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Sánchez-Iglesias JL, Morales-Coma C, Minig L, Lago V, Domingo S, Mancebo G, Siegrist J, Fidalgo García MS, Llueca A, Serra A, Cobas Lozano P, Lekuona Artola A, Gómez-Hidalgo NR, Acosta Ú, Ferrer-Costa R, Bradbury M, Pérez-Benavente A, Gil-Moreno A. Procalcitonin and C-reactive protein as early markers of anastomotic leakage in intestinal resections for advanced ovarian cancer (EDMOCS). Acta Obstet Gynecol Scand 2024. [PMID: 38532280 DOI: 10.1111/aogs.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Serum levels of procalcitonin and C-reactive protein (CRP) have been used to predict anastomotic leakage after colorectal surgery, but information is scarce in advanced ovarian cancer (AOC) surgery with bowel resection. This study aimed to assess the predictive value of procalcitonin and CRP in detecting anastomotic leakage after AOC surgery with bowel resection. The study also aimed to determine the optimal postoperative reference values and the best day for evaluating these markers. MATERIAL AND METHODS This prospective, observational and multicentric trial included 92 patients with AOC undergoing debulking surgery with bowel resection between 2017 and 2020 in 10 reference hospitals in Spain. Procalcitonin and CRP levels were measured at baseline and on postoperative days 1-6. Receiver operating characteristic analysis was performed to evaluate the predictive value of procalcitonin and CRP at each postoperative day. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Anastomotic leakage was detected in six patients (6.5%). Procalcitonin and CRP values were consistently higher in patients with anastomotic leakage at all postoperative days. The maximum area under the curve (AUC) for procalcitonin was observed at postoperative day 1 (AUC = 0.823) with a cutoff value of 3.8 ng/mL (83.3% sensitivity, 81.3% specificity). For CRP, the maximum AUC was found at postoperative day 3 (AUC = 0.833) with a cutoff level of 30.5 mg/dL (100% sensitivity, 80.4% specificity). CONCLUSIONS Procalcitonin and C-reactive protein are potential biomarkers for early detection of anastomotic leakage after ovarian cancer surgery with bowel resection. Further prospective studies with a larger sample size are needed to confirm these findings.
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Affiliation(s)
- José Luis Sánchez-Iglesias
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Morales-Coma
- Breast Pathology Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lucas Minig
- Department of Gynecologic Oncology, IMED Hospital, Valencia, Spain
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - Víctor Lago
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
- Department of Gynecologic Oncology, La Fe University Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University Hospital, Valencia, Spain
| | - Gemma Mancebo
- Gynecological Cancer Multidisciplinary Unit, Hospital del Mar, Barcelona, Spain
- Department of Gynecology, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jaime Siegrist
- Oncologic Gynecology Unit, Department of Gynecology, La Paz University Hospital, Madrid, Spain
| | | | - Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery, Hospital General Universitario de Castellon, Castellón, Spain
- Department of Medicine, Universidad Jaume I, Castellón, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery, Hospital General Universitario de Castellon, Castellón, Spain
- Department of Medicine, Universidad Jaume I, Castellón, Spain
| | - Paloma Cobas Lozano
- Department of Gynecologic Oncology, Hospital Universitario Donostia, OSI Donostialde, Donostia, Spain
| | - Arantza Lekuona Artola
- Department of Gynecologic Oncology, Hospital Universitario Donostia, OSI Donostialde, Donostia, Spain
| | | | - Úrsula Acosta
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Roser Ferrer-Costa
- Department of Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Melissa Bradbury
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Assumpció Pérez-Benavente
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Pastor-Mora JC, Fortea-Sanchís C, Coret-Franco A, García-Martínez JA, Cosa-Rodriguez R, Nomdédeu-Guinot J, Gibert-Gerez J, Laguna-Sastre M, Llueca A. Predictive risk model of recurrence of acute diverticulitis after the first episode. World J Surg 2024; 48:466-473. [PMID: 38310307 DOI: 10.1002/wjs.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The recurrence of acute diverticulitis (AD) of the colon is frequent and leads to hospital readmissions and the need for elective surgery in selected cases. It is important to individualize risk factors and develop predictive tools for their identification. MATERIALS AND METHODS This prospective observational study included 368 patients who were diagnosed with AD between 2016 and 2021 in a tertiary general university hospital during their first episode and who had a good response to antibiotic, percutaneous, or peritoneal lavage treatment. Univariate and multivariate Cox regression analyses of the variables associated with recurrence were performed. Subsequently, a predictive risk score was developed and validated through survival studies. RESULTS After a median follow-up of 50 months, there were 71 (19.3%) cases of recurrence out of a total of 368 patients. The mean time of recurrence was 15 months, and 73.3% of cases of recurrence occurred before 2 years of follow-up. Recurrence was independently associated with presentation with colonic perforation in the antimesenteric location (HR 3.67 95% CI [1.59-8.4]) and a CRP level greater than 100 mg/dl (HR 1.69 95% CI [1.04-2.77). A score with 5 variables was created that differentiated two risk groups: intermediate risk (0-3 points), with 19% recurrence and high risk (more than 3 points), with 42% recurrence. CONCLUSIONS The risk of recurrence after the first episode of diverticulitis can be estimated using predictive scores. The detection of high-risk patients facilitates the individualization of follow-up and treatment.
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Affiliation(s)
- Juan Carlos Pastor-Mora
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Carlos Fortea-Sanchís
- Department of General and Digestive Surgery, Regional Hospital of Vinaròs, Castellón de la Plana, Castellón, Spain
| | - Alba Coret-Franco
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Juan Antonio García-Martínez
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Rebeca Cosa-Rodriguez
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Jesus Nomdédeu-Guinot
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Juan Gibert-Gerez
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Manuel Laguna-Sastre
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Antoni Llueca
- Department of Medicine, Jaume I de Castelló University, Castellón de la Plana, Castellón, Spain
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Climent MT, Serra A, Balaguer C, Llueca A. Should We Abandon Intraperitoneal Chemotherapy in the Treatment of Advanced Ovarian Cancer? A Meta-Analysis. J Pers Med 2023; 13:1636. [PMID: 38138863 PMCID: PMC10745120 DOI: 10.3390/jpm13121636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ovarian cancer is the gynaecological malignancy with the highest mortality and diagnosis often occurs in its advanced stages. Standard treatment in these cases is based on complete cytoreductive surgery with adjuvant intravenous chemotherapy. Other types of treatment are being evaluated to improve the prognosis of these patients, including intraperitoneal chemotherapy and antiangiogenic therapy. These may improve survival or time to relapse in addition to intravenous chemotherapy. OBJECTIVE The aim of this meta-analysis is to determine whether treatment with intravenous chemotherapy remains the gold standard, or whether the addition of intraperitoneal chemotherapy has a benefit in overall survival (OS) and disease-free interval (DFS). MATERIALS AND METHODS A literature search was carried out in Pubmed and Cochrane, selecting clinical studies and systematic reviews published in the last 10 years. Statistical analysis was performed using the hazard ratio measure in the RevMan tool. RESULTS Intraperitoneal chemotherapy shows a benefit in OS and DFS compared with standard intravenous chemotherapy. The significant differences in OS (HR: 0.81 CI 95% 0.74-0.88) and in DFS (HR: 0.81 CI 95% 0.75-0.87) are statistically significant (p < 0.00001). There were no clinical differences in toxicity and side-effects. CONCLUSION Intraperitoneal chemotherapy is an option that improves OS and DFS without significant toxicity regarding the use of intravenous chemotherapy alone. However, prospective studies are needed to determine the optimal dose and treatment regimen that will maintain the benefits while minimising side effects and toxicity and the profile of patients who will benefit most from this treatment.
