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Baekelandt J, Jespers A, Huber D, Badiglian-Filho L, Stuart A, Chuang L, Ali O, Burnett A. vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series. Acta Obstet Gynecol Scand 2024. [PMID: 38623778 DOI: 10.1111/aogs.14843] [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: 11/25/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. MATERIAL AND METHODS A prospective multicenter case series was performed in four hospitals. A total of 64 women with early-stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near-infrared light followed by endoscopic removal of these nodes. RESULTS A total of 64 women with early-stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo-oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. CONCLUSIONS This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position.
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Affiliation(s)
- Jan Baekelandt
- Department of Gynecology, Imelda Hospital, Bonheiden, Belgium
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Astrid Jespers
- Department of Gynecology, Imelda Hospital, Bonheiden, Belgium
| | - Daniela Huber
- Department of Obstetrics and Gynecology, Sion Hospital, Sion, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | | | - Andrea Stuart
- Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - Linus Chuang
- Department of Gynecologic Oncology, Nuvance Health, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Oudai Ali
- Department of Gynecology, Epsom and St Helier University, London, UK
| | - Alexander Burnett
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Goncalves BT, Dos Reis R, Ribeiro R, Moretti-Marques R, Schamme FK, Oliveira GS, Tsunoda AT, Alvarenga-Bezerra V, Lopes A, Pastore CBP, Kumagai LY, Faloppa CC, Mantoan H, Badiglian-Filho L, De Brot L, Andrade CEMC, Baiocchi G. Does sentinel node mapping impact morbidity and quality of life in endometrial cancer? Int J Gynecol Cancer 2023; 33:1548-1556. [PMID: 37699707 DOI: 10.1136/ijgc-2023-004555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer. METHODS A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Lymphedema was also assessed by clinical evaluation and perimetry. RESULTS 152 patients were included: 113 (74.3%) in the SLN group and 39 (25.7%) in the SLN+LND group. Intra-operative surgical complications occurred in 2 (1.3%) cases, and all belonged to SLN+LND group. Patients undergoing SLN+LND had higher overall complication rates than those undergoing SLN alone (33.3% vs 14.2%; p=0.011), even after adjusting for confound factors (OR=3.45, 95% CI 1.40 to 8.47; p=0.007). The SLN+LND group had longer surgical time (p=0.001) and need for admission to the intensive care unit (p=0.001). Moreover, the incidence of lymphocele was found in eight cases in the SLN+LND group (0 vs 20.5%; p<0.001). There were no differences in lymphedema rate after clinical evaluation and perimetry. However, the lymphedema score was highest when lymphedema was reported by clinical examination at 6 months (30.1 vs 7.8; p<0.001) and at 12 months (36.3 vs 6.0; p<0.001). Regarding the overall assessment of QoL, there was no difference between groups at 12 months of follow-up. CONCLUSIONS There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found in overall QoL between SLN and SLN+LND groups.
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Affiliation(s)
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Reitan Ribeiro
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
| | | | | | | | - Audrey Tieko Tsunoda
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
- HCor Oncology, Sao Paulo, Brazil
- PPGTS/Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | | | - Andre Lopes
- Department of Gynecologic Oncology, Sao Camilo Oncologia, Sao Paulo, Brazil
| | | | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Diniz TP, Menezes JN, Goncalves BT, Faloppa CC, Mantoan H, Kumagai LY, Badiglian-Filho L, Bovolim G, Guimaraes APG, De Brot L, Baiocchi G. Can mismatch repair status be added to sentinel lymph node mapping algorithm in endometrioid endometrial cancer? Gynecol Oncol 2023; 169:131-136. [PMID: 36580755 DOI: 10.1016/j.ygyno.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/17/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the relation between mismatch repair (MMR) status and the risk of lymph node metastasis in endometrial cancer, and whether this additional data can be incorporated to current SLN (sentinel lymph node) algorithm. METHODS We included a series of 332 women that underwent SLN mapping ± systematic lymphadenectomy from January 2013 to December 2021. Protein expressions of MLH1, MSH2, MSH6, PMS2 were examined by immuno-histochemistry and considered MMRd (deficient) when at least one protein was not expressed. RESULTS MMRd was noted in 20.8% of cases and correlated to grade 3 (p = 0.018) and presence of lymphovascular space invasion (p = 0.032). Moreover, MMRd was an independent risk factor for lymph node metastasis (OR 2.76, 95% CI 1.36-5.62). Notably, 21.7% (15/69) cases with MMRd had lymph node metastasis compared to 9.5% (25/263) of cases with MMRp (proficient) (p = 0.005). The overall and bilateral SLN detection rates were 91.9% and 75.9%, respectively. Of the 80 (24%) cases of non-bilateral SLN detection, 66.2% had low-grade tumors (G1/G2) and myometrial invasion <50%. Considering MMR status an independent prognostic factor for lymph node metastasis, a systematic lymphadenectomy (side specific or bilateral) would forgo in 53.7% (43/80) of cases with non-bilateral detection, representing 13% (43/332) of all endometroid tumors. CONCLUSION MMR status was independently related to lymph node metastasis in endometrioid EC. Moreover, MMR status may help to select patients that can forgo systematic lymphadenectomy in case of undetected SLN.
