1
|
Huang J, Du D, Chen H, Luo D, Wang Q, Li C, Li Y, Yu Y. Clinical value of serum tumor markers in assessing the efficacy of neoadjuvant chemotherapy in advanced ovarian cancer: single-center prospective clinical study. Front Oncol 2024; 14:1399502. [PMID: 38863620 PMCID: PMC11165076 DOI: 10.3389/fonc.2024.1399502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
Objective This study aimed to assess the clinical importance of various biomarkers, including NLR, CEA, CA199, CA125, CA153, and HE4, through dynamic testing to evaluate the effectiveness of neoadjuvant chemotherapy (NACT) for individuals facing advanced ovarian cancer. This provides valuable information for tailoring treatment plans to individual patients, thereby leading to a more personalized and effective management of individuals facing ovarian cancer. Methods The levels of NLR, CA125, CA199, CEA, CA153, and HE4 were detected before chemotherapy and after 3 courses of chemotherapy. Patients were categorized into ineffective and effective groups according to the effectiveness of NACT. To evaluate the factors influencing NACT's effectiveness in individuals facing advanced ovarian cancer, receiver operating characteristic (ROC) curves, predictive modeling, and multifactorial regression analysis were employed. Results In the effective group, the patients' age, maximum tumor diameter, and CEA and HE4 levels of the patients were significantly higher compared to those in the ineffective group (P <.05). Additionally, the difference in HE4 levels before and after treatment between the effective and ineffective groups was statistically significant (P<.05). Multifactorial analysis showed that age and maximum tumor diameter were independent risk factors impacting the effectiveness of NACT in individuals facing advanced ovarian cancer (P<.05). The ROC curve for predicting the effectiveness of NACT in individuals facing advanced ovarian cancer showed a sensitivity of 93.3% for NLR and a specificity of 92.3% for CA199. HE4 emerged as the most reliable predictor, demonstrating a specificity of 84.6% and a sensitivity of 75.3%. The area under the curve of the combined CA125 and HE4 assays for predicting the ineffectiveness of NACT in individuals facing advanced ovarian cancer was 0.825, showcasing a specificity of 74.2% and a sensitivity of 84.6%. Conclusion The predictive capacity for the effectiveness of NACT in individuals facing advanced ovarian cancer is notably high when considering the sensitivity of NLR and the specificity of CA199. Additionally, the combination of CA125 and HE4 assays can obtain a better predictive effect, which can accurately select patients suitable for NACT, determine the appropriate timing of the interval debulking surgery (IDS) surgery, and achieve a satisfactory tumor reduction effect.
Collapse
Affiliation(s)
- Jing Huang
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| | - Danyi Du
- Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Hailong Chen
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| | - Deping Luo
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| | - Qi Wang
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| | - Chan Li
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| | - Yuanxiang Li
- Department of Clinical laboratory, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| | - Ying Yu
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, Jiangxi, China
| |
Collapse
|
2
|
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
|
3
|
Nieuwenhuyzen-de Boer GM, van de Berg NJ, Gao XS, Ewing-Graham PC, van Beekhuizen HJ. The effects of neutral argon plasma versus electrocoagulation on tissue in advanced-stage ovarian cancer: a case series. J Ovarian Res 2022; 15:140. [PMID: 36581854 PMCID: PMC9798615 DOI: 10.1186/s13048-022-01070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aim of surgery for advanced-stage ovarian cancer is a complete cytoreduction, because this is the most important independent prognostic factor for prolonged survival. Yet this can be difficult to achieve when there are micrometastases on the intestinal mesentery or intestines. The PlasmaJet device is an instrument to remove these micrometastases, but little is known about the depth of damage in human tissue compared to electrocoagulation devices. METHODS A prospective study was performed for the ex-vivo comparison of the histological depth of thermal damage of neutral argon plasma (PlasmaJet®) and electrocoagulation devices, in a series of 106 histological slides of 17 advanced-stage ovarian cancer patients. Depending on the tissue types resected during complete cytoreductive surgery, samples were collected from reproductive organs (uterus, ovaries), intestines (ileum, colon, rectum) and omentum, intestinal mesentery and peritoneum. RESULTS Average thermal damage depth was 0.15 mm (range 0.03-0.60 mm) after use of neutral argon plasma and 0.33 mm (range 0.08-1.80 mm) after use of electrocoagulation (p < 0.001). Greater disruption of the tissue surface was often observed after electrocoagulation. CONCLUSION Our case series suggests that the use of neutral argon plasma during cytoreductive surgery produces significantly less thermal damage than electrocoagulation treatment. It is therefore considered a thermally safe alternative, aiding in the achievement of cytoreductive surgery.
Collapse
Affiliation(s)
- Gatske M. Nieuwenhuyzen-de Boer
- grid.508717.c0000 0004 0637 3764Department of Gynecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000CA Rotterdam, The Netherlands ,grid.413972.a0000 0004 0396 792XDepartment of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Nick J. van de Berg
- grid.508717.c0000 0004 0637 3764Department of Gynecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000CA Rotterdam, The Netherlands ,grid.5292.c0000 0001 2097 4740Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Xu Shan Gao
- grid.508717.c0000 0004 0637 3764Department of Gynecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000CA Rotterdam, The Netherlands
| | - Patricia C. Ewing-Graham
- grid.5645.2000000040459992XDepartment of Pathology, Erasmus University MC, University Medical Center, Rotterdam, The Netherlands
| | - Heleen J. van Beekhuizen
- grid.508717.c0000 0004 0637 3764Department of Gynecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000CA Rotterdam, The Netherlands
| |
Collapse
|
4
|
Kuusela K, Norppa N, Auranen A, Saarelainen S. Maximal surgical effort increases the risk of postoperative complications in the treatment of advanced ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2525-2530. [PMID: 35717320 DOI: 10.1016/j.ejso.2022.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Surgery is the cornerstone of the treatment for advanced ovarian cancer. Reaching complete cytoreduction resulting in no gross residual disease often requires complex surgery. The aim of this study was to assess the impact of increased surgical radicality on the risk of complications in the treatment of advanced ovarian cancer. MATERIALS AND METHODS All consecutive patients with advanced ovarian cancer (FIGO Stage IIIB-IVB) who had undergone primary or interval debulking surgery during a six-year study period were identified. In the midst of the study period, a surgical practice change towards maximal surgical effort occurred. Two groups were formed for the analysis: cohort A, that consisted of patients operated before the surgical paradigm shift and cohort B, that consisted of patients operated under the period of increased surgical radicality. RESULTS 252 patients were included in the analysis. Complete resection (R0) was achieved in 21.3% of surgeries in cohort A and in 51.2% in cohort B. The total postoperative complication rate was 76.2%. Most of the complications (86.5%) were minor (Clavien-Dindo I-IIIA). The patients in cohort B were at increased risk for complications, OR 2.94 (95%CI 1.58-5.47; p = 0.001). As for the approach to cytoreduction (primary vs. interval debulking), there was no statistically significant association with the occurrence of postoperative complications (p = 0.659). CONCLUSION In the present study more extensive surgeries led to better surgical results but increased postoperative morbidity. Postoperative complication rates were similar in both primary and interval debulking surgeries.
Collapse
Affiliation(s)
| | - Niina Norppa
- Tampere University Hospital, Department of Obsteterics and Gynecology, PO BOX 2000, FI-33521, Tampere, Finland
| | - Annika Auranen
- Tampere University Hospital, Department of Obsteterics and Gynecology, PO BOX 2000, FI-33521, Tampere, Finland; Tays Cancer Centre, PO BOX 2000, FI-33521, Tampere, Finland
| | - Sami Saarelainen
- Tampere University Hospital, Department of Obsteterics and Gynecology, PO BOX 2000, FI-33521, Tampere, Finland.
| |
Collapse
|
5
|
Gauci PA, Deluche E, Azais H, Zaccarini F, Guani B, Balaya V, Kerbage Y, Jochum F, Sanson C, Guyon F, Akladios C, Bendifallah S, Dabi Y. Surgical management of patients with advanced ovarian cancer: Results of a French National Survey. J Gynecol Obstet Hum Reprod 2022; 51:102463. [DOI: 10.1016/j.jogoh.2022.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
|
6
|
Shan Y, Jin Y, Li Y, Gu Y, Wang W, Pan L. Rectosigmoid sparing en bloc pelvic resection for fixed ovarian tumors: Surgical technique and perioperative and oncologic outcomes. Front Oncol 2022; 12:980050. [PMID: 36072802 PMCID: PMC9441895 DOI: 10.3389/fonc.2022.980050] [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: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
PurposePatients with advanced ovarian cancer often undergo en bloc rectosigmoid resection with total hysterectomy to completely debulk the pelvis. We describe a unique rectosigmoid sparing en bloc pelvic resection technique for fixed ovarian tumors infiltrating the colon wall.MethodsFrom July 2020 to June 2021, 20 patients with advanced epithelial ovarian cancer (EOC) underwent rectosigmoid sparing en bloc pelvic resection successfully at our institution. We summarized our surgical technique and the peri-operative and oncological outcomes.ResultsTwenty cases with bowel infiltration achieved en bloc pelvic resection with rectosigmoid tumorectomy in a centripetal fashion. Only two patients required mucosal repair. None of the patients experienced any complications associated with en bloc resection. No pelvic recurrence occurred within the median follow-up time of 12 months.ConclusionRectosigmoid sparing en bloc pelvic resection may be feasible for select patients with fixed ovarian tumors infiltrating the colon wall.
Collapse
|
7
|
Kengsakul M, Nieuwenhuyzen-de Boer GM, Udomkarnjananun S, Kerr SJ, Niehot CD, van Beekhuizen HJ. Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol 2022; 33:e53. [PMID: 35712967 PMCID: PMC9250852 DOI: 10.3802/jgo.2022.33.e53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/22/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Advances in ovarian cancer cytoreductive surgery have enabled more extensive procedures to achieve maximal cytoreduction but with a consequent increase in postoperative morbidity and mortality. The aim of this study was to evaluate factors for postoperative morbidity after extensive cytoreductive surgery for primary epithelial ovarian cancer (EOC), particularly those which may be modifiable. Methods Electronic databases were searched. Meta-analysis was conducted using random-effects models. Results Fifteen relevant studies, involving 15,325 ovarian cancer patients, were included in this review. Severe 30-day postoperative complications occurred in 2,357 (15.4%) patients. The postoperative mortality rate was 1.92%. Meta-analysis demonstrated that patient with following risk factors; age (p<0.001), Eastern Cooperative Oncology Group score >0 (p=0.001), albumin level <3.5 g/dL (p<0.001), presence of ascites on CT scan (p=0.013), stage IV disease (p<0.001) and extensive surgical procedure (p<0.001) has a significantly increase risk of developing postoperative complications. Surgical procedures including peritonectomy (p=0.012), splenectomy (p<0.001) and colon surgery (p<0.001) were significant predictors for postoperative complications. Moreover, we found that patients who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) had a lower risk of developing severe complications compared to those who underwent primary debulking surgery (PDS) (p<0.001). Conclusion Our study demonstrated that patient performance status and hypoalbuminemia were the only significant adjustable preoperative risk factors associated with postoperative complications. Patients who underwent NACT-IDS had a lower risk of developing severe complications compared to PDS. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42021282770 We conducted a meta-analysis to demonstrate factors associated with postoperative complications in cytoreductive surgery for epithelial ovarian cancer. Our findings highlight the importance of patients’ performance and albumin status as the adjustable preoperative factors. These findings could be useful in developing future perioperative protocol to reduce postoperative morbidity.
