The objective of this study was to evaluate the role of laparoscopy in selecting candidates for complete cytoreduction surgery in epithelial ovarian carcinoma. We performed an explorative laparoscopy ...in 15 women presenting with advanced ovarian carcinoma, and for whom the preoperative evaluation was considered unsatisfactory, to define the possibility of achieving a complete cytoreduction. We focused on three sites of carcinomatosis: bowel, liver pedicle, and right diaphragmatic dome. Laparoscopic evaluation was successful in all 15 patients. Four patients were considered to have unresectable carcinomatosis because of extensive involvement of the small bowel and therefore had no laparotomy. These women underwent neoadjuvant chemotherapy in the following 2 weeks. Eleven patients were considered to have resectable peritoneal carcinomatosis (PC). Ten women had no macroscopic residual tumor after surgery. A modified posterior exenteration was performed in five patients. The laparoscopic exploration had underestimated the liver pedicle involvement in two patients, but only one had an infracentimetric residual tumor after surgery. Laparoscopy is a reliable method of exploring PC in advanced-stage ovarian cancer. Laparoscopy may obviate the need for unnecessary laparotomy in many cases and may, therefore, contribute to a better quality of life for patients found to have unresectable disease.
Background: The aim of this study was to determine the prognostic factors for patients with advanced stage, low malignant potential ovarian tumour (LMPOT). Patients and methods: A retrospective ...review of 80 patients with serous LMPOT and peritoneal implants treated at or referred to our institution was carried out. Results: Sixty-five patients had non-invasive implants. Fifteen patients had invasive implants. Twenty-nine patients had stage II and 51 patients had stage III disease. Three patients died of evolutive invasive disease and four of complications of treatment. The only prognostic factor of progression to ‘evolutive invasive disease’ is the pathologic subtype of peritoneal implants. The 5-year rates of evolutive invasive disease in patients with non-invasive implants and invasive implants were 2% and 31%, respectively (P <0.002). Conclusions: In this series, the only prognostic factor for patients with advanced stage borderline tumour is the type of peritoneal implant. More patients died of the treatment’s complications than of the disease itself. The patients’ prognosis with non-invasive implants seems to be excellent, and conservative management could be discussed in younger patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Initial debulking surgery followed by chemotherapy is the current treatment for International Federation of Gynecology and Obstetrics Stage IIIC/IV ovarian carcinoma but has a limited efficacy when ...optimal cytoreduction is not achieved at the end of the surgical procedure. An alternative treatment for these patients could be neoadjuvant chemotherapy. The purpose of this retrospective study was to report the results of neoadjuvant chemotherapy in operable patients (no medical contraindication to surgery) presenting with primary unresectable tumors.
Between January 1996 and March 1999, operable patients presenting with Stage IIIC or IV ovarian carcinoma underwent, in six French gynecologic oncology departments, surgical staging to evaluate tumor resectability. When the tumor was deemed unresectable by standard surgery, the patient received three to six cycles of platinum-based neoadjuvant chemotherapy according to the response and the center's usual protocol. Patients were surgically explored after completion of neoadjuvant chemotherapy when the tumor did not progress during treatment. Debulking was performed during this secondary surgery when a response to chemotherapy was observed.
Fifty-four patients were treated by neoadjuvant chemotherapy. The first surgical staging procedure was laparoscopy in 33 patients (61%) and laparotomy in 21 patients (39%). The median number of neoadjuvant chemotherapy cycles was 4 (range, 0-6). Forty-three patients (80%) responded to neoadjuvant chemotherapy and then tumors were debulked. Optimal cytoreduction was obtained in 39 patients (91% of the patients who underwent debulking) and with standard surgery in 32 patients (82%). For patients whose tumors were optimally debulked, blood transfusions were administered to 17 patients (43%), median intensive care unit stay was 0 days (range, 0-7 days), and median postoperative hospital stay was 10 days (range, 4-62 days). Median overall survival for the total series was 22 months. Survival was better for patients debulked after neoadjuvant chemotherapy compared with patients with nondebulked tumors (P < 0.001).