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Affiliation(s)
- Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
| | - Carolina Balaguer
- Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain;
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
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Soriano Hervás M, Robles-Hernández D, Serra A, Játiva-Porcar R, Gómez Quiles L, Maiocchi K, Llorca S, Climent MT, Llueca A. Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery. J Pers Med 2023; 13:1540. [PMID: 38003855 PMCID: PMC10672096 DOI: 10.3390/jpm13111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, University La Plana Hospital, Road from Vila-Real to Burriana, km 0.5, 12540 Castellón, Spain
| | - Anna Serra
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Rosa Játiva-Porcar
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Luis Gómez Quiles
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Karina Maiocchi
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - María Teresa Climent
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Antoni Llueca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
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Llueca A, Ibañez MV, Cascales P, Gil-Moreno A, Bebia V, Ponce J, Fernandez S, Arjona-Sanchez A, Muruzabal JC, Veiga N, Diaz-Feijoo B, Celada C, Gilabert-Estelles J, Aghababyan C, Lacueva J, Calero A, Segura JJ, Maiocchi K, Llorca S, Villarin A, Climent MT, Delgado K, Serra A, Gomez-Quiles L, Llueca M. Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study. Cancers (Basel) 2023; 15:4271. [PMID: 37686547 PMCID: PMC10486645 DOI: 10.3390/cancers15174271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). MATERIALS AND METHODS A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. RESULTS A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58-0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64-1.20; p = 0.44). There was no increase in complications in the CRSH group. CONCLUSION The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | | | - Pedro Cascales
- Department of General Surgery, Hospital Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Vicente Bebia
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Jordi Ponce
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Sergi Fernandez
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Alvaro Arjona-Sanchez
- Unit of Surgical Oncology and Pancreatic Surgery, University Hospital Reina Sofia, 14004 Cordoba, Spain;
| | - Juan Carlos Muruzabal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Cristina Celada
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Javier Lacueva
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Alicia Calero
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Juan Jose Segura
- Hepatobiliopancreatic Surgery and Peritoneal Oncology Surgery Unit, General Surgery and Digestive System Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Llueca
- Department of Obstetrics and Gynecology, Joan XXIII University Hospital of Tarragona, 43005 Tarragona, Spain;
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Climent MT, Serra A, Llueca M, Llueca A. Surgery in Recurrent Ovarian Cancer: A Meta-Analysis. Cancers (Basel) 2023; 15:3470. [PMID: 37444580 DOI: 10.3390/cancers15133470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Background: The second cytoreductive surgery performed for a patient who has recurrent ovarian cancer remains controversial. Our study analyzes overall survival (OS) and disease-free survival (DFS) for cytoreductive surgery in addition to chemotherapy in recurrent ovarian cancer instead of chemotherapy alone. Methods: A meta-analysis was conducted using PubMed and the Cochrane database of systematic reviews to select randomized controlled studies. In total, three randomized studies were used, employing a total of 1249 patients. Results: The results of our meta-analysis of these randomized controlled trials identified significant differences in OS (HR = 0.83, IC 95% 0.70-0.99, p < 0.04) and DFS (HR = 0.63, IC 95% 0.55-0.72, p < 0.000001). A subgroup analysis comparing complete cytoreductive surgery and surgery with residual tumor achieved better results for both OS (HR = 0.65, IC 95% 0.49-0.86, p = 0.002) and DFS (HR = 0.67, IC 95% 0.53-0.82, p = 0.0008), with statistical significance. Conclusions: A complete secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) demonstrates an improvement in the OS and DFS, and this benefit is most evident in cases where complete cytoreductive surgery is achieved. The challenge is the correct patient selection for secondary cytoreductive surgery to improve the results of this approach.
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Affiliation(s)
- Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellon, Spain
| | - Maria Llueca
- Department of Medicine, University CEU-Cardenal Herrera, 12006 Castellon, Spain
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellon, Spain
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Tomás-Pérez S, Oto J, Aghababyan C, Herranz R, Cuadros-Lozano A, González-Cantó E, Mc Cormack B, Arrés J, Castaño M, Cana F, Martínez-Fernández L, Santonja N, Ramírez R, Herreros-Pomares A, Cañete-Mota S, Llueca A, Marí-Alexandre J, Medina P, Gilabert-Estellés J. Increased levels of NETosis biomarkers in high-grade serous ovarian cancer patients' biofluids: Potential role in disease diagnosis and management. Front Immunol 2023; 14:1111344. [PMID: 36817483 PMCID: PMC9936152 DOI: 10.3389/fimmu.2023.1111344] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction High-grade serous ovarian cancer (HGSOC) is the second most frequent gynecological malignancy but the most lethal, partially due to the spread of the disease through the peritoneal cavity. Recent evidence has shown that, apart from their role in immune defense through phagocytosis and degranulation, neutrophils are able to participate in cancer progression through the release of neutrophil extracellular traps (NETs) in a process called NETosis. NETs are composed of DNA, histones, calprotectin, myeloperoxidase (MPO) and elastase and the NETosis process has been proposed as a pre-requisite for the establishment of omental metastases in early stages of HGSOC. Nevertheless, its role in advanced stages remains to be elucidated. Therefore, our principal aim is to characterize a NETosis biomarker profile in biofluids from patients with advanced HGSOC and control women. Methods Specifically, five biomarkers of NETosis (cell-free DNA (cfDNA), nucleosomes, citrullinated histone 3 (citH3), calprotectin and MPO) were quantified in plasma and peritoneal fluid (PF) samples from patients (n=45) and control women (n=40). Results Our results showed that HGSOC patients presented a higher concentration of cfDNA, citH3 and calprotectin in plasma and of all five NETosis biomarkers in PF than control women. Moreover, these biomarkers showed a strong ability to differentiate the two clinical groups. Interestingly, neoadjuvant treatment (NT) seemed to reduce NETosis biomarkers mainly systemically (plasma) compared to the tumor environment (PF). Discussion In conclusion, NETosis biomarkers are present in the tumor environment of patients with advanced HGSOC, which might contribute to the progression of the disease. Besides, plasma cfDNA and calprotectin could represent minimally invasive surrogate biomarkers for HGSOC. Finally, NT modifies NETosis biomarkers levels mainly at the systemic level.
