- Ali Channawi
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Florin-Catalin Pop
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Charif Khaled
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Galdon Gomez
- Department of Pathology, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Moreau
- Statistics Department, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Polastro
- Département of Medical Oncology, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Veys
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet (Hopitaux Universitaires de Bruxelles [HUB]), Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
2
|
Gallotta V, Certelli C, Oliva R, Rosati A, Federico A, Loverro M, Lodoli C, Foschi N, Lathouras K, Fagotti A, Scambia G. Robotic surgery in ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2023; 90:102391. [PMID: 37573801 DOI: 10.1016/j.bpobgyn.2023.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023]
Abstract
Ovarian cancer (OC) represents one of the most lethal cancers in women. The aim of surgical treatment is complete cytoreduction in advanced stages and a surgical staging in early stages. Although the guidelines still suggest laparotomy as the standard approach, in recent years minimally invasive surgery (MIS) has become increasingly popular in the treatment of OC, especially in early stages, because the 5-year relative survival exceeds 90% and the patients' quality of life cannot be overshadowed. However, MIS has been demonstrated to have a role even in advanced stages, in the prediction of optimal cytoreduction, identification patients who may benefit from neoadjuvant chemotherapy, and, more recently, in the interval debulking surgery, as in selected cases of secondary cytoreduction for recurrent ovarian cancer. The aim of this review is to describe the MIS (especially robotic surgery), with its advantages and pitfalls, in the treatment of OC.
Collapse
Affiliation(s)
- Valerio Gallotta
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Camilla Certelli
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Oliva
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Rosati
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Federico
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Loverro
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Lodoli
- Department of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nazario Foschi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | | | - Anna Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
3
|
Nishimura A, Motohara T, Morinaga J, Iwagoi Y, Yamamoto M, Yamaguchi M, Miyahara Y, Tashiro H, Katabuchi H. Surgical efficacy and quality of wide resection of the pelvic peritoneum in patients with epithelial ovarian cancer. Surg Oncol 2023; 48:101946. [PMID: 37094499 DOI: 10.1016/j.suronc.2023.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The aim of the study was to evaluate the impact of adding an extensive pelvic peritoneal stripping procedure, termed "wide resection of the pelvic peritoneum," (WRPP) to standard surgery for epithelial ovarian cancer on survival effectiveness and to investigate the role of ovarian cancer stem cells (CSCs) in the pelvic peritoneum. METHODS A total of 166 patients with ovarian cancer undergoing surgical treatment at Kumamoto University Hospital between 2002 and 2018 were retrospectively analyzed. Eligible patients were divided into three groups based on the surgical approach: standard surgery (SS) group (n = 36), WRPP group (standard surgery plus WRPP, n = 100), and rectosigmoidectomy (RS) group (standard surgery plus RS, n = 30). Survival outcomes were compared between the three groups. CD44 variant 6 (CD44v6) and EpCAM expression, as markers of ovarian CSCs, in peritoneal disseminated tumors were evaluated using immunofluorescence staining. RESULTS With respect to patients with stage IIIA-IVB ovarian cancer, there were significant differences in overall and progression-free survival between the WRPP and SS groups, as revealed by univariate (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.17-0.69; P = 0.003 and HR, 0.54; 95% CI, 0.31-0.95; P = 0.032, respectively) and multivariate Cox proportional hazards models (HR, 0.35; 95% CI, 0.17-0.70; P = 0.003 and HR, 0.54; 95% CI, 0.31-0.95; P = 0.032, respectively). Further, no significant differences were observed in survival outcomes between the RS group and the SS or WRPP group. Regarding the safety of WRPP, no significant differences in major intraoperative and postoperative complications were found between the three groups. Immunofluorescence analysis revealed a high percentage of CD44v6/EpCAM double-positive ovarian cancer cells in peritoneal disseminated tumors. CONCLUSION The present study demonstrates that WRPP significantly contributes to improved survival in patients with stage IIIA-IVB ovarian cancer. WRPP could result in eradicating ovarian CSCs and disrupting the CSC niche microenvironment in the pelvic peritoneum.
Collapse
Affiliation(s)
- Akiho Nishimura
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| | - Takeshi Motohara
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan.
| | - Jun Morinaga
- Department of Clinical Investigation Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| | - Yutaka Iwagoi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| | - Mayuko Yamamoto
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| | - Munekage Yamaguchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| | - Yo Miyahara
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| | - Hironori Tashiro
- Department of Woman's Health Sciences and Pediatric Nursing, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto-city, Kumamoto, 862-0976, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, 860-8556, Japan
| |
Collapse
|
4
|
Karadayi K, Karabacak U. Is complete mesocolic excision or total mesorectal excision necessary during cytoreductive surgery in ovarian peritoneal carcinomatosis with colonic involvement? Acta Chir Belg 2023; 123:124-131. [PMID: 34253150 DOI: 10.1080/00015458.2021.1955193] [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: 10/20/2022]
Abstract
INTRODUCTION Cytoreductive surgery (CRS) and intraperitoneal chemotherapy are effective in the treatment of ovarian peritoneal carcinomatosis (OPC). Colon resection is often required to achieve maximal cytoreduction during CRS. The success of complete mesocolic excision (CME) and total mesorectal excision (TME) in the surgical treatment of primary colorectal tumors is well-known. Our study aimed to investigate the factors affecting mesocolic lymph node metastasis (MLNM) and the contribution of CME/TME techniques to maximal cytoreduction in patients diagnosed with ovarian peritoneal carcinomatosis (OPC) with colon metastasis. PATIENTS AND METHODS Between 2004-2020, 30 patients who underwent colorectal resection with CME/TME techniques due to OPC-related colon metastasis were retrospectively analyzed. RESULTS The median age of patients was 61 (33-86). Six (20%) patients underwent total colectomy, 7 (23%) subtotal colectomy, 6 (20%) right hemicolectomy, 4 (13%) left hemicolectomy, and 7 (23%) rectosigmoid resection. Histopathological diagnosis was high-grade serous carcinoma in 29 (97%) patients, and malignant mixed Mullerian tumor in 1 (3%) patient. MLNM was detected in 17 (56%) of 30 patients. There was a significant relationship between MLNM and pelvic and para-aortic lymph node metastasis (PALNM) (p = 0.009) and lymphovascular invasion in primary ovarian tumors (p = 0.017). There was no significant relationship between MLNM and depth of colonic invasion (p = 0.463), histological grade (p = 0.711), and primary/secondary surgery (p = 0.638). MLNM was seen in 8 (47%) of 17 patients with only serosal invasion. CONCLUSION A high rate of MLNM can be seen in OPC-induced colon metastasis regardless of the degree of colon wall invasion. In patients with PALNM, the frequency of MLNM increases. We believe that if colon resection is to be performed in OPC, a colectomy should be performed by CME/TME principles to achieve maximal cytoreduction.