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Affiliation(s)
| | | | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Graziele Bovolim
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Louise De Brot
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
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Badiglian-Filho L, Baiocchi G, Baekelandt J. 10 steps to approach large ovarian masses through vNOTES. Int J Gynecol Cancer 2022; 32:ijgc-2022-003421. [PMID: 35580920 DOI: 10.1136/ijgc-2022-003421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
| | - Jan Baekelandt
- Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium
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Rodrigues Teixeira F, Vertematti de Castro V, Chaves Faloppa C, Mantoan H, Yuri Kumagai L, Narcizo Oliveira Menezes A, Badiglian-Filho L, De Brot L, Tirapelli Goncalves B, Paiva Gadelha Guimaraes A, Baiocchi G. Impact of lymph node staging in presumed early-stage ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 2022; 278:6-10. [PMID: 36108452 DOI: 10.1016/j.ejogrb.2022.08.027] [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: 04/22/2022] [Revised: 06/27/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our objective was to analyze the prevalence of lymph node metastasis in early-stage ovarian carcinoma after systematic lymph node dissection and its impact on indication of adjuvant chemotherapy. STUDY DESIGN We evaluated a series of 765 patients diagnosed with ovarian carcinoma who underwent surgical treatment from February 2007 to December 2019. Patients with peritoneal disease and incomplete surgical staging were excluded. All cases underwent systematic pelvic and para-aortic lymphadenectomy up to the renal vessels. RESULTS A total of 142 cases were analyzed. Median pelvic and para-aortic lymph node dissected were 30 (range, 6-81) and 21 (range, 3-86), respectively. Twelve (8.4%) patients had metastatic lymph nodes - high-grade serous, 10.4% (5/48); clear cell, 17.2% (5/29) and endometrioid, 5.7% (2/35). Any other histology (low grade serous, mucinous, carcinosarcoma or mixed) had lymph node metastasis. Notably, 50% of patients with positive lymph nodes had preoperative suspicious lymph nodes in imaging. The median hospital stay length was 6 days (range, 2-33) and 4.2% cases had grade ≥ 3 complications. A total of 110 (77.6%) patients underwent adjuvant chemotherapy and all cases had indication of adjuvant chemotherapy after histological type, despite the lymph node status. After a median follow-up of 52.5 months, we noted 24 (16.9%) recurrences. The 5-year recurrence-free survival and overall survival were 86.4% and 98.1%, respectively. High grade histology was the only variable that negatively impacted disease-free survival in univariate analysis [HR 4.70 (95%CI: 1.09-20); p = 0.037]. CONCLUSIONS We found a positive lymph node rate of less than 10% after lymphadenectomy in presumed early-stage ovarian carcinoma. Lymph node status was not determinant for adjuvant chemotherapy.
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Affiliation(s)
| | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | - Louise De Brot
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
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Baiocchi G, Andrade CEMC, Ribeiro R, Moretti-Marques R, Tsunoda AT, Alvarenga-Bezerra V, Lopes A, Costa RLR, Kumagai LY, Badiglian-Filho L, Faloppa CC, Mantoan H, De Brot L, Dos Reis R, Goncalves BT. Sentinel lymph node mapping versus sentinel lymph node mapping with systematic lymphadenectomy in endometrial cancer: an open-label, non-inferiority, randomized trial (ALICE trial). Int J Gynecol Cancer 2022; 32:676-679. [PMID: 35236752 DOI: 10.1136/ijgc-2022-003378] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Growing evidence suggest that sentinel lymph node (SLN) biopsy in endometrial cancer accurately detects lymph node metastasis. However, prospective randomized trials addressing the oncological outcomes of SLN biopsy in endometrial cancer without lymphadenectomy are lacking. PRIMARY OBJECTIVES The present study aims to confirm that SLN biopsy without systematic node dissection does not negatively impact oncological outcomes. STUDY HYPOTHESIS We hypothesized that there is no survival benefit in adding systematic lymphadenectomy to sentinel node mapping for endometrial cancer staging. Additionally, we aim to evaluate morbidity and impact in quality of life (QoL) after forgoing systematic lymphadenectomy. TRIAL DESIGN This is a collaborative, multicenter, open-label, non-inferiority, randomized trial. After total hysterectomy, bilateral salpingo-oophorectomy and SLN biopsy, patients will be randomized (1:1) into: (a) no further lymph node dissection or (b) systematic pelvic and para-aortic lymphadenectomy. MAJOR INCLUSION AND EXCLUSION CRITERIA Inclusion criteria are patients with high-grade histologies (endometrioid G3, serous, clear cell, and carcinosarcoma), endometrioid G1 or G2 with imaging concerning for myometrial invasion of ≥50% or cervical invasion, clinically suitable to undergo systematic lymphadenectomy. PRIMARY ENDPOINTS The primary objective is to compare 3-year disease-free survival and the secondary objectives are 5-year overall survival, morbidity, incidence of lower limb lymphedema, and QoL after SLN mapping ± systematic lymphadenectomy in high-intermediate and high-risk endometrial cancer. SAMPLE SIZE 178 participants will be randomized in this study with an estimated date for completing accrual of December 2024 and presenting results in 2027. TRIAL REGISTRATION NUMBER NCT03366051.
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Affiliation(s)
- Glauco Baiocchi
- Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Reitan Ribeiro
- Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
| | | | - Audrey Tieko Tsunoda
- Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil.,PPGTS, Universidade Positivo, Curitiba, Brazil
| | | | - Andre Lopes
- Gynecology, São Camilo Oncologia, São Paulo, Brazil
| | | | | | | | | | - Henrique Mantoan
- Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil
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Badiglian-Filho L, Fukazawa E, Baiocchi G. 238 Vnotes (vaginal – natural orifices transluminal endoscopic surgery) ovarian cystectomy guided by intraoperative ultrasound. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baiocchi G, Ribeiro R, Dos Reis R, Falcao DF, Lopes A, Costa RLR, Souza Pinto GL, de Andrade Vieira M, Kumagai LY, Faloppa CC, Mantoan H, Badiglian-Filho L, Tsunoda AT, Foiato TF, Andrade CECM, de Oliveira Palmeira L, Gonçalves BT, Zanvettor PH. ASO Visual Abstract: Open Versus Minimally Invasive Radical Hysterectomy in Cervical Cancer: The CIRCOL Group Study. Ann Surg Oncol 2021. [PMID: 34713373 DOI: 10.1245/s10434-021-10897-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Reitan Ribeiro
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Andre Lopes