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Affiliation(s)
- Sarai Tomás-Pérez
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain
| | - Julia Oto
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Cristina Aghababyan
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain,Department of Obstetrics and Gynecology, General University Hospital of Valencia Consortium, Valencia, Spain
| | - Raquel Herranz
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Aitor Cuadros-Lozano
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain,Department of Obstetrics and Gynecology, General University Hospital of Valencia Consortium, Valencia, Spain
| | - Eva González-Cantó
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain
| | - Bárbara Mc Cormack
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain
| | - Judith Arrés
- Department of Statistics and Operational Research, University of Valencia, Valencia, Spain
| | - María Castaño
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Fernando Cana
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Laura Martínez-Fernández
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain,Department of Obstetrics and Gynecology, General University Hospital of Valencia Consortium, Valencia, Spain
| | - Núria Santonja
- Department of Pathology, General University Hospital of Valencia Consortium, Valencia, Spain
| | - Rocío Ramírez
- Department of Medical Oncology, General University Hospital of Valencia Consortium, Valencia, Spain
| | - Alejandro Herreros-Pomares
- Department of Biotechnology, Polytechnic University of Valencia, Valencia, Spain,Cancer Biomedical Research Network Center, CIBERONC, Madrid, Spain
| | - Sarai Cañete-Mota
- Department of Obstetrics and Gynecology, General University Hospital of Castellon, Castellón, Spain
| | - Antoni Llueca
- Department of Obstetrics and Gynecology, General University Hospital of Castellon, Castellón, Spain,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), General University Hospital of Castellon, Castellón, Spain,Department of Medicine, University Jaume I, Castellón, Spain
| | - Josep Marí-Alexandre
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain,Department of Pathology, General University Hospital of Valencia Consortium, Valencia, Spain,*Correspondence: Josep Marí-Alexandre, ; Pilar Medina,
| | - Pilar Medina
- Hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain,*Correspondence: Josep Marí-Alexandre, ; Pilar Medina,
| | - Juan Gilabert-Estellés
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation of the General University Hospital of Valencia, Valencia, Spain,Department of Obstetrics and Gynecology, General University Hospital of Valencia Consortium, Valencia, Spain,Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
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Llueca M, Ibañez MV, Climent MT, Serra A, Llueca A. Effectiveness of Hyperthermic Intraperitoneal Chemotherapy Associated with Cytoreductive Surgery in the Treatment of Advanced Ovarian Cancer: Systematic Review and Meta-Analysis. J Pers Med 2023; 13:jpm13020258. [PMID: 36836494 PMCID: PMC9960788 DOI: 10.3390/jpm13020258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The use of hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment for epithelial ovarian cancer remains controversial. Our study aims to analyze the overall survival and disease-free survival for the use of HIPEC as a treatment for advanced epithelial ovarian cancer after neoadjuvant chemotherapy. METHODS A systematic review and meta-analysis was carried out using PubMed, Cochrane, Web of Science, and ClinicalTrials.gov. A total of six studies were used, comprising a total of 674 patients. RESULTS The results of our meta-analysis of all studies analyzed together (observational and randomized controlled trials (RCT)) did not achieve significant results. Contrary to the OS (HR = 0.56, 95% IC = 0.33-0.95, p = 0.03) and DFS (HR = 0.61, 95% IC = 0.43-0.86, p < 0.01) of the RCT analyzed separately, a clear impact on survival was suggested. The subgroup analysis showed that studies making use of higher temperatures (≥42 °C) for a shorter period of time (≤60 min) achieved better results for both OS and DFS, as well as the use of cisplatin as the form of chemotherapy in HIPEC. Moreover, the use of HIPEC did not increase high-grade complications. CONCLUSIONS The addition of HIPEC to cytoreductive surgery demonstrates an improvement in OS and DFS for patients with epithelial ovarian cancer in advanced stages, without an increase in the number of complications. The use of cisplatin as chemotherapy in HIPEC obtained better results.
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Affiliation(s)
- Maria Llueca
- Department of Medicine, University CEU-Cardenal Herrera, 12006 Castellon, Spain
| | | | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12006 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12006 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12006 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12006 Castellon, Spain
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12006 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12006 Castellon, Spain
- Correspondence:
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9
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Llueca A, Ibañez MV, Torne A, Gil-Moreno A, Martin-Jimenez A, Diaz-Feijoo B, Serra A, Climent MT, Gil-Ibañez B. Fertility-Sparing Surgery versus Radical Hysterectomy in Early Cervical Cancer: A Propensity Score Matching Analysis and Noninferiority Study. J Pers Med 2022; 12:jpm12071081. [PMID: 35887578 PMCID: PMC9325092 DOI: 10.3390/jpm12071081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. Methods: A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. Results: The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of −19.02 percentage points; 95% CI −32.08 to −5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. Conclusion: FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellón, Spain; (A.S.); (M.T.C.)
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
- Correspondence: ; Tel.: +34-964726500
| | - Maria Victoria Ibañez
- Department of Mathematics, University Jaume I (UJI), 12004 Castelló de la Plana, Spain;
| | - Aureli Torne
- Unit of Gynaecologic Oncology (ICGON), Endocrinology, Gynaecology and Human Reproduction (IDIBAPS), Hospital Clinic of Barcelona, 08007 Barcelona, Spain; (A.T.); (B.D.-F.)
| | - Antonio Gil-Moreno
- Gynaecological Oncology Department, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomedica en Red de Cancer, 08035 Barcelona, Spain;
| | | | - Berta Diaz-Feijoo
- Unit of Gynaecologic Oncology (ICGON), Endocrinology, Gynaecology and Human Reproduction (IDIBAPS), Hospital Clinic of Barcelona, 08007 Barcelona, Spain; (A.T.); (B.D.-F.)
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellón, Spain; (A.S.); (M.T.C.)
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
| | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellón, Spain; (A.S.); (M.T.C.)
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
| | - Blanca Gil-Ibañez
- Gynaecological Oncology and Endoscopy Unit, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, Research Institute i+12, 28041 Madrid, Spain;
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10
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Delgado-Barriga K, Medina C, Gomez-Quiles L, Marco-Domenech SF, Escrig J, Llueca A. CT Enterography for Preoperative Evaluation of Peritoneal Carcinomatosis Index in Advanced Ovarian Cancer. J Clin Med 2022; 11:jcm11030476. [PMID: 35159927 PMCID: PMC8836697 DOI: 10.3390/jcm11030476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 12/18/2022] Open
Abstract
To compare the diagnostic performance of routine CT (rCT), CT enterography (CTE) and intraoperative quantification of PCI to surgical and pathological reference standards in patients with advanced ovarian cancer, a retrospective study of 122 patients who underwent cytoreduction surgery for ovarian peritoneal carcinomatosis was conducted. Radiological, surgical, and pathological PCIs were obtained from the corresponding reports, and the latter two were considered reference standards. The radiological techniques used were rCT: 64 MDCT (32 × 1 mm) (100 mL iopromide 370 i.v., 800 mL water p.o.), and CTE: 64 MDCT (64 × 0.5 mm) (130 mL iopromide 370 i.v., 1800 mL mannitol solution p.o., 20 mg buscopan i.v.). Data were grouped by imaging technique and analyzed using total PCI and stratified by tumor burden (low-PCI < 10, high-PCI > 20). Agreement, diagnostic performance and degree of cytoreduction were evaluated. Disappointing results for rCT and CTE were obtained when using a surgical referent, but better diagnostic performance and concordance (0.86 vs. 0.78 vs. 0.62, p < 0.05) was observed when using a pathological referent—surgical PCI overestimates and overstaged patients. PCI is underestimated by rCT rather than CTE. For high-PCI, the ROC curve was mediocre for CTE and useless for rCT, as it failed to identify any cases. For low-PCI, the ROC was excellent (86% CTE vs. 75% rCT). In four cases with low-PCI as determined by rCT, cytoreduction was suboptimal. CTE has a better diagnostic performance than rCT in quantifying PCI in patients with advanced ovarian cancer, suggesting that CTE should be used as the initial technique. Surgical-PCI could be considered as an imperfect standard reference.