Collapse
Affiliation(s)
- Kursat Karadayi
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Ufuk Karabacak
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| |
Collapse
|
5
|
Song S, Chen H, Ning G, Guo Y, Li X. Clinical significance of enlarged cardiophrenic lymph nodes by CT in advanced ovarian cancer. Front Oncol 2023; 13:1149139. [PMID: 37007136 PMCID: PMC10063917 DOI: 10.3389/fonc.2023.1149139] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
AimThis study aims to assess the clinical influence of enlarged cardiophrenic lymph nodes (CPLN) on staging computed tomography (CT) among patients with advanced ovarian cancer.MethodsThis retrospective cohort study included 320 patients with advanced epithelial ovarian cancer who underwent staging CT from May 2008 to January 2019. The CPLN diameter was the average of two radiologists’ measurements. Enlarged CPLN was defined as a short-axis diameter of ≥5 mm. Clinical and imaging findings, management decisions, and progression-free survival(PFS) were compared between patients with and without enlarged CPLN.ResultsEnlarged CPLN was found in 129 (40.3%) patients, which was significantly associated with more pelvic peritoneal carcinomatosis (odds ratio [OR]: 6.61 with 95% confidence interval [CI]: 1.51–28.99), and involved the greater omentum (OR: 6.41, 95% CI: 3.05–13.46), spleen capsule nodules (OR: 2.83, 95% CI: 1.58–5.06), and liver capsule nodules (OR: 2.55, 95% CI: 1.57–4.17). The optimal cytoreduction rates did not differ between patients with and without enlarged CPLN (p = 0.656). The presence of enlarged CPLN had a significant negative influence on PFS (median PFS, 23.5 vs. 80.6 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.023) in patients with no RD after primary debulking surgery, but no adverse effect on PFS among patients with RD (median PFS, 28.0 vs. 24.4 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.359). However, enlarged CPLN on staging CT did not affect PFS in patients treated with neoadjuvant chemotherapy, with (median PFS, 22.4 vs. 23.6 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.360) or without RD (median PFS, 17.7 vs. 23.3 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.400). The enlarged CPLN showed a decreased trend in 81.6% (n = 80) of the patients with enlarged CPLN. No significant difference was found in PFS (p = 0.562) between patients with decreased and increased in the size of CPLN.ConclusionsEnlarged CPLN on staging CT is associated with more abdominal disease but is not reliable in predicting complete resection. Enlarged CPLN awareness is necessary for patients with a primary chance of complete resection of abdominal disease.
Collapse
Affiliation(s)
- Sisi Song
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, China
| | - Huizhu Chen
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Gang Ning
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yingkun Guo, ; Xuesheng Li,
| | - Xuesheng Li
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yingkun Guo, ; Xuesheng Li,
| |
Collapse
|
6
|
Valenti G, Sopracordevole F, Chiofalo B, Forte S, Ciancio F, Fiore M, Giorda G. Parenchymal liver metastasis in advanced ovarian cancer: Can bowel involvement influence the frequency and the related mortality rate? Eur J Obstet Gynecol Reprod Biol 2023; 280:48-53. [PMID: 36399920 DOI: 10.1016/j.ejogrb.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This retrospective study estimates the frequency of parenchymal liver metastasis (PLM) and the overall survival (OS) rate of patients with FIGO Stage IIIC-IV Advanced Epithelial Ovarian Cancer (EOC) with bowel involvement. STUDY DESIGN Between November 2008 and July 2020, all consecutive patients with FIGO Stage IIIC-IV EOC who underwent Visceral Peritoneal Debulking and bowel resection(s) at the Gynaecological Oncology Unit of "Centro di Riferimento Oncologico (CRO)", Aviano, Italy, without evidence of PLM at pre-operative imaging assessment, were included in the study. The presence and the time of the onset of PLM during the follow-up period were detected by diagnostic imaging (CT-scan, Ultrasound and PET). The OS of patients with and without PLM was compared. Considering the bowel's layers, the association between depth of bowel involvement, number of PLM, and the relative OS rate was evaluated. RESULTS The median follow-up period was 47.3 (12-138) months. PLM occurred in 24/72 (33.0%) cases; the average onset time of PLM was 13 months. PLM was associated with increased significant mortality risk and an average OS of 33.2 versus 56.8 months (p < 0.001). The risk of developing PLM correlated directly with the depth of bowel involvement. However, there was no statistical difference between the layers in terms of OS at the end of the observational period. CONCLUSIONS PLM occurred more frequently among patients with EOC and bowel involvement. The PLM arose within 15 months of follow-up and the frequency increased according to the depth of involvement. Particularly, the difference is remarkably higher starting from muscular layer where the total number of PLM arose significantly (p = 0.02). Although there was no significant difference among the infiltrated bowel layers in terms of OS, patients with bowel involvement up to muscular had a dramatic reduction in the OS rate during the first 30 months of follow-up.
Collapse
Affiliation(s)
- Gaetano Valenti
- Gynecological Oncology Unit of Oncological-National Cancer Institute, Aviano, Italy; Humanitas Medical Care, Catania, Italy.
| | | | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Forte
- Gynecological Oncology Unit of Oncological-National Cancer Institute, Aviano, Italy
| | | | - Maria Fiore
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit of Oncological-National Cancer Institute, Aviano, Italy
| |
Collapse
|
7
|
Panoskaltsis T, Papadimitriou C, Pallas N, Karamveri C, Kyziridis D, Hristakis C, Kiriakopoulos V, Kalakonas A, Vaikos D, Tzavara C, Tentes AA. Prognostic Value of En-Block Radical Bowel Resection in Advanced Ovarian Cancer Surgery With HIPEC. Cancer Control 2023; 30:10732748231165878. [PMID: 36958947 PMCID: PMC10041633 DOI: 10.1177/10732748231165878] [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: 03/25/2023] Open
Abstract
PURPOSE To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC. METHODS In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC. RESULTS Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence. CONCLUSION CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.
