1
|
Lago V, Arnaez M, Padilla-Iserte P, Guijarro-Campillo AR, Matute L, Gurrea M, Bello P, Domingo S. Alternatives of the pelvic sentinel lymph node migration pathway in early ovarian cancer: the simplest the best. Int J Gynecol Cancer 2024; 34:639-640. [PMID: 37945057 DOI: 10.1136/ijgc-2023-004912] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Victor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Comunitat Valenciana, Spain
| | - Marta Arnaez
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Luis Matute
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Marta Gurrea
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Bello
- Department of Nuclear Medicine, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|
2
|
Guijarro-Campillo AR, Padilla-Iserte P, Couso B, Erasun D, Utrilla-Layna J, Arencibia O, Boldo-Roda A, Gilabert-Estellés J, Veiga N, Lago V, Cárdenas-Rebollo JM, Domingo S. Accuracy of ICG compared with technetium-99 m for sentinel lymph node biopsy in vulvar cancer. Eur J Obstet Gynecol Reprod Biol 2024; 294:11-19. [PMID: 38183845 DOI: 10.1016/j.ejogrb.2023.12.037] [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: 05/18/2023] [Revised: 11/08/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Sentinel lymph node biopsy with radioactive tracer is the standard-of-care in lymph node status assessment in vulvar cancer. Indocyanine green fluorescence-ICG is a promising detection method, due to its advantages over technetium-99 m. In vulvar cancer, the procedure is controversial due to study heterogeneity and the small sample size in previous studies. This study evaluates ICG sentinel lymph node detection compared with the criterion-standard with technetium (dual modality method). METHODS Preoperative technetium and intraoperative ICG for sentinel lymph node have been prospectively evaluated in early-stage vulvar cancer. The primary endpoint was to determine accuracy in the detection rate for ICG compared with technetium. Secondary objectives included tracer modality relationship with obesity, tumor size and location. RESULTS In total, 75 patients participated at 8 centers; 38 had lateral and 37 had midline vulvar tumors. The overall sentinel lymph node detection rate was 85.3 % for technetium and 82.7 % for ICG. For lateral tumors, the detection rate was 84.2 % vs. 89.5 %, while it was 86.5 % vs. 75.7 % for middle tumors, using technetium and ICG, respectively. The median sentinel node harvest was 1.7 (range 1-4), with 24 % metastatic involvement. The sensitivity and positive predictive value for ICG based on the standard technique with technetium was 91.08 % (95 % CI, 83.76-95.84) and 94.8 % (95 % CI, 84.84-96.48), respectively. No significant differences were found comparing the two tracers in patients with midline lesions, obesity (body mass index ≥ 30) and tumor size ≥ 2-4 cm. CONCLUSION(S) ICG shows comparable performance parameters to the gold-standard of radioisotope localization.
Collapse
Affiliation(s)
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Bárbara Couso
- Department of Obstetrics and Gynecology, University Hospital of Ourense, Spain
| | - Diego Erasun
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Octavio Arencibia
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ana Boldo-Roda
- Department of Obstetrics and Gynecology, University Hospital La Plana, Villareal, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, University of Valencia, Spain
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|
3
|
Guijarro-Campillo AR, Lago V, Pous-Serrano S, Domingo S. Conservative management of burst adbomen after interval cytoreduction surgery of ovarian carcinosarcoma. Int J Gynecol Cancer 2024:ijgc-2023-005013. [PMID: 38326227 DOI: 10.1136/ijgc-2023-005013] [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: 02/09/2024] Open
Affiliation(s)
| | - Victor Lago
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- CEU Cardenal Herrera University Library, Moncada, Comunidad Valenciana, Spain
| | | | - Santiago Domingo
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|
4
|
Lago V, Guijarro-Campillo AR, Vidal BS, Padilla-Iserte P, Matute L, Álvarez JAP, Del Pozo SD. An Easy Learning Approach to a Complex Surgical Technique: A Step-by-Step Site-Relapse Lateral Extended Endopelvic Resection (LEER). Ann Surg Oncol 2023; 30:4991-4993. [PMID: 37273023 DOI: 10.1245/s10434-023-13368-9] [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: 02/07/2023] [Accepted: 03/06/2023] [Indexed: 06/06/2023]
Abstract
Lateral pelvic sidewall involvement by gynecological tumors has been considered traditionally an absolute contraindication to curative resection.1 Moreover, the involvement of the pelvic sidewall at the time of relapse in cervical cancer after primary or adjuvant pelvic radiation occurs in 8.3% of patients.2,3 Laterally extended endopelvic resection (LEER), based on the ontogenetic compartment theory, provides a potential surgical option for patients for whom palliative therapy is the only alternative.4 This complex and ultraradical, surgical technique allows a high rate of complete resection in more than 70% of patients with gynecological cancers and lateral pelvic sidewall involvement. An adequate selection of patients and a deep knowledge of pelvic anatomy are crucial to obtain acceptable morbimortality rates and improved overall survival in this population.5 To deconstruct this complex procedure, we show a detailed step-by-step technique to facilitate the easy learning curve of this surgical technique. We review the Höckel original technique with different site-relapse adapted steps. We provide a pedagogical high-quality video (Video 1) and anatomical outline drawings (Fig. 1) to understand lateral pelvic wall anatomy and standardize this surgical technique. Our purpose is to bring this knowledge to gynecologists and pelvic surgeons in which pelvic lateral approach may be useful beyond gynecological oncologic surgery (Table 1).