Collapse
Affiliation(s)
- Malika Kengsakul
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
| | - Gatske M Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Christa D Niehot
- Medical Library, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heleen J van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Bonsang-Kitzis H, Panchbhaya N, Bats AS, Pujade-Lauraine E, Pautier P, Ngô C, Le Frère-Belda MA, Kalbacher E, Floquet A, Berton-Rigaud D, Lefeuvre-Plesse C, Fabbro M, Ray-Coquard I, Lécuru F. Surgical Implications of Advanced Low-Grade Serous Ovarian Cancer: Analysis of the Database of the Tumeurs Malignes Rares Gynécologiques Network. Cancers (Basel) 2022; 14:cancers14092345. [PMID: 35565475 PMCID: PMC9105599 DOI: 10.3390/cancers14092345] [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: 03/19/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Low-grade serous carcinoma is a recent entity. The surgical management of advanced stages is modeled on that of high-grade tumors, with the use of neoadjuvant chemotherapy in the case of carcinosis not amenable to complete primary resection. We retrospectively analyzed data from the French national network dedicated to rare gynecologic tumors. We compared disease extension, surgical characteristics, postoperative course and survival after primary surgery vs. interval debulking. Carcinosis was more extended in the case of neoadjuvant chemotherapy. However, chemotherapy did not reduce surgical complexity, nor late postoperative morbidity. Surprisingly, progression-free and overall survival were similar after complete macroscopic or minimal resection (residuals < 2.5 mm). Survival was similar in the case of residuals ≥2.5 mm or more and nonoperated patients. Neoadjuvant chemotherapy does not improve the resectability of advanced low-grade serous cancers. Primary cytoreduction with complete or with minimal residuals should be preferred when feasible. Abstract The surgical specificities of advanced low-grade serous ovarian carcinoma (LGSOC) have been little investigated. Our objective was to describe surgical procedures/complications in primary (PDS) compared to interval debulking surgery (neoadjuvant chemotherapy and interval debulking surgery, NACT-IDS) and to assess the survival (progression-free (PFS) and overall survival (OS)) in patients with advanced LGSOC. We retrospectively analyzed advanced LGSOC from a nationwide registry (January 2000 to July 2017). A total of 127 patients were included (48% PDS and 35% NACT-IDS). Peritoneal carcinomatosis was more severe (p = 0.01 to 0.0001, according to sites), surgery more complex (p = 0.03) and late postoperative morbidity more frequent (p = 0.03) and more severe in the NACT-IDS group. PFS and OS were similar in patients with CC0 and CC1 residual disease after PDS or IDS. Prognosis was poorest for NACT-IDS patients with CC2/CC3 resection (PFS: HR = 2.31, IC95% (1.3–4.58); p = 0.005; OS: HR = 4.98, IC95% (1.59–15.61); p = 0.006). NACT has no benefit in terms of surgical outputs in patients with advanced LGSOC. Patients with complete resection or minimal residual disease (CC0 and CC1) have similar prognoses. On the other hand, patients with CC2 and more residual disease have similar survival rates compared to nonoperated patients. Primary cytoreduction with complete or with minimal residuals should be preferred when feasible.
Collapse
Affiliation(s)
- Hélène Bonsang-Kitzis
- Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Générale de Santé, Hôpital Privé des Peupliers, 75013 Paris, France; (H.B.-K.); (C.N.)
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
| | - Nabilah Panchbhaya
- Department of Obsterics and Gynecology, Hôpital Lariboisière, Assistance Publique—Hôpitaux de Paris, 75020 Paris, France;
| | - Anne-Sophie Bats
- Department of Breast and Gynecological Surgical Oncology, Hôpital Européen Georges Pompidou, Assistance Publique—Hôpitaux de Paris, 75015 Paris, France;
- School of Medicine, Université de Paris, 75005 Paris, France
| | - Eric Pujade-Lauraine
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- School of Medicine, Université de Paris, 75005 Paris, France
- Women Cancer Center and Clinical Research, Hôpital Hôtel-Dieu, Assistance Publique—Hôpitaux de Paris, 75006 Paris, France
| | - Patricia Pautier
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Institut Gustave Roussy, 94000 Villejuif, France
| | - Charlotte Ngô
- Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Générale de Santé, Hôpital Privé des Peupliers, 75013 Paris, France; (H.B.-K.); (C.N.)
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
| | - Marie-Aude Le Frère-Belda
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Pathology, Hôpital Européen Georges Pompidou, Assistance Publique—Hôpitaux de Paris, 75015 Paris, France
| | - Elsa Kalbacher
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Hôpital Jean Minjoz, 25000 Besançon, France
| | - Anne Floquet
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France
| | - Dominique Berton-Rigaud
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest-René Gauducheau, 44000 Saint Herblain, France
| | - Claudia Lefeuvre-Plesse
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Michel Fabbro
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, 33000 Montpellier, France
| | - Isabelle Ray-Coquard
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Department of Medical Oncology, Centre Léon Bérard, 69000 Lyon, France
- School of Medicine, Claude Bernard University, 69000 Lyon, France
| | - Fabrice Lécuru
- GINECO/TMRG Network, 75008 Paris, France; (E.P.-L.); (P.P.); (M.-A.L.F.-B.); (E.K.); (A.F.); (D.B.-R.); (C.L.-P.); (M.F.); (I.R.-C.)
- Women Cancer Center and Clinical Research, Hôpital Hôtel-Dieu, Assistance Publique—Hôpitaux de Paris, 75006 Paris, France
- Department of Breast, Gynecology and Reconstructive Surgery, Institut Curie, 75005 Paris, France
- Correspondence:
| |
Collapse
|
9
|
Zhang JP, Zhang N, Chen X, Zhou Y, Jiang Z, Gao C, Xie YH, Wang S, Zhang W. Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery. BMC Anesthesiol 2022; 22:20. [PMID: 35021994 PMCID: PMC8753880 DOI: 10.1186/s12871-021-01542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We sought to evaluate the postoperative control of pain and recovery in patients with ovarian cancer who underwent cytoreductive surgery by adding dexmedetomidine to ropivacaine in bilateral dual-transversus abdominis plane (Bd-TAP) blocks. METHODS We enrolled 90 patients with an American Society of Anesthesiologists physical status I to III undergoing open abdominal cytoreductive surgery in this study. Patients were randomized and assigned into three groups (TAP-R, TAP-DR, or CON) of 30 participants each. All of the patients received standardized general anesthesia, and postoperative Bd-TAP blocks were performed. The TAP-R, TAP-DR, and CON groups received Bd-TAP blocks with 0.3% ropivacaine, 0.3% ropivacaine and 0.5 μg/kg of dexmedetomidine, and 0.9% normal saline, respectively. All of the patients received patient-controlled analgesia (PCA) (formula, 100 μg of sufentanil and 16 mg of ondansetron diluted with normal saline to 100 mL). Flurbiprofen axetil was used as a rescue drug if the visual analog scale (VAS) score was more than four points. The first request time for PCA bolus; the VAS scores at 0, 6, 12, 24, and 48 h after operation; and the cumulative sufentanil consumption within 24 and 48 h, respectively, were compared. Pulmonary function was evaluated preoperatively and at 24 h after the operation. The use of the rescue drug was recorded. Postoperative functional recovery, including time to stand, time to walk, time to return of bowel function, time to readiness for discharge, and postoperative complications, were recorded. RESULTS Median values of the first request time for PCA of the TAP-R group was significantly prolonged compared to that of the CON group (median [interquartile range], 7.3 [6.5-8.0] hours vs. 3.0 [2.3-3.5] hours) (P < .001), while the TAP-DR group has the longest request time among the three groups (median [interquartile range], 13.5 [12.4-14.5] hours) (P < .001). The VAS scores at rest and upon coughing of the TAP-R group in the first 12 h were significantly lower than those of the CON group (P < 0.05), but showed no significant difference compared to those of the TAP-DR group. The VAS scores at rest and upon coughing were lower in the TAP-DR group at each time point compared to those of the CON group (P < .05). The cumulative sufentanil consumption in the TAP-DR group was significantly lower at 48 h (P = .04) after surgery than in the CON group, while there was no significant difference compared to that in the TAP-R group (P > .05). Less rescue analgesic was required by patients in the TAP-DR group than in the CON group (P < .05). Postoperative mean measured forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity values in the TAP-DR group were significantly higher than those of the CON group (P = .009), while there was no significant difference compared to those of the TAP-R group (P = .10). There was no significantly difference in postoperative functional recovery between TAP-DR and CON group (P > 0.05). CONCLUSION TAP blocks can provide effective pain relief up to 12 h postoperatively without a significant improvement in postoperative pulmonary function. The addition of dexmedetomidine to ropivacaine for Bd-TAP block prolonged the first bolus time of PCA when compared to that in the TAP-R group and decreased sufentanil consumption and the need of rescue analgesia relative to in the CON group at 48 h postoperative. The procedure provided better postoperative analgesia and improved postoperative pulmonary function relative to the CON group. Our results indicate that dexmedetomidine as an adjuvant of Bd-TAP can provide effective pain relief up to 48 h.