- Department of Gynecologic Oncology, Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brazil
| | | | | | | | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Audrey Tieko Tsunoda
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Tariane Friedrich Foiato
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Baiocchi G, Ribeiro R, Dos Reis R, Falcao DF, Lopes A, Costa RLR, Pinto GLS, Vieira M, Kumagai LY, Faloppa CC, Mantoan H, Badiglian-Filho L, Tsunoda AT, Foiato TF, Andrade CEMC, Palmeira LO, Gonçalves BT, Zanvettor PH. Open Versus Minimally Invasive Radical Hysterectomy in Cervical Cancer: The CIRCOL Group Study. Ann Surg Oncol 2021; 29:1151-1160. [PMID: 34545531 DOI: 10.1245/s10434-021-10813-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To analyze the survival outcomes of patients in a Brazilian cohort who underwent minimally invasive surgery (MIS) compared with open surgery for early stage cervical cancer. METHODS A multicenter database was constructed, registering 1280 cervical cancer patients who had undergone radical hysterectomy from 2000 to 2019. For the final analysis, we included cases with a tumor ≤ 4 cm (stages Ia2 to Ib2, FIGO 2018) that underwent surgery from January 2007 to December 2017. Propensity score matching was also performed. RESULTS A total of 776 cases were ultimately analyzed, 526 of which were included in the propensity score matching analysis (open, n = 263; MIS, n = 263). There were 52 recurrences (9.9%), 28 (10.6%) with MIS and 24 (9.1%) with open surgery (p = 0.55); and 34 deaths were recorded, 13 (4.9%) and 21 (8.0%), respectively (p = 0.15). We noted a 3-year disease-free survival (DFS) rate of 88.2% and 90.3% for those who received MIS and open surgery, respectively (HR 1.32; 95% CI: 0.76-2.29; p = 0.31) and a 5-year overall survival (OS) rate of 91.8% and 91.1%, respectively (HR 0.80; 95% CI: 0.40-1.61; p = 0.53). There was no difference in 3-year DFS rates between open surgery and MIS for tumors ≤ 2 cm (95.7% vs. 90.8%; p = 0.16) or > 2 cm (83.9% vs. 85.4%; p = 0.77). Also, the 5-year OS between open surgery and MIS did not differ for tumors ≤ 2 cm (93.1% vs. 93.6%; p = 0.82) or > 2 cm (88.9% vs. 89.8%; p = 0.35). CONCLUSIONS Survival outcomes were similar between minimally invasive and open radical hysterectomy in this large retrospective multicenter cohort.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Reitan Ribeiro
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Andre Lopes
- Department of Gynecologic Oncology, Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brazil
| | | | | | - Marcelo Vieira
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Audrey Tieko Tsunoda
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Tariane Friedrich Foiato
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Batista T, Carneiro V, Tancredi R, Costa R, Lopes A, Sarmento B, Badiglian-Filho L, Baiocchi G, Leão C. A phase II trial of short-course Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) for high tumor burden ovarian cancer: updated report with preliminary survival outcomes. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baiocchi G, de Freitas RR, Bovolim G, Badiglian-Filho L, da Costa AABA, De Brot L. Immunohistochemical expression of ErbB/HER family proteins in patients with vulvar cancer. Int J Gynaecol Obstet 2021; 157:102-109. [PMID: 34270807 DOI: 10.1002/ijgo.13829] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the immunohistochemical (IHC) expression of the ErbB/HER family in primary vulvar squamous cell carcinoma (VSCC). METHODS We analyzed a series of 125 patients who were surgically treated for VSCC from January 1980 to June 2016. All cases had lymph node (LN) staging and 80 had LN metastasis. A tissue microarray was built for epidermal growth factor receptor (EGFR), HER2, HER3, and HER4 IHC staining. RESULTS In the primary tumor we found positive expressions for EGFR, HER2, HER3, and HER4 in 5%, 0.9%, 0.9%, and 22.8%, respectively. For the LN metastasis, expressions of EGFR and HER4 were positive in 22.2% and 39.1%, respectively. No cases had positive staining for HER2 and HER3 in the LN metastasis. For HER4, positive expression correlated with smaller tumor sizes (P = 0.02). However, positive HER4 was related to adverse prognostic factors such as: histological grade (P = 0.012), presence of lymphovascular space invasion (40.9% vs 16.2%; P = 0.035), and perineural invasion (57.1% vs 16.7%; P = 0.006). Notably, all cases with LN metastasis had positive HER4 in the primary tumor (P < 0.001). ErbB/HER family expression was not related to worse survival. CONCLUSION EGFR, HER2, and HER3 were infrequently expressed in VSCC by IHC. HER4 IHC expression was found in 22.8% of cases and was related to adverse prognostic factors.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Graziele Bovolim
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Badiglian-Filho L, Lucia Rodrigues M, Facchini Lellis R, Munaretto Timm Baiocchi J, da Silveira Nogueira Lima JP, Baiocchi G. Vaginectomy with trachelectomy followed by ileal neovagina reconstruction and uterine corpus sparing for vaginal melanoma. Int J Gynecol Cancer 2021; 31:1301-1302. [PMID: 34226243 DOI: 10.1136/ijgc-2021-002761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Monica Lucia Rodrigues
- Head and Neck Surgery and Otorhinolaryngology, ACCamargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
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Baiocchi G, Diniz TP, Bovolim G, Gonçalves BT, Kumagai LY, Mantoan H, Faloppa CC, Guimaraes APG, da Costa AABA, Badiglian-Filho L, De Brot L. Predictive Factors for Residual Disease After Conization in Cervical Cancer. Ann Surg Oncol 2021; 28:6673-6681. [PMID: 33566245 DOI: 10.1245/s10434-021-09656-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate predictive factors for the presence of residual disease after conization followed by definitive surgery in cervical cancer, and suggest a margin distance threshold that could predict residual disease. METHODS We retrospectively analyzed a series of 42 patients with early-stage cervical cancer who underwent primary conization before definitive surgical treatment from March 2009 to May 2020. All conization specimens were reviewed for endocervical, ectocervical, and radial margins. Cases with residual disease in magnetic resonance imaging before definitive surgery were excluded. RESULTS Thirty-three (78.6%) patients underwent hysterectomies and 9 (21.4%) trachelectomies ± lymph node staging. Twelve (28.6%) cases were stage IA1, 5 (11.8%) cases were stage IA2, 13 (31%) cases were stage IB1, 11 (26.2%) cases were stage IB2, and 1 (2.4%) case was stage IIIC1 [International Federation of Gynecology and Obstetrics (FIGO) 2019]. We found residual disease in 17 (40.4%) surgical specimens. Of the 20 patients with negative margins, there were still 3 (15%) cases with residual disease. Conversely, residual disease was identified in 14 (63.6%) of the 22 patients with positive cone margins (p = 0.001). Tumor size [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.02-1.33] and positive endocervical margin status (OR 33.6, 95% CI 3.85-293.3) were related to a higher risk of residual disease in multivariate analysis. Notably, all patients with tumors larger than 2 cm had residual disease, in contrast to 29.4% in lesions up to 2 cm (p = 0.002). CONCLUSION We found that tumor size and positive margin were predictive factors for residual disease. We could not suggest a reliable minimum margin distance threshold that could predict residual disease.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