Collapse
Affiliation(s)
- T Panoskaltsis
- Gynaecological Oncology Unit, 2nd Academic Department of Obstetrics and Gynaecology, Aretaieion Hospital, 68989The National and Kapodistrian University of Athens, Athens, Greece
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - C Papadimitriou
- Oncology Unit, 2nd Department of Surgery Aretaieion Hospital, 68989The National and Kapodistrian University of Athens, Athens, Greece
| | - N Pallas
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - C Karamveri
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - D Kyziridis
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - C Hristakis
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - V Kiriakopoulos
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - A Kalakonas
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - D Vaikos
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - C Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, School of Medicine, 68989The National and Kapodistrian University of Athens, Athens, Greece
| | - A A Tentes
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| |
Collapse
|
8
|
Gilks CB, Selinger CI, Davidson B, Köbel M, Ledermann JA, Lim D, Malpica A, Mikami Y, Singh N, Srinivasan R, Vang R, Lax SF, McCluggage WG. Data Set for the Reporting of Ovarian, Fallopian Tube and Primary Peritoneal Carcinoma: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S119-S142. [PMID: 36305537 DOI: 10.1097/pgp.0000000000000908] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The move toward consistent and comprehensive surgical pathology reports for cancer resection specimens has been a key development in supporting evidence-based patient management and consistent cancer staging. The International Collaboration on Cancer Reporting (ICCR) previously developed a data set for reporting of the ovarian, fallopian tube and primary peritoneal carcinomas which was published in 2015. In this paper, we provide an update on this data set, as a second edition, that reflects changes in the 2020 World Health Organization (WHO) Classification of Female Genital Tumours as well as some other minor modifications. The data set has been developed by a panel of internationally recognized expert pathologists and a clinician and consists of "core" and "noncore" elements to be included in surgical pathology reports, with detailed commentary to guide users, including references. This data set replaces the widely used first edition, and will facilitate consistent and accurate case reporting, data collection for quality assurance and research, and allow for comparison of epidemiological and pathologic parameters between different populations.
Collapse
|
9
|
He X, Li Z. Ostomy Does Not Lead to Worse Outcomes After Bowel Resection With Ovarian Cancer: A Systematic Review. Front Oncol 2022; 12:892376. [PMID: 35677154 PMCID: PMC9169036 DOI: 10.3389/fonc.2022.892376] [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: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Debulking cytoreduction surgery with bowel resection is a common intervention for ovarian cancer. It is controversial whether ostomy causes worse survival outcomes and how clinical physicians should choose which patients to undergo ostomy. During this study, we performed a systematic review to determine whether ostomy leads to worse outcomes after bowel resection compared to anastomosis. We also summarized the possible indications for ostomy. Methods We searched PubMed, Embase, and Cochrane for articles containing the phrase "ovarian cancer with bowel resection" that were published between 2016 and 2021. We included studies that compared primary anastomosis with ostomy. We mainly focused on differences in the anastomotic leakage rate, length of hospital stay, overall survival, and other survival outcomes associated with the two procedures. Results and Conclusion Of the 763 studies, three were ultimately included in the systematic review (N=1411). We found that ostomy did not contribute to worse survival outcomes, and that the stoma-related complications were acceptable. Indications for ostomy require further study. Bowel resection segment margins and the distance from the anastomosis to the anal verge require consideration.
Collapse
Affiliation(s)
- Xinlin He
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
10
|
Maione F, Manigrasso M, Chini A, Vertaldi S, Anoldo P, D’Amore A, Marello A, Sorrentino C, Cantore G, Maione R, Gennarelli N, D’Angelo S, D’Alesio N, De Simone G, Servillo G, Milone M, De Palma GD. The Role of Indocyanine Near-Infrared Fluorescence in Colorectal Surgery. Front Surg 2022; 9:886478. [PMID: 35669252 PMCID: PMC9163431 DOI: 10.3389/fsurg.2022.886478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purposes The aim of this study was to evaluate the importance of Indocyanine Green in control of anastomosis perfusion and on anastomotic leakage rates during laparoscopic and robotic colorectal procedures. Methods A retrospective review of patients who underwent elective minimally invasive surgery for colorectal cancer from 1 January 2018 to 31 December 2020 was performed. All patients underwent Near-Infrared Fluorescence-Indocyanine Green system in two moments: before performing the anastomosis and after completing the anastomotic procedure. Primary outcomes were the rate of intraoperative change in the surgical resection due to an inadequate vascularization and the rate of postoperative anastomotic leakage. Secondary outcomes were the postoperative complications, both medical and surgical (intra-abdominal bleeding, anastomotic leakage). Results Our analysis included 93 patients. Visible fluorescence was detected in 100% of the cases. In 7 patients (7.5%), the planned site of resection was changed due to inadequate perfusion. The mean extension of the surgical resection in these 7 patients was 2.2 ± 0.62. Anastomotic leakage occurred in 2 patients (2.1%). Other complications included 8 postoperative bleedings (8.6%) and 1 pulmonary thromboembolism. Conclusions The intraoperative use of Near-Infrared Fluorescence-Indocyanine Green in colorectal surgery is safe, feasible, and associated with a substantial reduction in postoperative anastomotic leakage rate.
Collapse
Affiliation(s)
- Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- Correspondence: Francesco Maione ; Alessia Chini
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- Correspondence: Francesco Maione ; Alessia Chini
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Anna D’Amore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Rosa Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Salvatore D’Angelo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nicola D’Alesio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | |
Collapse
|
11
|
Ray MD, Deo SSV, Kumar L, Gaur MK. Upfront cytoreductive surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer in Indian patients. Future Oncol 2021; 17:3607-3614. [PMID: 34263662 DOI: 10.2217/fon-2021-0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
In cases of ovarian carcinoma, primary cytoreductive surgery (CRS) is the standard treatment up to stage IIIB, but patient selection for neoadjuvant chemotherapy (NACT) in selected cases is controversial. A total of 200 patients with advanced ovarian cancer were analyzed retrospectively, according to specific selection criteria. Primary CRS was performed in 95 patients (47.5%) and interval CRS after 3-6 cycles of NACT was performed in 105 patients (52.5%). After median follow-up of 35 months, 5-year overall survival was 53.7% in the upfront CRS group and 42.2% in the NACT group. Primary CRS is the standard in advanced stages of ovarian carcinoma, but in certain subset of patients, NACT is preferred. Identifying that group is challenging but feasible. Proper selection of patients is key to successful outcomes.
