Role Of Cytoreductive Surgery Research Articles

Cytoreductive surgery in the management of newly diagnosed glioblastoma in adults: a systematic review and evidence-based clinical practice guideline update.

These recommendations apply to adults with newly diagnosed or suspected glioblastoma. What is the effect of extent of surgical resection on patient outcome in the initial management of adult patients with suspected newly diagnosed glioblastoma? Level II: Maximal cytoreductive surgery is recommended in adult patients with suspected newly diagnosed supratentorial glioblastoma with gross total resection defined as removal of contrast enhancing tumor. Level III: Biopsy, subtotal resection, or gross total resection is suggested depending on medical comorbidities, functional status, and location of tumor if maximal resection may cause significant neurologic deficit. What is the role of cytoreductive surgery in adults with newly diagnosed bi-frontal "butterfly" glioblastoma? Level III: Resection of newly diagnosed bi-frontal "butterfly" glioblastoma is suggested to improve overall survival over biopsy alone. What is the goal of cytoreductive surgery in elderly adult patients with newly diagnosed glioblastoma? Level III: Elderly patients (> 65years) show survival benefit with gross total resection and it is suggested they undergo cytoreductive surgery. What is the role of advanced intraoperative guidance techniques in cytoreductive surgery in adults with newly diagnosed glioblastoma? Level III: The use of intraoperative guidance adjuncts such as intraoperative MRI (iMRI) or 5-aminolevulinic acid (5-ALA) are suggested to maximize extent of resection in newly diagnosed glioblastoma. There is insufficient evidence to make a suggestion on the use of fluorescein, indocyanine green, or intraoperative ultrasound.

THE VALUE OF CYTOREDUCTIVE SURGERY FOR ISOLATED LYMPH NODE RECURRENCE OF OVARIAN CANCER

The purpose of the study was to undertake a systematic literature review regarding the role of cytoreductive surgery in treatment of recurrent ovarian cancer, as well as to summarize available data on various current studies and estimate indications for secondary cytoreduction in recurrent ovarian cancer with isolated lymph node involvement.Material and Methods. The search for relevant sources was carried out in PubMed, Gynecol Oncol, Medline, NCCN, Elibrary systems; publications were included from January 2006 up to March 2019. Of the 87 studies found, 26 were used to write a systematic review.Results. Ovarian cancer (OC) remains the leading cause of death from gynecological cancer. The initial treatment for IC-IV stages of OC includes surgical cytoreduction followed by platinum-containing chemotherapy. The best outcomes are observed in patients, in whom complete cytoreduction has been achieved. Despite this fact, most patients develop relapses and the 5-year survival rate is about 30 %. The frequency of lymph node involvement in patients with recurrent OC is not reliably known; isolated lymph node recurrence is reported to occur in 5–32 % of patients. To date, the problem regarding the extent of lymph node dissection in treatment of OC recurrence is still unsolved. In our paper we review the available data concerning the role of secondary cytoreductive surgery for isolated lymph node recurrence of ovarian cancer.Conclusion. Isolated lymph node recurrence of ovarian cancer may indicate a more favorable prognosis and has a less aggressive pattern of OC relapse. The role of secondary cytoreduction in this context is not fully understood, but this category of patients may be one of the most suitable for surgical treatment of ovarian cancer recurrence.

Challenges and opportunities in the management of metastatic renal cell carcinoma: combination therapy and the role of cytoreductive surgery.

As the biology of metastatic renal cell carcinoma (mRCC) continues to be elucidated, novel treatments focused around immunotherapies and targeted therapies will continue to emerge. In this review, we will highlight recent treatment advances and their implications for surgical and systemic therapy. Several new treatments, including the tyrosine kinase inhibitor cabozantinib, the combination of a programmed cell death protein 1 antibody (nivolumab) with a cytotoxic T-lymphocyte-associated antigen 4 antibody (ipilimumab), and the combination of axitinib with pembrolizumab or avelumab have been approved by the US Food and Drug Administration as first-line therapy for the treatment of mRCC. Although promising survival benefits have been seen with these new therapies, careful patient selection is still critical. The introduction of novel therapies and the investigation of combinatorial therapies have shifted the treatment paradigm for advanced RCC. Present trials have provided promising data that could lead to further therapeutic advances.

