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Boeckhoff J, terGlane L, Wagner UAG, Hofmann R, Hegele A. Interdisciplinary surgery for advanced gynecologic malignancies: Outcome and complication rate. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17002 Background: Advanced gynecologic malignancies are known to have a poor prognosis. Due to local invasion in adjacent organs, finding the most suitable therapeutic option is often difficult. This study aims to assess the outcome of interdisciplinary surgery for locally advanced gynecologic malignancies focusing on women treated by pelvic exenteration (PE). Methods: All women that were treated with PE at the University Hospital Marburg between 04/2011 and 06/2016, were enrolled in this retrospective study. A data sheet was prepared assessing e.g. demographic informations, tumor type and previous therapies. Furthermore, complication rate (Clavien Dindo, follow-up and outcome were evaluated. Results: From the 57 women identified, the indications for PE were malignancies of the cervix (47.2%), vagina (15.1%), vulva (13.2%), endometrium (11.3%), ovaries (5.7%) and undifferentiated (uterus) (1.9%). 51.9% were treated for recurrent cancer. 26% received no treatment prior to PE, 16%, 38%, 20% received 1, 2 or 3 previous treatments respectively (chemotherapy, radiation, surgery). 54.7% of the patients underwent anterior, 37.8% total and 7.5% posterior PE. Urinary diversion was predominantly ileum conduit (76%). Major complications (Clavien Dindo > 2) were observed for 40.4%, 19.2% had no complications. No correlation with clinical parameters (e.g. BMI, age, time of surgery), previous therapy or urinary diversion could be shown. Renal function improved significantly postoperatively (p < 0.05). Mean hospital stay was 25 d. Median overall survival (OS) was 15.2 months. It was not influenced by the entity of the tumor. Two years survival rate (SR) was 38.2%; 3 years SR 27.3%. After 47 months median follow-up time, 23.7% of the treated women were still alive. Conclusions: PE remains to be a meaningful treatment option for women with invasive gynecologic malignancies also after multiple previous therapies, showing acceptable complication rates and satisfactory OS in regard to the extensive nature of the malignancies and the procedure.
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Affiliation(s)
- Jelena Boeckhoff
- Clinic for Gynecology, Gynecological Oncology and Gynecological Endocrinology, University Hospital Marburg, Marburg, Germany
| | - Luisa terGlane
- Department of Urology, Philipps University Marburg, Marburg, Germany
| | - Uwe A. G. Wagner
- Clinic for Gynecology, Gynecological Oncology and Gynecological Endocrinology, University Hospital Marburg, Marburg, Germany
| | - Rainer Hofmann
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Axel Hegele
- Department of Urology and Pediatric Urology, University of Marburg, Marburg, Germany
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Hasenburg A, Sehouli J, Lampe B, Reuss A, Schmalfeldt B, Belau AK, Bossart M, Mahner S, Hillemanns P, Petry KU, Du Bois A, Herwig U, Hilpert F, Gropp-Meier M, Hanf V, Janni W, Greimel E, Wagner UAG, Harter P. LION-PAW: Lymphadenectomy in ovarian neoplasm-pleasure ability of women—Prospective substudy of the randomized multicenter LION study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Boern Lampe
- AGO and Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Alexander Reuss
- AGO and Coordinating Center for Clinical Trials, Marburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Muenchen, Germany, Muenchen, Germany
| | - Antje Kristina Belau
- Ernst Moritz Arndt Universität Greifswald - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | | | - Sven Mahner
- Ludwig-Maximilians-Universität München and University Medical Center Hamburg-Eppendorf, Germany, Munich, Germany
| | - Peter Hillemanns
- Hannover Medical School, Department of Obstetrics and Gynecology, Breast Center, Hannover, Germany
| | | | | | - Uwe Herwig
- Albertinen-Krankenhaus, Hamburg, Germany
| | - Felix Hilpert
- Onkologisches Therapiezentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | | | - Volker Hanf
- Department of Gynecology, Fuerth Hospital, Fuerth, Germany
| | | | - Elfriede Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Harter P, Sehouli J, Lorusso D, Reuss A, Vergote I, Marth C, Kim JW, Raspagliesi F, Lampe B, Landoni F, Meier W, Cibula D, Mustea A, Mahner S, Runnebaum IB, Schmalfeldt B, Burges A, Kimmig R, Wagner UAG, Du Bois A. LION: Lymphadenectomy in ovarian neoplasms—A prospective randomized AGO study group led gynecologic cancer intergroup trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5500] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5500 Background: So far, there is no level-1 evidence regarding the role of systematic pelvic and para-aortic lymphadenectomy (LNE) in patients with advanced ovarian cancer (AOC) with macroscopic complete resection und clinically negative lymph nodes (LN). Therefore, surgical management regarding LNE worldwide is very heterogeneous. Methods: Prospective