Objectives. To determine the incidence and prognostic implications of positive mesorectal lymph nodes in patients undergoing total pelvic exenteration for recurrent gynecologic malignancies. Methods. We performed a re...Objectives. To determine the incidence and prognostic implications of positive mesorectal lymph nodes in patients undergoing total pelvic exenteration for recurrent gynecologic malignancies. Methods. We performed a retrospective chart review of all patients who had undergone total pelvic exenteration for a gynecologic malignancy between July 1992 and December 2003. Patient charts were reviewed for information regarding demographics, site of cancer, histology, pathology report, and time to recurrence. Results. Fifty-eight women had undergone total pelvic exenteration for recurrent gynecologic malignancies during the study period and 57 were available for analysis. Primary cancer site was as follows: cervix, 37 (65% ); vagina, 8 (14% ); vulva, 5 (9% ); and uterine corpus, 7 (12% ). In 30 patients (53% ), the mesorectal lymph node status was pathologically evaluated. Of these 30 patients, 3 (10% ) had positive mesorectal lymph nodes at the time of total pelvic exenteration. All 3 patients had rectal wall involvement (rectal submucosa, 2; rectal mucosa, 1), and all 3 patients recurred within 4 months of pelvic exenteration. The median time to recurrence after surgery was 2.4 months in those patients with positive mesorectal lymph nodes compared with 7.3 months in those with negative mesorectal lymph nodes (P = 0.005). When individually adjusted for other prognostic variables, such as margin status, tumor grade, lymphovascular space involvement, primary cancer site, and histologic type, a finding of positive mesorectal lymph nodes was associated with a shorter time to recurrence of disease (all < 0.05). Conclusions. Mesorectal lymph node involvement is a common finding at total pelvic exenteration, particularly in patients with rectal wall involvement. Patients with positive mesorectal lymph nodes appear to have a worse outcome with a shorter time to recurrence of disease.展开更多
Objective. To analyze the findings and impact on the management of vi deo-assi sted thoracoscopic surgery (VATS) before planned abdominal exploration in patien ts with suspected advanced ovarian cancer and moderate to...Objective. To analyze the findings and impact on the management of vi deo-assi sted thoracoscopic surgery (VATS) before planned abdominal exploration in patien ts with suspected advanced ovarian cancer and moderate to large pleural effusion s. Methods. We reviewed the charts of all patients with suspected advanced ovari an cancer and moderate to large pleural effusions who underwent VATS from 10/01 to 7/03. VATS was performed under double lumen endotracheal anesthesia. A 2-cm chest wall incision was made in the fifth intercostal space on the side of the e ffusion. The thoracoscope was introduced and biopsies of suspicious lesions were performed through the single incision. After VATS, all patients had a chest tub e placed through the incision, and those with malignant effusions underwent talc pleurodesis either intraoperatively or postoperatively. Results. Twelve patient s underwent VATS during the study period. Median operative time for VATS was 31 min (range: 20-49 min) with no complications attributable to the procedure. The median amount of pleural fluid drained was 1000 ml (range: 500-2000 ml). Solid , pleural-based tumor was found in six cases (50%), with nodules >1 cm noted i n four patients (33%) and nodules < 1 cm noted in two patients (17%). Of the s ix cases with no grossly visible pleural tumor, the pleural fluid was positive f or malignant cells in two patients (17%)-and negative in four patients (33%). Further initial patient management included the following: laparotomy with opti mal cytoreduction, 6 (50%); diagnostic laparoscopy, 3 (25%); and no abdominal exploration, 3 (25%). Final diagnosis of primary disease site was as follows: o vary, 9 (75%); fallopian tube, 1 (8%); endometrium, 1 (8%); and lymphoma, 1 ( 8%). Based on the findings duringVATS, laparotomy and attempted cytoreduction w ere avoided in four patients (33%), and the cytoreductive procedure was modifie d in one patient (8%). Conclusion. Fifty percent of patients with suspected adv anced ovarian cancer and moderate to large pleural effusions who underwent VATS had solid pleural-based tumor identified, and in 33%of cases the tumor nodules were >1 cm in diameter. VATS should be considered in these cases to delineate t he extent of disease, treat the effusion, and to potentially select patients for either intrathoracic cytoreduction or a neoadjuvant chemotherapy approach.展开更多