Surgery for Gastric Cancer: State of the Art

Surgery remains the undisputed mainstay in the management of gastric cancer, and advances in chemotherapy and radiation have improved outcomes in patients with resectable disease. A multidisciplinary approach, with active coordination across specialties dealing with management of gastric cancers provides improved quality of care and outcomes. Radical gastrectomy involves complete removal of tumor with adequate margins and appropriate lymph node dissection. Spleen preserving D2 lymphadenectomy is the present standard of care for all resectable tumors except few early tumors (T1a lesions) where endoscopic or local resections are deemed suitable. Perioperative or adjuvant chemotherapy should be offered to all patients with resectable tumor, having advanced T stage or node-positive disease. In patients with advanced tumors with invasion of adjacent organs, multivisceral resections can be offered selectively in the presence of good performance status and response to chemotherapy, which can lead to improvement in overall survival. The role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy needs to be evaluated in patients with limited peritoneal disease.

Role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer.

Patients with peritoneal carcinomatosis (PC) of gastric origin have a poor prognosis of life with an average survival of 1-3 months. Systemic chemotherapy has improved the survival of those patients with gastric metastatic cancer at 7-10 months. However, this benefit could not be reproduced in those patients with PC. The current literature for the use of hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric PC has significant variation related to patient selection, treatment intent (palliative vs. attempt at curative treatment), surgical technique, intraperitoneal chemotherapy agent utilized, and systemic chemotherapy administered adjuvantly. From the perspective of patient selection for cytoreduction and HIPEC, patients with extensive PC are not candidates. In addition, unresectable location would make a patient a poor candidate for cytoreduction and HIPEC. Optimally, those with positive peritoneal cytology alone could benefit most. However, the role of cytoreductive surgery and HIPEC in patients with PC of gastric origin has not yet been clarified.

Perioperative Morbidity of Gastrectomy During CRS-HIPEC: An ACS-NSQIP Analysis

BackgroundFormal gastrectomy is occasionally required to achieve complete cytoreduction for patients with peritoneal surface malignancies. In addition, the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer is increasingly being explored. Nevertheless, data on the safety of gastrectomy at the time of CRS-HIPEC are limited. MethodsThe American College of Surgeons–National Surgical Quality Improvement Program databases from 2005 to 2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared between patients who underwent CRS-HIPEC with and without gastrectomy. ResultsAmong 1168 patients who underwent CRS-HIPEC, 43 (4%) underwent partial (n = 20) or total (n = 23) gastrectomy. Patients who underwent gastrectomy at the time of CRS-HIPEC had a longer operative time (529.3 versus 457.6 min, P = 0.004), were more likely to need an intraoperative transfusion (32.6% versus 14.3%, P = 0.001), experienced a longer length of stay (19.0 versus 11.3 d, P < 0.001), and had a significantly greater complication rate (60.5% versus 27.9%, P < 0.001), whereas postoperative mortality was not statistically significantly different (4.7% versus 1.4%, P = 0.09). On multivariate logistic regression, gastrectomy (odds ratio [OR] 3.52, P < 0.001) was the strongest predictor of postoperative morbidity, in addition to American Society of Anesthesiologists class 4 (OR 2.82, P = 0.001), malnutrition (OR 1.63, P = 0.01), liver resection (OR 1.88, P = 0.01), and colectomy (OR 2.04, P < 0.001). ConclusionsPatients undergoing gastrectomy at the time of CRS-HIPEC experience a substantial postoperative complication rate (60%) and extended length of stay (mean 19 d). These findings highlight the need for cautious patient selection and preoperative counseling before performing concomitant gastrectomy and CRS-HIPEC.

The Role of PARP Inhibitors in Ovarian Cancer: An Emerging Picture

Dr Oaknin welcomed the delegates to the symposium and presented the objectives and agenda for the meeting as well as a case study presentation. Dr Birrer presented on the current landscape of platinum-sensitive recurrent ovarian cancer (PSR OC), including USA and European treatment guidelines. He highlighted data from three landmark Phase III studies that demonstrated the efficacy of platinum-based doublet therapy for patients with PSR OC. The role of cytoreductive surgery is still being debated but bevacizumab and a newer anti-angiogenic agent, cediranib, may both extend progression-free survival (PFS) in these patients. He predicted that new combinations of therapies will be tested. Prof Ledermann followed with a presentation on the role of poly(ADP-ribose) polymerase (PARP) inhibitors, olaparib, niraparib, and rucaparib, in the treatment of PSR OC. The largest increase in PFS is seen in patients with platinum-sensitive BRCA-mutant tumours but there is also significant benefit over placebo in groups of patients with platinum-sensitive BRCA wild-type tumours. Prof McNeish discussed the challenge of identifying the 30% of women with high-grade serous OC who would respond to treatment with a PARP inhibitor even though their tumour does not carry a BRCA mutation. Loss of heterozygosity (LOH) is a key indicator of homologous recombination deficiency (HRD) but current tests miss some women who would benefit from treatment. Dr Lorusso concluded the meeting by exploring future directions for research into PARP inhibitors, such as whether they should be used in the front-line setting and as single agents rather than in combination with chemotherapy. New combinations with anti-angiogenic and immune-oncology agents show promise, as does the potential for retreatment with a different PARP inhibitor.