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Affiliation(s)
- Katty Delgado-Barriga
- Department of Radiology, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
| | - Carmen Medina
- Department of Pathology, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Department of General Surgery, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
| | - Santiago F Marco-Domenech
- Department of Radiology, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
| | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
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11
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Elorriaga MÁ, Neyro JL, Mieza J, Cristóbal I, Llueca A. Biomarkers in Ovarian Pathology: From Screening to Diagnosis. Review of the Literature. J Pers Med 2021; 11:jpm11111115. [PMID: 34834467 PMCID: PMC8624892 DOI: 10.3390/jpm11111115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Ovarian cancer has a low incidence, but high mortality due to a habitual diagnosis in advanced cancer stages. Currently, used biomarkers have good sensitivity, but low specificity. Aim: To determine the usefulness of the biomarkers and algorithms used up to now in the screening, diagnosis, response to treatments and identification of recurrence in patients with ovarian masses. Methodology: Systematic search of publications in English in the Medline-PubMed database with the terms: “biomarkers”, “tumour”, “tumour biomarkers”, “marker”, “tumour marker”, “ovarian cancer”, “ovarian”, “Neoplasms”, “cancer”, CA-125 Antigen; Human Epididymis-specific Protein E4; Risk of Malignancy Index (RMI); Risk of Ovarian Malignancy Algorithm (ROMA); Ovarian Neoplasms. Original articles, clinical trials, reviews, systematic reviews and meta-analyses, published between January 2000 and November 2020, were selected to determine the usefulness (among others) of CA 125 and HE4 antigen in ovarian cancer. Results: Finally, 39 transcendental publications were selected to write this article to determine the usefulness of tumour markers and algorithms in ovarian cancer. Conclusions: The usefulness of the tumour markers antigen CA125 and antigen HE4 individually or as a basis for decision-making algorithms has low specificity; however, there is little evidence that confirms their usefulness as markers in ovarian cancer screening.
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Affiliation(s)
- Miguel Ángel Elorriaga
- Servicio de Ginecología y Obstetricia, Hospital Universitario Cruces, Universidad del País Vasco, EHU—UPV, 48903 Baracaldo, Spain; (M.Á.E.); (J.L.N.); (J.M.)
| | - José Luis Neyro
- Servicio de Ginecología y Obstetricia, Hospital Universitario Cruces, Universidad del País Vasco, EHU—UPV, 48903 Baracaldo, Spain; (M.Á.E.); (J.L.N.); (J.M.)
- Internacional de Climaterio y Menopausia, Universidad a Distancia de Madrid (UDIMA) y Universidad Veracruzana Lomas del Estadio S/N, Col. Zona Universitaria C.P. 91090, Xalapa, Mexico
| | - Jon Mieza
- Servicio de Ginecología y Obstetricia, Hospital Universitario Cruces, Universidad del País Vasco, EHU—UPV, 48903 Baracaldo, Spain; (M.Á.E.); (J.L.N.); (J.M.)
- Instituto Ginecológico Deusto, 48014 Bilbao, Spain
| | - Ignacio Cristóbal
- Servicio de Obstetricia y Ginecología, Hospital Clínico San Carlos, Universidad Francisco de Vitoria, 28223 Madrid, Spain;
| | - Antoni Llueca
- Unidad de Referencia en Cirugía Oncológica Abdomino-Pélvica (UR-COAP), Hospital General Universitario de Castellón, 12004 Castelló, Spain
- Departamento de Medicina, University Jaume I (UJI), 12071 Castellón, Spain
- University Jaume I (UJI), Av de Vicent Sos Baynat s/n, 12071 Castellón, Spain
- Correspondence: ; Tel.: +34-964-387-440, University Jaume I (UJI)
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12
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Llueca A, Barneo-Muñoz M, Escrig J, de Llanos R. SARS-CoV-2 Prevalence in Laparoscopic Surgery Filters. Analysis in Patients with Negative Oropharyngeal RT-qPCR in a Pandemic Context: A Cross-Sectional Study. J Pers Med 2021; 11:jpm11111052. [PMID: 34834404 PMCID: PMC8623856 DOI: 10.3390/jpm11111052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: Surgical societies of different specialties have lately demonstrated a growing concern regarding the potential risk of SARS-CoV-2 transmission during surgery, mainly via aerosols carrying SARS-CoV-2 particles during laparoscopy smoke evacuation. Since there is not sufficient scientific evidence to rule out this hypothesis, our study aimed to evaluate the prevalence of the appearance of SARS-CoV-2 genetic material in the in-filter membrane of the smoke filter systems, used in laparoscopic surgery, in a tertiary referral hospital during the peak phases of the pandemic. Methods: During the highest incidence of the pandemic outbreak, 180 laparoscopic smoke evacuation systems were collected from laparoscopies performed between April 2020 and May 2021 in University General Hospital of Castellón. As part of the safety protocol established as a result of the pandemic, an oropharyngeal reverse-transcription polymerase chain reaction (RT-PCR) was performed before surgery. We performed RT-qPCR tests for the detection and quantification of SARS-CoV-2 genetic material in the in-filter membranes extracted from the smoke evacuation systems. Results: We found two RT-qPCR positive in-filters from a sample of 128 patients with SARS-CoV-2-negative results in their oropharyngeal RT-qPCR, i.e., 1.6% (95% CI: 0.5–5.5%). From this estimation, the predictive posterior probabilities of finding n cases of negative oropharyngeal COVID-19 patients with positive filters increases with the increasing number of surgeries performed. Conclusions: This cross-sectional study provides evidence suggesting that airborne transmission of SARS-CoV-2 particles from smoke evacuation of aerosols carrying viral particles during laparoscopy should not be ruled out.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12071 Castellón, Spain
- Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain; (M.B.-M.); (J.E.); (R.d.L.)
- Correspondence:
| | - Manuela Barneo-Muñoz
- Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain; (M.B.-M.); (J.E.); (R.d.L.)
| | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain; (M.B.-M.); (J.E.); (R.d.L.)
| | - Rosa de Llanos
- Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain; (M.B.-M.); (J.E.); (R.d.L.)
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Mc Cormack BA, González-Cantó E, Agababyan C, Espinoza-Sánchez NA, Tomás-Pérez S, Llueca A, Marí-Alexandre J, Götte M, Gilabert-Estellés J. miRNAs in the Era of Personalized Medicine: From Biomarkers to Therapeutics. Int J Mol Sci 2021; 22:8154. [PMID: 34360918 PMCID: PMC8348078 DOI: 10.3390/ijms22158154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
In recent years, interest in personalized medicine has considerably increased [...].
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Affiliation(s)
- Bárbara A. Mc Cormack
- Research Laboratory in Biomarkers in Reproduction, Gynaecology and Obstetrics, Research Foundation of the General University Hospital of Valencia, 46014 Valencia, Spain; (B.A.M.C.); (E.G.-C.); (C.A.); (S.T.-P.); (J.G.-E.)
| | - Eva González-Cantó
- Research Laboratory in Biomarkers in Reproduction, Gynaecology and Obstetrics, Research Foundation of the General University Hospital of Valencia, 46014 Valencia, Spain; (B.A.M.C.); (E.G.-C.); (C.A.); (S.T.-P.); (J.G.-E.)
| | - Cristina Agababyan
- Research Laboratory in Biomarkers in Reproduction, Gynaecology and Obstetrics, Research Foundation of the General University Hospital of Valencia, 46014 Valencia, Spain; (B.A.M.C.); (E.G.-C.); (C.A.); (S.T.-P.); (J.G.-E.)