randomized trial including patients with newly diagnosed AOC FIGO IIB-IV with macroscopic complete resection and pre- and intra-operatively clinical negative LN were randomized intra-operatively to LNE versus no-LNE. All centers had to qualify regarding surgical skills before participation in this trial. The primary endpoint was overall survival. Results: 647 patients were randomized between 12/08 and 1/12 to LNE (n=323) or no-LNE (n=324). The median number of removed LN in patients randomized to LNE was 57 (pelvic 35 and para-aortic22). Post-op platinum-taxane based chemotherapy was applied in 85% of the patients in the no-LNE arm and 80% in the LNE arm. Microscopic metastases were diagnosed in 56% of the pts in the LNE arm. Median OS in the no-LNE arm was 69 months and 66 months in the LNE arm (HR 1.06, 95%CI 0.83-1.34, p=0.65) and the median PFS was 26 months in both arms (HR 1.11, 95%CI 0.92-1.34 p=0.30). Surgery in the LNE arm was 64 minutes longer (means: 352 vs 288 min), resulted in a higher median blood loss (650 vs 500 ml), and a higher transfusion rate (67% vs 59%). Furthermore, serious post-operative complications occurred more frequently in the LNE arm (e.g. rate of re-laparotomies 12.1% vs 5.9% [p=0.006], hospital re-admittance rate 8.0% vs 3.1% [p=0.006] and deaths within 60 days after surgery 3.1 vs 0.9% [p=0.049]). Conclusions: Systematic pelvic and para-aortic LNE in patients with AOC with both intra-abdominal complete resection and clinically negative LN neither improve overall nor progression-free survival despite detecting (and removing) sub-clinical retroperitoneal lymph node metastases in 56% of the patients. Our data indicate that systematic LNE of clinical negative LN in patients with AOC and complete resection should be omitted to reduce post-operative morbidity and mortality. Clinical trial information: NCT00712218.
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Affiliation(s)
| | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Domenica Lorusso
- MITO and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Alexander Reuss
- AGO and Coordinating Center for Clinical Trials, Marburg, Germany
| | - Ignace Vergote
- BGOG and University of Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Christian Marth
- AGO-A and Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Jae Weon Kim
- KGOG and Seoul National University, Seoul, Korea South
| | | | - Boern Lampe
- AGO and Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Fabio Landoni
- MaNGO and Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - Werner Meier
- AGO and Frauenklinik, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany
| | - David Cibula
- AGO and Oncogynecological Centre, Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic
| | - Alexander Mustea
- AGO and University Medicine Greifswald, Department of Gynaecology and Obstetrics, Greifswald, Germany
| | - Sven Mahner
- AGO and University of Munich, Munich, Germany
| | | | - Barbara Schmalfeldt
- AGO and Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Burges
- AGO and Department of Gynecology, University Hospital Munich-Großhadern, Munich, Germany
| | - Rainer Kimmig
- AGO and Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
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Pignata S, Scambia G, Raspagliesi F, Murgia V, Pisano C, Salutari V, Bologna A, Sorio R, Ferrandina G, Sacco C, Vergote I, Cormio G, Breda E, Cinieri S, Cecere SC, Wagner UAG, Daniele G, Gallo C, Perrone F, Piccirillo MC. The MITO8 phase III international multicenter randomized study testing the effect on survival of prolonging platinum-free interval (PFI) in patients with ovarian cancer (OC) recurring between 6 and 12 months after previous platinum-based chemotherapy: A collaboration of MITO, MANGO, AGO, BGOG, ENGOT, and GCIG. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sandro Pignata
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, IRCCS, Napoli, Italy
| | - Giovanni Scambia
- Universita Cattolica del Sacro Cuore di Roma, Unità di Ginecologia Oncologica UOC, Rome, Italy
| | | | | | - Carmela Pisano
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, IRCCS, Napoli, Italy
| | - Vanda Salutari
- Universita Cattolica del Sacro Cuore di Roma, Unità di Ginecologia Oncologica UOC, Rome, Italy
| | - Alessandra Bologna
- Medical Oncology Unit, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Roberto Sorio
- Centro di Riferimento Oncologico-IRCCS, Aviano, Italy
| | - Gabriella Ferrandina
- Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Cosimo Sacco
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria S. M. della Misericordia, Udine, Italy
| | | | | | - Enrico Breda
- S. Giovanni Calibita- Fatebenefratelli Hospital, Roma, Italy
| | | | - Sabrina Chiara Cecere
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, IRCCS, Napoli, Italy
| | | | - Gennaro Daniele
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, IRCCS, Napoli, Italy
| | | | - Francesco Perrone
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, IRCCS, Napoli, Italy
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