Ovarian Cytoreductive Surgery Research Articles

ARIA II: a randomized controlled trial of near-infrared Angiography during RectosIgmoid resection and Anastomosis in women with ovarian cancer

BackgroundOvarian cancer with extensive metastatic disease involving pelvic structures often requires rectosigmoid resection for complete gross resection; however, it is associated with increased surgical morbidity. There are limited data, and...

Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis developed after ovarian cancer cytoreduction surgery: a case report and literature review

BackgroundAnti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis, a rare subtype of autoimmune encephalitis (AE), is often found associated with tumors such as thymoma, lung cancer, ovarian tumors, and breast cancer, and the tumors were generally detected during the screening process after the encephalitis initiated. The tumor is considered a trigger of AE, but the mechanism remains unclear.Case PresentationA 53-year-old woman presented short-term memory loss two days after the primary cytoreduction for high-grade serous ovarian cancer (HGSOC, FIGO stage IC3). Cell-based assay found AMPAR CluA2 IgG positive in both serum (1:3.2) and cerebrospinal fluid (1:32). Moreover, mild AMPAR GluA1 and strong GluA2 expressions were also found positive in the paraffin sections of ovarian tumor tissue, indicating the ovarian cytoreduction surgery might stimulate the release of receptor antigens into the circulation system. The patient’s condition deteriorated within two weeks, developing consciousness and autonomic dysfunction, leading to ICU admission. With oral steroids, intravenous immunoglobulin, plasmapheresis, and rituximab treatment, the patient’s consciousness markedly improved after three months.ConclusionWe presented the first case of anti-AMPAR encephalitis developed right after the primary cytoreduction of a patient with HGSOC and retrieved paraneoplastic anti-AMPAR encephalitis cases (n = 66). Gynecologists should pay attention to patients who develop cognitive dysfunction or psychiatric symptoms shortly after the ovarian tumor resection and always include AE in the differentiation diagnosis.

Anastomotic Leak in Ovarian Cancer Cytoreduction Surgery: A Systematic Review and Meta-Analysis.

Anastomotic leaks (AL) following ovarian cytoreduction surgery could be detrimental, leading to significant delays in commencing adjuvant chemotherapy, prolonged hospital stays and increased morbidity. The aim of this study was to investigate risk factors associated with anastomotic leaks after ovarian cytoreduction surgery. The MEDLINE (via PubMed), Cochrane Library, EMBASE and Scopus bibliographical databases were searched. Original clinical studies investigating risk factors for AL in ovarian cytoreduction surgery were included. Eighteen studies with non-overlapping populations reporting on patients undergoing cytoreduction surgery for ovarian cancer (n = 4622, including 344 cases complicated by AL) were included in our analysis. Patients undergoing ovarian cytoreduction surgery complicated by AL had a significantly higher rate of 30-day mortality but no difference in 60-day mortality. Multiple bowel resections were associated with an increased risk of postoperative AL, while no association was observed with body mass index (BMI), American Society of Anesthesiologists (ASA) score, age, smoking, operative approach (primary versus interval cytoreductive, stapled versus hand-sewn anastomoses and formation of diverting stoma), neoadjuvant chemotherapy and use of hyperthermic intraperitoneal chemotherapy (HIPEC). Multiple bowel resections were the only clinical risk factor associated with increased risk for AL after bowel surgery in the ovarian cancer population. The increased 30-day mortality rate in patients undergoing ovarian cytoreduction complicated by AL highlights the need to minimize the number of bowel resections in this population. Further studies are required to clarify any association between neoadjuvant chemotherapy and decreased AL rates.

Is there a need for consultant team for bowel resection? An evaluation of surgical outcomes of bowel resection at time of ovarian cytoreductive surgery

<h3>Objectives:</h3> Bowel resections (BR) performed at the time of ovarian cytoreductive surgery (OCS) may be necessary to achieve optimal tumor resection rates; however BR has been associated with increased postoperative morbidity. The aims of this study were to determine the proportion of BR performed by the primary gynecologic oncology team versus another consultant team during OCS, and to compare the postoperative surgical outcomes between OCS with BR performed by either the primary or consultant teams. <h3>Methods:</h3> Women who underwent BR at time of OCS from 2013 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using corresponding CPT, ICD-9, and ICD-10 codes. Determination of which surgical team performed the BR was based upon the surgical specialty of the primary team and whether the resection was coded as a primary or concurrent procedure. Comparative analyses were then stratified by surgical team to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. <h3>Results:</h3> A total of 8,750 women who underwent OCS were identified, and 1,784 (20.4%) of these women underwent a concurrent BR. Among the women who had a BR, 1,479 (82.9%) were performed by the primary team and 304 (17.0%) by a consultant team. Data was not available for one patient, and she was excluded from the analysis. Between the groups, there were no significant baseline differences in patient age, body mass index, preoperative functional status, American Society of Anesthesiology (ASA) class, and albumin and hematocrit levels. The two groups had similar operative times, total relative value units, and total lengths of hospital stay. More stomas were created when a consultant team performed the bowel resection (36.1% vs. 26.8%, p=0.002). When evaluating for the incidence of superficial, deep, and organ space infections separately, there were no differences between the two groups (Table 1). There were also no significant differences in reoperation, readmission, and death rates within the 30-day postoperative period. <h3>Conclusions:</h3> Routine consultation for BR may not result in improved surgical outcomes. There were no major differences in overall complications within the 30-day postoperative period whether the primary or a consultant team performed the BR. When a separate team was consulted to perform the BR during OCS, there were higher rates of stoma creation. Given the known morbidities associated with stoma creation, such as volume dehydration and electrolyte abnormalities, more stomas in this patient population could have an overall detrimental impact on quality of life that is not captured in the NSQIP database.