Neoadjuvant chemotherapy for primary unresectable ovarian carcinoma leads to the selection of a subset of patients sensitive to chemotherapy in whom optimal cytoreduction can be achieved after chemotherapy by standard surgery in a high proportion of cases. Conversely, aggressive surgery can be avoided in patients with initial chemoresistance, in whom the prognosis is known to be poor regardless of treatment.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background: The aim of this study was to assess clinical outcome after laparoscopic treatment of borderline ovarian tumor (BOT). Patients and methods: Thirty-four patients treated initially and/or ...for recurrent disease using a laparoscopic approach for BOT from 1984 to January 2002. Results: Thirty-four patients underwent laparoscopic pure treatment (without conversion by laparotomy and/or reassessment surgery by laparotomy) for BOT. Conservative treatment was performed in 31 (91%) patients. Median follow-up time was 45 months (range 6–228). Six (17%) patients recurred (in the remaining ovary following conservative surgery in five patients and in the peritoneum in one patient). Two port-site metastases were observed. None of the patients had recurrent disease in the form of ovarian carcinoma. Nine spontaneous pregnancies were observed in six patients from a group of 15 patients desiring pregnancy. All patients are alive today and disease-free. Conclusion: These results seem to demonstrate that laparoscopic treatment can be safely performed in young patients with early stage BOT. Such a procedure is then feasible, but should be evaluated in patients with BOT and peritoneal implants.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background. To determine the feasibility of a laparoscopic hand-assisted Miami Pouch following a laparoscopic anterior pelvic exenteration.
Case. We performed a laparoscopic hand-assisted Miami Pouch ...following a laparoscopic anterior pelvic exenteration. The procedure involved resection of the bladder, uterus, ovaries, and upper vagina en bloc and the formation of a “Miami Pouch” for continent urinary diversion. The procedure was successful. The operative time was 6 h. The postoperative course was uneventful.
Conclusion. Laparoscopic hand-assisted Miami Pouch following laparoscopic anterior pelvic exenteration is feasible.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background: Our aim was to study the prognostic value of the presence of lymphovascular space invasion (LVSI) in patients with stage IB and II cervical carcinoma treated by initial surgery. Patients ...and methods: A retrospective analysis was performed on 193 patients who underwent, between 1985 and 1998, an initial radical hysterectomy with pelvic (± para-aortic) lymphadenectomy using midline laparotomy for stage IB (180 patients) or II (13 patients) cervical carcinoma. Postoperative therapy was delivered according to prognostic factors. Results: The rate of LVSI correlated significantly with tumor stage, nodal status and the location of positive nodes. Using univariate analysis, tumor size (<4 or ≥4 cm), LVS status and nodal status were prognostic factors. At multivariate analysis, two prognostic factors were identified: LVS status and nodal status. In a subgroup of 89 patients with a small tumor (≤2 cm) and absence of nodal or isthmic involvement, the overall survival was significantly correlated with the presence of LVSI. Conclusions: LVSI is a frequent occurrence in patients with early stage cervical cancer. It represents an unfavorable prognostic factor in univariate and multivariate analyses. Such results suggest that improvement is needed in the treatment of patients with a small tumor and LVS invasion.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Contexte. –
Depuis 1998, date de la parution des premières recommandations, plus de 2500 références sur ce sujet ont été publiées.
Méthodologie. –
Un groupe d'experts réunis à la demande du ministère ...de la Santé a rédigé un premier document. Cinq autres experts ont par la suite analysé de manière critique le premier document qui a ainsi bénéficié de leurs remarques.
