Infracolic Omentectomy Research Articles

Impact of surgical staging in patients with macroscopic “stage I” ovarian borderline tumours: analysis of a continuous series of 101 cases

The aim of this study was to assess the patient's clinical outcome following complete or incomplete surgical staging in cases treated for an early stage low-malignant-potential ovarian tumour (LMPOT). One-hundred and one patients treated between 1965 and 1998 for a early stage I LMPOT were reviewed according to whether the initial surgical staging was complete (Group 1/defined by peritoneal cytology + peritoneal biopsies + infracolic omentectomy) or incomplete (Group 2/omission of at least one of the peritoneal staging procedures described above). Complete and incomplete surgical stagings were carried out in 48 (48%) and 53 (52%) patients, respectively. Four (8%) LMPOT recurrences were observed in Group 2, all following conservative management, but there were no recurrences in Group 1. No relapses with invasive carcinoma or peritoneal disease and no tumour-related deaths were observed. The absence of complete peritoneal staging in patients with an apparent “stage I” LMPOT increased the recurrence rate. However, this surgical restaging (in cases of incomplete initial surgery) does not modify the survival of patients with apparent “stage I” LMPOT misdiagnosed during the initial surgery. This procedure could probably be omitted: (1) if the peritoneum is clearly reported as “normal” during the initial surgery; (2) in the absence of a micropapillary pattern; and (3) if the patient agrees to be carefully followed-up.

The long-term survival of women with surgical stage II endometrioid type endometrial cancer

Objective. The aim of this study was to evaluate the survival estimates, treatment outcomes, prognostic factors, and recurrence patterns of patients with surgical stage II endometrial cancer. Methods. Forty-eight stage II endometrial cancer patients treated between 1982 and 2000 were included. All the patients were subjected to the initial surgical staging procedure consisting of peritoneal cytology, infracolic omentectomy, abdominal hysterectomy (radical or simple), bilateral salpingo-oophorectomy, and complete pelvic–paraaortic lymphadenectomy. Of these 48 patients, 21 (44%) were treated with radical hysterectomy (RH) without adjuvant therapy. The remaining 27 (56%) patients were treated with simple hysterectomy plus adjuvant radiotherapy. With respect to the prognostic factors, no statistically significant difference was found between these two groups. The median follow-up period was 5 years (range, 2–9). Results. The mean age at the time of diagnosis was 55.8 years (range, 34–75). The 5-year disease-free and overall survival (OS) rates of entire group were 83% and 86%, respectively. These figures for 27 (56%) patients treated with simple hysterectomy plus radiation were 81% and 83%, respectively. For 21 (44%) patients who were treated with radical hysterectomy without adjuvant therapy, the 5-year disease-free and overall survival rates were 85% and 90%, respectively. When these two groups were compared, survival rates were not significantly different from each other ( P = 0.60 for disease-free survival and P = 0.46 for overall survival). In multivariate analysis, only the high grade predicted poor survival significantly ( P = 0.04). Eight patients (17%) had recurrence: two local, five distant, and one both local and distant. Initial therapeutic approach was not related with the subsequent site of relapse. Two patients with only local failure were successively treated, but all the six patients who had distant component of relapse died within the same year. Surgical morbidity was seen in six (12.5%) patients. No surgical mortality was seen, and no patient developed a major complication directly related to the radical hysterectomy or lymphadenectomy. Conclusions. Without adjuvant radiotherapy, initial surgical staging procedure consisting radical hysterectomy and complete pelvic–paraaortic lymphadenectomy achieved excellent survival and minimal morbidity in stage II endometrial cancer. Distant failure was the main problem.

Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours

Objectives To review our experience with the laparoscopic restaging procedure of presumed early stage borderline ovarian tumours. Design Retrospective study. Setting Cancer centre. Population Thirty patients with presumed stage I borderline ovarian tumours after limited initial surgery Methods From April 1991 to May 2001, the patients were laparoscopically reassessed. The procedure involved peritoneal cytology, exploration of the peritoneal cavity, infracolic omentectomy, directed or random peritoneal biopsies, and when appropriate, contralateral oophorectomy and hysterectomy and appendectomy. Medical records were reviewed for patients' age, interval time between procedures, tumour stage, histological type, operative time, hospital stay, peri-operative complications and follow up. Main outcome measures Seroperative and postoperative data, pathology and clinical follow up. Results Laparoscopic restaging was completed in all 30 (100%) identified patients. The mean age was 34.8 (10.5) years; the delay between initial operation and restaging laparoscopy averaged 9.8 (6.6) weeks. The mean operative time was 165.4 (53.8) minutes, and the mean hospital stay was 2.7 (1.3) days. There were two (7.0%) major complications related directly to the procedure. Eight (26.6%) patients were upstaged. Mean follow up was 29.1 (6.6) months, all patients are alive and one (3.2%) recurrence was observed. Conclusions Laparoscopic approach of restaging for borderline ovarian tumours is an accurate safe procedure. It is associated with an acceptable rate of minor complications, it has similar morbidity associated with laparotomy and it minimises the incidence of infertility in the young patients. Whenever staging of borderline ovarian tumours is to be considered in an individual patient, laparoscopy provides a suitable alternative approach.

Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours

To review our experience with the laparoscopic restaging procedure of presumed early stage borderline ovarian tumours. Retrospective study. Cancer centre. Thirty patients with presumed stage I borderline ovarian tumours after limited initial surgery. From April 1991 to May 2001, the patients were laparoscopically reassessed. The procedure involved peritoneal cytology, exploration of the peritoneal cavity, infracolic omentectomy, directed or random peritoneal biopsies, and when appropriate, contralateral oophorectomy and hysterectomy and appendectomy. Medical records were reviewed for patients' age, interval time between procedures, tumour stage, histological type, operative time, hospital stay, peri-operative complications and follow up. Seroperative and postoperative data, pathology and clinical follow up. Laparoscopic restaging was completed in all 30 (100%) identified patients. The mean age was 34.8 (10.5) years; the delay between initial operation and restaging laparoscopy averaged 9.8 (6.6) weeks. The mean operative time was 165.4 (53.8) minutes, and the mean hospital stay was 2.7 (1.3) days. There were two (7.0%) major complications related directly to the procedure. Eight (26.6%) patients were upstaged. Mean follow up was 29.1 (6.6) months, all patients are alive and one (3.2%) recurrence was observed. Laparoscopic approach of restaging for borderline ovarian tumours is an accurate safe procedure. It is associated with an acceptable rate of minor complications, it has similar morbidity associated with laparotomy and it minimises the incidence of infertility in the young patients. Whenever staging of borderline ovarian tumours is to be considered in an individual patient, laparoscopy provides a suitable alternative approach.

Paraneoplastic cerebellar degeneration with ovarian endometroid carcinoma

Paraneoplastic cerebellar degeneration with ovarian endometroid carcinoma

Is there a survival benefit to adjuvant radiotherapy in high-risk surgical stage I endometrial cancer?

The aim of this study was to examine the effects of therapeutic modalities on survival of stage I endometrial cancer and also to evaluate the surgical morbidity and the prognostic importance of surgicopathological variables. A hundred and ninety-six stage I endometrial cancer patients treated at Hacettepe University Hospital between 1982 and 1997 were included. After initial diagnosis all patients underwent surgical procedures including peritoneal cytology, infracolic omentectomy, total abdominal hysterectomy, bilateral salphingoopherectomy, and complete pelvic-paraaortic lymphadenectomy. The mean age at initial diagnosis was 56 years (SD = 9.9 years) and the patients were followed 3-18 years (median, 8 years). All patients had endometrioid carcinoma. Stage IC and/or grade 3 tumors were considered high-risk factors and by this definition 147 (75%) patients were low risk and 49 (25%) patients were high risk. Forty-nine percent of high-risk patients received adjuvant radiotherapy compared with 3.5% of patients in the low-risk group. The 10-year disease-free and overall survival rates of the entire group were 97 and 98%, respectively. Ten-year overall survival rate for the low-risk group was 100% compared with 94% for patients with high-risk features (P = 0.002). The 10-year disease-free survival rate in the high-risk group was 96% for 24 patients who received adjuvant radiotherapy versus 92% for 25 patients who did not receive adjuvant therapy (P = 0.53). Only high grade was a significant predictor of poor survival (P = 0.0004). Overall surgical morbidity rate was 8.1% without mortality related to surgery. Surgical staging achieved excellent survival for stage I endometrial cancer patients without incurring untoward morbidity and mortality. No survival advantage of adjuvant radiotherapy was detected even for high-risk patients, so we suggest the use of radiotherapy may be reserved for relapse.

Primary Endodermal Sinus Tumor of the Omentum

Endodermal sinus tumor (EST) is a rare neoplasm which usually arises in the testis or ovary. But extragonadal EST is well recognized and may arise in a wide array of sites such as the mediastinum, vagina, and brain. We report a case of primary EST of the omentum and to our knowledge it is the first case of omental EST in the literature. A 45-year-old woman with a history of abdominal distension was treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy, followed by four cycles of BEP (bleomycin, etoposide, cisplatin) combination chemotherapy. Microscopically, the tumor exhibited typical patterns of EST and stained for α-fetoprotein and cytokeratin. She has remained free of disease for 10 months of follow-up. According to previous studies, debulking surgery and BEP chemotherapy were used as primary therapy with good results. The subject of extragonadal EST is reviewed, and the possible histogenesis of this tumor at such a rare site is discussed.