Collapse
Affiliation(s)
- Víctor Lago
- Universitary and Polytecnic Hospital La Fé, Valencia, Spain
| | | | | | | | - Luis Matute
- Universitary and Polytecnic Hospital La Fé, Valencia, Spain
| | | | | |
Collapse
|
5
|
Guijarro-Campillo AR, Segarra Vidal B, Lago V, Padilla-Iserte P, Hernández Chinchilla JA, Martín-González I, Domingo Del Pozo S. Low-grade endometrial stromal sarcoma with intravenous thrombus extension: a multidisciplinary surgical challenge. J Gynecol Oncol 2023; 34:e21. [PMID: 36562130 PMCID: PMC9995862 DOI: 10.3802/jgo.2023.34.e21] [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: 08/24/2022] [Revised: 10/13/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Low-grade endometrial stromal sarcoma (LG-ESS) usually exhibits indolent behavior, often misdiagnosed and is associated with a favorable prognosis [1]. Despite the indolent nature of LG-ESS, recurrence is common, the risk is as high as 1 in 3 to 1 in 2 [2]. The behavior of such tumors can lead to invade blood vessels [3]. An intravascular tumor is associated with direct risk of sudden death from pulmonary embolism. There are very few reported cases with clinically obvious intravascular extension. Chemotherapy, radiotherapy and hormone therapy are adjuvant treatments that have not been able to demonstrate a definitive benefit in survival [4]. We want to take advantage of the opportunity, so far unpublished, to demonstrate with this case the surgical challenge described step by step, as well as to demonstrate the importance of surgery as the only curative treatment even in extended intravascular disease [5]. Here in, we present the surgical challenge of a LG-ESS in a 59-year old woman with iliac and cava vein tumoral thrombus extension. We performed a tumoral thrombectomy and vascular repair, with a pelvic exenteration and double barrel wet colostomy. After performing pelvic exenteration, the thrombus with intravascular involvement was addressed at 2 points: inferior cava vein and right common iliac vein with the extraction of the entire thrombus. These defects are corrected by angioplasty and venorrhaphy, respectively. The surgery got a complete cytoreduction. It lasted 290 minutes, with 430 mL blood loss. In patients with LG-ESS, cytoreduction is a reliable option even in extended metastatic disease.
Collapse
Affiliation(s)
| | - Blanca Segarra Vidal
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Víctor Lago
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Padilla-Iserte
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Iván Martín-González
- Department of Vascular Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | |
Collapse
|
6
|
Guijarro-Campillo AR, Kumar V, Patil J, Janna R, Domingo S. Modified Martius technique for complex vesicovaginal fistula repair. Int J Gynecol Cancer 2023:ijgc-2022-004131. [PMID: 36650012 DOI: 10.1136/ijgc-2022-004131] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Veerendra Kumar
- Department of Obstetrics and Gynecology, Kalyandurg Hospital, Kalyandurg, Andra Pradesh, India
| | - Jayaprakash Patil
- Department of Obstetrics and Gynecology, Kalyandurg Hospital, Kalyandurg, Andra Pradesh, India
| | - Rakesh Janna
- Department of Urology, Bellary Medical College, Bellary, Karnataka, India
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Department of Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|