| | | | - Graziele Bovolim
- Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil
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Diniz TP, Faloppa CC, Mantoan H, Gonçalves BT, Kumagai LY, Menezes ANO, Badiglian-Filho L, Guimaraes APG, da Costa AABA, De Brot L, Baiocchi G. Pathological factors associated with non-sentinel lymph node metastasis in early stage cervical cancer. J Surg Oncol 2021; 123:1115-1120. [PMID: 33524165 DOI: 10.1002/jso.26341] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze the predictive factors for non-sentinel lymph node (non-SLN) metastasis in early-stage cervical cancer. METHODS We analyzed a series of 113 patients who underwent sentinel lymph node (SLN) mapping for cervical cancer. The SLNs were examined by immunohistochemistry (IHC) when the hematoxylin-eosin stain was negative. RESULTS The overall bilateral detection rate was 81.5%, with a median of two SLNs resected. The study ultimately included 92 patients with SLNs that were mapped who had also undergone systematic pelvic lymph node dissection. Thirteen (14.1%) patients had positive SLNs, with a median of one positive SLN. Regarding the size of SLN metastasis, one (1.1%) had isolated tumor cells (ITC), seven (7.6%) had micrometastases, and five (5.4%) had macrometastases. Notably, 46.1% (6/13) had lymph node metastases detected only after IHC. Five (38.5%) cases had positive non-SLNs, with a median count of one positive lymph node. Parametrial invasion was the only risk factor for positive non-SLN (p = .045). Regarding the size of SLN metastasis, non-SLN involvement was present in the only case with ITC (1/1), 42.9% (3/7) of cases with micrometastases, and in 20% (1/5) with macrometastases. CONCLUSIONS Our data suggest that parametrial invasion correlates with the risk of non-SLN metastasis in cervical cancer.
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Affiliation(s)
- Thiago P Diniz
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Carlos C Faloppa
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Bruna T Gonçalves
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Lillian Y Kumagai
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Ademir N O Menezes
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Diniz TP, Drizlionoks E, Faloppa CC, Menezes JN, Mantoan H, Gonçalves BT, Brandao PHDM, Kumagai LY, Badiglian-Filho L, da Costa AABA, Baiocchi G. Impact of Sentinel Node Mapping in Decreasing the Risk of Lymphocele in Endometrial Cancer. Ann Surg Oncol 2020; 28:3293-3299. [PMID: 33108597 DOI: 10.1245/s10434-020-09282-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Due to the growing evidence of sentinel lymph node (SLN) mapping in endometrial cancer (EC), our aim was to evaluate the impact of SLN mapping and other clinical-pathological variables in the risk of developing lymphocele. METHODS We retrospectively analyzed a series of patients with ECs who underwent lymph node staging with SLN mapping with or without systematic pelvic ± para-aortic lymphadenectomy from November 2012 to January 2020. The lymphocele diagnosis was performed by computed tomography or magnetic resonance imaging. RESULTS Of 348 patients included, 178 underwent SLN mapping only and 170 underwent SLN mapping and systematic lymphadenectomy (46.5% pelvic only; 53.5% pelvic and para-aortic). Seventy-three (21%) patients had open surgery and 275 (79%) had a minimally invasive approach. After a median follow-up of 25.4 months, the overall prevalence of lymphocele was 8.6% (n = 30), with 29 cases in a pelvic location. Lymphocele was found in 3.4% (n = 6/178) of patients submitted to SLN mapping only, compared with 14.1% (n = 24/170) among those who underwent SLN with lymphadenectomy (p = 0.009). Among those patients with lymphocele, seven (23.3%) were symptomatic and five (16.6%) required drainage. All symptomatic cases occurred in lymphoceles larger than 4 cm (p = 0.001). Neither resected lymph node count nor the type of systematic lymphadenectomy were related to the presence of lymphocele. Systematic lymphadenectomy was the only factor that emerged as a risk factor for the presence of lymphocele in multivariate analysis (odds ratio 3.68, 95% confidence interval 1.39-9.79; p = 0.009). CONCLUSIONS Our data suggest that SLN mapping independently decreases the risk of lymphocele formation compared with full lymphadenectomy in EC.
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Affiliation(s)
| | - Eric Drizlionoks
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | | | | | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
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Lustosa RJC, Batista TP, Carneiro VCG, Badiglian-Filho L, Costa RLÚR, Lopes A, Sarmento BJDEQ, Lima JTDEO, Mello MJGDE, LeÃo CS. Quality of life in a phase 2 trial of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) at interval debulking surgery for high tumor burden ovarian cancer. ACTA ACUST UNITED AC 2020; 47:e20202534. [PMID: 32667582 DOI: 10.1590/0100-6991e-20202534] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/27/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION to evaluate the effect of short-course (i.e.: 30 minutes) HIPEC on health-related quality of life (HRQoL) in our feasibility study; NCT02249013. METHODS a prespecified secondary end-point of our open-label, multicenter, single-arm, phase 2 trial on safety and efficacy was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0). Patients were required to complete the HRQoL questionnaire at baseline, after HIPEC, and after the end of the treatment. Changes of HRQoL over time were assessed by median scores for each domain and analyzed by Friedman`s test at a significant two-sided level of 0.05. RESULTS fifteen patients with high tumor burden EOC were recruited from our public health system between February 2015 and July 2019. A baseline EORTC QLQ-C30 questionnaire and at least one follow-up questionnaire was received from all of the patients. No significant difference over time in the QLQC30 summary scores was observed (p>0.05). The transitory impairment on patients HRQoL immediately after the short-course HIPEC trended to return to baseline at the end of the multimodal treatment. CONCLUSIONS we found no significant impairment of short-course HIPEC on patients HRQoL into the context of our comprehensive treatment protocol.