Collapse
Affiliation(s)
- Jian-Ping Zhang
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Na Zhang
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xu Chen
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yin Zhou
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zhen Jiang
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Chen Gao
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yan-Hu Xie
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Wei Zhang
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
| |
Collapse
|
10
|
Frailty based on the memorial Sloan Kettering Frailty Index is associated with surgical decision making, clinical trial participation, and overall survival among older women with ovarian cancer. Gynecol Oncol 2021; 161:687-692. [PMID: 33773807 DOI: 10.1016/j.ygyno.2021.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether the Memorial Sloan Kettering Frailty Index (MSK-FI) is associated with decision-making in older women surgically treated for advanced-stage ovarian cancer. METHODS We retrospectively applied the MSK-FI to women ≥70 years with newly diagnosed advanced-stage ovarian cancer surgically treated at our institution from 01/2001-05/2017. MSK-FI components, including 10 comorbidities and functional assessment, were extracted from medical records. The MSK-FI ranges from 0 to 11, with higher scores indicating greater frailty. The primary outcome was the association between frailty and rate of primary debulking surgery (PDS), for which a multivariable logistic regression was used, adjusted for stage and histology. RESULTS We identified 430 women treated with PDS (n = 231, 54%) or neoadjuvant chemotherapy/interval debulking (n = 199, 46%) with complete data. MSK-FI score distribution was: "0", 95 patients (22%); "1", 172 (40%); "2", 89 (21%); and "3+", 74 (17%). More-frail patients were less likely to have undergone PDS (OR for a unit increase of MSK-FI: 0.64; 95%CI, 0.53-0.77; p < 0.0001). Grade 3+ complications and unintended intensive care admission occurred in 40 (9%) and 38 (9%) women, respectively, but were not associated with frailty (OR 1.21; 95%CI, 0.96-1.52; p = 0.11). More-frail patients were more likely to delay postoperative chemotherapy (non-linear association p = 0.009) and less likely to enroll in research (OR 0.84; 95%CI, 0.70-1.00; p = 0.049). Greater frailty was associated with poorer overall survival (HR 1.16; 95%CI, 1.05-1.30; p = 0.005). CONCLUSIONS Frailty, as calculated by the MSK-FI, is strongly associated with treatment approach in older women with advanced ovarian cancer, suggesting objective or subjective correlates of the MSK-FI influence decision-making.
Collapse
|
11
|
Nath AG, Rema P, Suchetha S, Sivaranjith J, Krishna J, Vijayashanti T. Survival Outcome After Interval Cytoreductive Surgery in Advanced-Stage Epithelial Ovarian Carcinoma: A Tertiary Care Centre Experience. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-020-00487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
12
|
Mulligan KM, Glennon K, Donohoe F, O'Brien Y, Mc Donnell BC, Bartels HC, Vermeulen C, Walsh T, Shields C, McCormack O, Conneely J, Boyd WD, Mc Vey R, Mulsow J, Brennan DJ. Multidisciplinary Surgical Approach to Increase Complete Cytoreduction Rates for Advanced Ovarian Cancer in a Tertiary Gynecologic Oncology Center. Ann Surg Oncol 2021; 28:4553-4560. [PMID: 33423175 DOI: 10.1245/s10434-020-09494-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit. METHODS The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A). RESULTS This study included 146 patients in cohort A (2006-2015) and 93 patients in cohort B (2017-2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006-2019). CONCLUSIONS The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
Collapse
Affiliation(s)
- Karen M Mulligan
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Kate Glennon
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Fionán Donohoe
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Yvonne O'Brien
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Brian C Mc Donnell
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Helena C Bartels
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Carolien Vermeulen
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Tom Walsh
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Orla McCormack
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John Conneely
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - William D Boyd
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Ruaidhrí Mc Vey
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal J Brennan
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland. .,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| |
Collapse
|
13
|
Tozzi R, Valenti G, Vinti D, Campanile RG, Cristaldi M, Ferrari F. Rectosigmoid resection during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer: morbidity of gynecologic oncology vs. colorectal team. J Gynecol Oncol 2021; 32:e42. [PMID: 33825357 PMCID: PMC8039168 DOI: 10.3802/jgo.2021.32.e42] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
Objective This study investigates the specific morbidity of rectosigmoid resection (RSR) during Visceral-Peritoneal Debulking (VPD) in a consecutive series of patients with stage IIIC-IV ovarian cancer and compares the results of the colo-rectal vs. the gynaecologic oncology team. Methods All patients with the International Federation of Gynecology and Obstetrics (FIGO) stage IIIC–IV ovarian cancer who had VPD and RSR were included in the study. Between 2009 and 2013 all operations were performed by the gynecologic oncology team alone (group 1). Since 2013 the RSR was performed by the colorectal team together with the gynecologic oncologist (group 2). All pre-operative information and surgical details were compared to exclude significant bias. Intra- and post-operative morbidity events were recorded and compared between groups. Results One hundred and sixty-two patients had a RSR during VPD, 93 in group 1 and 69 in group 2. Groups were comparable for all pre-operative features other than: albumin (1<2) hemoglobin (2<1) and up-front surgery (1>2). Overall morbidity was 33% vs. 40% (p=0.53), bowel specific morbidity 11.8% vs. 11.5% (p=0.81), anastomotic leak 4.1% vs. 6.1% (p=0.43) and re-operation rate 9.6% vs. 6.1% (p=0.71) in groups 1 and 2, respectively. None of them were significantly different. The rate of bowel diversion was 36.5% in group 1 vs. 46.3% in group 2 (p=0.26). Conclusions Our study failed to demonstrate any significant difference in the morbidity rate of RSR based on the team performing the surgery. These data warrant further investigation as they are interesting with regards to education, finance, and medico-legal aspects.
Collapse
Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Churchill Hospital, Oxford University, Oxford, UK.,Nuffield Department of Women & Reproductive Health, University of Oxford, Oxford, UK.
| | - Gaetano Valenti
- Department of Gynaecologic Oncology, Churchill Hospital, Oxford University, Oxford, UK
| | - Daniele Vinti
- Department of Gynaecologic Oncology, Churchill Hospital, Oxford University, Oxford, UK
| | | | - Massimo Cristaldi
- Department of Colorectal Surgery, Harley Street Medical Centre, Abu Dhabi, UAE
| | - Federico Ferrari
- Department of Gynaecologic Oncology, Churchill Hospital, Oxford University, Oxford, UK
| |
Collapse
|
14
|
Llueca A, Serra A, Climent MT, Segarra B, Maazouzi Y, Soriano M, Escrig J. Outcome quality standards in advanced ovarian cancer surgery. World J Surg Oncol 2020; 18:309. [PMID: 33239057 PMCID: PMC7690155 DOI: 10.1186/s12957-020-02064-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Advanced ovarian cancer surgery (AOCS) frequently results in serious postoperative complications. Because managing AOCS is difficult, some standards need to be established that allow surgeons to assess the quality of treatment provided and consider what aspects should improve. This study aimed to identify quality indicators (QIs) of clinical relevance and to establish their acceptable quality limits (i.e., standard) in AOCS. MATERIALS AND METHODS We performed a systematic search on clinical practice guidelines, consensus conferences, and reviews on the outcome and quality of AOCS to identify which QIs have clinical relevance in AOCS. We then searched the literature (from January 2006 to December 2018) for each QI in combination with the keywords of advanced ovarian cancer, surgery, outcome, and oncology. Standards for each QI were determined by statistical process control techniques. The acceptable quality limits for each QI were defined as being within the limits of the 99.8% interval, which indicated a favorable outcome. RESULTS A total of 38 studies were included. The QIs selected for AOCS were complete removal of the tumor upon visual inspection (complete cytoreductive surgery), a residual tumor of < 1 cm (optimal cytoreductive surgery), a residual tumor of > 1 cm (suboptimal cytoreductive surgery), major morbidity, and 5-year survival. The rates of complete cytoreductive surgery, optimal cytoreductive surgery, suboptimal cytoreductive surgery, morbidity, and 5-year survival had quality limits of < 27%, < 23%, > 39%, > 33%, and < 27%, respectively. CONCLUSION Our results provide a general view of clinical indicators for AOCS. Acceptable quality limits that can be considered as standards were established.
Collapse
Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain. .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain. .,Department of Medicine, University Jaume I (UJI), Castellón, Spain.
| | - Anna Serra
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellón, Spain
| | - Maria Teresa Climent
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellón, Spain
| | - Blanca Segarra
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | - Yasmine Maazouzi
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | - Marta Soriano
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Anesthesiology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellón, Spain.,Department of General Surgery, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | | |
Collapse
|
15
|
O’Dwyer J, O’Cearbhaill RE, Wylie R, O’Mahony S, O’Dwyer M, Duffy GP, Dolan EB. Enhancing delivery of small molecule and cell-based therapies for ovarian cancer using advanced delivery strategies. ADVANCED THERAPEUTICS 2020; 3:2000144. [PMID: 33709016 PMCID: PMC7942751 DOI: 10.1002/adtp.202000144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 12/17/2022]
Abstract
Ovarian cancer is the most lethal gynecological malignancy with a global five-year survival rate of 30-50%. First-line treatment involves cytoreductive surgery and administration of platinum-based small molecules and paclitaxel. These therapies were traditionally administered via intravenous infusion, although intraperitoneal delivery has also been investigated. Initial clinical trials of intraperitoneal administration for ovarian cancer indicated significant improvements in overall survival compared to intravenous delivery, but this result is not consistent across all studies performed. Recently cell-based immunotherapy has been of interest for ovarian cancer. Direct intraperitoneal delivery of cell-based immunotherapies might prompt local immunoregulatory mechanisms to act synergistically with the delivered immunotherapy. Based on this theory, pre-clinical in vivo studies have delivered these cell-based immunotherapies via the intraperitoneal route, with promising results. However, successful intraperitoneal delivery of cell-based immunotherapy and clinical adoption of this technique will depend on overcoming challenges of intraperitoneal delivery and finding the optimal combinations of dose, therapeutic and delivery route. We review the potential advantages and disadvantages of intraperitoneal delivery of cell-based immunotherapy for ovarian cancer and the pre-clinical and clinical work performed so far. Potential advanced delivery strategies, which might improve the efficacy and adoption of intraperitoneal delivery of therapy for ovarian cancer, are also outlined.
