Objective. To investigate whether laparoscopy can be considered as adequate and reliable as standard laparotomy in predicting optimal cytoreduction (RT ≤ .1 cm) in patients with advanced ovarian cancer. Methods. From...Objective. To investigate whether laparoscopy can be considered as adequate and reliable as standard laparotomy in predicting optimal cytoreduction (RT ≤ .1 cm) in patients with advanced ovarian cancer. Methods. From March to November 2003, 95 patients with suspected advanced ovarian or peritoneal cancer have been evaluated. Thirty- one cases were excluded due to an anesthesiological class of risk ASA III- IV (51.6% ) and for the presence of a large size mass reaching the xiphoid (48.4% ). Sixty- four patients completed the study. All patients were submitted to preoperative clinico- radiological evaluation and then to both laparoscopy and standard longitudinal laparotomy, sequentially. Some specific preoperatively defined parameters were analyzed during each procedure in order to obtain the most accurate evaluation on the possibility to get an optimal cytoreduction. Results. The overall accuracy rate of laparoscopy in assessing optimal cytoreduction was 90% .The negative predictive value (NPV) of the clinical- radio- logic evaluation corresponded to 73% , whereas in no case was the judgment of unresectable disease obtained by laparoscopy changed by the laparotomic approach (NPV 100% ). On the contrary, an optimal debulking was achievable in 34 of 39 cases (87% ) selected as completely resectable by explorative laparoscopy. Conclusions. Laparoscopy can be considered super imposable to standard longitudinal laparotomy in identifying not optimally resectable advanced ovarian cancer patients.展开更多
Background: Considering the enormous advantages of minimally invasive surgery, attempts to explore less invasive trans-abdominal incisions could represent an alternative to laparoscopic gynecologic surgery. The aim of...Background: Considering the enormous advantages of minimally invasive surgery, attempts to explore less invasive trans-abdominal incisions could represent an alternative to laparoscopic gynecologic surgery. The aim of this study was to assess the feasibility and clinical outcome of minilaparotomy in a large series of patients. Methods: In this retrospective study we describe our 6-year experience on 252 patients undergoing surgery by minilaparotomy for benign adnexal or uterine disease. Surgical treatments included total abdominal hysterectomy, myomectomy, mono or bilateral salpingo-oophorectomy and adnexal surgery. Results: The mean population age and BMI were 39.2 years (±13.2 S.D.) and 23.6 (±3.31 S.D.), respectively. The mean operative time was 75.4 min (±31.8) and the estimated blood loss was never significant except in two cases (0.8%). The mean duration of ileus was 1.58 days (±0.6 S.D.) and the mean days until discharge were 3.06 (±1.14 S.D.), with a significantly lower duration of recovery in the group of simple adnexal surgery with respect to the others (P = 0.0001). No severe early post-operative morbidity was observed. Conclusions: The current report describes minilaparotomy as a feasible surgical approach in benign gynecological diseases. The operative time is quite similar or shorter than reported for laparoscopy, laparotomy and vaginal surgery. The estimated blood loss is not significant as well as the duration of the ileus and discharge. Moreover, a prospective randomised study, already ongoing in our department, will better answer the question of whether minilaparotomy could be an alternative to laparoscopic and vaginal surgery.展开更多
文摘Objective. To investigate whether laparoscopy can be considered as adequate and reliable as standard laparotomy in predicting optimal cytoreduction (RT ≤ .1 cm) in patients with advanced ovarian cancer. Methods. From March to November 2003, 95 patients with suspected advanced ovarian or peritoneal cancer have been evaluated. Thirty- one cases were excluded due to an anesthesiological class of risk ASA III- IV (51.6% ) and for the presence of a large size mass reaching the xiphoid (48.4% ). Sixty- four patients completed the study. All patients were submitted to preoperative clinico- radiological evaluation and then to both laparoscopy and standard longitudinal laparotomy, sequentially. Some specific preoperatively defined parameters were analyzed during each procedure in order to obtain the most accurate evaluation on the possibility to get an optimal cytoreduction. Results. The overall accuracy rate of laparoscopy in assessing optimal cytoreduction was 90% .The negative predictive value (NPV) of the clinical- radio- logic evaluation corresponded to 73% , whereas in no case was the judgment of unresectable disease obtained by laparoscopy changed by the laparotomic approach (NPV 100% ). On the contrary, an optimal debulking was achievable in 34 of 39 cases (87% ) selected as completely resectable by explorative laparoscopy. Conclusions. Laparoscopy can be considered super imposable to standard longitudinal laparotomy in identifying not optimally resectable advanced ovarian cancer patients.
文摘Background: Considering the enormous advantages of minimally invasive surgery, attempts to explore less invasive trans-abdominal incisions could represent an alternative to laparoscopic gynecologic surgery. The aim of this study was to assess the feasibility and clinical outcome of minilaparotomy in a large series of patients. Methods: In this retrospective study we describe our 6-year experience on 252 patients undergoing surgery by minilaparotomy for benign adnexal or uterine disease. Surgical treatments included total abdominal hysterectomy, myomectomy, mono or bilateral salpingo-oophorectomy and adnexal surgery. Results: The mean population age and BMI were 39.2 years (±13.2 S.D.) and 23.6 (±3.31 S.D.), respectively. The mean operative time was 75.4 min (±31.8) and the estimated blood loss was never significant except in two cases (0.8%). The mean duration of ileus was 1.58 days (±0.6 S.D.) and the mean days until discharge were 3.06 (±1.14 S.D.), with a significantly lower duration of recovery in the group of simple adnexal surgery with respect to the others (P = 0.0001). No severe early post-operative morbidity was observed. Conclusions: The current report describes minilaparotomy as a feasible surgical approach in benign gynecological diseases. The operative time is quite similar or shorter than reported for laparoscopy, laparotomy and vaginal surgery. The estimated blood loss is not significant as well as the duration of the ileus and discharge. Moreover, a prospective randomised study, already ongoing in our department, will better answer the question of whether minilaparotomy could be an alternative to laparoscopic and vaginal surgery.
