1
|
Trelis Blanes A, Lago Leal V, Padilla Iserte P, Pérez Martínez R, Belloch Ripollés V, Matute L, Gurrea M, Cardenas Rebollo JM, Domingo Del Pozo S. Optimal cytoreduction: is a CT's picture worth a surgeon's word? Surg Oncol 2023; 49:101948. [PMID: 37210893 DOI: 10.1016/j.suronc.2023.101948] [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: 11/22/2022] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The presence of residual disease after cytoreductive surgery is subjectively determined by the surgeon at the end of the operation. Nevertheless, in up to 21-49% of CT scans, residual disease can be found. The aim of this study was to establish the relationship between post-surgical CT findings after optimal cytoreduction in patients with advanced ovarian cancer and oncological outcome. MATERIAL AND METHODS Patients with advanced ovarian cancer (FIGO II and IV), diagnosed between 2007 and 2019 in Hospital La Fe Valencia, in whom cytoreductive surgery was performed, achieving R0 or R1, were assessed for eligibility (n = 440). A total of 323 patients were excluded because a post-operative CT scan was not performed between the third and eighth post-surgery week and prior to the start of chemotherapy. RESULTS 117 patients were finally included. The CT findings were classified into three categories: no evidence, suspicious or conclusive of residual tumour/progressive disease. 29.9% of CT scans were "conclusive of residual tumour/progressive disease". No differences were found when the DFS (p = 0.158) and OS (p = 0.215) of the three groups were compared (p = 0.158). CONCLUSION After cytoreduction in ovarian cancer with no macroscopic disease or residual tumour < 1 cm result, up to 29.9% of post-operative CT scans before chemotherapy found measurable residual or progressive disease. Notwithstanding, a worse DFS or OS was not associated with this group of patients.
Collapse
Affiliation(s)
- Alexandra Trelis Blanes
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain; Department of Obstetrics and Gynecology, Hospital Virgen de los Lirios, Alcoy, Spain
| | - Víctor Lago Leal
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain; CEU Cardenal Herrera, Valencia, Spain.
| | | | | | | | - Luis Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Marta Gurrea
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | | | | |
Collapse
|
2
|
Abstract
Congenital high airway obstruction syndrome (CHAOS) is a rare sequence due to a complete obstruction of the fetal airway that blocks the larynx or trachea, either intrinsic atresia or extrinsic compression (e.g., congenital neck mass). Despite the true incidence of CHAOS is unknown, an incidence of 1 per 50,000 newborns is described. If any obstruction occurs in the tracheobronchial airway, this secretion cannot be extricated. Because of this situation, a knock-on effect starts: the enlargement of the lungs squeezes the heart and great veins, what results in a replacement of the heart to the center of the chest becoming small and dysfunctional. Decreased venous return and the failure of cardiovascular system end in ascites and hydrops. The diaphragm planes or inverts according to the severity of the process. In case of unrecognized syndrome during the prenatal period, it usually results in stillbirth or death shortly after delivery. The overall prognosis remains fatal, and long-term medical and surgical challenges for survivors remain considerable even after overcoming fetal intervention.
Collapse
Affiliation(s)
- Víctor Lago Leal
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Luis Martínez Cortés
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Carlos Seco Del Cacho
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Getafe, Madrid, Spain
| |
Collapse
|
3
|
Lago Leal V, Pamplona Bueno L, Cabanillas Vilaplana L, Nicolás Montero E, Martín Blanco M, Fernández Romero C, El Bakkali S, Pradillo Aramendi T, Sobrino Lorenzano L, Castellano Esparza P, Ballesteros Benito E, Rayo Navarro N, Del Barrio Fernández P, Ocaña Martínez V, Martínez Cortés L. Effect of Milking Maneuver in Preterm Infants: A Randomized Controlled Trial. Fetal Diagn Ther 2018; 45:57-61. [PMID: 29506014 DOI: 10.1159/000485654] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.
Collapse
Affiliation(s)
- Víctor Lago Leal
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Madrid, Spain.,European University of Madrid, Madrid, Spain
| | | | | | | | - Mónica Martín Blanco
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Madrid, Spain
| | | | - Sara El Bakkali
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Madrid, Spain
| | | | | | | | | | - Nieves Rayo Navarro
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Madrid, Spain
| | | | - Vanesa Ocaña Martínez
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Madrid, Spain
| | - Luis Martínez Cortés
- Department of Obstetrics and Gynecology, University Hospital of Getafe, Madrid, Spain
| |
Collapse
|