Stoma creation at the time of large bowel resection during ovarian cytoreductive surgery does not improve 30-day postoperative surgical outcomes

Objectives: Large bowel resections (LBR) are occasionally required to achieve optimal resection during cytoreductive surgery for ovarian cancer. Stoma creation (SC) has been proposed as a protective measure to reduce the incidence and potential consequences of an anastomotic leak after LBR; however there is conflicting data on whether this does indeed reduce rates of leak. The objectives of this study were to evaluate the rate of SC at time of LBR during ovarian cytoreductive surgery (OCS), and to determine whether SC reduces the rates of sepsis and reoperation. Methods: Women who underwent LBR at time of OCS from 2013 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using corresponding CPT, ICD-9, and ICD-10 codes. SC was determined based on CPT codes. Comparative analyses were then stratified by SC to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: A total of 8,750 women who underwent OCS were identified, and 1,603 (18.3%) of these women underwent a concurrent LBR. Among the women who had a LBR, 1,418 (88.5%) had one bowel resection and 185 (11.5%) had multiple bowel resections performed. At the time of LBR, 1,003 (62.6%) had a primary anastomosis without SC, 272 (17.0%) had a colostomy, and 190 (11.8%) had an ileostomy. SC data was not available for 138 (8.6%) women, and these women were excluded from analysis. Preoperatively, women with SC tended to be of older age, and have a higher body mass index (BMI), higher American Society of Anesthesiology (ASA) class, higher White blood cell count, and lower albumin level. Women who had multiple bowel resections were more likely to have SC at time of OCS (17.3% vs. 8.4%, p Download : Download high-res image (120KB) Download : Download full-size image Conclusions: Over a quarter of women who had a concurrent LBR at time of OCS underwent SC. These women tended to be older with higher BMI and ASA class. Although the specific indications for SC are not captured in the NSQIP database, SC was associated with higher rates surgical site infection, organ space infection, sepsis, and hospital readmission during the 30-day postoperative period.

Is Dexamethasone Associated with Recurrence of Ovarian Cancer?

Basic science studies suggest that perioperative immune impairment may augment the risk of cancer recurrence after otherwise potentially curative surgery. Despite its immunosuppressant properties, dexamethasone is commonly given to oncologic patients in an effort to reduce postoperative nausea and vomiting. We therefore tested the hypothesis that perioperative dexamethasone administration increases the risk of ovarian cancer recurrence. Women who had primary ovarian cytoreductive surgery between January 1997 and October 2007 were identified using a database maintained by the division of Gynecologic Oncology at Northwestern University. Tumor recurrence in women given perioperative systemic dexamethasone (4-10 mg) was compared with those who did not receive dexamethasone. The primary outcome was the propensity-matched time to cancer recurrence. Recurrence was defined by a carcinoantigen 125 >21 U/mL or computerized tomography evidence of the disease followed by tissue confirmation. Median difference and 95% confidence interval between the propensity-matched groups were calculated using a 10,000 sample bootstrap. Among 260 women having primary cytoreductive surgery for ovarian cancer that met our inclusion criteria, 102 subjects were given perioperative systemic dexamethasone. Cancer recurrence was observed in 178 subjects, and the overall unadjusted median (IQR) time to recurrence was 18 (7-50) months. Eighty-seven cases and 87 controls were propensity matched to adjust for confounding covariates. After propensity matching the groups for confounding covariates, the median (IQR) time to recurrence in the dexamethasone group was 23 (6-46) compared with 18 (8-53) months in the control group (P = 0.63) with a median (95% confidence interval) difference of time to recurrence between the dexamethasone and the control group of 5 (-8 to 17) months. We could not find evidence for an association between perioperative systemic dexamethasone administration and ovarian cancer recurrence after primary cytoreductive surgery. Our results do not support avoiding low-dose perioperative dexamethasone for prevention of postoperative nausea, vomiting, and pain in ovarian cancer patients.