- Obstetrics and Gynaecology Service, General University Hospital of Valencia Consortium, 46014 Valencia, Spain
| | - Nancy A. Espinoza-Sánchez
- Research Laboratory, Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany;
| | - Sarai Tomás-Pérez
- Research Laboratory in Biomarkers in Reproduction, Gynaecology and Obstetrics, Research Foundation of the General University Hospital of Valencia, 46014 Valencia, Spain; (B.A.M.C.); (E.G.-C.); (C.A.); (S.T.-P.); (J.G.-E.)
| | - Antoni Llueca
- Department of Medicine, University Jaume I, 12071 Castellón, Spain;
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), General University Hospital of Castellón, 12004 Castellón, Spain
| | - Josep Marí-Alexandre
- Research Laboratory in Biomarkers in Reproduction, Gynaecology and Obstetrics, Research Foundation of the General University Hospital of Valencia, 46014 Valencia, Spain; (B.A.M.C.); (E.G.-C.); (C.A.); (S.T.-P.); (J.G.-E.)
| | - Martin Götte
- Research Laboratory, Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany;
| | - Juan Gilabert-Estellés
- Research Laboratory in Biomarkers in Reproduction, Gynaecology and Obstetrics, Research Foundation of the General University Hospital of Valencia, 46014 Valencia, Spain; (B.A.M.C.); (E.G.-C.); (C.A.); (S.T.-P.); (J.G.-E.)
- Obstetrics and Gynaecology Service, General University Hospital of Valencia Consortium, 46014 Valencia, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, 46010 Valencia, Spain
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14
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Climent MT, Serra A, Gilabert-Estellés J, Gilabert-Aguilar J, Llueca A. Comparison of Peritoneal Carcinomatosis Scoring Methods in Predicting Resectability and Prognosis in Gynecologic Malignancies. J Clin Med 2021; 10:2553. [PMID: 34207720 PMCID: PMC8229310 DOI: 10.3390/jcm10122553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Peritoneal carcinomatosis is a disease's presentation in the advanced stages of many gynecologic tumours. The distribution and volume of the disease are the main factors in achieving complete debulking. Diagnostic laparoscopy is a technique to allow evaluation of the disease. This study's objective is to compare two laparoscopic scores (Fagotti's index and Sugarbaker's peritoneal cancer index (PCI)) and assess the diagnostic accuracy to select patients for neoadjuvant treatment and reduce unnecessary laparotomies. METHODS A non-randomised retrospective cohort study was conducted in patients with peritoneal carcinomatosis (ovarian and endometrial origin) who underwent laparoscopy and subsequent laparotomy. We evaluated the scores' ability to predict incomplete surgery and whether they were related to the patients' prognosis. RESULTS We included 34 patients, of which 23.5% received neoadjuvant chemotherapy. The rate of complete cytoreductive surgery was 79.4% (n = 27 patients). The highest sensitivity was obtained with a PCI value greater than 20. It was the best parameter to determine incomplete debulking. Survival curves were analysed according to the "cut off" established for each score, and statically significant differences were found using PCI with respect to Fagotti's Index. However, these differences were not found with Fagotti's score. CONCLUSION The best diagnostic method to classify patients with peritoneal cancer is the PCI. It could be adapted to each surgical team because it allows identifying the "cut off point", which depends on incomplete surgery rate.
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Affiliation(s)
- María Teresa Climent
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
| | - Anna Serra
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
| | - Juan Gilabert-Estellés
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain
| | - Juan Gilabert-Aguilar
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
| | - Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
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Hidalgo JJ, Llueca A, Zolfaroli I, Veiga N, Ortiz E, Alcázar JL. Comparison of IOTA three-step strategy and logistic regression model LR2 for discriminating between benign and malignant adnexal masses. Med Ultrason 2021; 23:168-175. [PMID: 33626112 DOI: 10.11152/mu-2732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIMS To compare the diagnostic performance of two ultrasound-based diagnostic systems for the classification of benign or malignant adnexal masses, the three-step strategy and the predictive logistic regression model LR2, both proposed by the International Ovarian Tumour Analysis (IOTA) Group. MATERIAL AND METHODS Prospective observational study at a single centre that included patients diagnosed with a persistent adnexal mass by transvaginal ultrasound over a period of two years. They were evaluated by a non-expert sonographer by applying the three-step diagnostic strategy and the LR2 predictive model to classify the masses as benign or malignant. Patients were treated surgically or followed up for at least one year, taking as the standard reference for benignity or malignancy the histological diagnosis of the lesion or ultrasound changes suggestive of malignancy during the follow-up period. Sensitivity, specificity, positive and negative likelihood ratios and overall accuracy of both systems was calculated and compared. RESULTS One hundred patients were included, with a mean age of 50.6 years (range 18-87). Surgery was performed on 62 (62%) patients and 38 (38%) were managed expectantly. Eighty-three (83%) lesions were benign and 17 (17%) were malignant. The IOTA three-step strategy presented sensitivity of 94.1% (95%CI, 86.7-98.3%) and specificity 97.6% (95%CI, 94.8-99%). The LR2 logistic regression model showed sensitivity 94.1% (95%CI, 73-98.9%) and specificity 81.9% (95%CI 72.3-88.7%). Comparison of the two systems showed a statistically significant dif-ference in specificity in favour of the three-step strategy. CONCLUSIONS The IOTA three-step strategy, in addition to being sim-ple to use in clinical practice, has a high diagnostic accuracy for the classification of benignity and malignancy of the adnexal masses, overtaking that of other predictive models such as the LR2 logistic regression model.
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Affiliation(s)
- Juan José Hidalgo
- Department of Obstetrics and Gynaecology, Hospital Clínico Universitario de Valencia. Spain.
| | - Antoni Llueca
- Department of Medicine. University Jaume I, Castellón. Spain.
| | - Irene Zolfaroli
- Department of Obstetrics and Gynaecology, Hospital Clínico Universitario de Valencia. Spain.
| | - Nadia Veiga
- Department of Obstetrics and Gynaecology, Hospital Peset, Valencia. Spain.
| | - Ester Ortiz
- Department of Obstetrics and Gynaecology, Hospital Peset, Valencia. Spain.
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynaecology, Clínica Universidad de Navarra, University of Navarra, Pamplona. Spain.
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Gil-Moreno A, Alonso-Alconada L, Díaz-Feijoo B, Domingo S, Vilar A, Hernández A, Gilabert J, Llueca A, Torné A, de Santiago J, Carbonell-Socias M, Lago V, Arias E, Sampayo V, Siegrist J, Chipirliu A, Sánchez-Iglesias JL, Pérez-Benavente A, Padilla-Iserte P, Santacana M, Matias-Guiu X, Abal M, Lopez-Lopez R. M-TRAP: Safety and performance of metastatic tumor cell trap device in advanced ovarian cancer patients. Gynecol Oncol 2021; 161:681-686. [PMID: 33795131 DOI: 10.1016/j.ygyno.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite radical surgery and chemotherapy, most patients with ovarian cancer die due to disease progression. M-Trap is an implantable medical device designed to capture peritoneal disseminated tumor cells with the aim to focalize the disease. This trial analyzed the safety and performance of the device. METHODS This first-in-human prospective, multi-center, non-blinded, single-arm study enrolled 23 women with high-grade serous advanced ovarian cancer. After primary or interval debulking surgery, 3 M-Trap devices were placed in the peritoneum of the abdominal cavity. 18-months post-implantation or at disease progression, devices were initially removed by laparoscopy. The primary safety endpoint was freedom from device and procedure-related major adverse events (MAEs) through 6-months post-implantation compared to an historical control. The primary performance endpoint was histopathologic evidence of tumor cells capture. RESULTS Only one major adverse event was attributable to the device. 18 women were free of device and procedure related MAEs (78.3%). However, the primary safety endpoint was not achieved (p = 0.131), primarily attributable to the greater surgical complexity of the M-Trap patient population. 62% of recurrent patients demonstrated tumor cell capture in at least one device with a minimal tumor cell infiltration. No other long-term device-related adverse events were reported. The secondary performance endpoint demonstrated a lack of disease focalization. CONCLUSIONS The M-Trap technology failed to meet its primary safety objective, although when adjusted for surgical complexity, the study approved it. Likewise, the devices did not demonstrate the anticipated benefits in terms of tumor cell capture and disease focalization in recurrent ovarian cancer.