Collapse
Affiliation(s)
- Mukur Dipi Ray
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Suryanarayana S V Deo
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Lalit Kumar
- Department of Medical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manish Kumar Gaur
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| |
Collapse
|
12
|
Shin DW, Bae J, Ha J, Jung KW. Conditional Relative Survival of Ovarian Cancer: A Korean National Cancer Registry Study. Front Oncol 2021; 11:639839. [PMID: 33996553 PMCID: PMC8113866 DOI: 10.3389/fonc.2021.639839] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Conditional relative survival (CRS) rates, which take into account changes in prognosis over time, are useful estimates for survivors and their clinicians as they make medical and personal decisions. We aimed to present the 5-year relative conditional survival probabilities of patients diagnosed with ovarian cancer from 1997-2016. METHODS This nationwide retrospective cohort study used data from the Korean Central Cancer Registry. Patients diagnosed with ovarian cancer between 1997 and 2016 were included. CRS rates were calculated stratified by age at diagnosis, cancer stage, histology, treatment received, year of diagnosis, and social deprivation index. RESULTS The 5-year relative survival rate at the time of diagnosis was 61.1% for all cases. The probability of surviving an additional 5 years, conditioned on having already survived 1, 2, 3, 4, and 5 years after diagnosis was 65.0, 69.5, 74.6, 79.3, and 83.9%, respectively. Patients with poorer initial survival estimates (older, distant stage, serous histology) generally showed the largest increases in CRS over time. The probability of death was highest in the first year after diagnosis (11.8%), and the conditional probability of death in the 2nd, 3rd, 4th, and 5th years declined to 9.4%, 7.9%, 6.1%, and 5.2%, respectively. CONCLUSION CRS rates for patients with ovarian cancer increased with each year they survived, but this did not reach the level of 'no excess mortality' even 5 years after diagnosis. The largest improvements in CRS were observed in patients with poorer initial prognoses. Our findings provide updated prognosis to ovarian cancer survivors and clinicians.
Collapse
Affiliation(s)
- Dong Wook Shin
- Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Jaeman Bae
- Department of Obstetric and Gynecology, Hanyang University, Seoul, South Korea
| | - Johyun Ha
- The Korea Central Cancer Registry, National Cancer Center, Goyang, South Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Kyu-Won Jung
- The Korea Central Cancer Registry, National Cancer Center, Goyang, South Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| |
Collapse
|
13
|
Park SJ, Mun J, Lee EJ, Park S, Kim SY, Lim W, Song G, Kim JW, Lee S, Kim HS. Clinical Phenotypes of Tumors Invading the Rectosigmoid Colon Affecting the Extent of Debulking Surgery and Survival in Advanced Ovarian Cancer. Front Oncol 2021; 11:673631. [PMID: 33968784 PMCID: PMC8100598 DOI: 10.3389/fonc.2021.673631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
We classified clinical phenotypes based on tumor separability from the rectosigmoid colon and then evaluated the effect of these clinical phenotypes on surgical outcomes and prognosis of advanced ovarian cancer. We collected data of patients with stage IIIB-IVB disease who either underwent visceral segmental serosectomy (VSS) or low anterior resection (LAR) during maximal debulking surgery. All patients were divided into the following, according to the resection types of tumors involving the rectosigmoid colon: the focal (tumor-involved length <18 cm) and separable (FS) group that received VSS, the focal and inseparable (FI) that received LAR, or the diffuse (tumor-involved length ≥18 cm) group (D) that also received LAR. A total of 83 patients were included in FS (n=44, 53%), FI (n=18, 21.7%), and D (n=24, 25.3%) groups. FS and D groups with more extensive tumors were related to wider extent of surgery and more tumor infiltration except for bowels, whereas FI and D groups with more invasive tumors were associated with wider extent of surgery, more tumor infiltration to bowels, longer operation time, more blood loss, more transfusion, longer hospitalization, and higher surgical complexity scores. Moreover, FS and FI groups showed better progression-free survival than D group, whereas FS group demonstrated better overall survival than FI and D groups. Clinical phenotypes based on tumor separability from the rectosigmoid colon may depend on tumor invasiveness and extensiveness in advanced ovarian cancer. Moreover, these clinical phenotypes may affect surgical outcomes and survival.
Collapse
Affiliation(s)
- Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jaehee Mun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sunwoo Park
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, South Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Whasun Lim
- Department of Food and Nutrition, Kookmin University, Seoul, South Korea
| | - Gwonhwa Song
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, South Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seungmee Lee
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
14
|
Tanaka K, Shimada Y, Nishino K, Yoshihara K, Nakano M, Kameyama H, Enomoto T, Wakai T. Clinical Significance of Mesenteric Lymph Node Involvement in the Pattern of Liver Metastasis in Patients with Ovarian Cancer. Ann Surg Oncol 2021; 28:7606-7613. [PMID: 33821347 DOI: 10.1245/s10434-021-09899-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mesenteric lymph node (MLN) involvement is often observed in ovarian cancer (OC) with rectosigmoid invasion. This study aimed to investigate the clinical significance of MLN involvement in the pattern of liver metastasis in patients with OC. METHODS We included 85 stage II-IV OC patients who underwent primary or interval debulking surgery. Twenty-seven patients underwent rectosigmoid resection, whose status of MLN involvement was judged from hematoxylin and eosin (H&E) staining of resected specimens. The prognostic significance of clinicopathological characteristics, including MLN involvement, was evaluated using univariate and multivariate analyses. RESULTS MLN involvement was detected in 14/85 patients with stage II-IV OC. Residual tumor status, cytology of ascites, and MLN involvement were independent prognostic factors for progression-free survival (PFS; p = 0.033, p = 0.014, and p = 0.008, respectively). When patients were classified into three groups (no MLN, one MLN, two or more MLNs), the number of MLNs involved corresponded to three distinct groups in PFS (p = 0.001). The 3-year cumulative incidence of liver metastasis of patients with MLN involvement was significantly higher than that of patients without MLN involvement (61.1% vs. 8.9%, p < 0.001). MLN involvement was significantly associated with liver metastasis of hematogenous origin (p < 0.001) compared with peritoneal disseminated origin. CONCLUSION MLN involvement is an important prognostic factor in OC, predicting poor prognosis and liver metastasis of hematogenous origin.