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Affiliation(s)
- Roberto JosÉ Costa Lustosa
- Departamento de Cirurgia, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Thales Paulo Batista
- Departamento de Cirurgia, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - VandrÉ Cabral Gomes Carneiro
- Departamento de Cirurgia / Oncologia, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | | | | | - AndrÉ Lopes
- Departamento de Ginecologia, Instituto Brasileiro de Controle do Câncer, São Paulo, SP, Brasil
| | | | | | | | - Cristiano Souza LeÃo
- Departamento de Cirurgia, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
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Badiglian-Filho L, Fukazawa EM, Faloppa C, Baiocchi G. Ovarian sparing cystectomy for borderline serous tumor through vNOTES (vaginal Natural Orifices Transluminal Endoscopic Surgery). Int J Gynecol Cancer 2020; 30:1253-1254. [PMID: 32624499 DOI: 10.1136/ijgc-2020-001513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Carlos Faloppa
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, São Paulo, Brazil
| | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, São Paulo, Brazil
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Badiglian-Filho L, Menezes ANDO, Faloppa CC, Fukazawa EM, Mantoan H, Kumagai LY, Baiocchi G. Intraoperative Ultrasound Leads to Conservative Management of Benign Ovarian Tumors: A Retrospective, Single-Center Study. Rev Bras Ginecol Obstet 2019; 41:673-678. [PMID: 31745961 PMCID: PMC10316794 DOI: 10.1055/s-0039-1698774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate whether the use of intraoperative ultrasound leads to more conservative surgeries for benign ovarian tumors. METHODS Women who underwent surgery between 2007 and 2017 for benign ovarian tumors were retrospectively analyzed. The women were classified into two groups: those who underwent intraoperative ultrasound (group A) and those who did not (group B). In group A, minimally-invasive surgery was performed for most patients (a specific laparoscopic ultrasound probe was used), and four patients were submitted to laparotomy (a linear ultrasound probe was used). The primary endpoint was ovarian sparing surgery (oophoroplasty). RESULTS Among the 82 cases identified, only 36 met the inclusion criteria for the present study. Out of these cases, 25 underwent intraoperative ultrasound, and 11 did not. There were no significant differences in arterial hypertension, diabetes, smoking history, and body mass index for the two groups (p = 0.450). Tumor diameter was also similar for both groups, ranging from 1 cm to 11 cm in group A and from 1.3 cm to 10 cm in group B (p = 0.594). Tumor histology confirmed mature teratomas for all of the cases in group B and for 68.0% of the cases in group A. When the intraoperative ultrasound was performed, a more conservative surgery was performed (p < 0.001). CONCLUSION The use of intraoperative ultrasound resulted in more conservative surgeries for the resection of benign ovarian tumors at our center.
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Affiliation(s)
- Levon Badiglian-Filho
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | - Carlos Chaves Faloppa
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Elza Mieko Fukazawa
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Henrique Mantoan
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Lillian Yuri Kumagai
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
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Baiocchi G, Mantoan H, Gonçalves BT, Faloppa CC, Kumagai LY, Badiglian-Filho L, da Costa AABA, De Brot L. Size of Sentinel Node Metastasis Predicts Non-sentinel Node Involvement in Endometrial Cancer. Ann Surg Oncol 2019; 27:1589-1594. [DOI: 10.1245/s10434-019-08045-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Indexed: 01/01/2023]
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Baiocchi G, Drizlionoks E, Brandao P, Mantoan H, Kumagai L, Badiglian-Filho L, Faloppa C. What are the risk factors for lymphocyst formation after endometrial cancer staging? Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Batista TP, Carneiro VCG, Tancredi R, Teles ALB, Badiglian-Filho L, Leão CS. Neoadjuvant chemotherapy followed by fast-track cytoreductive surgery plus short-course hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: preliminary results of a promising all-in-one approach. Cancer Manag Res 2017; 9:869-878. [PMID: 29263704 PMCID: PMC5732565 DOI: 10.2147/cmar.s153327] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose Hyperthermic intraperitoneal chemotherapy (HIPEC) has been considered a promising treatment option for advanced or recurrent ovarian cancer, but there is no clear evidence based on randomized controlled trials to advocate this approach as a standard therapy. In this study, we aim to present the early outcomes and insights after an interim analysis of a pioneering clinical trial in Brazil. Methods This study was a cross-sectional analysis of early data from our ongoing clinical trial – an open-label, double-center, single-arm trial on the safety and efficacy of using HIPEC for advanced ovarian cancer (ClinicalTrials.gov: NCT02249013). A fast-track recovery strategy was also applied to improve patient outcomes. Results Nine patients with stage IIIB (n=1) or IIIC (n=8) epithelial malignancies were enrolled until February 2017. The median (range) serum CA125 level at diagnosis was 692 (223.7–6550) U/mL. The median number of preoperative cycles of intravenous (i.v.) chemotherapy was 3 (2–4), resulting in peritoneal cancer index scores of 9 (3–18) at the time of HIPEC. Time of restarting i.v. chemotherapy was 37 (33–50) days with all patients completing 6 cycles as planned. The median operation time was 395 (235–760) minutes, the length of hospital stay was 4 (3–10) days, and all the patients left the ICU on the morning after the procedure. Two patients experienced no postoperative complications, whereas 91% of the complications were minor G1/G2 events. Preliminary assessment also suggested no impairment of the patient’s quality of life. Conclusion Our comprehensive protocol might represent a promising all-in-one approach for advanced ovarian cancer. The patient recruitment for this trial is ongoing.