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Affiliation(s)
- Antonio Gil-Moreno
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain.
| | | | - Berta Díaz-Feijoo
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana Vilar
- Department of Gynecology, University Hospital of Santiago de Compostela, Spain
| | - Alicia Hernández
- Department of Gynecology, University Hospital La Paz, Madrid, Spain
| | - Juan Gilabert
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Antoni Llueca
- Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, Castelló de la Plana, Spain
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | - Melchor Carbonell-Socias
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Víctor Lago
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Efigenia Arias
- Department of Gynecology, University Hospital of Santiago de Compostela, Spain
| | - Victoria Sampayo
- Department of Gynecology, University Hospital of Santiago de Compostela, Spain
| | - Jaime Siegrist
- Department of Gynecology, University Hospital La Paz, Madrid, Spain
| | - Anca Chipirliu
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Jose Luis Sánchez-Iglesias
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Assumpció Pérez-Benavente
- Department of Gynecologic Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Maria Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - Miguel Abal
- Nasasbiotech, S.L., A Coruña, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), CIBERONC, Santiago de Compostela, Spain
| | - Rafael Lopez-Lopez
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), CIBERONC, Santiago de Compostela, Spain.
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Llueca A, Serra A, Climent MT, Maiocchi K, Villarin A, Delgado K, Mari-Alexandre J, Gilabert-Estelles J, Carrasco P, Segarra B, Gomez L, Hidalgo JJ, Escrig J, Laguna M. Postoperative Intestinal Fistula in Primary Advanced Ovarian Cancer Surgery. Cancer Manag Res 2021; 13:13-23. [PMID: 33442290 PMCID: PMC7797294 DOI: 10.2147/cmar.s280511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background Advanced ovarian cancer (AOC) requires an aggressive surgery with large visceral resections in order to achieve an optimal or complete cytoreduction and increase the patient’s survival. However, the surgical aggressiveness in the treatment of AOC is not exempt from major complications, such as the gastrointestinal fistula (GIF), which stands out among others due to its high morbidity and mortality. Methods We evaluated the clinicopathological features in patients with AOC and their association with GI. Data for 107 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. Clinicopathological features, including demographic, surgical procedures and follow-up data, were analyzed in relation to GIF. Results GIF was present in 11% of patients in the study, 5 (4.5%) and 7 (6.4%) of colorectal and small bowel origin, respectively. GIF was significantly associated with peritoneal cancer index (PCI) >20, more than 2 visceral resections, and multiple digestive resections. Overall and disease-free survival were also associated with GIF. Multivariate analysis identified partial bowel obstruction and operative bleeding as independent prognostic factors for survival. The presence of GIF is positively associated with poor prognosis in patients with AOC. Conclusion Given the importance of successful cytoreductive surgery in AOC, the assessment of the amount of tumor and the aggressiveness of the surgery to avoid the occurrence of GIF become a priority in patients with AOC.
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Affiliation(s)
- Antoni Llueca
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Anna Serra
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Maria Teresa Climent
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Radiology, University General Hospital of Castellon, Castellón, Spain
| | - Josep Mari-Alexandre
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan Gilabert-Estelles
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain.,Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain
| | - Paula Carrasco
- Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Blanca Segarra
- University of Texas MD Anderson Cancer Center, Gynecology Oncology, Houston, Texas, USA
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | | | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), Castellon, Spain
| | - Manuel Laguna
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
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Llueca A, Serra A, Climent MT, Segarra B, Maazouzi Y, Soriano M, Escrig J. Correction to: Outcome quality standards in advanced ovarian cancer surgery. World J Surg Oncol 2020; 18:323. [PMID: 33287840 PMCID: PMC7722420 DOI: 10.1186/s12957-020-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Llueca A, Escrig J, Gil-Moreno A, Benito V, Hernández A, Díaz-Feijoo B. The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival. J Gynecol Oncol 2020; 32:e4. [PMID: 33185045 PMCID: PMC7767657 DOI: 10.3802/jgo.2021.32.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/11/2020] [Accepted: 09/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. METHODS Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. RESULTS A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of -2 was established as a prognostic indicator. CALS and LODDS <-2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥-2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. CONCLUSION When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Department of Medicine, Universitat Jaume I (UJI), Castellón, Spain.
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Department of Medicine, Universitat Jaume I (UJI), Castellón, Spain
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Llueca A, Maazouzi Y, Ponce P, Serra A, Garau C, Rodrigo M. Step by step Indiana pouch construction in a previously irradiated patient with a cervical cancer relapse. Int J Surg Case Rep 2019; 66:187-191. [PMID: 31865230 PMCID: PMC6928324 DOI: 10.1016/j.ijscr.2019.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Radiation therapy and radical pelvic surgery, either radical cystectomy or pelvic exenteration, is the golden standard treatment for infiltrating bladder carcinoma, as well as advanced or recurrent cervical, vulvar, vaginal and endometrial cancer. However, due to the poor radiation sensitivity of the cervix and vagina, a high-radiation dose is required, leading to early and/or late onset urogenital complications in approximately 50% of the patients. CASE PRESENTATION The following case report describes a 64-year-old native Russian woman presenting a relapse of a vaginal cuff squamous cell carcinoma, who underwent a laterally extended endopelvic resection (LEER) followed by a neobladder reconstruction based on the Indiana pouch (IP) technique. The process is described here step by step. DISCUSSION Indiana pouch urinary diversion was based on thorough research, the reproducibility of the technique, our urologist's experience with the Indiana Pouch, as well the lower rate of complications published in various separate series. CONCLUSION Indiana pouch is a successful continence urinary reservoir with a reproductible technique, however long-term observation is needed.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain.
| | - Yasmine Maazouzi
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Paula Ponce
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Carmen Garau
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Miguel Rodrigo
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
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Llueca A, Serra A, Delgado K, Maiocchi K, Jativa R, Gomez L, Escrig J. A radiologic-laparoscopic model to predict suboptimal (or complete and optimal) debulking surgery in advanced ovarian cancer: a pilot study. Int J Womens Health 2019; 11:333-342. [PMID: 31239786 PMCID: PMC6554528 DOI: 10.2147/ijwh.s198355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Medical models assist clinicians in making diagnostic and prognostic decisions in complex situations. In advanced ovarian cancer, medical models could help prevent unnecessary exploratory surgery. We designed two models to predict suboptimal or complete and optimal cytoreductive surgery in patients with advanced ovarian cancer. Methods: We collected clinical, pathological, surgical, and residual tumor data from 110 patients with advanced ovarian cancer. Computed tomographic and laparoscopic data from these patients were used to determine peritoneal cancer index (PCI) and lesion size score. These data were then used to construct two-by-two contingency tables and our two predictive models. Each model included three risk score levels; the R4 model also included operative PCI, while the R3 model did not. Finally, we used the original patient data to validate the models (narrow validation). Results: Our models predicted suboptimal or complete and optimal cytoreductive surgery with a sensitivity of 83% (R4 model) and 69% (R3 model). Our results also showed that PCI>20 was a major risk factor for unresectability. Conclusion: Our medical models successfully predicted suboptimal or complete and optimal cytoreductive surgery in 110 patients with advanced ovarian cancer. Our models are easy to construct, based on readily available laboratory test data, simple to use clinically, and could reduce unnecessary exploratory surgery in this patient group.