Collapse
Affiliation(s)
- Kana Tanaka
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Koji Nishino
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masato Nakano
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
15
|
Gu Y, Qin M, Jin Y, Zuo J, Li N, Bian C, Zhang Y, Li R, Wu YM, Wang CY, Zhang KQ, Yue Y, Wu LY, Pan LY. A Prediction Model for Optimal Primary Debulking Surgery Based on Preoperative Computed Tomography Scans and Clinical Factors in Patients With Advanced Ovarian Cancer: A Multicenter Retrospective Cohort Study. Front Oncol 2021; 10:611617. [PMID: 33489921 PMCID: PMC7819136 DOI: 10.3389/fonc.2020.611617] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study assessed the predictive value of preoperative computed tomography (CT) scans and clinical factors for optimal debulking surgery (ODS) in patients with advanced ovarian cancer (AOC). METHODS Patients with AOC in International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent primary debulking surgery (PDS) between 2016 and 2019 from nine tertiary Chinese hospitals were included. Large-volume ascites, diffuse peritoneal thickening, omental cake, retroperitoneal lymph node enlargement (RLNE) below and above the inferior mesenteric artery (IMA), and suspected pelvic bowel, abdominal bowel, liver surface, liver parenchyma and portal, spleen, diaphragm and pleural lesions were evaluated on CT. Preoperative factors included age, platelet count, and albumin and CA125 levels. RESULTS Overall, 296 patients were included, and 250 (84.5%) underwent ODS. The prediction model included age >60 years (P=0.016; prediction index value, PIV=1), a CA125 level >800 U/ml (P=0.033, PIV=1), abdominal bowel metastasis (P=0.034, PIV=1), spleen metastasis (P<0.001, PIV=2), diaphragmatic metastasis (P=0.014, PIV=2), and an RLNE above the IMA (P<0.001, PIV=2). This model had superior discrimination (AUC=0.788>0.750), and the Hosmer-Lemeshow test indicated its stable calibration (P=0.600>0.050). With the aim of maximizing the accuracy of prediction and minimizing the rate of inappropriate explorations, a total PIV ≥5 achieved the highest accuracy of 85.47% and identified patients who underwent suboptimal PDS with a specificity of 100%. CONCLUSIONS We developed a prediction model based on two preoperative clinical factors and four radiological criteria to predict unsatisfactory debulking surgery in patients with AOC. The accuracy of this prediction model needs to be validated and adjusted in further multicenter prospective studies.
Collapse
Affiliation(s)
- Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Qin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zuo
- Department of Obstetrics and Gynecology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Obstetrics and Gynecology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ce Bian
- Department of Obstetrics and Gynecology, The West China Second University Hospital of Sichuan University, Chengdu, China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Xiangya Hospital of Central South University, Changsha, China
| | - Rong Li
- Department of Obstetrics and Gynecology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu-mei Wu
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chun-yan Wang
- Department of Obstetrics and Gynecology, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Ke-qiang Zhang
- Department of Obstetrics and Gynecology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ying Yue
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Jilin, China
| | - Ling-ying Wu
- Department of Obstetrics and Gynecology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling-ya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
16
|
Llueca A, Serra A, Climent MT, Maiocchi K, Villarin A, Delgado K, Mari-Alexandre J, Gilabert-Estelles J, Carrasco P, Segarra B, Gomez L, Hidalgo JJ, Escrig J, Laguna M. Postoperative Intestinal Fistula in Primary Advanced Ovarian Cancer Surgery. Cancer Manag Res 2021; 13:13-23. [PMID: 33442290 PMCID: PMC7797294 DOI: 10.2147/cmar.s280511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background Advanced ovarian cancer (AOC) requires an aggressive surgery with large visceral resections in order to achieve an optimal or complete cytoreduction and increase the patient’s survival. However, the surgical aggressiveness in the treatment of AOC is not exempt from major complications, such as the gastrointestinal fistula (GIF), which stands out among others due to its high morbidity and mortality. Methods We evaluated the clinicopathological features in patients with AOC and their association with GI. Data for 107 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. Clinicopathological features, including demographic, surgical procedures and follow-up data, were analyzed in relation to GIF. Results GIF was present in 11% of patients in the study, 5 (4.5%) and 7 (6.4%) of colorectal and small bowel origin, respectively. GIF was significantly associated with peritoneal cancer index (PCI) >20, more than 2 visceral resections, and multiple digestive resections. Overall and disease-free survival were also associated with GIF. Multivariate analysis identified partial bowel obstruction and operative bleeding as independent prognostic factors for survival. The presence of GIF is positively associated with poor prognosis in patients with AOC. Conclusion Given the importance of successful cytoreductive surgery in AOC, the assessment of the amount of tumor and the aggressiveness of the surgery to avoid the occurrence of GIF become a priority in patients with AOC.
Collapse
Affiliation(s)
- Antoni Llueca
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Anna Serra
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Maria Teresa Climent
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Radiology, University General Hospital of Castellon, Castellón, Spain
| | - Josep Mari-Alexandre
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan Gilabert-Estelles
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain.,Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain
| | - Paula Carrasco
- Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Blanca Segarra
- University of Texas MD Anderson Cancer Center, Gynecology Oncology, Houston, Texas, USA
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | | | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Manuel Laguna
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | | |
Collapse
|
17
|
Lu HY, Tai YJ, Chen YL, Chiang YC, Hsu HC, Cheng WF. Ovarian cancer risk score predicts chemo-response and outcome in epithelial ovarian carcinoma patients. J Gynecol Oncol 2020; 32:e18. [PMID: 33327048 PMCID: PMC7930441 DOI: 10.3802/jgo.2021.32.e18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Cytoreductive surgery followed by adjuvant chemotherapy is a standard frontline treatment for epithelial ovarian cancer (EOC). We aimed to develop an ovarian cancer risk score (OVRS) based on the expression of 10 ovarian-cancer-related genes to predict the chemoresistance, and outcomes of EOC patients. METHODS We designed a case-control study with total 149 EOC women including 75 chemosensitives and 74 chemoresistants. Gene expression was measured using the quantitative real-time polymerase chain reaction. We tested for correlation between the OVRS and chemosensitivity or chemoresistance, disease-free survival (DFS), and overall survival (OS), and validated the OVRS by analyzing patients from the TCGA database. RESULTS The chemosensitive group had lower OVRS than the chemoresistant group (5 vs. 15, p≤0.001, Mann-Whitney U test). Patients with disease relapse (13 vs. 5, p<0.001, Mann-Whitney U test) or disease-related death (13.5 vs. 6, p<0.001) had higher OVRS than those without. OVRS ≥10 (hazard ratio=3.29; 95% confidence interval=1.94-5.58; p<0.001) was the only predictor for chemoresistance in multivariate analysis. The median DFS (5 months vs. 24 months) and OS (39 months vs. >60 months) of patients with OVRS ≥10 were significantly shorter than those of patients with OVRS <10). The high OVRS group also had significantly shorter median OS than the low OVRS group in 255 patients in the TCGA database (39 vs. 49 months, p=0.046). CONCLUSIONS Specific genes panel can be clinically applied in predicting the chemoresistance and outcome, and decision-making of epithelial ovarian cancer.