Malignant Melanoma Metastatic to the Ovary

The diagnosis of malignant melanoma metastatic to the ovary is rarely made in living patients. A case of malignant melanoma metastatic to one ovary, skin of both axillae, and brain occurring 7 years after wide local excision of the primary cutaneous lesion on the patient's back is described. The patient had total abdominal hysterectomy, bilataral salpingo-oophorectomy, infracolic omentectomy, and selective pelvic retroperitoneal lymphadenectomy, followed by whole brain irradiation and chemoimmunotherapy. This case illustrates the clinical variability and unpredictable biologic behavior of malignant melanoma and it is concluded that malignant melanoma metastatic to the ovary should be suspected in any patient who presents with an adnexal mass and has a history of malignant melanoma.

Laparoscopic Staging of Early Ovarian Cancer

The relevance of staging in early ovarian carcinoma is reviewed in light of the advances in surgical laparoscopy. Data from the literature suggest that a lymphadenectomy should be performed instead of a sampling. We have realized the former through laparoscopy. In this paper we propose a detailed surgical technique, similar to the laparotomy approach, that ensures an adequate nodal evaluation. Ten patients underwent a completion of staging by laparoscopy, including peritoneal washings for cytology, peritoneal and ovarian biopsies, an infracolic omentectomy, and a lymph node dissection. The use of laparoscopy for staging of early ovarian carcinoma appears to be a valuable alternative to traditional surgical staging.

Laparoscopic surgical therapy and staging in a case of early malignant granulosa cell tumor of the ovary

An early right granulosa cell tumor was removed without rupture through the vaginal route after laparoscopic division of the ovarian ligament. Staging biopsies, peritoneal cytology, infracolic omentectomy, pelvic and right infrarenal para-aortic dissection were completed laparoscopically. The patient was discharged on the third day, and she is doing well 22 months postoperatively.

The surgical staging of ovarian cancer–current practice in 15 European countries

Fifteen leading oncology centers from 15 European countries were polled about the necessity of 16 different surgical procedures for staging ovarian cancer. A considerable lack of agreement was found. Blind peritoneal biopsies are considered mandatory by only half of the participating institutes. Para-iliac lymph node sampling was regarded as an even less necessary step. General agreement was reported on the necessity to include peritoneal washing, infracolic omentectomy, inspection and palpation of all peritoneal surfaces, biopsies of suspect lesions, resection of adhesions adjacent to the primary tumor and para-aortic lymph node sampling. The rationale of the various staging steps is discussed. It is emphasized that attention should be devoted to achieve a consensus of surgical staging before multicenter trials in early ovarian cancer can be successfully undertaken.

Primary staging in ovarian tumors of low malignant potential

Surgical staging, consisting of peritoneal washings for cytology, infracolic omentectomy, and biopsies of diaphragm, extrapelvic peritoneum, and pelvic and aortic lymph nodes, was performed in 29 patients with ovarian tumors of low malignant potential, presumed to be either Stage I (25) or Stage II (4), in order to determine the incidence of unsuspected metastases in patients with localized disease. Fourteen patients had all and fifteen patients had one or more of these procedures performed. Overall, in stages I and II, positive peritoneal cytology was found in 7%, unexpected omental metastases in 13%, diaphragmatic metastases in 7%, positive pelvic lymph nodes in 27%, and positive aortic lymph nodes in 7%. Seven out of 29 (24%) patients with presumed localized disease, were upstaged by virtue of the staging procedures. Based on our findings, we conclude that surgical-pathologic staging to search for occult metastases in ovarian tumors of low malignant potential is justified from an investigational standpoint: however, its impact on therapeutic management is far from being defined.

Incidental Diagnosis of Ovarian Mucinous Cyst Adenocarcinoma during Emergency Caesarean Section - A Case Report

Mucinous cystadenocarcinoma contribute about 10 to 20 % of epithelial carcinoma ovaries. A large Mucinous cystadenocarcinoma about 15kg weight and about 25cm×15cm×10cm size was found during emergency caesarean section due to obstructed labor in a primi gravida with term pregnancy. Right sided salpingo-ovariotomy with the mass was done. Per-operative no evidence of metastasis, other ovary was healthy. Histopathological report confirmed the diagnosis of well differentiated mucinous cystadenocarcinoma .The patient was referred to the National Institute of Cancer Research & Hospital, Mohakhali, Dhaka. She was treated with 3 cycles chemotherapy (Inj.paclotaxel 250mg. 01+Inj.carboplatin 450mg×02 for 4 days 1st week, 3 days 2nd week, 2 days 3rd week). 3 months later, the patient was treated in Christian Medical College Vellore, Tamil Nadu, India, where interval debulking (total abdominal hysterectomy, left sided salpingo-oophorectomy with infra colic omentectomy) was done and another same 3 cycles chemotherapy was given. Further follow up in the same institute in India after 6 months revealed no abnormalities (C.T scan of the abdomen and pelvis -no evidence of intra abdominal adenopathy). Now the patient is symptom free for about two years (Last visit 3 months back). Key words: Mucinous cystadenocarcinoma; caesarean section; primi gravida; salpingooophorectomy; chemotherapy. DOI: 10.3329/bjog.v24i1.6325 Bangladesh J Obstet Gynaecol, 2009; Vol. 24(1) 32-35