Objective.:Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures f...Objective.:Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.:Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.:Of 112 patients,66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%),formal lymphadenectomy (31%),or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%),facilitation of an en bloc resection of perisplenic disease (41%),and intraoperative trauma (13%). Histologically,65%had hilar involvement; 52%,capsular involvement; and 16%,parenchymal metastases. Short-term complications included wound infections (7),pneumonias (5),thromboembolic events (9),and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient,with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess),and with no identifiable infectious source in 2. Two patients required reoperation for bleeding:1 for diffuse intraabdominal bleeding,including the splenic bed,and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%:3 from sepsis (1 anastomotic leak,2 pneumonias),2 from pulmonary embolism,and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years,with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years,with an estimated 2-year survival of 42%. Conclusions.:In patients with clinically significant upper abdominal disease,splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.展开更多
Purpose: The aim of this study was to assess prognostic factors that may have an impact on overall survival in patients with advanced epithelial ovarian cancer who underwent extensive primary cytoreductive surgery (de...Purpose: The aim of this study was to assess prognostic factors that may have an impact on overall survival in patients with advanced epithelial ovarian cancer who underwent extensive primary cytoreductive surgery (debulking). Material and Methods: Between 1996 and 2001 we assessed the clinical history of 99 patients with primary advanced ovarian cancer (FIGO III/ IV)who underwent cytoreductive surgery at the Department of Gynecology at the Universittsklinikum Hamburg-Eppendorf. Results: Maximal efforts were directed towards a complete resection of all visible tumor manifestations prior to initiation of systemic chemotherapy (92%platinum based, 72%paclitaxel combinations). In 85%of our patients we achieved optimal cytoreduction (no residual disease 58%, residual tumor size < 1 cm in 27%). Major morbidity occurred in 31 %and mortality was 3%. Median follow-up was 25 months. The estimated median survival was 48 months for the entire group (Stage III+IV). In the group with residual tumor of 9 mm and below median survival was 60 months. Cox regression revealed “no residual disease”as the only significant prognostic factor for reduced mortality (HR 0.61 [0.428-0.87]). Conclusion: Complete cytoreduction is feasible in a majority of patients with advanced epithelial ovarian cancer (FlGO III +IV) with limited rates of complications, as radical surgery prolongs survival time substantially. Our data demonstrate that success of extensive cytoreductive surgery is independent on tumorbiology or the pattern of intraabdominal spread of the disease. Therefore, patients with initially extensive spread of tumor deposits should always undergo maximal primary cytoreductive surgery with the aim of complete tumor resection.展开更多
Objective: The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer. Study design: All women with stage III/IV epithelial ovarian c...Objective: The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer. Study design: All women with stage III/IV epithelial ovarian cancer treated with initial surgery at our hospital between January 1, 1995 and January 1, 2003 were eligible; 56 patients met inclusion criteria and underwent retrospective chart review. Statistical analysis was performed using SPSS. Results: Twenty-nine women (52% ) had optimal cytoreduction (OC), and 27 (48% ) had suboptimal cytoreduction (SC). Women in the SC group had higher median CA- 125 values at surgery (954 SC vs 597 OC, P = .07). Three sites of disease on preoperative CT were reported more frequently in the SC patients; omentum (P = .007), parietal peritoneum (P = .096), and ascites (P = .093). Conclusion: A suboptimal cytoreduction confers no survival advantage to women with advanced ovarian cancer. Thus, these patients may be the best candidates for initial chemotherapy, and identifying them preoperatively becomes important.展开更多