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Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I(UJI), Castellon, Spain
| | - Anna Serra
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I(UJI), Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Radiology, University General Hospital of Castellon, Castellón, Spain
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Rosa Jativa
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Anesthesiology, University General Hospital of Castellon, Castellón, Spain
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I(UJI), Castellon, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
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Llueca A, Serra A, Maiocchi K, Delgado K, Jativa R, Gomez L, Escrig J. Predictive model for major complications after extensive abdominal surgery in primary advanced ovarian cancer. Int J Womens Health 2019; 11:161-167. [PMID: 30881145 PMCID: PMC6410758 DOI: 10.2147/ijwh.s190493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Surgery for advanced ovarian cancer (AOC) frequently results in serious complications. The present study aimed to determine the importance of various factors and complications in cytoreductive surgery for AOC. Patients and methods The present study included 90 patients with AOC who underwent primary cytoreductive surgery in a single institution from January 2013 to August 2017. Demographic and clinicopathologic characteristics, surgical procedures, residual disease, and follow-up data were analyzed. Cytoreductive surgery was defined as complete (no residual tumor), optimal (residual tumor <1 cm in diameter), and suboptimal (residual tumor >1 cm in diameter). Grade III–IV complications were considered major. Patients were evaluated every 3–6 months. Results Surgical outcome was complete in 75 (82%), optimal in 5 (6%), and suboptimal in 11 (12%) patients. Major complications occurred in 28 (31%) patients. Independent risk factors for major complications were ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. A score created by weighing the multivariate OR for each risk factor correctly predicted major complications in 67% of cases. A score cut-off of >2 discriminated between patients with and without complications in 79% of cases (95% CI: 70%–86%, P<0.001). Adjuvant chemotherapy was performed as planned in 67 patients (74%), including 50 (75%) without major complications and 17 (25%) with major complications. Conclusion Risk factors for major complications in cytoreductive surgery for AOC are ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. Our model predicts morbidity based on major and minor classifications of complications.
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Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain, .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Medicine, University Jaume I (UJI), Castellon, Spain,
| | - Anna Serra
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain, .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Medicine, University Jaume I (UJI), Castellon, Spain,
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of General Surgery, University General Hospital of Castellon, Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Radiology
| | - Rosa Jativa
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Anaesthesiology, University General Hospital of Castellon, Castellon, Spain
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of General Surgery, University General Hospital of Castellon, Castellon, Spain
| | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), Castellon, Spain, .,Department of General Surgery, University General Hospital of Castellon, Castellon, Spain.,Department of Radiology
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Llueca A, Piquer D, Maazouzi Y, Medina C, Delgado K, Serra A, Escrig J. Hepatic epithelioid hemangioendothelioma: A great mimicker. Int J Surg Case Rep 2018; 53:25-28. [PMID: 30366173 PMCID: PMC6205146 DOI: 10.1016/j.ijscr.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Epithelioid hemangioendothelioma is a malignant mesenchymal tumor of unknown etiology. They tend to be asymptomatic or with non-specific symptoms. The lesion is usually multiple and variable size. PRESENTATION OF CASE We describe a clinical case of a 23-years-old patient diagnosed with a pelvic mass, a possible uterine fibroid or adnexal mass, and multiple liver lesions that seemed an advanced ovarian cancer presentation and after liver biopsy turned out to be a hepatic epithelioid hemangioendothelioma. DISCUSSION It may be confused with a metastatic process in diagnostic imaging. There have been described some possible risk factors but the etiology remains unknown. The prognosis is usually lethal in 50% of cases. The surgical removal of the lesion and liver transplant appear to be the only hope for these patients. CONCLUSION Epithelioid hemangioendothelioma must be part of our differential diagnosis when we find a liver tumour, especially in young women. Treatment is excision of the tumour in limited disease. In the case of unresectable disease are candidates for liver transplantation.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain.
| | - Dolors Piquer
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Yasmine Maazouzi
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Carmen Medina
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Javier Escrig
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
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Llueca A, Serra A, Herraiz JL, Rivadulla I, Gomez-Quiles L, Gilabert-Estelles J, Escrig J. Peritoneal carcinomatosis index as a predictor of diaphragmatic involvement in stage III and IV ovarian cancer. Onco Targets Ther 2018; 11:2771-2777. [PMID: 29844678 PMCID: PMC5961326 DOI: 10.2147/ott.s147559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze the surgical outcomes and diaphragmatic involvement in stage III and IV ovarian cancer. Patients and methods All patients with stage III–IV ovarian cancer between January 2013 and January 2016 were included. The outcomes of interest reviewed were as follows: surgical (complications, mortality), peritoneal carcinomatosis index (PCI), rate of complete resection, and disease-free interval and survival. Results Fifty-seven patients were included, 38 (67%) with diaphragmatic involvement; in 10 cases (18%), diaphragmatic resection was required. Optimal cytoreduction (OCR) was obtained in 49 cases (86%). The PCI was >10 in 31 cases (54%). Respiratory complications occurred in 10 cases (18%) and mortality in 3 (5%). Disease-free survival rate in 3 years was 53%, being 87% in cases without diaphragmatic involvement. The overall survival rate in 3 years is 46%, 83% in the cases without diaphragmatic involvement and 27% in cases with affectation (p<0.05). In cases of OCR, 3 year survival rate was 65%. In the multivariate analysis for the overall survival of cases with OCR, the only independent prognostic factor found was the operative PCI. A strong correlation was found between the total PCI and the diaphragmatic PCI (p<0.001). With a PCI >10, virtually all cases will present diaphragmatic involvement (p<0.05). Conclusion The tumor burden is different in stages III and IV of advanced ovarian cancer and the PCI is an effective method to quantify it. The PCI constitutes an independent prognostic factor for the advanced stages of ovarian cancer. A PCI >10 constitutes a useful prognostic factor of the affectation and forces the surgeon to thoroughly review both diaphragms.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Castellón, Spain.,Department of Obstetrics and Gynecology, University General Hospital of Castellón, Castellón, Spain.,Department of Medicine, Universitat Jaume I, Castellón, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Castellón, Spain.,Department of Obstetrics and Gynecology, University General Hospital of Castellón, Castellón, Spain.,Department of Medicine, Universitat Jaume I, Castellón, Spain
| | - José Luis Herraiz
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Castellón, Spain
| | - Isabel Rivadulla
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellón, Castellón, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellón, Castellón, Spain
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, Valencia, Spain.,Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Castellón, Spain.,Department of Medicine, Universitat Jaume I, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellón, Castellón, Spain
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Llueca A, Serra A, Rivadulla I, Gomez L, Escrig J. Prediction of suboptimal cytoreductive surgery in patients with advanced ovarian cancer based on preoperative and intraoperative determination of the peritoneal carcinomatosis index. World J Surg Oncol 2018; 16:37. [PMID: 29471831 PMCID: PMC5824576 DOI: 10.1186/s12957-018-1339-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/14/2018] [Indexed: 01/14/2023] Open
Abstract
Background The peritoneal carcinomatosis index (PCI) can be used to quantify the tumor burden in patients with advanced ovarian cancer. The aim of the present study was to establish a predictive model for suboptimal cytoreductive surgery (SCS) (residual tumor of > 1 cm) using preoperative and intraoperative determination of the PCI. Methods In total, 110 consecutive patients treated for advanced ovarian cancer during a 4-year period in our institution were assessed. Eighty of these patients were eligible for primary debulking surgery and thus included in the present study. All data were prospectively collected and retrospectively evaluated. We determined the PCI both preoperatively and intraoperatively and assessed postoperative complications. Results A PCI of > 20 was the best cut-off with which to predict a risk of SCS among all three diagnostic techniques assessed in this study (computed tomography, laparoscopy, and laparotomy). Intraoperative PCI determination was associated with the lowest risk of false negatives for SCS when detecting a PCI of < 20. The combination of preoperative computed tomography and laparoscopy, when both techniques predicted SCS, was associated with the lowest risk of false positives for SCS when detecting a PCI of > 20. Conclusion The combination of computed tomography and laparoscopy to obtain the PCI can help to determine which patients with advanced ovarian cancer are suitable for primary debulking surgery and which should undergo neoadjuvant chemotherapy.