Collapse
Affiliation(s)
- Joanne O’Dwyer
- Department of Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland; Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Roisin E. O’Cearbhaill
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland; Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Robert Wylie
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Saoirse O’Mahony
- Department of Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland
| | - Michael O’Dwyer
- Apoptosis Research Centre, National University of Ireland Galway, Ireland
| | - Garry P. Duffy
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Eimear B. Dolan
- Department of Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland
| |
Collapse
|
16
|
Chen J, Guo Y, Li H, Zhang C, Chang X, Ma R, Cheng H, Ye X, Cui H, Li Y. Near-infrared dye-labeled antibody COC183B2 enables detection of tiny metastatic ovarian cancer and optimizes fluorescence-guided surgery. J Surg Oncol 2020; 122:1207-1217. [PMID: 32705686 DOI: 10.1002/jso.26130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We aimed to evaluate the ability of the fluorescent monoclonal antibody probe COC183B2-Cy7 (Cy7-conjugated COC183B2 antibody) to detect tiny metastatic lesions of ovarian cancer and thus guide precise tumor resection. METHODS The expression of the tumor-associated antigen OC183B2 in lymph nodes and SKOV3-Luc cells was detected using immunohistochemistry and immunofluorescence. A subcutaneous mouse tumor model and an intraperitoneal ovarian cancer metastasis model were constructed using SKOV3-Luc cells. Near-infrared fluorescence (NIRF) imaging was performed to determine the imaging parameters and evaluate the ability of COC183B2-Cy7 to detect tiny metastatic lesions. RESULTS OC183B2 was expressed in metastatic lymph nodes and SKOV3-Luc cells. NIRF imaging of the subcutaneous mouse tumor model showed that the tumor background ratio was significantly higher in the COC183B2-Cy7 group than in the control group at different time points postinjection. Biodistribution study showed that COC183B2-Cy7 did not accumulate in other organs. COC183B2-Cy7 can detect tiny metastatic lesions of ovarian cancer. The smallest intraperitoneal metastatic tumor detected by COC183B2-Cy7 was approximately 1 mm. CONCLUSIONS COC183B2-Cy7 probe has relatively high specificity and sensitivity. Our study suggests that COC183B2-Cy7 probe is a promising diagnostic tool for the complete and accurate resection of malignant lesions in fluorescence-guided surgery.
Collapse
Affiliation(s)
- Junchen Chen
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Yanxiu Guo
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Hui Li
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Chen Zhang
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Xiaohong Chang
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Ruiqiong Ma
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Hongyan Cheng
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Xue Ye
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Heng Cui
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Yi Li
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
17
|
A multivariate analysis of the prognostic impact of tumor burden, surgical timing and complexity after complete cytoreduction for advanced ovarian cancer. Gynecol Oncol 2020; 158:614-621. [PMID: 32709536 DOI: 10.1016/j.ygyno.2020.06.495] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/18/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the survival benefit of primary debulking surgery (PDS) compared to interval debulking surgery (IDS) after complete cytoreduction (CC-0) or cytoreduction to minimal residual disease (CC-1) in advanced ovarian cancer. Secondary objective was to evaluate the effect of tumor load and surgical complexity on patients' survival. METHODS A retrospective multicentric study was designed, including patients with IIIC-IV FIGO stage ovarian cancer who underwent PDS or IDS with CC-0 or CC-1 from January 2008 to December 2015 in four high-volume institutions. Patients were classified in three groups: PDS, IDS after 3-4 cycles of neoadjuvant chemotherapy (NACT), and IDS after 6 cycles. Disease-free survival (DFS) and overall survival (OS) were estimated. Univariable and multivariable analyses were conducted. RESULTS We included 549 patients, 175 (31.9%) underwent PDS, 224 (40.8%) had IDS after 3-4 cycles of NACT, and 150 (27.3%) underwent IDS after 6 cycles. Median DFS in PDS, IDS at 3-4 cycles and IDS at 6 cycles were 23.0 months (95%CI = [20.0-29.3]), 18.0 months (95%CI = [15.9-20.0]) and 17.1 months (95%CI = [15.0-20.9]), respectively; p < .001. Median OS were 84.0 months (95%CI = [68.3-111.0]), 50.7 months (95%CI = [44.6-59.5]) and 47.5 months (95%CI = [39.3-52.9]), respectively; p < .001. In multivariable analysis, high peritoneal cancer index score and NACT were negatively associated to DFS and OS. Surgical complexity and CC-1 were negatively associated to DFS. CONCLUSION PDS offered a survival gain of almost three years compared to IDS in patients with minimal or no residual disease after surgery. PDS should remain the standard of care for advanced ovarian cancer.
Collapse
|
18
|
The shifting trends towards a robotically-assisted surgical interface: Clinical and financial implications. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
19
|
Hayden JM, Oras J, Block L, Thörn SE, Palmqvist C, Salehi S, Nordstrom JL, Gupta A. Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study. Br J Anaesth 2020; 124:562-570. [DOI: 10.1016/j.bja.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022] Open
|
20
|
Dabi Y, Huchon C, Ouldamer L, Bendifallah S, Collinet P, Bricou A, Daraï E, Ballester M, Lavoue V, Haddad B, Touboul C. Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival. J Transl Med 2020; 18:134. [PMID: 32293460 PMCID: PMC7087387 DOI: 10.1186/s12967-020-02295-y] [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: 10/07/2019] [Accepted: 03/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management. Methods Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT–IDS (p < 0.001). In multivariable analysis, three factors were independent predictors of survival: upfront surgery (HR 0.32 95% CI 0.14–0.71, p = 0.005), postoperative residual disease = 0 (HR 0.37 95% CI 0.18–0.75, p = 0.006) and association of Carboplatin and Paclitaxel regimen (HR 0.45 95% CI 0.25–0.80, p = 0.007). Conclusions Presence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival.
Collapse
Affiliation(s)
- Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy - Saint Germain - en - Laye, 78103, Poissy, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Pierre Collinet
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, Paris, France
| | - Emile Daraï
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Marcos Ballester
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Vincent Lavoue
- CRLCC Eugène-Marquis, Department of Gynecology, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France. .,Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France. .,Service de Gynécologie Obstétrique, Hôpital Intercommunal de Créteil, 40 Avenue de Verdun, Créteil, 94000, France.
| | | |
Collapse
|
21
|
Di Donato V, Bardhi E, Tramontano L, Capomacchia FM, Palaia I, Perniola G, Plotti F, Angioli R, Giancotti A, Muzii L, Panici PB. Management of morbidity associated with pancreatic resection during cytoreductive surgery for epithelial ovarian cancer: A systematic review. Eur J Surg Oncol 2019; 46:694-702. [PMID: 31806515 DOI: 10.1016/j.ejso.2019.11.516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/09/2019] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION In ovarian cancer (OC), survival benefit in case of complete cytoreduction with absence of residual tumor has been clearly demonstrated; however, it often requires extensive surgery. Particularly, pancreatic resection during cytoreduction, may severely impact perioperative morbidity and mortality. OBJECTIVES The aim of this systematic review is to evaluate complication rates and related optimal management of ovarian cancer patients undergoing pancreatic resection as part of cytoreductive surgery. METHODS Literature was searched for relevant records reporting distal pancreatectomy for advanced ovarian cancer. All cohorts were rated for quality. We focused our analysis on complications related to pancreatic surgical procedures evaluating the following outcomes: pancreatic fistula (PF), abdominal abscess, pancreatitis, iatrogenic diabetes, hemorrhage from splenic vessels and pancreatic-surgery-related mortality. RESULTS The most frequent complication reported was PF. Similar rates of PF were reported after hand-sewn (20%) or stapled closure (24%). Continued drainage is the standard treatment, and often, the leak can be managed conservatively and does not require re-intervention. Abdominal abscess is the second most frequent complication and generally follows a non-adequately drained PF and often required re-laparotomy. Pancreatitis is a rare event that could be treated conservatively; however, death can occur in case of necrotic evolution. Cases of post-operative hemorrhage due to splenic vessel bleeding have been described and represent an emergency. CONCLUSIONS Knowledge of pancreatic surgery and management of possible complications ought to be present in the oncologic-gynecologic armamentarium. All patients should be referred to specialized, dedicated, tertiary centers in order to reduce, promptly recognize and optimally manage complications.
Collapse
Affiliation(s)
- Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Erlisa Bardhi
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy.
| | - Luca Tramontano
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Filippo Maria Capomacchia
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Francesco Plotti
- Department of Gynecology, University of Rome "Campus Bio-Medico", Via Álvaro Del Portillo, 21, 00128, Rome, Italy
| | - Roberto Angioli
- Department of Gynecology, University of Rome "Campus Bio-Medico", Via Álvaro Del Portillo, 21, 00128, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale Del Policlinico 155, 00161, Rome, Italy
| |
Collapse
|
22
|
Abitbol J, Gotlieb W, Zeng Z, Ramanakumar A, Kessous R, Kogan L, Pare-Miron V, Rombaldi M, Salvador S, Kucukyazici B, Brin S, How J, Lau S. Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer 2019; 29:1341-1347. [PMID: 31601648 DOI: 10.1136/ijgc-2019-000413] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With the rapid uptake of robotic surgery in surgical oncology, its use in the treatment of epithelial ovarian cancers is being evaluated. Complete cytoreduction represents the goal of surgery either at primary cytoreduction or after neoadjuvant chemotherapy in the setting of interval cytoreduction. In selected patients, the extent of disease would enable minimally invasive surgery. The objective of this study was to evaluate the impact of introducing robotic surgery for interval cytoreduction of selected patients with stage III-IV ovarian cancer. METHODS All patients who underwent surgery from November 2008 to 2014 (concurrent time period when robotic and open surgery were used simultaneously) after receiving neoadjuvant chemotherapy for advanced ovarian cancer (stage III-IV) were compared with all consecutive patients who underwent cytoreductive surgery by laparotomy after neoadjuvant chemotherapy between January 2006 and November 2008. Inclusion criteria included an interval cytoreductive surgery by laparotomy or robotic assistance for stage III-IV non-mucinous epithelial ovarian, fallopian tube, or primary peritoneal cancer. Exclusion criteria included patients treated concurrently for a non-gynecologic cancer, as well as secondary cytoreductive surgeries and diagnostic surgeries without an attempt at tumor reduction. Overall survival, progression-free survival, and peri-operative outcomes were compared for the entire patient cohort with those with advanced ovarian cancer who received neoadjuvant chemotherapy immediately before and after the introduction of robotic surgery. RESULTS A total of 91 patients were selected to undergo interval cytoreduction either via robotic surgery (n=57) or laparotomy (n=34) after the administration of neoadjuvant chemotherapy. The median age of the cohort was 65 years (range 24-88), 78% had stage III disease, and the median follow-up time was 37 months (5.6-91.4 months). The median survival was 42.8±3.1 months in the period where both robotic surgery and laparotomy were offered compared with 37.9±9.8 months in the time period preceding when only laparotomy was performed (p=0.6). All patients selected to undergo interval robotic cytoreduction following neoadjuvant chemotherapy had a reduction of cancer antigen 125 by at least 80%, resolution of ascites, and CT findings suggesting the potential to achieve optimal interval cytoreduction. All these patients achieved optimal cytoreduction with <1 cm residual disease, including 82% with no residual disease. The median blood loss was 100 mL (mean 135 mL, range 10-1250 mL), and the median hospital stay was 1 day. CONCLUSION Robotic interval cytoreductive surgery is feasible in well-selected patients. Future studies should aim to define ideal patients for minimally invasive cytoreductive surgery.
