Objective.Panniculectomy has been used to facilitate pelvic surgery i n obese w omen. The goal of this study was to determine the effect of panniculectomy on st aging adequacy and lymph node yield in obese women with ...Objective.Panniculectomy has been used to facilitate pelvic surgery i n obese w omen. The goal of this study was to determine the effect of panniculectomy on st aging adequacy and lymph node yield in obese women with endometrial carcinoma un dergoing staging laparotomy. Methods. A retrospective review of patients with endometrial neoplasms who underwent pann iculectomy at the time of hysterectomy was performed. For each subject, two cont rol patients were matched by body mass index (BMI). Results. Twenty-seven endom etrial cancer patients who underwent panniculectomy at the time of staging were identified. Panniculectomy was successfully performed in all 27 patients. While the mean number of pelvic nodes was statistically similar between the two groups (16.2 vs. 13.7)-(P = 0.199), the paraaortic node count was higher in patients who underwent panniculectomy (4.3 vs. 2.9) (P = 0.032). A paraaortic node dissec tion was not feasible in 3 (11.1%) of the panniculectomy patients and in 11 (20 .4%) of the controls (P = 0.365). There were no differences in intraoperative o r postoperative complications or in survival between the two groups. Conclusion. Among obese women with endometrial cancer, panniculectomy is well tolerated, fe asible, and associated with acceptable morbidity. While the clinical significanc e of an increased paraaortic node count is uncertain, our findings suggest that panniculectomy may enhance operative exposure and facilitate endometrial cancer staging.展开更多
Objective:The purpose of this study was to investigate the safety and efficacy of alvimopan,a novel peripherally acting mu-opioid receptor antagonist,in patients who undergo simple total abdominal hysterectomy. Study ...Objective:The purpose of this study was to investigate the safety and efficacy of alvimopan,a novel peripherally acting mu-opioid receptor antagonist,in patients who undergo simple total abdominal hysterectomy. Study design:Women (n = 519)-were randomized (4:1) to receive alvimopan 12 mg (n = 413) or placebo (n = 106)≥2 hours before the operation then twice daily for 7 days (hospital and home). Adverse events were monitored up to 30 days after the last dose of study drug was administered. Efficacy was assessed for 7 postoperative days. Results:Overall,the most common adverse events were nausea,vomiting,and constipation; < 5%of patients discontinued use because of adverse events. Alvimopan significantly accelerated the time to first bowel movement (hazard ratio,2.33; P < .001). Average time to first bowel movement was reduced by 22 hours,with more frequent bowel movement and better bowel movement quality found in the treatment cohort. Conclusion:Alvimopan has a safety profile that is similar to that of placebo and provides significantly improved lower gastrointestinal recovery in women who undergo simple total abdominal hysterectomy.展开更多
Vulvar carcinoma is rare in the premenopausal age group. The incidence during pregnancy is even more uncommon. To date, no cases of recurrent vulvar carcinoma in pregnancy have been reported. We describe the first cas...Vulvar carcinoma is rare in the premenopausal age group. The incidence during pregnancy is even more uncommon. To date, no cases of recurrent vulvar carcinoma in pregnancy have been reported. We describe the first case of recurrent vulvar carcinoma during the same pregnancy. A 36- year- old G5P4004 presented with vulvar pain at 18 weeks of pregnancy. She had a 2.2- cm tender mass anterior to the left labium majus, of which a biopsy revealed invasive squamous cell carcinoma. At 23 weeks gestation, she underwent a modified radical vulvectomy and bilateral inguinofemoral lymph node dissection. Eleven weeks later, she complained of a newly tender area to the right of the clitoris. A biopsy at that time demonstrated predominantly severe vulvar intraepithelial neoplasia (VIN III) with a small focus of invasive squamous cell carcinoma. A radical local excision was performed at 9 weeks postpartum. Careful surveillance is warranted as squamous cell carcinoma recurrence can occur quickly in the setting of pregnancy.展开更多
文摘Objective.Panniculectomy has been used to facilitate pelvic surgery i n obese w omen. The goal of this study was to determine the effect of panniculectomy on st aging adequacy and lymph node yield in obese women with endometrial carcinoma un dergoing staging laparotomy. Methods. A retrospective review of patients with endometrial neoplasms who underwent pann iculectomy at the time of hysterectomy was performed. For each subject, two cont rol patients were matched by body mass index (BMI). Results. Twenty-seven endom etrial cancer patients who underwent panniculectomy at the time of staging were identified. Panniculectomy was successfully performed in all 27 patients. While the mean number of pelvic nodes was statistically similar between the two groups (16.2 vs. 13.7)-(P = 0.199), the paraaortic node count was higher in patients who underwent panniculectomy (4.3 vs. 2.9) (P = 0.032). A paraaortic node dissec tion was not feasible in 3 (11.1%) of the panniculectomy patients and in 11 (20 .4%) of the controls (P = 0.365). There were no differences in intraoperative o r postoperative complications or in survival between the two groups. Conclusion. Among obese women with endometrial cancer, panniculectomy is well tolerated, fe asible, and associated with acceptable morbidity. While the clinical significanc e of an increased paraaortic node count is uncertain, our findings suggest that panniculectomy may enhance operative exposure and facilitate endometrial cancer staging.
文摘Objective:The purpose of this study was to investigate the safety and efficacy of alvimopan,a novel peripherally acting mu-opioid receptor antagonist,in patients who undergo simple total abdominal hysterectomy. Study design:Women (n = 519)-were randomized (4:1) to receive alvimopan 12 mg (n = 413) or placebo (n = 106)≥2 hours before the operation then twice daily for 7 days (hospital and home). Adverse events were monitored up to 30 days after the last dose of study drug was administered. Efficacy was assessed for 7 postoperative days. Results:Overall,the most common adverse events were nausea,vomiting,and constipation; < 5%of patients discontinued use because of adverse events. Alvimopan significantly accelerated the time to first bowel movement (hazard ratio,2.33; P < .001). Average time to first bowel movement was reduced by 22 hours,with more frequent bowel movement and better bowel movement quality found in the treatment cohort. Conclusion:Alvimopan has a safety profile that is similar to that of placebo and provides significantly improved lower gastrointestinal recovery in women who undergo simple total abdominal hysterectomy.
文摘Vulvar carcinoma is rare in the premenopausal age group. The incidence during pregnancy is even more uncommon. To date, no cases of recurrent vulvar carcinoma in pregnancy have been reported. We describe the first case of recurrent vulvar carcinoma during the same pregnancy. A 36- year- old G5P4004 presented with vulvar pain at 18 weeks of pregnancy. She had a 2.2- cm tender mass anterior to the left labium majus, of which a biopsy revealed invasive squamous cell carcinoma. At 23 weeks gestation, she underwent a modified radical vulvectomy and bilateral inguinofemoral lymph node dissection. Eleven weeks later, she complained of a newly tender area to the right of the clitoris. A biopsy at that time demonstrated predominantly severe vulvar intraepithelial neoplasia (VIN III) with a small focus of invasive squamous cell carcinoma. A radical local excision was performed at 9 weeks postpartum. Careful surveillance is warranted as squamous cell carcinoma recurrence can occur quickly in the setting of pregnancy.