Évolutions principales. –
La part attribuable aux mutations délétères constitutionnelles dans les cancers du sein et de l'ovaire est actuellement estimée à environ 5 %. L'efficacité du dépistage par imagerie du cancer du sein est probable et pourrait à l'avenir bénéficier de protocoles fondés sur l'IRM. L'impact du dépistage du cancer de l'ovaire est plus discutable. L'efficacité de la chirurgie prophylactique a été confirmée et quantifiée. La réduction probable de fréquence de cancer du sein en cas d'ovariectomie pour les femmes
BRCA1+ augmente encore l'impact de cette intervention. Ainsi, la chirurgie prophylactique sous réserve d'une qualité de vie post-intervention compatible avec le niveau de protection attendu peut être médicalement recommandée en respectant une liste de critères définis.
Conclusions principales. –
Du fait des limites méthodologiques, d'effectifs parfois insuffisants observés dans les études et du manque de recul, ces positions ne peuvent néanmoins prétendre à une stabilité importante.
Background. –
Since the last recommendations, up to 2500 new references had been published on that topic.
Methodology. –
On the behalf of the health Minister, the Ad Hoc Committee consisted of 13 experts carried out a first version revisited by five additional experts who critically analyzed the first version of the report.
Main updating. –
Breast and ovarian cancer seem to be associated with fewer deleterious mutations of
BRCA1 and
BRCA2 than previously thought. The screening of ovarian cancer is still not an attractive option while in contrast MRI may be soon for these young women with dense breast, the recommended option for breast cancer screening. The effectiveness of prophylactic surgeries is now well established. French position is to favor such surgeries with regard to a quality of life in line with the expected benefit, and providing precise and standardized process described in the recommendation.
Conclusions. –
Due to methodological flaws, the low power and a short follow-up of the surveys, this statement cannot however aspire to a high stability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Laparoscopy classically reduces morbidity and invasiveness. To decrease the operative morbidity associated with exenteration, we considered the possibility of performing a total pelvic exenteration ...by the laparoscopic approach.
A 34-year-old woman presented with a cervical cancer relapse. The bladder, uterus, vagina, ovaries, and rectum were mobilized en bloc from the pelvic sidewall. We used vascular endoscopic staplers for the control of sigmoid vessels and anterior branches of internal iliac vessels. The specimen was removed through the vulva. A colo-anal anastomosis and an ileal-loop conduit for urinary tract diversion were made. The operative time was 9 h. The postoperative course was uneventful. Specimen margins were free of disease.
With laparoscopic surgical knowledge and new endoscopic staplers, laparoscopic pelvic exenteration procedure is feasible.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background: The aim of this study was to determine the value of routine follow-up for the detection of recurrence in patients treated for cervical cancer. Patients and methods: From 1986 to 1998, 583 ...women with stage I and II cervical carcinoma were treated with combined surgery–radiation therapy. After treatment, follow-up was based on clinical examination, a systematic Pap smear and radiography (chest X-ray and abdomino-pelvic ultrasonography). Results: Forty-five patients had recurrence observed with a delay ≥6 months following the end of treatment. Thirty-eight patients had symptoms and seven were asymptomatic at the time of their recurrence. Among asymptomatic patients only two recurrences were diagnosed following routine examinations. Survival is similar in asymptomatic and symptomatic recurrent patients. Conclusions: In conclusion, follow-up of patients treated for cervical cancer based on routine Pap smears and systematic radiography does not permit earlier detection of recurrence and does not increase survival.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: To study the results of interval debulking surgery (IDS) in patients treated for ‘unresectable’ advanced stage ovarian cancer compared with primary debulking surgery (PDS) followed by ...chemotherapy. Patients and methods: An exposed–non-exposed study including a group of 34 patients who underwent an IDS and were matched to an historic control group of 34 patients treated with PDS. Results: Optimal cytoreductive surgery was achieved in 94% (32 out of 34) of patients in both groups. The rates of post-operative morbidity, blood transfusion and median length of hospitalisation were significantly reduced in the study (IDS) group, but survival did not differ in both groups. Conclusions: IDS in patients with advanced stage ovarian cancer offers the same chance of survival as PDS, but it is better tolerated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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