Collapse
Affiliation(s)
- Jeremie Abitbol
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Walter Gotlieb
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| | - Ziggy Zeng
- Department of Ob-Gyn, McGill University, Montreal, Quebec, Canada
| | | | - Roy Kessous
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| | - Liron Kogan
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Marcelo Rombaldi
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| | - Beste Kucukyazici
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Sonya Brin
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| | - Jeffrey How
- Department of Ob-Gyn, McGill University, Montreal, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, McGill University Jewish General Hospital, Montreal, Quebec, Canada
| |
Collapse
|
23
|
du Bois A, Baert T, Vergote I. Role of Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer. J Clin Oncol 2019; 37:2398-2405. [DOI: 10.1200/jco.19.00022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Thaïs Baert
- Kliniken Essen-Mitte, Essen, Germany
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ignace Vergote
- Katholieke Universiteit Leuven, Leuven, Belgium
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| |
Collapse
|
24
|
Tozzi R, Traill Z, Campanile RG, Kilic Y, Baysal A, Giannice R, Morotti M, Soleymani Majd H, Valenti G. Diagnostic flow-chart to identify bowel involvement in patients with stage IIIC-IV ovarian cancer: Can laparoscopy improve the accuracy of CT scan? Gynecol Oncol 2019; 155:207-212. [PMID: 31481247 DOI: 10.1016/j.ygyno.2019.08.025] [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: 07/30/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study investigates the diagnostic power of CT scan combined with exploratory laparoscopy (EXL) at identifying large bowel involvement in patients with stage IIIC-IV primary Epithelial Ovarian Cancer (EOC) by comparing with the macroscopic surgical findings at laparotomy. METHODS All patients with FIGO Stage IIIC-IV EOC who had Visceral Peritoneal Debulking (VPD) were included in the study. Results of CT scan, EXL and laparotomy (LPT) with regards to the bowel involvement were prospectively recorded in an ad hoc study form. Setting LPT findings as the gold standard, positive and negative predictive value (PPV/NPV), sensitivity, specificity and accuracy of CT and EXL were calculated. In addition, the diagnostic power of the combination CT scan + EXL was investigated. RESULTS Ninety-four out of 177 patients (53.2%) had a bowel resection during VPD. CT-scan alone had sensitivity, specificity, PPV, NPV and accuracy of 56.7%, 72.4%, 70.8%, 58.5% and 63.8% respectively. EXL alone 84.4%, 93.8%, 93.8%, 84.3%, 88.8%. CT combined with EXL detected bowel involvement with a sensitivity, specificity, PPV, NPV and accuracy of 87.5%, 70.4%, 77.8%, 82.6% and 79.6% and respectively. The combined tests showed a statistically significant improvement vs. CT scan alone (p < 0001) in sensitivity, NPV and accuracy, with non-significant difference in specificity and PPV. CONCLUSIONS CT-scan alone shows a limited diagnostic power at detecting large bowel involvement in patients with stage IIIC-IV EOC. The combination of CT scan with EXL increases the diagnostic power and enables to appropriately plan the bowel resection and consent the patients.
Collapse
Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Zoe Traill
- Department of Radiology, Oxford University Hospital, Oxford, UK
| | | | - Yakup Kilic
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Ahmet Baysal
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Raffaella Giannice
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Matteo Morotti
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | | | - Gaetano Valenti
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| |
Collapse
|
25
|
Hayden J, Gupta A, Thörn S, Thulin P, Block L, Oras J. Does intraperitoneal ropivacaine reduce postoperative inflammation? A prospective, double-blind, placebo-controlled pilot study. Acta Anaesthesiol Scand 2019; 63:1048-1054. [PMID: 31206591 DOI: 10.1111/aas.13410] [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: 03/06/2019] [Revised: 04/11/2019] [Accepted: 05/07/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative inflammation is a common consequence of surgery and the ensuing stress response. Local anesthetics have anti-inflammatory properties. The primary aim of this study was to evaluate if LA administrated intraperitoneally perioperatively might inhibit expression of inflammatory cytokines. METHODS This was a, randomized, double blind, placebo-controlled study (ClinicalTrial.gov reg no: NCT02256228) in patients undergoing surgery for ovarian cancer. Patients were randomized to receive: intraperitoneal ropivacaine (Group IPLA) or saline (Group P) perioperatively. Except for study drug, patients were treated similarly. At the end of surgery, a multi-port catheter was inserted intraperitoneally, and ropivacaine 2 mg/mL or 0.9% saline, 10 mL was injected intermittently every other hour during 72 hours postoperatively. Systemic expression of cytokines and plasma ropivacaine were determined before and 6, 24, and 48 hours after surgery. Stress response was measured by serum glucose, cortisol, and insulin. RESULTS Forty patients were recruited, 20 in each group. There was no statistical significant difference in systemic cytokine between the groups at any time point. Serum cortisol was significantly lower in the IPLA group at 6 hours, median 103 nmol/L (IQR 53-250) compared to placebo, median 440 nmol/L (IQR 115-885), P = 0.023. Serum glucose and insulin were similar between the groups. Total and free serum concentrations of ropivacaine were well below toxic concentrations. CONCLUSION In this small study, perioperative intraperitoneal ropivacaine did not reduce the systemic inflammatory response associated with major abdominal surgery. Total and free ropivacaine concentrations were below known toxic concentrations in humans.
Collapse
Affiliation(s)
- Jane Hayden
- Department of Anesthesiology and Intensive Care, Institute of Clinical sciences Sahlgrenska Academy, University of Gothenburg, Västra Götalandsregionen, Sahlgrenska University Hospital Gothenburg Sweden
| | - Anil Gupta
- Institute of Physiology and Pharmacology Karolinska Institutet, Karolinska University Hospital Solna Stockholm Sweden
| | - Sven‐Egron Thörn
- Department of Anesthesiology and Intensive Care, Institute of Clinical sciences Sahlgrenska Academy, University of Gothenburg, Västra Götalandsregionen, Sahlgrenska University Hospital Gothenburg Sweden
| | - Pontus Thulin
- Department of Clinical Immunology and Transfusion Medicine Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Linda Block
- Department of Anesthesiology and Intensive Care, Institute of Clinical sciences Sahlgrenska Academy, University of Gothenburg, Västra Götalandsregionen, Sahlgrenska University Hospital Gothenburg Sweden
| | - Jonatan Oras
- Department of Anesthesiology and Intensive Care, Institute of Clinical sciences Sahlgrenska Academy, University of Gothenburg, Västra Götalandsregionen, Sahlgrenska University Hospital Gothenburg Sweden
| |
Collapse
|
26
|
Predictive Factors for Surgical Morbidities and Adjuvant Chemotherapy Delay for Advanced Ovarian Cancer Patients Treated by Primary Debulking Surgery or Interval Debulking Surgery. Int J Gynecol Cancer 2019; 28:1520-1528. [PMID: 30036229 DOI: 10.1097/igc.0000000000001325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Postoperative complications and adjuvant chemotherapy delay (ACD) are the most damaging outcomes after surgical treatment of advanced ovarian cancer. Establishing predictive factors should prevent their occurrence. METHODS We analyzed retrospectively all patients with advanced ovarian cancer who underwent cytoreduction at our institution between December 2010 and May 2016. We evaluated all 30-day complications and considered ACD all cases who did not start adjuvant chemotherapy until 42 days or did not perform it after cytoreductive surgery. These data were analyzed in the general group, and between primary debulking surgery (PDS) and interval debulking surgery (IDS) using χ test and Student t test. Relationship of variables was verified using Multiple Logistic Regression. RESULTS A total of 83 women were included. Of these, 43 (51.8%) were submitted to PDS and 40 (48.2%) to IDS. In the PDS group, 23 (53.5%) of the patients had complications. For the IDS group, 27 (67.5%) complicated (P = 0.192). Regarding the general group, independent predictors for 30-day complications were presence of comorbidities (odds ratio [OR], 5.466, 95% confidence interval [CI], 1.151-25,972; P = 0.033) and estimated blood loss of greater than 300 mL (OR, 14.407; 95% CI, 2.736-75.863; P = 0.002). In multivariate analysis of the general group, independent predictors for ACD were the presence of hypertension as comorbidity (OR, 3.898; 95% CI, 1.119-13.578; P = 0.033), body mass index of greater than 30 kg/m (OR, 5.728; 95% CI, 1.169-28.069; P = 0.031), 30-day reoperation (OR, 21.275; 95% CI, 1.799-251.651; P = 0.015), and fever within 30 days (OR, 11.594; 95% CI, 1.714-78.412; P = 0.012). CONCLUSIONS Comorbidities and intraoperative bleeding are the most relevant findings related to surgical complications. Surgical approach (PDS or IDS) was not related with complications. Surgical complications were significantly related to ACD.
Collapse
|
27
|
He Y, Gu Z, Zhu Q, Chen M, He C, Huang Y, Li Q, Di W. CA125 over‐release behavior following a 75‐g oral glucose test as a predictive biomarker of multidrug resistance in patients with ovarian cancer. Int J Cancer 2019; 145:1690-1700. [PMID: 30807642 DOI: 10.1002/ijc.32237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Yifeng He
- Department of Obstetrics and GynecologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Tumor Microenvironment and Metastasis ProgramThe Wistar Institute, University of Pennsylvania Philadelphia PA
| | - Zhuowei Gu
- Department of Obstetrics and GynecologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Qiujing Zhu
- Department of Obstetrics and GynecologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Mo Chen
- Department of GynecologyObstetrics and Gynecology Hospital, Fudan University Shanghai China
| | - Chenghui He
- Department of Obstetrics and GynecologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Yuting Huang
- Children's Research Institute, Children's National Medical Center Washington WA
| | - Qing Li
- Department of Obstetrics and GynecologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- State Key Laboratory of Oncogene and Related GenesShanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Wen Di
- Department of Obstetrics and GynecologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
- State Key Laboratory of Oncogene and Related GenesShanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| |
Collapse
|
28
|
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
|
29
|
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
|
30
|
Debie P, Vanhoeij M, Poortmans N, Puttemans J, Gillis K, Devoogdt N, Lahoutte T, Hernot S. Improved Debulking of Peritoneal Tumor Implants by Near-Infrared Fluorescent Nanobody Image Guidance in an Experimental Mouse Model. Mol Imaging Biol 2019; 20:361-367. [PMID: 29090412 DOI: 10.1007/s11307-017-1134-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Debulking followed by combination chemotherapy is currently regarded as the most effective treatment for advanced ovarian cancer. Prognosis depends drastically on the degree of debulking. Accordingly, near-infrared (NIR) fluorescence imaging has been proposed to revolutionize cancer surgery by acting as a sensitive, specific, and real-time tool enabling visualization of cancer lesions. We have previously developed a NIR-labeled nanobody that allows fast, specific, and high-contrast imaging of HER2-positive tumors. In this study, we applied this tracer during fluorescence-guided surgery in a mouse model and investigated the effect on surgical efficiency. PROCEDURES 0.5 × 106 SKOV3.IP1-Luc+ cells were inoculated intraperitoneally in athymic mice and were allowed to grow for 30 days. Two nanomoles of IRDye800CW-anti-HER2 nanobody was injected intravenously. After 1h30, mice were killed, randomized in two groups, and subjected to surgery. In the first animal group (n = 7), lesions were removed by a conventional surgical protocol, followed by excision of remaining fluorescent tissue using a NIR camera. The second group of mice (n = 6) underwent directly fluorescence-guided surgery. Bioluminescence imaging was performed before and after surgery. Resected tissue was categorized as visualized during conventional surgery or not, fluorescent or not, and bioluminescent positive or negative. RESULTS Fluorescence imaging allowed clear visualization of tumor nodules within the abdomen, up to submillimeter-sized lesions. Fluorescence guidance resulted in significantly reduced residual tumor as compared to conventional surgery. Moreover, sensitivity increased from 59.3 to 99.0 %, and the percentage of false positive lesions detected decreased from 19.6 to 7.1 %. CONCLUSIONS This study demonstrates the advantage of intraoperative fluorescence imaging using nanobody-based tracers on the efficiency of debulking surgery.