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Affiliation(s)
- Thales Paulo Batista
- Department of Surgery/Oncology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira.,Department of Surgery, UFPE - Universidade Federal de Pernambuco
| | - Vandré Cabral G Carneiro
- Department of Surgery/Oncology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira.,Department of Gynecology, HCP - Hospital de Câncer de Pernambuco
| | - Rodrigo Tancredi
- Department of Clinical Oncology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira.,Department of Clinical Oncology, HCP - Hospital de Câncer de Pernambuco
| | - Ana Ligia Bezerra Teles
- Department of Anaesthesiology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Recife
| | | | - Cristiano Souza Leão
- Department of Surgery, IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
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Baiocchi G, Mantoan H, Kumagai LY, Gonçalves BT, Badiglian-Filho L, de Oliveira Menezes AN, Faloppa CC, De Brot L, da Costa AABA. The Impact of Sentinel Node-Mapping in Staging High-Risk Endometrial Cancer. Ann Surg Oncol 2017; 24:3981-3987. [PMID: 29058141 DOI: 10.1245/s10434-017-6132-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to determine the impact of sentinel lymph node (SLN)-mapping on the staging of high-risk endometrial cancer (endometrioid grade 3, serous, clear cell, carcinosarcoma, deep myometrial invasion, or angiolymphatic invasion). METHODS The study analyzed a series of 236 patients treated at AC Camargo Cancer Center from June 2007 to February 2017. The compared 75 patients who underwent SLN-mapping (SLN group) with 161 patients who received pelvic ± para-aortic lymphadenectomy (N-SLN group). Patients with adnexal, peritoneal, or suspicious node metastases were excluded from the study. RESULTS The groups did not differ in terms of age, histologic type, or presence of deep myometrial invasion. The overall detection rate for SLNs was 85.3%, and bilateral SLNs were observed in 60% of the patients. Of 20 positive SLNs, 8 (40%) were detected only after immunohistochemistry (IHC). The findings showed an overall sensitivity of 90%, a negative predictive value of 95.7%, and a false-negative predictive value of 4.3%. The SLN group had more pelvic node metastases detected than the N-SLN group (26.7 vs 14.3%; p = 0.02). However, the rate of para-aortic node metastases did not differ between the two groups (13.5 vs 5.6%; p = 0.12). Five patients (3.5%) in the N-SLN group had isolated para-aortic node metastases versus none in the patients with SLN mapped. Additionally, the SLN group received more adjuvant chemotherapy (48 vs 33.5%; p = 0.03). CONCLUSIONS The data suggest that SLN-mapping identifies more pelvic node metastases than lymph node dissection alone and increases the node detection rate by 12.5% after IHC. Furthermore, no isolated para-aortic node metastases are observed when SLN is detected.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
| | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | | | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Baiocchi G, Mantoan H, Kumagai L, Faloppa C, Badiglian-Filho L, Costa A, De Brot L. Is sentinel node mapping in cervical cancer cost effective? Beyond the detection of node metastasis. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baiocchi G, Faloppa CC, Mantoan H, Camarço WR, Badiglian-Filho L, Kumagai LY, De Brot L, da Costa AABA. Para-aortic lymphadenectomy can be omitted in most endometrial cancer patients at risk of lymph node metastasis. J Surg Oncol 2017; 116:220-226. [DOI: 10.1002/jso.24651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology; AC Camargo Cancer Center; Sao Paulo Brazil
| | | | - Henrique Mantoan
- Department of Gynecologic Oncology; AC Camargo Cancer Center; Sao Paulo Brazil
| | | | | | | | - Louise De Brot
- Department of Anatomic Pathology; AC Camargo Cancer Center; Sao Paulo Brazil
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Baiocchi G, Begnami MD, Chen MJ, Fukazawa EM, Badiglian-Filho L, Pellizzon ACA, Soares FA, Lopes A. HER-2 Expression and Response to Radiotherapy in Patients with Advanced Cervical Cancer. J Reprod Med 2017; 62:234-240. [PMID: 30027715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Glauco Baiocchi, M.D., Ph.D., Maria Dirlei Begnami, M.D., Ph.D., Michael Jenwei Chen, M.D., Elza Mieko Fukazawa, M.D., Ph.D., Levon Badiglian-Filho, M.D., Ph.D., Antonio Cassio Assis Pellizzon, M.D., Ph.D., Fernando Augusto Soares, M.D., Ph.D., and Ademar Lopes, M.D., Ph.D. OBJECTIVE: To evaluate HER-2 expression as a predictor of the response to radiotherapy and its value as a prognostic marker. STUDY DESIGN: A retrospective analysis was performed in a series of 34 individuals with advanced stage cervical cancer who underwent radiotherapy followed by radical hysterectomy. HER-2 expression was measured by immunohistochemistry in biopsies from all patients prior to radiotherapy and in 14 patients with residual tumors after radiotherapy. The presence of gene amplification was also examined. RESULTS: Eighteen (53%) patients had residual disease after radical hysterectomy. HER-2 was expressed in 26.5% of cases. Gene amplification by FISH was detected in 2.9% of cases. HER-2 expression was associated with a higher risk of residual disease after radiotherapy (p= 0.019). HER-2 expression did not correlate with the risk of recurrence or death. CONCLUSION: The prevalence of HER-2 expression is low in cervical cancer, and although HER-2 can predict the response to radiotherapy, it does not correlate with poor outcomes.