Objective. To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries. Patients and methods. One hundred and fifty-four patients with nongenital cancers metastatic t...Objective. To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries. Patients and methods. One hundred and fifty-four patients with nongenital cancers metastatic to the ovaries treated in Hacettepe University Hospital, Gynecologic Oncology Unit between 1982 and 2004 years were retrospectively evaluated. Data were obtained from patients’ records and pathology reports. Demographic characteristics, prognostic factors, 5- year and median survivals were analyzed in all patients. Results. During study period, nongenital cancers metastatic to the ovaries constituted 9% of all malignant ovarian neoplasms. Primary cancers were breast (35), stomach (35) and colorectal (33) cancers, lymphoma (17), undetermined origin (16), appendix (7), ileum (4), pancreas (3), gallbladder cancer (2) and mesothelioma (2). Of patients, 67% were premenopausal and 33% were postmenopausal. Although most common presenting symptoms were abdominal distension with dyspeptic complaints in 46% , abdominal mass in 22% , and pressure symptoms in 8.4% , 15 patients (10% ) were asymptomatic and were diagnosed in routine control examinations. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), omentectomy, and bilateral pelvic and para-aortic lymphadenectomy (BP-PALND) with cytoreduction were performed in 102 patients (66% ), TAH + BSO + omentectomy in 21 patients (14% ), TAH + BSO in 23 patients (15% ), minimal surgical effort including BSO or biopsy in 8 patients (5% ). Eighty-four percent of patients received adjuvant treatment according to the primary origins. Mean follow-up was 47.3 ± 5.9 months. Overall, 5 year survival was 36% and median survival was 42 months. Comparison of median survival times for the primary sites showed a significant overall differences (P = 0.0001) and were as follows: breast 54 months, stomach 18 months, colorectal 48 months, lymphoma 181 months, unknown primary 16 months, appendix 18 months, ileum 40 months, pancreas 3 months, gallbladder 8 months and mesothelioma 20 months. Median survival time of patients who underwent cytoreductive surgery was 48 months, compared with 26 months for patients with suboptimal cytoreductive surgery (P = 0.0039). The 5- year survival rate was 47% and 23% , respectively. Multivariate analysis identified age, menopausal status, primary site, diffuse peritoneal involvement and type of operation as prognostic factors. Conclusion. Presence of ovarian metastasis is associated with a poor prognosis in nongenital cancers. Surgery is essential for diagnosis of primary tumor and necessary for relief of symptoms. Cytoreductive surgery seems to have a beneficial effect on survival of selected patients, especially for patients with colorectal cancer metastatic to the ovary.展开更多
文摘目的:腹膜假黏液瘤(pseudomyxoma peritonei,PMP)是一种罕见的临床综合征,细胞减灭术(cytoreductive surgery,CRS)联合腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)因其良好的治疗效果已经成为各中心公认的标准治疗方案,航天中心医院从2008年开始致力于PMP患者诊治工作,2016年开始将全腹膜切除应用于临床,本研究通过对既往资料进行收集整理,对PMP治疗经验进行总结。方法:回顾分析2008年1月到2019年1月航天中心医院腹膜假黏液瘤中心收治并接受手术治疗的PMP患者临床资料及随访结果。对所有患者的手术方式、根治程度及并发症发生情况等临床资料进行搜集整理,并通过随访结果对相关因素进行生存分析,了解CRS+HIPEC在PMP治疗中的临床价值,同时对腹膜切除技术治疗效果进行评价。结果:共纳入854例患者,平均年龄50岁,中位改良腹膜肿瘤指数(peritoneal cancer index,PCI)为29,其中25.5%的患者接受了根治性手术切除,细胞减灭程度(completeness of cytoreduction,CC)达到0或1。总体并发症发生率为21.7%,围术期死亡率为1.1%。自2016年引进腹膜切除技术后,本中心达CC-0/1的比例由14.3%升至36.5%,且并发症发生率显著下降(16.8%vs.28.8%,P<0.001)。总体而言,CC-0/1的患者5年和10年生存率分别为77%、64.3%,显著优于CC-2/3患者的45.8%、39.4%。在未达根治的患者中,CC-2和CC-3患者10年生存率也存在明显差异(45.5%vs.34.5%,P=0.006)。对总体生存进行分析,改良腹膜肿瘤指数、手术方式、术中是否行热灌注治疗、病理级别、CA125水平均为影响术后生存的独立危险因素。结论:细胞减灭术+腹腔热灌注化疗治疗腹膜假黏液瘤安全有效,腹膜切除技术可显著提高根治程度并降低并发症风险;对于无法达到根治切除的患者,最大限度的减瘤亦可延长远期生存。
文摘Objective.:Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.:Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.:Of 112 patients,66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%),formal lymphadenectomy (31%),or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%),facilitation of an en bloc resection of perisplenic disease (41%),and intraoperative trauma (13%). Histologically,65%had hilar involvement; 52%,capsular involvement; and 16%,parenchymal metastases. Short-term complications included wound infections (7),pneumonias (5),thromboembolic events (9),and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient,with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess),and with no identifiable infectious source in 2. Two patients required reoperation for bleeding:1 for diffuse intraabdominal bleeding,including the splenic bed,and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%:3 from sepsis (1 anastomotic leak,2 pneumonias),2 from pulmonary embolism,and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years,with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years,with an estimated 2-year survival of 42%. Conclusions.:In patients with clinically significant upper abdominal disease,splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.