Collapse
Affiliation(s)
- Pieterjan Debie
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY, Vrije Universiteit Brussel, Laabeeklaan 103, 1090, Jette, Brussels, Belgium.
| | - Marian Vanhoeij
- Department of Oncological Surgery, UZ Brussel, Brussels, Belgium
| | | | - Janik Puttemans
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY, Vrije Universiteit Brussel, Laabeeklaan 103, 1090, Jette, Brussels, Belgium
| | - Kris Gillis
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY, Vrije Universiteit Brussel, Laabeeklaan 103, 1090, Jette, Brussels, Belgium.,Department of Cardiology, UZ Brussel, Brussels, Belgium
| | - Nick Devoogdt
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY, Vrije Universiteit Brussel, Laabeeklaan 103, 1090, Jette, Brussels, Belgium
| | - Tony Lahoutte
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY, Vrije Universiteit Brussel, Laabeeklaan 103, 1090, Jette, Brussels, Belgium.,Department of Nuclear Medicine, UZBrussel, Brussels, Belgium
| | - Sophie Hernot
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY, Vrije Universiteit Brussel, Laabeeklaan 103, 1090, Jette, Brussels, Belgium
| |
Collapse
|
31
|
Tozzi R, Casarin J, Baysal A, Valenti G, Kilic Y, Majd HS, Morotti M. Bowel resection rate but not bowel related morbidity is decreased after interval debulking surgery compared to primary surgery in patents with stage IIIC-IV ovarian cancer. J Gynecol Oncol 2018; 30:e25. [PMID: 30740956 PMCID: PMC6393637 DOI: 10.3802/jgo.2019.30.e25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the morbidity associate with rectosigmoid resection (RSR) in patients with stage IIIC-IV ovarian cancer (OC) undergone primary debulking surgery (PDS) vs. interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). METHODS From the Oxford Advanced OC database, we retrieved all patients who underwent surgery between January 2009 and July 2016 and included all patients who underwent RSR. We compared the rates of overall related and not-related morbidity and bowel diversion in patients undergone RSR during PDS vs. IDS. RESULTS Three hundred and seventy-one patients underwent surgery: 126 in PDS group and 245 in IDS group. Fifty-two patients in the PDS group (41.3%) and 65 patients in IDS group (26.5%) underwent RSR (p<0.001). Overall not related morbidity rate was 37.5% and 28.6%, p=0.625. Bowel specific complications affected 16.3% vs. 11.1% of the patients (p=0.577). IDS group had higher rate of bowel diversion compared with PDS (46.0% vs. 26.5%, p=0.048). CONCLUSION NACT was associated to an overall reduced rate of RSR compared to IDS. No differences in overall related and not-related complications in patients requiring RSR were seen between the 2 groups. Patients in the IDS group had a significantly higher rate of bowel diversion.
Collapse
Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom.
| | - Jvan Casarin
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Ahmet Baysal
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gaetano Valenti
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Yakup Kilic
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Hooman Soleymani Majd
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Matteo Morotti
- Department of Gynaecologic Oncology, Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
32
|
Phillips A, Sundar S, Singh K, Pounds R, Nevin J, Kehoe S, Balega J, Elattar A. The NICE classification for 'Ultra-radical (extensive) surgery for advanced ovarian cancer' guidance does not meaningfully predict postoperative complications: a cohort study. BJOG 2018; 126:96-104. [PMID: 30092615 DOI: 10.1111/1471-0528.15423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine which descriptors of cytoreductive surgical extent in advanced ovarian cancer (AOC) best predict postoperative morbidity. DESIGN Retrospective notes review. SETTING A gynaecological cancer centre in the UK. POPULATION Six hundred and eight women operated on for AOC over a period of 114 months at a tertiary cancer centre, between 16 August 2007 and 16 February 2017. METHODS Outcome data were analysed by six approaches to classify the extent of surgery: standard/ultra-radical surgery; standard/radical/supra-radical surgery; presence/absence of gastrointestinal resections; low/intermediate/high surgical complexity score (SCS); presence of bowel anastomoses and/or diaphragmatic surgery; and the presence/absence of multiple bowel resections. MAIN OUTCOME MEASURES Major (grades 3-5) postoperative morbidity and mortality. RESULTS Forty-three (7.1%) patients experienced major complications. Grade-5 complications occurred in six patients (1.0%). Patients who underwent multiple bowel resections had a relative risk (RR) of 7.73 (95% confidence interval, 95% CI 3.92-15.26), patients with a high SCS had an RR of 6.12 (95% CI 3.25-11.52), patients with diaphragmatic surgery and gastrointestinal anastomosis had an RR of 5.57 (95% CI 2.65-11.72), patients with 'any gastrointestinal resection' had an RR of 4.69 (95% CI 2.66-8.24), patients with ultra-radical surgery had an RR of 4.65 (95% CI 2.26-8.79), and patients with supra-radical surgery had an RR of 4.20 (95% CI 2.35-7.51) of grades 3-5 morbidity, compared with patients undergoing standard surgery as defined by the National Institute for Health and Care Excellence (NICE) in the UK. No significant difference was seen in the rate of major morbidity between standard (6/59, 10.2%) and ultra-radical (9/81, 11.1%) surgery within the cohort who had intermediate complex surgery (P > 0.05). CONCLUSIONS The numbers of procedures performed significantly correlate with major morbidity. The number of procedures performed better predicted major postoperative morbidity than the performance of certain 'high risk' procedures. We recommend using SCS to define a higher risk operation. NICE should re-evaluate the use of the term 'ultra-radical' surgery. TWEETABLE ABSTRACT Multiple bowel resection is the best predictor of morbidity and is more predictive than 'ultra-radical surgery'.
Collapse
Affiliation(s)
- A Phillips
- Department of Obstetrics and Gynaecology, Royal Derby Hospital, Derby, UK
| | - S Sundar
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - K Singh
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - R Pounds
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - J Nevin
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - S Kehoe
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Balega
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - A Elattar
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| |
Collapse
|
33
|
Latif N, Kobie J, Mitra N, Burger R, Morgan M, Guintoli R, Ko E. A Prediction Model and Risk Calculator for Surgical Mortality and Serious Morbidity After Primary Cytoreductive Surgery. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nawar Latif
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Julie Kobie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Robert Burger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mark Morgan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Robert Guintoli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Emily Ko
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
34
|
Fournier M, Huchon C, Ngo C, Bensaid C, Bats AS, Combe P, le FrèreBelda MA, Fournier L, Berger A, Lecuru F. Morbidity of rectosigmoid resection in cytoreductive surgery for ovarian cancer. Risk factor analysis. Eur J Surg Oncol 2018; 44:750-753. [PMID: 29580734 DOI: 10.1016/j.ejso.2018.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 11/23/2017] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
AIM Rectosigmoid resection is often performed during cytoreductive surgery for ovarian cancer, to achieve the goal of no residual tumour. Here, we evaluated the morbidity associated with rectosigmoid resection and the underlying risk factors. METHODS We retrospectively assessed consecutive patients managed with rectosigmoid resection during cytoreductive surgery for ovarian cancer at our centre in Paris, France, between 2005 and 2013. All previously identified risk factors were analysed. Major complications were defined as grade III-IV in the Clavien-Dindo classification. RESULTS Of 228 patients, 116 had primary and 112 interval surgery; 43/228 [18.9%]; experienced major complications, and these were more common after primary surgery [24.1% vs. 13.4%, p = .04]. The 69 patients who had rectosigmoid resection [33 primary vs. 36 interval surgery, p = .32] had a higher morbidity rate compared to the other patients [30.4% vs. 14.6%, p = .006]. The anastomotic leakage rate was 2.89%. By multivariate logistic regression, independent risk factors for morbidity were postmenopausal status [adjusted odds ratio (aOR), 13.7; 95% confidence interval (95%CI), 1.2;161.9], surgery after neoadjuvant chemotherapy [aOR, 4.4; 95%CI, 1.1;18.8], and peritoneal stripping of the left; paracolic gutter [aOR, 11.3; 95%CI, 2.3;54.3]. CONCLUSION The morbidity of rectosigmoid resection during cytoreductive surgery for ovarian cancer seems acceptable. Ileostomy does not seem associated with a lower risk of major complications or adjuvant bevacizumab with a higher complication rate.