The Role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Appendiceal Tumors and Colorectal Adenocarcinomas.

Peritoneal surface disease (PSD) has historically been used interchangeably with the term peritoneal carcinomatosis (PC) and has a dismal natural history. A variety of malignant pathologies, including colorectal and appendiceal primary tumors, can disseminate throughout the peritoneal cavity, leading to bowel obstruction and death. In general, peritoneal spread from high-grade appendiceal and colorectal primaries has the potential of hepatic and distant spread and best classified as PC. Low-grade appendiceal tumors are better categorized as PSD, due to low cellularity, high mucin production, and lack of potential spread outside the peritoneal cavity. Growing international experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) over the past 30 years has presented a therapeutic option to patients with PSD from colorectal and appendiceal tumors that can provide significant disease control, as well as potential for previously unattainable long-term survival. The proliferation of HIPEC centers and ongoing prospective trials are helping to standardize HIPEC techniques and patient selection.

2017 Update on Ovarian Cancer Peritoneal Carcinomatosis Multimodal-Treatment Considerations.

Ovarian cancer peritoneal carcinomatosis requires a multimodal-treatment approach. Current treatment considerations are analyzed in this update and include the management of recurrent malignant ascites and the understanding of its pathophysiology, the role of peritoneal washing cytology in detecting peritoneal metastases, capsular invasion and ovarian cancer histologic type, interpretation of pretreatment Ca-125 levels at different time points of ovarian cancer therapeutic management, characteristics of 10-year survivors of high-grade ovarian cancer, and the role of lymphadenectomy in ovarian cancer peritoneal carcinomatosis. This update also includes current considerations on the role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer peritoneal carcinomatosis as well as relevant ongoing phase III randomized controlled trial protocols.

Current Management of Peritoneal Carcinomatosis From Colorectal Cancer: The Role of Cytoreductive Surgery and Hyperthermic Peritoneal Chemoperfusion.

Peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is a disease with a poor prognosis, often thought to be a terminal illness with no hope except for palliative treatment. New therapeutic modalities combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown favorable outcomes and may provide a significant survival benefit in a selected group of patients. The main rational for CRS is to remove all visible tumor burden to allow for the chemotherapeutic agent (HIPEC) to eradicate any microscopic residual disease. The Amsterdam statement formulated at the 9th International Congress on Peritoneal Surface Malignancies supports the use of CRS with HIPEC as a standard of care for selected patients with small-to-moderate volume PC from CRC. Selecting appropriate patients who would benefit from CRS/ HIPEC is paramount to derive the maximum oncological outcomes while minimizing the risks of postoperative complications and mortality. In this paper, we will review the role for CRS/HIPEC in the management of PC from CRC.

Role of CRS and HIPEC in appendiceal and colorectal malignancies: Indian experience.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are recently being considered as standard of treatment for patients with peritoneal carcinomatosis of appendiceal or colorectal origin. It is an extensive procedure with high morbidity. Being a newer treatment modality, not much experience has been published from an Indian center about it. All patients of colorectal and appendiceal cancer with peritoneal metastasis from January 2012 to March 2015 who were planned for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) were analyzed with respect to morbidity, mortality, and survival. Thirty-three patients were planned for cytoreductive surgery (CRS)+HIPEC for peritoneal carcinomatosis of colorectal or appendiceal origin. There were 18 males and 15 females and mean age was 48.2years (21-75years). Of these, 14 had disease from appendiceal origin and 19 of colorectal origin. Cytoreductive surgery was performed 29 times in 27 patients and was abandoned in 6 patients. Overall morbidity was 55.17% with hematological toxicity being the most common (46.1%) and mortality being 3.4%. Four-year actuarial survival of patients undergoing CRS and HIPEC was 58.39% and 33.33% for patients undergoing CRS alone (p=0.302). Appendiceal primary neoplasms had better overall survival compared to colorectal primary (63.64% vs. 50.68% 4-year actuarial survival). CRS and HIPEC can be performed with acceptable morbidity and mortality in selected patients of colorectal and appendiceal malignancies with peritoneal carcinomatosis. In addition, it is associated with better overall survival. Morbidity profile of Indian subcontinent patients is different from that of western population with hematological toxicity being the most common.