Collapse
Affiliation(s)
- Hsiao Yun Lu
- Graduate Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan.
| | - Heng Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Wen Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
18
|
Bund V, Lecointre L, Velten M, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Baldauf JJ, Ballester M, Lavoué V, Akladios C. Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). J Clin Med 2020; 9:jcm9082427. [PMID: 32751303 PMCID: PMC7464978 DOI: 10.3390/jcm9082427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
Collapse
Affiliation(s)
- Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
- Correspondence: ; Tel.: +33-(0)7-8170-2239
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- I-Cube UMR 7357—Laboratoire des Sciences de L’ingénieur, de L’informatique et de L’imagerie, Université de Strasbourg, 67081 Strasbourg, France
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Michel Velten
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, 37000 Tours, France;
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, 75020 Paris, France;
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, 75018 Paris, France;
| | - Pierre-Adrien Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France;
| | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, 59000 Lille, France;
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, 75013 Paris, France;
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 94000 Créteil, France;
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 78100 Poissy, France;
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 21000 Dijon, France;
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, 67000 Strasbourg, France;
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Marcos Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix, Saint-Simon, 75020 Paris, France;
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, 35000 Rennes, France;
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| |
Collapse
|
19
|
Bacalbasa N, Balescu I, Diaconu C, Iliescu L, Filipescu A, Pop C, Dima S, Vilcu M, Brezean I. Right Upper Abdominal Resections in Advanced Stage Ovarian Cancer. In Vivo 2020; 34:1487-1492. [PMID: 32354951 DOI: 10.21873/invivo.11934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The right upper abdominal involvement is frequently encountered in patients with advanced stage ovarian cancer. The aim of this paper is to study the safety and efficacy of extended resections at this level as well as to determine the sites of residual disease. PATIENTS AND METHODS Between January 2016 and December 2019, 26 patients submitted to right upper abdominal resections were identified. RESULTS Peritoneal stripping and full thickness resections were the most commonly performed resections (in 57% and 19% of cases, respectively), followed by capsular liver resection and atypical liver resection (in 30% and 23% of cases, respectively) while the most common sites where resection was incomplete were the liver pedicle and porta hepatis. Exceptionally, one case necessitated performing a pancreatoduodenectomy as part of debulking surgery. Postoperatively, two cases developed serious complications and required reintervention; however, the overall mortality was null. CONCLUSION Right upper abdominal resections seem to be feasible and effective in order to maximize the debulking effort with acceptable risks arising from perioperative complications.
Collapse
Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania .,Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Diaconu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital, Bucharest, Romania
| | - Laura Iliescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Cora Pop
- Department of Internal Medicine, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Simona Dima
- Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Mihaela Vilcu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Iulian Brezean
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| |
Collapse
|
20
|
Wang Y, Ren F, Song Z, Wang X, Zhang C, Ouyang L. Prognostic Significance of Systematic Lymphadenectomy in Patients With Optimally Debulked Advanced Ovarian Cancer: A Meta-Analysis. Front Oncol 2020; 10:86. [PMID: 32117740 PMCID: PMC7026262 DOI: 10.3389/fonc.2020.00086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/16/2020] [Indexed: 01/11/2023] Open
Abstract
Background: The effect of systematic lymphadenectomy (SL) on survival in patients with optimally debulked advanced ovarian cancer remains unclear. We evaluated the therapeutic value of SL in advanced ovarian cancer patients who underwent primary optimal debulking surgery. Methods: A meta-analysis was carried out using articles retrieved from the PubMed, Embase, and Cochrane databases. Overall survival (OS) and progression-free survival (PFS) were compared between patients who underwent SL and those who underwent unsystematic lymphadenectomy (USL). Results: Seven studies that included 2,425 patients with advanced ovarian cancer were included in the meta-analysis. The overall analyses indicated significantly improved OS [hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.49–0.84, P < 0.01] but not PFS (HR = 0.89, 95% CI: 0.69–1.15, P = 0.38) in patients who underwent SL compared to those who underwent USL. Subgroup analyses based on study type, study quality, total numbers of patients, and International Federation of Gynecology and Obstetrics (FIGO) stage provided similar results. However, subgroup analysis of patients with no residual tumor revealed that SL was not associated with improved OS (HR = 0.81, 95% CI: 0.66–1.00, P = 0.05) or PFS (HR = 1.09, 95% CI: 0.91–1.30, P = 0.33). Conclusions: In patients with optimally debulked advanced ovarian cancer, SL may improve OS but not PFS. However, SL does not provide a survival advantage when macroscopically complete resection of all visible tumors is achieved.
Collapse
Affiliation(s)
- Yizi Wang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang Ren
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoying Wang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chiyuan Zhang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Ouyang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
21
|
Zhu C, Zhu H, Wang Y, Cui H, Li Y. Para-aortic lymphadenectomy below inferior mesenteric artery versus renal vessels in stage IIIC epithelial ovarian cancer: A comparison of surgical outcomes. Int J Gynaecol Obstet 2019; 148:192-197. [PMID: 31746467 DOI: 10.1002/ijgo.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/28/2019] [Accepted: 11/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the surgical outcomes of para-aortic lymphadenectomy up to the level of inferior mesenteric artery (IMA) and renal vessels in women with stage IIIC epithelial ovarian cancer after primary optimal cytoreductive surgery. METHODS In a retrospective study at Peking University People's Hospital, Beijing, China, undertaken between January 1, 2001, and December 31, 2015, patients were classified into two groups based on the level of the para-aortic lymphadenectomy at either IMA (group A) or renal vessels (group B). Progression-free survival (PFS) and overall survival were assessed. RESULTS The study involved 102 women (56 in group A and 46 in group B). The two groups were comparable regarding clinical characteristics, and there were no statistically significant differences in perioperative variables between the groups. 15.2% of patients (7/46) had metastases at renal vessels level without metastases below IMA. Median PFS in group B was longer than group A (41 months vs 23 months, P=0.041) and 5-year survival rate was greater in group B compared to group A (74.6% vs 48.2%, P=0.003). Median overall survival was longer in group B compared to group A (not reached vs 55 months, P=0.03). CONCLUSION Para-aortic lymphadenectomy at the level of renal vessels was safe and could improve the prognosis of patients with advanced ovarian cancer who completed optimal cytoreduction.