Collapse
Affiliation(s)
- M Fournier
- Gynecologic Oncology, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France.
| | - C Huchon
- Obstetrics and Gynecology Department, CHI Poissy-St-Germain, Université Versailles- Saint-Quentin en Yvelines, Poissy, France; EA 7285, Risques Cliniques et Sécurité en Santé des Femmes, Université Versailles-Saint- Quentin en Yvelines, Versailles, France
| | - C Ngo
- Gynecologic Oncology, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; UMR S 1124, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - C Bensaid
- Gynecologic Oncology, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - A S Bats
- Gynecologic Oncology, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; ARCAGY-GINECO, Hôpital Hôtel Dieu, 1 parvis Notre Dame, 75004, Paris, France; UMR S 1124, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - P Combe
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; ARCAGY-GINECO, Hôpital Hôtel Dieu, 1 parvis Notre Dame, 75004, Paris, France; Medical Oncology, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - M A le FrèreBelda
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Pathology Department, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - L Fournier
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Imaging Department, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - A Berger
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; General and Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - F Lecuru
- Gynecologic Oncology, Centre Expert Oncologie Gynécologique, Paris Descartes- Hôpital Européen Georges Pompidou, APHP, Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; ARCAGY-GINECO, Hôpital Hôtel Dieu, 1 parvis Notre Dame, 75004, Paris, France; UMR S 1124, Faculté de Médecine, Université Paris Descartes, Paris, France
| |
Collapse
|
35
|
Pozzar RA, Berry DL. Patient-centered research priorities in ovarian cancer: A systematic review of potential determinants of guideline care. Gynecol Oncol 2017; 147:714-722. [PMID: 29029759 DOI: 10.1016/j.ygyno.2017.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To (a) determine what is known about the individual and contextual factors that may influence whether a woman with ovarian cancer receives guideline care, and (b) identify patient-centered research priorities in ovarian cancer. METHODS A systematic review of the PubMed, MEDLINE, CINAHL Complete, and PsycInfo online databases. Eligible articles were published in English, described original research, and either (a) identified factors associated with the receipt of guideline care for ovarian cancer, or (b) described treatment decision making by women with ovarian cancer. Studies were excluded in which women with ovarian cancer did not comprise the entire sample of patient participants. Data were collected in accordance with Garrard's Matrix Method. Study quality was evaluated using the QualSyst tool for evaluating primary research papers. Relevant study findings were imported into NVivo Pro 11 for qualitative synthesis. RESULTS The search strategy yielded 502 unique citations, of which 78 full-text articles were reviewed. Thirty-three articles met the criteria for inclusion. Study quality was high overall. Factors associated with the receipt of guideline care included race and ethnicity, socioeconomic status, insurance type, age, comorbidity, disease stage, tumor characteristics, hospital volume, hospital type, physician volume, and geographic location. Influences on treatment decision making among women with ovarian cancer included the desire to prolong survival, the patient-provider relationship, perceived ability to participate in the treatment decision, values and preferences, information needs, side effects, cost of care, and past experiences with chemotherapy. CONCLUSIONS There is a need for further research that examines ovarian cancer treatment decision making from the perspective of the patient. Priority topics for future research may include the experiences of diverse women receiving treatment for ovarian cancer and the role of shared decision making with providers, referral networks, and practice patterns in the delivery of guideline care.
Collapse
Affiliation(s)
- Rachel A Pozzar
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, 360 Huntington Avenue, Boston, MA 02115, United States; Dana-Farber Cancer Institute, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, 450 Brookline Avenue, LW 518; Boston, MA 02215, United States.
| | - Donna L Berry
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, 360 Huntington Avenue, Boston, MA 02115, United States; Dana-Farber Cancer Institute, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, 450 Brookline Avenue, LW 518; Boston, MA 02215, United States
| |
Collapse
|
36
|
Di Donato V, Kontopantelis E, Aletti G, Casorelli A, Piacenti I, Bogani G, Lecce F, Benedetti Panici P. Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies. Ann Surg Oncol 2017; 24:1688-1697. [DOI: 10.1245/s10434-016-5680-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
37
|
Tozzi R, Hardern K, Gubbala K, Garruto Campanile R, Soleymani majd H. En-bloc resection of the pelvis (EnBRP) in patients with stage IIIC–IV ovarian cancer: A 10 steps standardised technique. Surgical and survival outcomes of primary vs. interval surgery. Gynecol Oncol 2017; 144:564-570. [DOI: 10.1016/j.ygyno.2016.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
|
38
|
Total Infragastric Omentectomy Including the Vascular Perigastric Arcade in Patients With Advanced Serous Ovarian Tumors. Int J Gynecol Cancer 2017; 27:252-257. [DOI: 10.1097/igc.0000000000000832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of this study was to document the need of including the perigastric area when performing omentectomy in patients with stage III to IV serous epithelial ovarian tumors.Patients and MethodsPatients undergoing omentectomy in the setting of surgery for advanced epithelial serous ovarian cancer between February and September 2015 were included. Patients with macroscopic involvement of the perigastric area, nonepithelial serous tumors, and recurrences of ovarian cancer were excluded. The perigastric area was isolated and comprehensively processed for pathological examination.ResultsTwenty-four patients were included. Six patients underwent primary debulking surgery, and 18 patients underwent an interval debulking surgery. The mean number of pathologic blocks in the perigastric area was 24 (range, 8–41). Microscopic involvement of the perigastric omentum area was found in 62.5% of the cases. One patient had a low-grade serous carcinoma, with microscopic involvement of the perigastric area. Among the 23 patients with a high-grade serous carcinoma, 10 (83%) of 12 patients with a gross involvement of the rest of the omentum had a microscopic involvement of the perigastric area. The presence of microscopic disease in the perigastric arcade was found in 4 (36.3%) of 11 patients with a macroscopically normal omentum.ConclusionsIn this study, evidence is given that total omentectomy including the perigastric area is a necessary component of complete cytoreductive surgery in advanced ovarian cancer, whatever the macroscopic appearance of the omentum.
Collapse
|
39
|
Tozzi R, Gubbala K, Majd HS, Campanile RG. Interval Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) in patients with stage IIIC-IV ovarian cancer: Description of the technique and surgical outcomes. Gynecol Oncol 2016; 142:477-83. [PMID: 27450637 DOI: 10.1016/j.ygyno.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe the technique and evaluate the feasibility, efficacy and morbidity of the Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) during Visceral-Peritoneal Debulking (VPD) at time of interval surgery. METHODS This report is part of a prospective non randomized study (service evaluation protocol) on the feasibility and safety of laparoscopy in patients with stage IIIC-IV ovarian cancer and gross residual disease following neoadjuvant chemotherapy. Primary endpoints of this part of the study were the feasibility (rate of patients in whom the surgery could be completed by laparoscopy), efficacy (rate of patients ended with a complete resection) and morbidity (number of patients that suffered complications specifically associated to the procedure) of L-EnBRP. The results were compared between patients in group 1 (L-EnBRP+L-VPD), group 2 (L-EnBRP+VPD) and group 3 (VPD). RESULTS Eighteen patients were in group 1, 8 in group 2 and 32 in group 3. Feasibility of L-EnBRP was 45% (26 patients out of 58), efficacy was 100% of the pelvic disease (94.4% overall disease) and morbidity was 5.5%. Main cause for conversion to laparotomy was high tumor load on diaphragm and/or mesentery. All but one patient had a complete resection (CR) of the disease. Group 1 patients had significantly earlier hospital discharge, lower blood loss and reduced overall morbidity than group 2 and 3. CONCLUSION L-EnBRP was feasible in almost half of the patients. In these patients a CR was achieved with a low morbidity rate. The latter was significantly decreased when compared to the patients who had a laparotomy.
Collapse
Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Kumar Gubbala
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | | | | |
Collapse
|
40
|
Ahmed I, Karedath T, Andrews SS, Al IK, Mohamoud YA, Querleu D, Rafii A, Malek JA. Altered expression pattern of circular RNAs in primary and metastatic sites of epithelial ovarian carcinoma. Oncotarget 2016; 7:36366-36381. [PMID: 27119352 PMCID: PMC5095006 DOI: 10.18632/oncotarget.8917] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/02/2016] [Indexed: 12/31/2022] Open
Abstract
Recently, a class of endogenous species of RNA called circular RNA (circRNA) has been shown to regulate gene expression in mammals and their role in cellular function is just beginning to be understood. To investigate the role of circRNAs in ovarian cancer, we performed paired-end RNA sequencing of primary sites, peritoneal and lymph node metastases from three patients with stage IIIC ovarian cancer. We developed an in-house computational pipeline to identify and characterize the circRNA expression from paired-end RNA-Seq libraries. This pipeline revealed thousands of circular isoforms in Epithelial Ovarian Carcinoma (EOC). These circRNAs are enriched for potentially effective miRNA seed matches. A significantly larger number of circRNAs are differentially expressed between tumor sites than mRNAs. Circular and linear expression exhibits an inverse trend for many cancer related pathways and signaling pathways like NFkB, PI3k/AKT and TGF-β typically activated for mRNA in metastases are inhibited for circRNA expression. Further, circRNAs show a more robust expression pattern across patients than mRNA forms indicating their suitability as biomarkers in highly heterogeneous cancer transcriptomes. The consistency of circular RNA expression may offer new candidates for cancer treatment and prognosis.
Collapse
Affiliation(s)
- Ikhlak Ahmed
- Department of Genetic medicine, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| | - Thasni Karedath
- Department of Genetic medicine, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| | - Simeon S. Andrews
- Department of Genetic medicine, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| | - Iman K. Al
- Genomics Core, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| | - Yasmin Ali Mohamoud
- Genomics Core, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| | - Denis Querleu
- Department of Gynecologic Oncology, Université Montepllier 1, Montpellier, France
| | - Arash Rafii
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| | - Joel A. Malek
- Department of Genetic medicine, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
- Genomics Core, Weill Cornell Medicine-Qatar, Education City, Ar-Rayyan, Qatar
| |
Collapse
|
41
|
Impact of Extended Primary Surgery on Suboptimally Operable Patients With Advanced Ovarian Cancer. Int J Gynecol Cancer 2016; 26:873-83. [DOI: 10.1097/igc.0000000000000707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesExtensive surgical efforts to achieve an optimal debulking (no residual tumor) in primary surgery of ovarian cancer are today’s criterion standard in gyneco-oncologic surgery. However, it is controversial whether extensive surgery, including resections of metastases in the upper abdomen and bowel resections, is justifiable in patients with not completely operable lesions.MethodsAll patients who had undergone surgery for ovarian cancer in the years 2002 to 2013 at our institution were viewed (n = 472). We retrospectively identified 278 operations for primary ovarian cancer. Ninety-six (35%) of the 278 patients showed postoperative tumor residuals and were included in this study.ResultsFifty-five (57%) of 96 patients underwent bowel resection, showing significantly higher complication rates (64% vs 39% minor complications, P = 0.017; 31% vs 9.8% severe complications, P = 0.013) compared with patients without bowel resections as well as no improvement in progression-free or overall survival (median overall survival, 19.5 vs 32.9; P = 0.382). Multiple anastomoses (≥2) were associated with higher rates for anastomotic leakage (16.7% vs 2.6%, P = 0.02) and a higher mortality (16.7% vs 0%, P = 0.04) compared with patients with only 1 anastomosis. Extensive surgery of the upper abdomen was not associated with a significant increase in complication rates.ConclusionsBecause of the increased morbidity of bowel resections without any evidence for improvement of survival, we suggest to restrain from further resection of intestines if an optimal debulking seems not feasible after removal of the major tumor bulk.