Management for Peritoneal Metastasis of Colonic Origin: Role of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy: A Single Institution's Experience During Two Decades.

Peritoneal metastasis of colonic origin is associated with a poor prognosis. This study aimed to analyze the clinicopathologic characteristics and prognostic predictors of survival in a cohort of patients treated with cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (POIC) during two decades. A retrospective study analyzed a prospectively maintained database for all patients treated for peritoneal metastasis of a colonic origin (PCC) from January 1990 to April 2015. The 318 patients in our study comprised 171 men (53.8%) and 147 women (46.2%). The mean age of the patients at presentation was 50.6years, (range 18-86years). Overall survival was 42.5%, median survival and follow-up time was 21.5 and 15.0 months respectively. The 3 and 5years survival rates were respectively 35 and 25%. The median survival time was 20.6months for the men and 23.1months for the women (p=0.14). The mean intraoperative peritoneal carcinomatosis index (PCI) was 15.2. The patients who had a completeness of cytoreduction (CC) score of 0 or 1 (no residual disease <0.25mm) had a median survival time of 36.6months compared with 18.3months for the patients with a CC-2 score and 7.6months for the patients with a CC-3 score (p<0.000). The significant independent predictors of survival in the multivariate analysis were the CC score and elevated tumor makers CA153 and CA125. For patients with a limited extent of peritoneal metastases, CC is the most important prognostic variable for improved survival of colon cancer patients with peritoneal metastases.

Surgical Management of Metastatic Colorectal Cancer: A Single-Centre Experience on Oncological Outcomes of Pulmonary Resection vs Cytoreductive Surgery and HIPEC.

Metastasectomy is accepted as standard of care for selected patients with colorectal pulmonary metastases (CLM); however, the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM) is not universally accepted. We aim to compare oncological outcomes of patients with CLM and CPM after pulmonary resection and CRS-HIPEC, respectively, by comparing overall survival (OS) and disease-free survival (DFS). A retrospective review of 49 CLM patients who underwent pulmonary resection, and 52 CPM patients who underwent CRS-HIPEC in a single institution from January 2003 to March 2015, was performed. The 5-year OS for CLM patients and CPM patients were 59.6 and 40.5%, respectively (p=0.100), while the 5-year DFS were 24.0 and 14.2%, respectively (p=0.173). CPM patients had longer median operative time (8.38 vs. 1.75h, p<0.001), median hospital stay (13 vs. 5days, p<0.001), a higher rate of intensive care unit (ICU) admissions (67.3 vs. 8.2%, p<0.001), and a higher rate of high-grade complications (17.3 vs. 4.1%, p<0.001). Multivariate analysis demonstrated that recurrent lung metastasis after metastasectomy was an independent prognostic factor for OS of CLM patients (OR=0.045, 95%, CL 0.003-0.622, p=0.021). There were no independent prognostic factors for OS in CPM patients by multivariate analysis. There were no independent prognostic factors for DFS in CLM patients by multivariate analysis, but peritoneal cancer index score, bladder involvement, and higher nodal stage at presentation of the initial malignancy were independent prognostic factors for DFS in CPM patients. OS and DFS for CPM patients after CRS and HIPEC are comparable to CLM patients after lung resection, although morbidity appears higher. The prognostic factors affecting survival after surgery are different between CPM and CLM patients and must be considered when selecting patients for metastasectomy.

Role of cytoreductive surgery for metastatic gastrointestinal cancer – views of medical oncologist

Role of cytoreductive surgery for metastatic gastrointestinal cancer – views of medical oncologist

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review.