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Baiocchi G, de Brot L, Faloppa CC, Mantoan H, Duque MR, Badiglian-Filho L, da Costa AABA, Kumagai LY. Is parametrectomy always necessary in early-stage cervical cancer? Gynecol Oncol 2017; 146:16-19. [PMID: 28392128 DOI: 10.1016/j.ygyno.2017.03.514] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 02/14/2017] [Revised: 03/15/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Increasing data suggest that patients with early-stage cervical cancer and favorable pathological characteristics have a low risk of parametrial invasion (PI) and benefit from less radical surgery. Our aim was to evaluate the clinical-pathological factors that are related to PI and identify a group of patients who are at low risk for PI. METHODS We analyzed a series of 345 patients with stage Ia2 to Ib2 cervical cancer, for which they underwent radical surgery from January 1990 to October 2016 at AC Camargo Cancer Center. Chi-square and Fisher's exact tests were used to analyze the correlations between PI and clinicopathological variables. RESULTS A total of 217 (62.9%) patients were classified as having squamous cell carcinoma, and 128(37.1%) had adenocarcinoma or adenosquamous carcinoma. Sixteen (4.6%) patients had PI. The presence of perineural invasion (p=0.003), tumor size >2cm (p=0.044), depth of invasion >10mm (p=0.004), the presence of lymphovascular space invasion(LVSI) (p<0.001), and lymph node metastasis (p<0.001) were related to PI. However, only LVSI (p=0.043) and lymph node metastasis (p<0.001) remained risk factors for PI in the multivariate analysis. Of the patients with tumors ≤2cm and no LVSI, only 1(1.2%) had PI; however, this patient had lymph node metastasis and deep stromal invasion (>10mm). No patient with tumor size ≤2cm and negative lymph nodes had PI. CONCLUSIONS Patients with tumors ≤2cm and those who lack LVSI are unlikely to have PI, unless lymph node metastasis or deep stromal invasion is present. Our data can help select patients in whom a more conservative approach is warranted, such as simple hysterectomy and simple trachelectomy that is associated with pelvic lymphadenectomy.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
| | - Louise de Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Baiocchi G, Faloppa C, Mantoan H, Camarco W, Kumagai L, De Brot L, Costa A, Badiglian-Filho L. Prognostic factors in stage IIIC endometrial cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baiocchi G, Mantoan H, Kumagai L, Badiglian-Filho L, Faloppa C, De Brot L, Costa A, Menezes A, Fukazawa E. Sentinel node mapping in endometrial cancer: A Brazilian cancer center experience. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mantoan H, Baiocchi G, Kumagai L, Badiglian-Filho L, Faloppa C, De Brot L, Costa A, Menezes A, Fukazawa E. Endometrial evaluation in adult granulosa cell tumors: Is it really necessary? Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baiocchi G, Mantoan H, de Brot L, Badiglian-Filho L, Kumagai LY, Faloppa CC, da Costa AABA. How important is the pathological margin distance in vulvar cancer? Eur J Surg Oncol 2015; 41:1653-8. [PMID: 26507171 DOI: 10.1016/j.ejso.2015.09.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 08/18/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The ideal pathological margin in vulvar squamous cell carcinoma (VSCC) is still debated. Our aim was to analyze the value of tumor-free pathological margin distance with regard to local recurrence in VSCC. METHODS We analyzed a series of 205 patients who were treated for VSCC from January 1980 to November 2007. Patients were categorized into 3 groups, based on pathological free margin (PFM): <3 mm (n = 18); ≥3 and <8 mm (n = 61); and ≥8 mm (n = 126). RESULTS The median age was 69 years. The median PFM was 10 mm (range: 1-65). Of 168 patients who underwent lymphadenectomy, 64 (38.1%) developed LN metastasis. After a median follow-up of 36.2 months, 78 (38%) cases recurred-47 (60.2%) experienced a local recurrence (LR). LR occurred in 16.7% of patients with a PFM of <3 mm, 24.6% with a PFM ≥3 and <8 mm, and 22.2% of those with a PFM ≥8 mm (p = 0.77). PFM did not correlate with LR when analyzed continuously (p = 0.98). The 5-year disease-free survival (DFS) for LR was 79.6%. Margin distance did not negatively impact DFS (p = 0.94); the presence of perineural invasion was the only variable that negatively influenced DFS (p = 0.009). CONCLUSIONS Although our results suggest no correlation between LR and pathological margin distance, the tumor-free resection margin remains significant with regard to locoregional control in vulvar cancer. A more conservative surgical approach may be considered in certain situations, such as margins near the clitoris, urethra, and anus.
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Affiliation(s)
- G Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
| | - H Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - L de Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - L Badiglian-Filho
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - L Y Kumagai
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - C C Faloppa
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - A A B A da Costa
- Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Baiocchi G, Faloppa C, Camarco W, Badiglian-Filho L, Mantoan H, Kumagai L, Fukazawa E, De Brot L, Costa A. Prognostic factors for paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baiocchi G, Faloppa C, Oliveira R, Kumagai L, Mantoan H, Badiglian-Filho L, Costa A, Guimaraes G. Patterns of recurrence after pelvic exenteration for cervical and vaginal cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baiocchi G, Costa A, Amorim C, Saito A, Mantoan H, Faloppa C, Kumagai L, Badiglian-Filho L, Guimaraes A, Sanches S. Prognostic factors in recurrent epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baiocchi G, Kumagai L, Mantoan H, Badiglian-Filho L, Faloppa C, Fukazawa E, De Brot L, Costa A. Is parametrectomy in early stage cervical cancer always necessary? Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baiocchi G, Costa A, Amorim C, Mantoan H, Saito A, Kumagai L, Faloppa C, Badiglian-Filho L, Sanches S, Guimaraes A. Prognostic factors after secondary cytoreducton in epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Faloppa CC, Baiocchi G, Cunha IW, Fregnani JHTG, Osorio CABT, Fukazawa EM, Kumagai LY, Badiglian-Filho L, Pinto GLS, Soares FA. NF-κB and COX-2 expression in nonmalignant endometrial lesions and cancer. Am J Clin Pathol 2014; 141:196-203. [PMID: 24436266 DOI: 10.1309/ajcpv7u7pghoweqg] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To examine the immunohistochemical expression of cyclooxygenase-2 (COX-2) and nuclear factor-κB (NF-κB) in benign endometrial polyps (EPs), endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN), and endometrioid endometrial cancer (EC). METHODS The immunohistochemical expression of COX-2 and NF-κB was performed using an Aperio Scanscope XT automated system in 218 patients with endometrioid EC and 107 patients with nonmalignant endometrial lesions: 53 with benign EPs, 37 with EH, and 17 with EIN. RESULTS COX-2 and NF-κB p50 expression were significantly lower in EC compared with nonmalignant lesions. We observed significant decreased NF-κB p65 expression in EC vs EPs (P < .001) and EH (P = .014) as well as in EIN vs. EPs (P = .01). For patients with EC, COX-2 correlated positively with NF-κB p65 and NF-κB p50 (P < .001). Grade 3 tumors had a higher mean expression of NF-κB p65 (P = .03). NF-κB p50, NF-κB p65, and COX-2 expression had no impact on survival. CONCLUSIONS We conclude that COX-2 and NF-κB expression are lower in EC compared with nonmalignant endometrial lesions. COX-2 and NF-κB expression have no prognostic value in EC.