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Affiliation(s)
- Antoni Llueca
- Deparment of Obstetrics and Gynecology, Av Benicasim s/n, 12004, Castellón, Spain. .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Av Benicasim s/n, 12004, Castellón, Spain. .,Department of Medicine, University Jaume I (UJI), Av Benicasim s/n, 12004, Castellón, Spain.
| | - Anna Serra
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Av Benicasim s/n, 12004, Castellón, Spain
| | - Isabel Rivadulla
- Department of General Surgery, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Av Benicasim s/n, 12004, Castellón, Spain
| | - Luis Gomez
- Department of General Surgery, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Av Benicasim s/n, 12004, Castellón, Spain
| | - Javier Escrig
- Department of General Surgery, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Av Benicasim s/n, 12004, Castellón, Spain
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Llueca A, Escrig J. Prognostic value of peritoneal cancer index in primary advanced ovarian cancer. Eur J Surg Oncol 2017; 44:163-169. [PMID: 29198495 DOI: 10.1016/j.ejso.2017.11.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/12/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Effective tumor debulking is a major factor associated with a favorable prognosis in patients with advanced ovarian cancer (AOC). However, FIGO staging fails to take full account of the extent of the disease in the peritoneum, making it difficult to plan appropriate surgical treatment. In contrast, the peritoneal cancer index (PCI) can provide more detailed information about peritoneal spread. METHOD We evaluated the prognostic value of PCI and its association with clinicopathological features in patients with AOC. Data for 80 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. PCI scores of 0-39 were calculated based on the sizes of lesions in 13 abdominopelvic regions, and patients were classified into three categories with scores of 1-10, 11-20, and >20, respectively. Clinicopathological features, including the presence of residual tumor after surgery and the incidence of postoperative complications, were assessed in relation to PCI score. RESULTS PCI was significantly associated with suboptimal surgery and postoperative complications, as well as with preoperative CA125, ascites, prolonged surgery, FIGO stage, positive aortic lymph nodes, prolonged hospitalization, and number of visceral resections. Overall and disease-free survival was also associated with PCI, with an optimal cut-off value of 15. Multivariate analysis identified age, residual tumor, and PCI as independent prognostic factors for survival. A PCI >10 is positively associated with a poor prognosis in patients with AOC. CONCLUSION Given the importance of effective tumor debulking, PCI may provide important information for surgical planning in patients with AOC.
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Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón, Spain; Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain; Department of Medicine, University Jaume I(UJI), Castellon, Spain.
| | - Javier Escrig
- Department of General Surgery, University General Hospital of Castellon, Castellón, Spain; Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain; Department of Medicine, University Jaume I(UJI), Castellon, Spain
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- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain
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Llueca A, Herraiz JL, Del Moral R, Piquer D, Maazouzi Y, Segarra B, Barres J, Serra A. Use of negative pressure wound therapy after infection and flap dehiscence in radical vulvectomy: A case report. Int J Surg Case Rep 2017; 41:370-372. [PMID: 29156232 PMCID: PMC5709344 DOI: 10.1016/j.ijscr.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/26/2022] Open
Abstract
Radical vulvectomy is a very agressive surgery. Deshiscence of vulvar wound is one of the most feared complications. Negative wound pressure therapy could be incorporate in the management of this complications.
Introduction Vulvar cancer has a lower incidence in high income countries, but is rising, in part, due to the high life expectancy in these societies. Radical vulvectomy is still the standard treatment in initial stages. Wound dehiscence contitututes one of the most common postoperative complications. Presentation of case A 76 year old patient with a squamous cell carcinoma of the vulva, FIGO staged, IIIb is presented. Radical vulvectomy and bilateral inguinal lymph node dissection with lotus petal flaps reconstruction are performed as the first treatment. Wound infection and dehiscence of lotus petal flaps was seen postoperatively. Initial management consisted in antibiotics administration and removing necrotic tissue from surgical wound. After this initial treatment, negative wound pressure therapy was applied for 37 days with good results. Discussion Wound dehiscence in radical vulvectomy remains the most frequent complication in the treatment of vulvar cancer. The treatment of this complications is still challenging for most gynecologic oncologist surgeons. Conclusion The utilization of the negative wound pressure therapy could contribute to reduce hospitalization and the direct and indirect costs of these complications.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain.
| | - Jose Luis Herraiz
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Raquel Del Moral
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Dolors Piquer
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Yasmine Maazouzi
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Blanca Segarra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Jordan Barres
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Anna Serra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
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Llueca A, Maazouzi Y, Herraiz JL, Medina MC, Piquer D, Segarra B, Del Moral R, Serra A, Bassols G. Treatment and follow-up in an asymptomatic malignant struma ovarii: A case report. Int J Surg Case Rep 2017; 40:113-115. [PMID: 28982046 PMCID: PMC5635336 DOI: 10.1016/j.ijscr.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022] Open
Abstract
Struma ovarii is a rare and asymptomatic ovarian tumor and is usually diagnosed by the pathologist. Struma ovarii malignancy is from thyroid origin and usually associated with thyroid tumors. Management and follow up is not well established.
Introduction Struma ovarii is a rare ovarian tumor, representing 0.5-1% of all ovarian tumors and 2–5% of ovarian teratomas. It is defined as an ovarian teratoma composed mostly of thyroid tissue. The symptoms are nonspecific, and the imaging studies can help in characterize the mass; however, the definitive diagnosis is usually given by the Pathologist. Classically, the treatment is the surgical resection of the ovarian mass, however there is no consensus regarding the follow-up. Presentation of case An asymptomatic malignant struma ovarii in a 43 year-old patient is presented. The diagnosis was postoperatively following a laparoscopic adnexectomy due to an apparently benign ovarian teratoma. The histopathology results revealed a mature ovarian cystic teratoma with papillary carcinoma with immunohistochemical characteristics suggesting a thyroid origin. Seeing that there was no thyroid affectation or metastatic disease, we decided a conservative management. A yearly follow-up with CT scan and tumor markers was performed. The endocrinologist also performed annual controls with thyroid ultrasound and serum tests. The patient has remained asymptomatic during these last four years. Discussion There is little evidence in literature on the conservative management in cases with evidence of malignancy. If fertility preservation is desired, an unilateral oophorectomy could be performed, along with levels of serum thyroglobulin as a marker of relapse. Other authors claim for aggressive ovarian cancer surgery followed by a total thyroidectomy. There is still no established management for struma ovarii patients and the choice for a conservative or radical approach depends only on the professional decision.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain.
| | - Yasmine Maazouzi
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain
| | - Jose Luis Herraiz
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Mari Carmen Medina
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain
| | - Dolors Piquer
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain
| | - Blanca Segarra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain
| | - Raquel Del Moral
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery(MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Guillermo Bassols
- Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
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