文摘Objectives. To determine the incidence and prognostic implications of positive mesorectal lymph nodes in patients undergoing total pelvic exenteration for recurrent gynecologic malignancies. Methods. We performed a retrospective chart review of all patients who had undergone total pelvic exenteration for a gynecologic malignancy between July 1992 and December 2003. Patient charts were reviewed for information regarding demographics, site of cancer, histology, pathology report, and time to recurrence. Results. Fifty-eight women had undergone total pelvic exenteration for recurrent gynecologic malignancies during the study period and 57 were available for analysis. Primary cancer site was as follows: cervix, 37 (65% ); vagina, 8 (14% ); vulva, 5 (9% ); and uterine corpus, 7 (12% ). In 30 patients (53% ), the mesorectal lymph node status was pathologically evaluated. Of these 30 patients, 3 (10% ) had positive mesorectal lymph nodes at the time of total pelvic exenteration. All 3 patients had rectal wall involvement (rectal submucosa, 2; rectal mucosa, 1), and all 3 patients recurred within 4 months of pelvic exenteration. The median time to recurrence after surgery was 2.4 months in those patients with positive mesorectal lymph nodes compared with 7.3 months in those with negative mesorectal lymph nodes (P = 0.005). When individually adjusted for other prognostic variables, such as margin status, tumor grade, lymphovascular space involvement, primary cancer site, and histologic type, a finding of positive mesorectal lymph nodes was associated with a shorter time to recurrence of disease (all < 0.05). Conclusions. Mesorectal lymph node involvement is a common finding at total pelvic exenteration, particularly in patients with rectal wall involvement. Patients with positive mesorectal lymph nodes appear to have a worse outcome with a shorter time to recurrence of disease.
文摘Objective. To analyze the findings and impact on the management of vi deo-assi sted thoracoscopic surgery (VATS) before planned abdominal exploration in patien ts with suspected advanced ovarian cancer and moderate to large pleural effusion s. Methods. We reviewed the charts of all patients with suspected advanced ovari an cancer and moderate to large pleural effusions who underwent VATS from 10/01 to 7/03. VATS was performed under double lumen endotracheal anesthesia. A 2-cm chest wall incision was made in the fifth intercostal space on the side of the e ffusion. The thoracoscope was introduced and biopsies of suspicious lesions were performed through the single incision. After VATS, all patients had a chest tub e placed through the incision, and those with malignant effusions underwent talc pleurodesis either intraoperatively or postoperatively. Results. Twelve patient s underwent VATS during the study period. Median operative time for VATS was 31 min (range: 20-49 min) with no complications attributable to the procedure. The median amount of pleural fluid drained was 1000 ml (range: 500-2000 ml). Solid , pleural-based tumor was found in six cases (50%), with nodules >1 cm noted i n four patients (33%) and nodules < 1 cm noted in two patients (17%). Of the s ix cases with no grossly visible pleural tumor, the pleural fluid was positive f or malignant cells in two patients (17%)-and negative in four patients (33%). Further initial patient management included the following: laparotomy with opti mal cytoreduction, 6 (50%); diagnostic laparoscopy, 3 (25%); and no abdominal exploration, 3 (25%). Final diagnosis of primary disease site was as follows: o vary, 9 (75%); fallopian tube, 1 (8%); endometrium, 1 (8%); and lymphoma, 1 ( 8%). Based on the findings duringVATS, laparotomy and attempted cytoreduction w ere avoided in four patients (33%), and the cytoreductive procedure was modifie d in one patient (8%). Conclusion. Fifty percent of patients with suspected adv anced ovarian cancer and moderate to large pleural effusions who underwent VATS had solid pleural-based tumor identified, and in 33%of cases the tumor nodules were >1 cm in diameter. VATS should be considered in these cases to delineate t he extent of disease, treat the effusion, and to potentially select patients for either intrathoracic cytoreduction or a neoadjuvant chemotherapy approach.