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Affiliation(s)
| | - Glauco Baiocchi
- Departments of Gynecologic Oncology, AC Camargo Cancer Hospital, São Paulo, Brazil
| | | | | | | | - Elza Mieko Fukazawa
- Departments of Gynecologic Oncology, AC Camargo Cancer Hospital, São Paulo, Brazil
| | - Lillian Yuri Kumagai
- Departments of Gynecologic Oncology, AC Camargo Cancer Hospital, São Paulo, Brazil
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Baiocchi G, Silva Cestari F, Rocha R, Lavorato-Rocha A, Maia B, Cestari L, Kumagai L, Faloppa C, Fukazawa E, Badiglian-Filho L, Sant'Ana Rodrigues I, Soares F. Prognostic value of the number and laterality of metastatic inguinal lymph nodes in vulvar cancer: Revisiting the FIGO staging system. Eur J Surg Oncol 2013; 39:780-5. [DOI: 10.1016/j.ejso.2013.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/25/2013] [Accepted: 03/04/2013] [Indexed: 11/28/2022] Open
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Baiocchi G, Macedo M, Badiglian-Filho L, De Brot L, Faloppa C, Fukazawa E, Kumagai L, Osorio C. Prognostic value of positive cytology in endometrial cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baiocchi G, Silva Cestari F, Rocha R, Faloppa C, Kumagai L, Fukazawa E, Badiglian-Filho L, Cestari L, Sant’Ana Rodrigues I, Lavorato-Rocha A, Maia B, Soares F. Does the count after inguinofemoral lymphadenectomy in vulvar cancer correlate with outcome? Eur J Surg Oncol 2013; 39:339-43. [DOI: 10.1016/j.ejso.2013.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/09/2013] [Accepted: 02/01/2013] [Indexed: 11/28/2022] Open
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Baiocchi G, Begnami MD, Fukazawa EM, Oliveira RAR, Faloppa CC, Kumagai LY, Badiglian-Filho L, Pellizzon ACA, Maia MAC, Jacinto AA, Soares FA, Lopes A. Prognostic value of nuclear factor κ B expression in patients with advanced cervical cancer undergoing radiation therapy followed by hysterectomy. J Clin Pathol 2012; 65:614-8. [DOI: 10.1136/jclinpath-2011-200599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AimsThe nuclear factor κ B (NF-κB) family comprises transcription factors that promote the development and progression of cancer. The NF-κB pathway is induced by radiation therapy and may be related to tumour radioresistance. The aim of this study was to evaluate the expression of NF-κB as a predictor of the response to radiotherapy and its value as a prognostic marker.MethodsA retrospective analysis was performed in a series of 32 individuals with stage IB2 and IIB cervical cancer who underwent radiotherapy, followed by radical hysterectomy, from January 1992 to June 2001. NF-κB-p65 and NF-κB-p50 expression was examined by immunohistochemistry in biopsies from all patients before radiotherapy and in 12 patients with residual tumours after radiotherapy.Results16 (50%) patients had residual disease after radical hysterectomy. The median follow-up time was 73.5 months, and the 5-year overall survival was 66.5%. Before radiotherapy, cytoplasmic expression of NF-κB-p65 and NF-κB-p50 was noted in 91% and 97% of cases, respectively, versus 59% of cases with nuclear expression of these subunits. Cytoplasmic expression of NF-κB-p65 and NF-κB-p50 in the residual tumours after radiotherapy was observed in 50% of cases; 75% of cases with residual tumours had nuclear expression of NF-κB-p50 versus none with NF-κB-p65. NF-κB-p65 and NF-κB-p50 did not correlate with the risk of residual tumours after radiotherapy or recurrence or death.ConclusionsThese data suggest that NF-κB does not predict the response to radiotherapy and does not correlate with poor outcomes in advanced cervical cancer.
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Badiglian-Filho L, Baiocchi G, Faloppa CC, Fukazawa EM, Kumagai LY, de Oliveira RAR. Intraoperative ultrasound for benign cystic teratoma. Report of two cases. Arch Gynecol Obstet 2011; 285:705-7. [PMID: 21830006 DOI: 10.1007/s00404-011-2042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Teratoma is one of the most common ovarian neoplasms and frequently leads to laparoscopic surgical procedure. When this tumor is small and the ovarian surface seems regular during the surgery, it is difficult to localize the tumor. METHODS We used a standard transvaginal ultrasound probe during the procedure and filled the pelvic cavity with saline solution of 0.9% in order to create an interface between the saline solution and the surgical instruments. RESULTS We could localize the teratoma with confidence and precision, allowing to perform a sparing surgery. CONCLUSION This is a simple, secure and efficient technique that can be performed in most of the institutions.
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Affiliation(s)
- Levon Badiglian-Filho
- Department of Gynecology, Hospital AC Camargo, Rua Prof. Antonio Prudente, 211, Sao Paulo, SP 01509-010, Brazil.
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Baiocchi G, Cestari LA, Macedo MP, Oliveira RAR, Fukazawa EM, Faloppa CC, Kumagai LY, Badiglian-Filho L, Menezes ANO, Cunha IW, Soares FA. Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection. J Surg Oncol 2011; 104:250-4. [DOI: 10.1002/jso.21940] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/17/2011] [Indexed: 11/06/2022]
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Baiocchi G, Faloppa CC, Araujo RLC, Fukazawa EM, Kumagai LY, Menezes ANO, Badiglian-Filho L. Chylous ascites in gynecologic malignancies: cases report and literature review. Arch Gynecol Obstet 2009; 281:677-81. [PMID: 19685063 DOI: 10.1007/s00404-009-1211-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 08/04/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE Chylous ascites is an infrequent postoperative complication after retroperitoneal surgical procedure. Despite its infrequent occurrence, postoperative chylous ascites are associated with significant morbidity. Reports of chylous ascites or fistula after retroperitoneal lymph node dissection for gynecologic malignancies without radiation therapy are rare. A search in the English literature showed only 31 cases of chylous fistula for gynecologic malignancies. Treatment may be conservative with low-fat oral diet with medium-chain triglycerides associated or not to octreotide and total parenteral nutrition. In case of conservative measures failure, it can be managed by surgical intervention or peritoneo-venous shunt. METHODS We report two cases of chylous fistula following systematic pelvic and retroperitoneal lymph node dissection for gynecological cancer without radiotherapy and review the literature. RESULTS Both were successfully managed with the maintenance of the postoperative drain, total parenteral nutrition, octreotide and dietary intervention. CONCLUSIONS Chylous ascites should be included in differential diagnosis of abdominal distention after surgical retroperitoneal approach or radiotherapy. Most of the patients may have their chylous ascites successfully treated with conservative management. However, the best policy is to prevent chylous complications by employing meticulous dissection techniques and careful control of the major lymphatics by suture ligation during the primary surgical intervention.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, Hospital do Câncer AC Camargo, Rua Antonio Prudente 211, São Paulo, Brazil.
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