文摘Purpose: The aim of this study was to assess prognostic factors that may have an impact on overall survival in patients with advanced epithelial ovarian cancer who underwent extensive primary cytoreductive surgery (debulking). Material and Methods: Between 1996 and 2001 we assessed the clinical history of 99 patients with primary advanced ovarian cancer (FIGO III/ IV)who underwent cytoreductive surgery at the Department of Gynecology at the Universittsklinikum Hamburg-Eppendorf. Results: Maximal efforts were directed towards a complete resection of all visible tumor manifestations prior to initiation of systemic chemotherapy (92%platinum based, 72%paclitaxel combinations). In 85%of our patients we achieved optimal cytoreduction (no residual disease 58%, residual tumor size < 1 cm in 27%). Major morbidity occurred in 31 %and mortality was 3%. Median follow-up was 25 months. The estimated median survival was 48 months for the entire group (Stage III+IV). In the group with residual tumor of 9 mm and below median survival was 60 months. Cox regression revealed “no residual disease”as the only significant prognostic factor for reduced mortality (HR 0.61 [0.428-0.87]). Conclusion: Complete cytoreduction is feasible in a majority of patients with advanced epithelial ovarian cancer (FlGO III +IV) with limited rates of complications, as radical surgery prolongs survival time substantially. Our data demonstrate that success of extensive cytoreductive surgery is independent on tumorbiology or the pattern of intraabdominal spread of the disease. Therefore, patients with initially extensive spread of tumor deposits should always undergo maximal primary cytoreductive surgery with the aim of complete tumor resection.
文摘Objective: The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer. Study design: All women with stage III/IV epithelial ovarian cancer treated with initial surgery at our hospital between January 1, 1995 and January 1, 2003 were eligible; 56 patients met inclusion criteria and underwent retrospective chart review. Statistical analysis was performed using SPSS. Results: Twenty-nine women (52% ) had optimal cytoreduction (OC), and 27 (48% ) had suboptimal cytoreduction (SC). Women in the SC group had higher median CA- 125 values at surgery (954 SC vs 597 OC, P = .07). Three sites of disease on preoperative CT were reported more frequently in the SC patients; omentum (P = .007), parietal peritoneum (P = .096), and ascites (P = .093). Conclusion: A suboptimal cytoreduction confers no survival advantage to women with advanced ovarian cancer. Thus, these patients may be the best candidates for initial chemotherapy, and identifying them preoperatively becomes important.
文摘Objective. To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries. Patients and methods. One hundred and fifty-four patients with nongenital cancers metastatic to the ovaries treated in Hacettepe University Hospital, Gynecologic Oncology Unit between 1982 and 2004 years were retrospectively evaluated. Data were obtained from patients’ records and pathology reports. Demographic characteristics, prognostic factors, 5- year and median survivals were analyzed in all patients. Results. During study period, nongenital cancers metastatic to the ovaries constituted 9% of all malignant ovarian neoplasms. Primary cancers were breast (35), stomach (35) and colorectal (33) cancers, lymphoma (17), undetermined origin (16), appendix (7), ileum (4), pancreas (3), gallbladder cancer (2) and mesothelioma (2). Of patients, 67% were premenopausal and 33% were postmenopausal. Although most common presenting symptoms were abdominal distension with dyspeptic complaints in 46% , abdominal mass in 22% , and pressure symptoms in 8.4% , 15 patients (10% ) were asymptomatic and were diagnosed in routine control examinations. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), omentectomy, and bilateral pelvic and para-aortic lymphadenectomy (BP-PALND) with cytoreduction were performed in 102 patients (66% ), TAH + BSO + omentectomy in 21 patients (14% ), TAH + BSO in 23 patients (15% ), minimal surgical effort including BSO or biopsy in 8 patients (5% ). Eighty-four percent of patients received adjuvant treatment according to the primary origins. Mean follow-up was 47.3 ± 5.9 months. Overall, 5 year survival was 36% and median survival was 42 months. Comparison of median survival times for the primary sites showed a significant overall differences (P = 0.0001) and were as follows: breast 54 months, stomach 18 months, colorectal 48 months, lymphoma 181 months, unknown primary 16 months, appendix 18 months, ileum 40 months, pancreas 3 months, gallbladder 8 months and mesothelioma 20 months. Median survival time of patients who underwent cytoreductive surgery was 48 months, compared with 26 months for patients with suboptimal cytoreductive surgery (P = 0.0039). The 5- year survival rate was 47% and 23% , respectively. Multivariate analysis identified age, menopausal status, primary site, diffuse peritoneal involvement and type of operation as prognostic factors. Conclusion. Presence of ovarian metastasis is associated with a poor prognosis in nongenital cancers. Surgery is essential for diagnosis of primary tumor and necessary for relief of symptoms. Cytoreductive surgery seems to have a beneficial effect on survival of selected patients, especially for patients with colorectal cancer metastatic to the ovary.