Ovarian cancer is one of the leading causes of cancer related deaths in women worldwide. It is usually diagnosed in an advanced stage (Stages III and IV) when peritoneal cancer spread has already occurred. The standard treatment comprises of surgery to remove all macroscopic disease followed by systemic chemotherapy. Despite all efforts, it recurs in over 75% of the cases, most of these recurrences being confined to the peritoneal cavity. Recurrent ovarian cancer has a poor long term outcome and is generally treated with multiple lines of systemic chemotherapy and targeted therapy. The propensity of ovarian cancer to remain confined to the peritoneal cavity warrants an aggressive locoregional approach. The combined treatment comprising of cytoreductive surgery (CRS) that removes all macroscopic disease and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) has been effective in providing long term survival in selected patients with peritoneal metastases of gastrointestinal origin. Intraperitoneal chemotherapy used as adjuvant therapy has shown a survival benefit in ovarian cancer. This has prompted the use of CRS and HIPEC in the management of ovarian cancer as a part of first line therapy and second line therapy for recurrent disease. This article reviews the current literature and evidence for the use of HIPEC in ovarian cancer.

The role of cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) in patients with peritoneal carcinomatosis (PC) of appendiceal origin (AO).

707 Background: Peritoneal carcinomatosis of mucinous appendiceal tumor origin is a rare condition which has poor prognosis if treated with limited surgery or systemic chemotherapy. Several publications show that CRS/HIPEC gives a significant survival benefit for patients with PC of AO. However, many patients do not get appropriate treatment. We show data from our 17-year experience using CRS/HIPEC in PC of AO. Methods: Retrospective analysis of a prospective database of 251 patients with PC of AO was performed. Peritoneal cancer index (PCI), completeness of cytoreduction (CC), lymph node (LN) status, and histopathology data was collected. The impact of each variable evaluated by Hazard ratio analysis. Overall survival (OS) estimated by Kaplan-Meier curves. Results: Mean age 53 years (range 23-81). 251 patients underwent 290 CRS/HIPEC procedures. 31 patients had 2, and 4 patients had 3 CRS/HIPEC. A total of 149 patients (59%) had peritoneal mucinous carcinomatosis (PMCA) and 102 (41%) had disseminated peritoneal adenomucinosis (DPAM) (Ronnett classification). Mean follow-up 4.8 years with a median of 4.7 years. Complete cytoreduction was achieved in 84% (89% DPAM, 80% PMCA; p = 0.047). Mean length of surgery 11.3 hours, mean hospital stay 14 days. No in-hospital or 30-day mortality. 73% had PCI &gt; 20 (78% DPAM; 68% PMCA). LN metastasis in 42% with PMCA. OS from date of HIPEC was 93%, 86%, 81% in DPAM and 90%, 60%, 44% in PMCA for 1, 3, and 5 years, respectively. With CC, the 5-year OS was 84% in DPAM and 49% in PMCA. All PMCA patients with incomplete cytoreduction (n = 30) had PCI ≥ 20 (p &lt; 0.001). Hazard ratios were 2.5 (95% confidence interval [95% CI] 1.3-4.5), 3.1 (95% CI 2.0-4.9), 3.6 (95% CI 2.1-6.2), for PCI &lt; 20, complete cytoreduction, and histopathology (DPAM vs. PMCA), respectively. Hazard ratio (for LN status in patients with PMCA was 3.0 (95% CI 1.8-5.1). Conclusions: Meaningful survival could be achieved in PC of AO even with extensive peritoneal disease (PCI &gt; 20). We consider CRS/HIPEC a standard of care for these patients. CRS/HIPEC should be provided in specialized centers by trained surgeons where complete cytoreduction could be frequently accomplished.

The role of cytoreductive surgery in the era of targeted agents.

Two randomized trials were initiated to define the role and sequence of cytoreductive nephrectomy in combination with VEGF-targeted therapy for metastatic renal cell cancer. While these trials will not report before the end of 2016, recent retrospective population-based studies published real-world data on incidence, treatment, prognosis and outcome that may help to better define the role of cytoreductive nephrectomy for this heterogeneous patient population in the targeted therapy era. Since the introduction of targeted agents, utilization of cytoreductive nephrectomy has declined. Potentially more patients are being treated with their primary tumours in place. Some countries also observed an additional decline in the incidence of primary metastatic disease. Although large population-based studies consistently demonstrate a survival benefit after cytoreductive nephrectomy, confounding factors preclude definite conclusions. However, patients with a life expectancy of less than 1 year or at least four IMDS risk factors may not benefit from cytoreductive nephrectomy. Recent retrospective data suggest a more refined use of cytoreductive nephrectomy in the targeted therapy era. With the exception of patients in whom cytoreductive nephrectomy and resection of solitary or oligometastasis may result in cure or delay of systemic therapy, performance, prognostic models and life expectancy estimates help to define the role of cytoreductive nephrectomy in the individual patient.