Collapse
Affiliation(s)
- Chongyuan Zhu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Honglan Zhu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Heng Cui
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yi Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
22
|
[Are there still indications of lymph node dissection in epithelial ovarian cancers after the LION trial?]. Bull Cancer 2019; 107:707-714. [PMID: 31587803 DOI: 10.1016/j.bulcan.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/16/2019] [Indexed: 11/22/2022]
Abstract
In March 2019, Harter et al. published the results of the LION study (Lymphadenectomy in patients with advanced ovarian neoplasms) which raises the question of pelvic and para-aortic lymphadenectomy for patients with advanced-stage epithelial ovarian cancer (EOC). These results influenced the new French recommendations published in December 2018 by the French National Cancer Institute (INCa). Thus, it no longer seems consistent to perform a systematic lymphadenectomy for patients for whom there is no argument for nodal involvement, when a macroscopic complete peritoneal cytoreductive surgery has been performed. The question of preoperative lymph node assessment is therefore essential, whereas more than half of the patients in the LION study had metastatic lymph node involvement that was histologically proven. For the assessment of lymph node status by imaging, superior sensitivity for Positron Emission Tomography is demonstrated in comparison with CT-scan or Magnetic Resonance Imaging. Nevertheless, thoraco-abdomino-pelvic CT-scan with contrast injection remains the gold standard for this indication. In the absence of suspected involvement, supra-renal, mesenteric, coelio-hepatic, and cardio-phrenic lymphadenectomy are not recommended. Lymphadenectomies should always be performed in the other situations of EOC management apart from the rare case of stage 1 expansile subtype mucinous carcinoma. The aim of this review is to discuss lymphadenectomy indications for the surgical management of EOC by taking into account new data from the scientific literature.
Collapse
|
23
|
Wang M, Zhou J, Zhang L, Zhao Y, Zhang N, Wang L, Zhu W, He X, Zhu H, Xu W, Pan Q, Mao A, Li Q, Wang L. Surgical treatment of ovarian cancer liver metastasis. Hepatobiliary Surg Nutr 2019; 8:129-137. [PMID: 31098360 DOI: 10.21037/hbsn.2018.12.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In addition to hepatocellular carcinoma, metastatic liver cancer (MLC) is another focus of hepatic surgeon. Good outcome of patients with liver metastasis (LM) from colorectal cancer or neuroendocrine tumor have been achieved. Ovarian cancer liver metastasis (OCLM) has its unique oncological characteristics and a variety of metastasis patterns, which brings a challenge to hepatic surgeon. Hepatic surgeons hold different views and techniques from gynecologists, which makes differences in the evaluation and treatment of the disease. We reviewed recent studies and, in combination with our own clinical experience, attempted to introduce the progress of surgical treatment of liver metastases from OC. In our experience, both preoperative imaging and surgical procedures are based on the assurance of R0 resection. R0 cytoreductive surgery (CRS) is the most favorable determinant for the prognosis of OC patients, and R0 liver resection (LR) is a component of R0 CRS. Gynecologists and hepatic surgeons should do their own preoperative and intraoperative evaluation for the extrahepatic and intrahepatic metastasis respectively. During the operation, regardless of the miliary nodules dissemination between the right hemidiaphragm and liver capsule, liver parenchymal infiltration (LPI) or liver parenchymal metastasis (LPM), 1-2 cm resection margin should be emphasized. For patients with liver portal lymph node metastasis (LPLNM), hepatic portal skeletonization should be performed, rather than portal lymph node dissection. The operation should be as radical as possible to ensure the patients to achieve good prognosis.
Collapse
Affiliation(s)
- Miao Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiamin Zhou
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lyu Zhang
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yiming Zhao
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ning Zhang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Longrong Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiping Zhu
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xigan He
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hongxu Zhu
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiqi Xu
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qi Pan
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Anrong Mao
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qinchuan Li
- Department of Cardiothoracic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Lu Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| |
Collapse
|
24
|
Ferron G, Narducci F, Pouget N, Touboul C. [Surgery for advanced stage ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:197-213. [PMID: 30792175 DOI: 10.1016/j.gofs.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 01/10/2023]
Abstract
Debulking surgery is the key step of advanced stage ovarian cancer treatment with chemotherapy. The quality of surgical resection is the main prognosis factor, thus a complete resection must be achieved (grade A) in an expert center (grade B). Surgery for stage IV is possible and has a benefit in case of complete peritoneal resection (LoE3). Pelvic and aortic lymphadenectomies are recommended in case of clinical or radiological suspicious lymph nodes (grade B). In absence of clinical or radiological suspicious lymph nodes and in case of complete peritoneal resection during initial debulking surgery, lymphadenectomy can be omitted because it won't change nor medical treatment nor overall survival (grade B). Neoadjuvant chemotherapy can be proposed in case of: impossibility to perform initial complete surgical resection (grade B) ; alteration of general state or co-morbidities or elderly patient (in order to decrease morbidity and increase quality of life) (grade B); stage IV with multiple intra-hepatic or pulmonary metastasis or important ascites with miliary (grade B). In case of stage III or IV ovarian cancer diagnosed on a biopsy during prior laparotomy, a neoadjuvant chemotherapy and interval debulking surgery should be preferred (gradeC). In case of palliative surgery or peroperative impossibility to perform a complete resection, no data regarding the type of surgery to perform influencing survival or quality of life is available. Peritoneal carcinosis description before resection and residual disease at the end of the surgery should be reported (size, location and reason of non-extirpability) (grade B). A score of peritoneal carcinosis such as Peritoneal Carcinosis Index (PCI) should be used in order to objectively evaluate the tumoral burden (gradeC). A standardized operative report is recommended (gradeC).
Collapse
Affiliation(s)
- G Ferron
- Inserm CRCT 19, département de chirurgie oncologique, institut Claudius Regaud, institut universitaire du cancer, 31000 Toulouse, France
| | - F Narducci
- Inserm U1192, département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France
| | - N Pouget
- Département de chirurgie oncologique, chirurgie gynécologique et mammaire, institut Curie, site Saint-Cloud, 75005 Paris, France
| | - C Touboul
- IMRB, U955 Inserm, service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Créteil, institut Mondor de recherche biomédicale, 94000 Créteil, France.