Collapse
|
42
|
Minig L, Patrono MG, Cárdenas-Rebollo JM, Martin Marfil P, Rodriguez-Tabares V, Chuang L. Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study. Gynecol Obstet Invest 2016; 81:497-503. [PMID: 27046053 DOI: 10.1159/000443640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/23/2015] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To describe the incidence of symptomatic lymphocele (SLC) after an aggressive tumor debulking surgery and lymphadenectomy in patients with ovarian cancer and peritoneal carcinomatosis with or without TachoSil®. MATERIAL AND METHODS A pilot retrospective comparative observational study was performed between patients with advanced ovarian cancer International Federation of Gynecology and Obstetrics stages III-IV who underwent complete debulking surgery and radical retroperitoneal lymphadenectomy. In 18 patients, 4 TachoSil® patches were placed in the retroperitoneal area, since January 2014-October 2014. This group was compared with other 18 consecutive patients matched by age, International Federation of Gynecology and Obstetrics stage, surgical complexity, American Society of Anesthesiologists score, comorbidity, and BMI without the use of TachoSil®. RESULTS Baseline characteristics were similar between groups. There were no statistically significant differences in terms of surgical complexity, surgical time, estimated blood loss, node removed, length of hospital stay, and complications between groups. SLC was diagnosed in 7 patients (38.8%) without TachoSil®, and in 2 patients (11.1%) with TachoSil® (p = 0.121). The use of TachoSil® was associated with a statistically significant lower re-admission rate (p = 0.041) and with a significantly shorter time to adjuvant chemotherapy (p = 0.02). CONCLUSIONS Using TachoSil® in women with advanced stage ovarian cancer who underwent radical debulking with retroperitoneal lymph node dissection is associated with a non-statistically significant reduction in the incidence of SLC. A larger-scale randomized controlled study should be conducted to confirm our preliminary results.
Collapse
Affiliation(s)
- Lucas Minig
- Gynecology Department, Valencian Institute of Oncology (IVO), Valencia, Spain
| | | | | | | | | | | |
Collapse
|
43
|
Vidal F, Al Thani H, Haddad P, Luyckx M, Stoeckle E, Morice P, Leblanc E, Lecuru F, Daraï E, Classe JM, Pomel C, Mahfoud Z, Ferron G, Querleu D, Rafii A. Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations. Ann Surg Oncol 2015; 23:434-42. [PMID: 26542592 DOI: 10.1245/s10434-015-4890-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. METHODS Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. RESULTS Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10(-3)). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. CONCLUSIONS In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.
Collapse
Affiliation(s)
- Fabien Vidal
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Haya Al Thani
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Pascale Haddad
- Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Mathieu Luyckx
- Department of Gynecologic Surgery, Saint Luc Academic Hospital, Catholic University of Louvain, Bruxelles, Belgium
| | - Eberhard Stoeckle
- Comprehensive Cancer Center, Department of Surgery, Institut Bergonie, Bordeaux, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Institut Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
| | - Fabrice Lecuru
- Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France
| | - Emile Daraï
- Department of Gynecologic Surgery, Tenon Hospital, Paris, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Centre Gauducheau, Comprehensive Cancer Center, Saint Herblain, France
| | - Christophe Pomel
- Department of Surgical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Ziyad Mahfoud
- Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Gwenael Ferron
- Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Arash Rafii
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. .,Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. .,Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, Education City, Doha, Qatar.
| |
Collapse
|
44
|
Neo-adjuvant chemotherapy does not increase the rate of complete resection and does not significantly reduce the morbidity of Visceral–Peritoneal Debulking (VPD) in patients with stage IIIC–IV ovarian cancer. Gynecol Oncol 2015; 138:252-8. [DOI: 10.1016/j.ygyno.2015.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/14/2015] [Indexed: 12/28/2022]
|
45
|
Complications après exentération pelvienne postérieure modifiée selon Hudson dans le cadre de tumeurs malignes ovariennes. ACTA ACUST UNITED AC 2015; 43:342-7. [DOI: 10.1016/j.gyobfe.2015.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 03/06/2015] [Indexed: 11/18/2022]
|
46
|
Primary Surgery or Interval Debulking for Advanced Epithelial Ovarian Cancer: Does It Matter? Int J Gynecol Cancer 2014; 24:1420-8. [DOI: 10.1097/igc.0000000000000241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of the present study was to investigate the surgical complexity, the postoperative morbidity, and the survival of the women after primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for advanced epithelial ovarian cancer.Materials and MethodsWe consecutively included all patients who underwent debulking surgery at our institution between January 2007 and December 2012 for stages IIIc and IV of epithelial ovarian cancer.ResultsOf the 332 patients included, 165 (49.7%) underwent PDS, and 167 (50.3%) had NACT-IDS. Complete intraperitoneal cytoreduction was achieved in 70.9% after PDS and in 59.9 % after NACT-IDS. Residual disease of greater than 1 cm was left in 18.5% and 27.5% after PDS and NACT-IDS, respectively. Compared with NACT-IDS, PDS was associated with higher surgical complexity (P < 0.001), longer operating time (P < 0.001), greater blood loss (P < 0.001), longer hospitalization (P = 0.001), and a higher rate of major postoperative complications (26.7% vs 16.8%). No statistical difference in the median overall survival (OS) was found between the patients having complete cytoreduction and residual disease of 1 cm or less after NACT-IDS. Furthermore, no statistical difference in the median OS was found between the patients with macroscopic residual disease (≤1 vs >1 cm) after NACT-IDS. Patients with residual disease of greater than 1 cm after PDS had a median OS of 15 months.ConclusionsWe suggest that NACT-IDS may be a better treatment alternative for the group of highly selected women not suitable for PDS, where expected suboptimal cytoreduction does not have any appreciable survival benefit and exposes them for unnecessary risks. A substantial number of women who receive either PDS or NACT-IDS have greater than 1 cm of tumor tissue left after the operation. These women probably have no survival benefit from the operation, and future studies should focus on how to select these women preoperatively.
Collapse
|
47
|
Sehouli J, Reinthaller A, Marth C, Reimer D, Reimer T, Stummvoll W, Angleitner-Boubenizek L, Brandt B, Chekerov R. Intra- and postoperative catumaxomab in patients with epithelial ovarian cancer: safety and two-year efficacy results from a multicentre, single-arm, phase II study. Br J Cancer 2014; 111:1519-25. [PMID: 25225907 PMCID: PMC4200087 DOI: 10.1038/bjc.2014.443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/25/2014] [Accepted: 07/13/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This is the first study investigating the safety and efficacy of the trifunctional antibody catumaxomab administered i.p. at the end of cytoreductive surgery and postoperatively prior to standard chemotherapy in patients with primary epithelial ovarian cancer (EOC). METHODS Patients received i.p. catumaxomab 10 μg intraoperatively and 10, 20, 50 and 150 μg on days 7, 10, 13 and 16, respectively, postoperatively. After the study, patients received standard chemotherapy and were followed for 23 months. The primary endpoint was the rate of postoperative complications. RESULTS Forty-one patients entered the study and were evaluable for safety and 34 were alive at 24 months. Complete tumour resection rate was 68%. Postoperative complications were observed in 51%, the most common anastomotic leakage (7%) and wound infections (5%). The most common catumaxomab-related adverse events were abdominal pain, nausea, vomiting and pyrexia. Thirty-nine percent discontinued catumaxomab therapy, and 98% received chemotherapy post study. Kaplan-Meier estimates of disease-free and overall survival after 24 months were 56% and 85%, respectively. CONCLUSIONS Intra- and close postoperative catumaxomab seems feasible, but efficacy and safety were limited by postsurgical complications. In the future prospective trials are needed to investigate the best schedule of integration of catumaxomab into current treatment strategies for EOC.
Collapse
Affiliation(s)
- J Sehouli
- 1] NOGGO, Ovarian cancer study group of the North-Eastern German Society of Gynaecological Oncology (NOGGO), Berlin, Germany [2] Department of Gynaecology, Charité University Hospital, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany
| | - A Reinthaller
- Department of Gynaecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - C Marth
- Department of Obstetrics and Gynaecology, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria
| | - D Reimer
- Department of Gynaecology, Charité University Hospital, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany
| | - T Reimer
- Department of Obstetrics and Gynaecology, Klinikum Suedstadt, University of Rostock, Südring 81, D-18059 Rostock, Germany
| | - W Stummvoll
- Department of Obstetrics and Gynaecology, Landesfrauenklinik Linz, Krankenhausstraße 26-30, A-4020 Linz, Austria
| | - L Angleitner-Boubenizek
- Department of Obstetrics and Gynaecology, Landesfrauenklinik Linz, Krankenhausstraße 26-30, A-4020 Linz, Austria
| | - B Brandt
- Neovii (formerly Fresenius) Biotech GmbH, Frankfurter Ring 193a, 80807 Munich, Germany
| | - R Chekerov
- Department of Gynaecology, Charité University Hospital, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany
| |
Collapse
|
48
|
Measurement of cardiac index by transpulmonary thermodilution using an implanted central venous access port: a prospective study in patients scheduled for oncologic high-risk surgery. PLoS One 2014; 9:e104369. [PMID: 25136951 PMCID: PMC4138096 DOI: 10.1371/journal.pone.0104369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/10/2014] [Indexed: 01/31/2023] Open
Abstract
Background Transpulmonary thermodilution allows the measurement of cardiac index for high risk surgical patients. Oncologic patients often have a central venous access (port-a-catheter) for chronic treatment. The validity of the measurement by a port-a-catheter of the absolute cardiac index and the detection of changes in cardiac index induced by fluid challenge are unknown. Methods We conducted a monocentric prospective study. 27 patients were enrolled. 250 ml colloid volume expansions for fluid challenge were performed during ovarian cytoreductive surgery. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution by a central venous access (CIcvc) and by a port-a-catheter (CIport) were recorded. Results 23 patients were analyzed with 123 pairs of measurements. Using a Bland and Altman for repeated measurements, the bias (lower and upper limits of agreement) between CIport and CIcvc was 0.14 (−0.59 to 0.88) L/min/m2. The percentage error was 22%. The concordance between the changes in CIport and CIcvc observed during volume expansion was 92% with an r = 0.7 (with exclusion zone). No complications (included sepsis) were observed during the follow up period. Conclusions The transpulmonary thermodilution by a port-a-catheter is reliable for absolute values estimation of cardiac index and for measurement of the variation after fluid challenge. Trial Registration clinicaltrials.gov NCT02063009
Collapse
|
49
|
La chirurgie des cancers de l’ovaire : les grands principes encore valides. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
50
|
Weil G, Suria S. Doppler-guided fluid therapy in gynaecological surgery. Anaesthesia 2014; 69:281-2. [PMID: 24548357 DOI: 10.1111/anae.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Weil
- Gustave Roussy, Villejuif, France.
| | | |
Collapse
|