Pseudo-pseudomyxoma peritonei from peritoneal sarcomatosis

Background: Pseudomyxoma peritonei (PMP) is a rare clinical entity of mucinous ascites, most commonly associated with appendiceal mucinous neoplasms. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains the current standard of care for PMP. Peritoneal sarcomatosis (PS) is an exceptionally rare disease with a poor prognosis. PMP associated with PS has not been previously described. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for PS with or without PMP is not well-defined. PS manifesting like PMP has not been previously described. Case presentation: A 74-year-old patient with several weeks history of vague abdominal pain and increased abdominal girth was referred to our facility after incidental finding of PMP during laparoscopic inguinal hernia repair. After complete work-up, he was advised to undergo CRS/HIPEC. Intra-operatively, he was noted to have extensive mucinous ascites and underwent aggressive CRS and HIPEC Result: Final pathology revealed myxoid liposarcoma with associated intraperitoneal mucin dissemination, which was confirmed with cytogenetic analysis. Conclusion: We describe a rare case of pseudomyxoma peritonei originating from an intra-abdominal sarcoma. We propose the term of “pseudo-pseudomyxoma peritonei” to appropriately describe this unusual clinical event.

Cytoreductive surgery for intestinal cancer patients metastatic to the adnexal presenting as primary ovarian cancer.

e14651 Background: For patients with unresectable, and nonobstructing metastatic colon cancer, chemotherapy is the primary treatment option. Despite combination regimens, median overall survival in patients with peritoneal carcinomatosis is about 15 months. The purpose of this study is to evaluate the role of cytoreductive surgery in colon and small intestine cancer patients with metastases to adnexal. Methods: Twenty-six patients with intestinal cancers metastatic to adnexal operated as primary ovarian cancer in Zekai Tahir Burak Women Health Hospital, Gynecologic Oncology Unit between 2008 and 2014 years were retrospectively evaluated. Data were obtained from pathology reports and patients’ records. Demographic and clinical characteristics, and median survival were analyzed Results: Of a total of 26 patients were included, the majority was colon cancer (n = 24) and the remaining was small intestine (n = 2). Median age was 54 years. Most common presenting symptom was abdominal distention (80%). Optimal c...

The role of cytoreductive surgery for recurrent endometrial cancer

Objectives: To determine the rate and performance of sentinel lymph node (SLN) mapping among women with high-risk endometrial cancers. Methods: Patients diagnosed between 2012 and 2014 with uterine cancer of grade 3 endometrioid, clear cell, serous, or carcinosarcoma histology who underwent SLN mapping before full lymph node dissection were included. Patients underwent either methylene blue or indocyanine green injection for laparoscopic (n = 15) or roboticassisted laparoscopic staging (n = 12). Outcomes examined included rates of SLN mapping using each surgical approach, SLN and non-SLN positive rates, false-negative SLN rate, and the negative predictive value of SLN. Ultrastaging of SLN was not routinely performed during the study period. Fisher's exact test was used to compare mapping and node positivity rates. Results: A total of 10/27 (37%) patients with high-risk uterine cancer had at least one positive lymph node identified. Twelve patients (44%) mapped bilaterally, 10 (37%) mapped unilaterally, and 5 (18%) did not map. Thirty-four of 54 sides (63%) mapped successfully. Successful SLN mapping rates by side were: 19/30 sides (63%) for the laparoscopic and 15/24 sides (66%) for the robotic approach (P=0.53). Among 20 sides that failed to map, 4 (26%) had findings of grossly enlarged nodes, 7 (35%) had reportable adhesions, 6 (30%) had fibroids, and 4 (20%) were morbidly obese, making node visualization difficult. Nine of 75 (12%) sentinel nodes and 8/513 (2%) nonsentinel nodes were positive (P = 0.0009). Eight of nine (89%) positive SLNs were the only positive lymph nodes identified on that side. The false-negative SLN rate (negative SLN but other malignant lymph nodes identified on the same side) was 1/20 (5%); the negative predictive value of SLN was 95%. Conclusions: In this series of women with high-risk uterine cancer, SLNs had a significantly higher rate of metastasis than nonsentinel lymph nodes. However, successful mapping rates may be slightly lower than historical controls among high-risk histology cancers. The 95% negative predictive value of SLN is consistent with larger subsets of lower risk endometrial cancers.