| |
Collapse
|
25
|
Angeles MA, Ferron G, Cabarrou B, Balague G, Martínez-Gómez C, Gladieff L, Pomel C, Martinez A. Prognostic impact of celiac lymph node involvement in patients after frontline treatment for advanced ovarian cancer. Eur J Surg Oncol 2019; 45:1410-1416. [PMID: 30857876 DOI: 10.1016/j.ejso.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Completeness of cytoreduction is the most important prognostic factor in patients with advanced ovarian cancer (OC). Extensive upper abdominal surgery has allowed to increase the rate complete cytoreduction and the feasibility of resection of celiac lymph nodes (CLN) and porta hepatis disease in these patients has been demonstrated. The aim of our study was to assess the prognostic impact of CLN involvement in patients with primary advanced OC undergoing a complete cytoreductive surgery (CRS). MATERIAL AND METHODS We designed a retrospective unicentric study. We reviewed data from patients who underwent CLN resection with or without porta hepatis disease resection, within upfront or interval complete CRS in the frontline treatment of advanced epithelial OC between January 2008 and December 2015. Patients were classified in two groups according to CLN status. Univariate and multivariate analyses were conducted. Survival rates were estimated using Kaplan-Meier method. RESULTS Forty-three patients were included and positive CLN were found in 39.5% of them. The median disease-free survival in the group of patients with positive and negative CLN were 11.3 months and 25.8 months, respectively. In multivariable analysis, both CLN involvement and high peritoneal cancer index were independently associated with decreased disease-free survival. Computed tomography re-reading by an expert radiologist has good sensitivity for detection of positive CLN. CONCLUSION CLN involvement and high preoperative tumor burden are independently associated with decreased survival after complete cytoreduction for OC. CLN involvement is a marker of diffuse disease and an independent risk factor for early recurrent disease.
Collapse
Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 19, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Gisèle Balague
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 1, Toulouse, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Christophe Pomel
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 1, Toulouse, France.
| |
Collapse
|
26
|
Berretta R, Capozzi VA, Sozzi G, Volpi L, Ceni V, Melpignano M, Giordano G, Marchesi F, Monica M, Di Serio M, Riccò M, Ceccaroni M. Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer. Arch Gynecol Obstet 2018; 297:997-1004. [PMID: 29380107 DOI: 10.1007/s00404-018-4675-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/15/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this retrospective study is to analyze the prognostic role and the practical implication of mesenteric lymph nodes (MLN) involvements in advanced ovarian cancer (AOC). METHODS A total of 429 patients with AOC underwent surgery between December 2007 and May 2017. We included in the study 83 patients who had primary (PDS) or interval debulking surgery (IDS) for AOC with bowel resection. Numbers, characteristics and surgical implication of MLN involvement were considered. RESULTS Eighty-three patients were submitted to bowel resection during cytoreduction for AOC. Sixty-seven patients (80.7%) underwent primary debulking surgery (PDS). Sixteen patients (19.3%) experienced interval debulking surgery (IDS). 43 cases (51.8%) showed MLN involvement. A statistic correlation between positive MLN and pelvic lymph nodes (PLN) (p = 0.084), aortic lymph nodes (ALN) (p = 0.008) and bowel infiltration deeper than serosa (p = 0.043) was found. A longer overall survival (OS) and disease-free survival was observed in case of negative MLN in the first 20 months of follow-up. No statistical differences between positive and negative MLN in terms of operative complication, morbidity, Ca-125, type of surgery (radical vs supra-radical), length and site of bowel resection, residual disease and site of recurrence were observed. CONCLUSIONS An important correlation between positive MLN, ALN and PLN was detected; these results suggest a lymphatic spread of epithelial AOC similar to that of primary bowel cancer. The absence of residual disease after surgery is an independent prognostic factor; to achieve this result should be recommended a radical bowel resection during debulking surgery for AOC with bowel involvement.
Collapse
Affiliation(s)
- Roberto Berretta
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Vito Andrea Capozzi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy.
| | - Giulio Sozzi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Lavinia Volpi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Valentina Ceni
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Mauro Melpignano
- The Department of Obstetrics and Gynecology of Oglio Po, Cremona, Italy
| | - Giovanna Giordano
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Federico Marchesi
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Michela Monica
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Maurizio Di Serio
- Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy
| | - Matteo Riccò
- Local Health Unit of Reggio Emilia, Department of Public Health, Reggio Emilia, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Sacred Heart Hospital of Negrar, Verona, Italy
| |
Collapse
|
27
|
Gallotta V, Ferrandina G, Vizzielli G, Conte C, Lucidi A, Costantini B, De Rose AM, Di Giorgio A, Zannoni GF, Fagotti A, Scambia G, Chiantera V. Hepatoceliac Lymph Node Involvement in Advanced Ovarian Cancer Patients: Prognostic Role and Clinical Considerations. Ann Surg Oncol 2017; 24:3413-3421. [PMID: 28718034 DOI: 10.1245/s10434-017-6005-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND The study aimed too investigate the rate of hepatoceliac lymph node (HCLN) involvement, as well as its association with clinicopathologic features, together with morbidity of HCLN resection and the prognostic impact of metastatic HCLN status on patients with advanced ovarian cancer (OC) undergoing cytoreductive surgery. METHODS All consecutive patients with stages 3c to 4 epithelial OC who underwent HCLN surgery from January 2010 to September 2016 were analyzed for surgical procedures, pathology, and oncologic outcomes. RESULTS During the study period, 85 patients underwent HCLN resection. Absence of visible tumor at the end of surgery was documented for 73 of the patients (85.9%). The median number of HCLNs removed was 6 (range 1-18). Histopathologic evaluation was able to identify HCLN metastasis in 45 (52.9%) of the 85 cases. No difference in the rate of surgical morbidity according to pathologic status of HCLN was observed. As of December 2016, the median follow-up period was 36 months (range 6-54 months). Recurrence of disease was observed in 35 (41.2%) of the 85 cases. Relapse of disease most frequently occurred for the patients with metastatic HCLN involvement (65.7%) compared with the patients who had no HCLN involvement (34.3%) (p = 0.048). The median progression-free survival values were 16 months (95% confidence interval [CI], 12-19 months) for the patients with metastatic HCLNs and 22 months (95% CI, 12-19 months) for the patients with no HCLN involvement (p = 0.035). CONCLUSIONS The study confirmed that HCLN surgery is feasible with acceptable morbidities for patients with advanced OC. Metastatic HCLNs are a marker of disease severity associated with worst oncologic outcome.
Collapse
Affiliation(s)
- Valerio Gallotta
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy.
| | - Gabriella Ferrandina
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy.,Department of Health Sciences and Medicine, University of Molise, Campobasso, Italy
| | - Giuseppe Vizzielli
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - Carmine Conte
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - Alessandro Lucidi
- Division of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Barbara Costantini
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - Agostino Maria De Rose
- Hepatobiliary Surgery Unit, A. Gemelli Hospital "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - Andrea Di Giorgio
- Division of Surgery, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - Gian Franco Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, University of Palermo, Palermo, Italy
| |
Collapse
|