Splenic metastasis of ovarian clear cell adenocarcinoma: A case report and review of the literature

Splenic metastasis of ovarian cancer appears to be more common in serous cystadenocarcinomas. Splenic metastasis usually occurs postoperatively and simultaneously with dissemination to the greater omentum and pelvic cavity. Compared with other ovarian cancer subtypes, ovarian clear cell adenocarcinoma (OCCA) is rare, accounting for <5% of all ovarian malignancies. OCCA has a distinct histological type with poor prognosis and resistance to platinum-based chemotherapy. In the present study, a case of isolated splenic metastasis of OCCA was reported. A 53-year-old female presented with a mass in the left upper quadrant without any other clinical manifestations. Subsequent abdominal and pelvic computed tomography scans revealed multiple mixed cystic-solid lesions, potentially predicting ovarian malignancy. Pathological tests following ovarian cytoreductive surgery revealed primary OCCA with metastases to the spleen. The current study also reviewed recently published literature on splenic metastasis of ovarian carcinoma and demonstrated that the reported case was a rare case of isolated splenic metastasis of OCCA.

Malignant Brenner Tumor of Ovary

ABSTRACT Introduction Ovarian carcinoma remains the most lethal disease of the female reproductive tract and most difficult to diagnose early. Brenner tumor of ovary is a relatively uncommon neoplasm constituting 1.4 to 2.5% of all ovarian tumors. In vast majority of cases, these tumor are benign, only 2.5% being malignant. Case Report A 46 years old parous menopausal female presented with complains of pain in abdomen since 2 months and lump in right iliac region. Per abdomen examination showed irregular mass of variable consistency with 16 to 18 weeks gravid uterus size arising from pelvis. On per vaginum examination, firm to hard mass was felt in the posterior and lateral fornices exact size of which could not be determined. Per rectal examination revealed hard nodules in Pouch of Douglas (POD). Ovarian cytoreduction surgery was performed. Omentectomy was performed. Histopathology showed malignant Brenner tumor (transitional cell carcinoma). Conclusion Although Brenner tumors are rare and the majority of them are benign, the correct histological diagnosis with identification of the small proportion of malignant tumors allows the extent of the operation to be needed. How to cite this article Hariharan C, Joshi S, Ubeja P. Malignant Brenner Tumor of Ovary. J South Asian Feder Obst Gynae 2014;6(2):126-128.

Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review

Surgical cytoreduction and platinum/taxane combination chemotherapy are the mainstay for the treatment of epithelial ovarian cancer patients. In order to minimise the tumour mass before chemotherapy, cytoreductive surgery is usually performed first. Currently, a splenectomy is included as part of surgical cytoreduction in epithelial ovarian cancer, but it is rarely performed. A splenectomy is also performed as part of secondary cytoreduction surgery. Although there are many reports on surgical techniques, safety and associated clinical outcomes of a splenectomy as a standard adjunct of ovarian cytoreductive surgery, most evidence is from case(s) reports, with only a few studies. Thus, we conducted a review of the literature on this unusual procedure in the context of primary and secondary cytoreduction of epithelial ovarian cancer to assess the published evidence for its efficacy and safety.

Clinical analysis of 20 cases with lower extremity deep venous thrombosis after gynaecological surgery

Objective To explore the causes,risk factors,diagnosis and control methods of LEDVT after gynaecological surgery. Methods The clinical data of 20 inpatients with LEDVT after gynaecological surgery were analyzed retrospectively. Results The LEDVT distribution related to the factors:1.operation time:<2 h 3cases (15%),2 ～3 h 5cases(25%),＞ 3h 12 cases(60%);2.operation manners:TAH 0.23%(4/1746);TVH 0.91%(9/984);RH and ovarian cytoreductive surgery 4.6%(5/106); Myomectomy 0.29%(2/691);patient age:85% for ＞ 50 years; 15% for ≤50 years.All the 20 patients were cured by means of positive treatment of thrombolysis and anticoagulation. Conclusion The patients who had the risk factors of LEDVT should strengthen the prevention and control cases actively,the standardized management could improve their prognosis significantly. Key words: Gynaecological surgical procedures; Lower extremity deep venous thrombosis

Feasibility of the Maylard transverse incision for ovarian cancer cytoreductive surgery

The vast majority of abdominal incisions used in gynecologic surgery are either transverse or vertical midline. The advantages of a vertical midline incision are considered to be rapid abdominal entry and increased exposure to the abdomen and pelvis. The advantages of transverse incisions are purported to be cosmesis, decreased postoperative pain, decreased hernia rate, decreased abdominal adhesions, and fewer postoperative pulmonary complications. The Maylard incision is a transverse incision that combines the advantages of a transverse incision with improved pelvic and abdominal exposure. We wanted to evaluate the feasibility of the Maylard incision to provide adequate abdominal and pelvic exposure in women with advanced ovarian cancer undergoing cytoreductive surgery and to evaluate the extent of anterior abdominal wall adhesions at secondary cytoreductive surgery. In our experience, it appears that the Maylard incision provides adequate exposure to perform ovarian cytoreductive surgery. It appears that there are minimal anterior abdominal adhesions after cytoreductive surgery through a Maylard incision.

CUSA splenorrhaphy for ovarian cytoreductive surgery

Use of the CUSA to resect splenic capsular metastases from ovarian adenocarcinoma is a viable surgical alternative to splenectomy for achieving optimal cytoreductive surgery.