Aims: To evaluate overall survival (OS) and progression-free survival (PFS) in patients with stage IIIC epithelial ovarian, tubal and peritoneal cancer (EOC) who underwent a laparoscopy to assess surgical resectability prior to Primary Debulking Surgery (PDS) or Interval Debulking Surgery (IDS). Methods: Retrospective cohort study that included all women with stage IIIC EOC treated at our center between 2000 and 2010. Patients were classified in groups: PDS, neoadjuvant chemotherapy (NACT) with IDS, NACT without IDS; and then sub-classified based on residual tumor (RT). A laparoscopy to assess resectability was performed before PDS and IDS. Results: Among 111 patients included, 66 underwent PDS, and 45 were treated with NACT, 80% of them receiving subsequent IDS. OS was 75.6 months in the PDS group, and 52.8 months for IDS group (p = 0.100); the PFS was 30 months and 19.2 months respectively (p = 0.049). Median OS was 104.4 and 52.8 months for patients with optimal cytoreduction (RT = 0) in the PDS and IDS group respectively (p < 0.05). Laparoscopy did not modify the preoperative consideration for PDS; however, 9 laparotomies were avoided based on laparoscopic findings after NACT. Conclusion: Laparoscopy for the assessment of surgical resectability in stage IIIC EOC has no impact on survival; but it still could be useful for the reduction of unnecessary laparotomies after NACT.
Objective: To evaluate the reliability of sagittal abdominal
diameter (SAD)—a surrogate of visceral obesity—in MRI, and its
accuracy to predict the surgical morbidity of aortic lymphadenectomy.
Design: A multicentre reliability (phase 1) and accuracy (phase
2) cohort study. Setting: Three Spanish referral hospitals.
Population: High-risk endometrial cancer patients undergoing
minimally invasive surgical staging. Patients were classified into
subgroups: conventional vs. robotic-assisted laparoscopy, and
transperitoneal vs. extraperitoneal technique. Methods:
Retrospective analysis of data from the STELLA-2 randomized controlled
trial. In the first phase, we measured the agreement of three SAD
measurements (at the umbilicus, the renal vein, and the inferior
mesenteric artery) and selected the most reliable one. In phase two, we
evaluated the diagnostic accuracy of SAD to predict surgical morbidity.
Main Outcome Measures: surgical morbidity was defined by a core
outcome set including variables related to blood loss, operative time,
surgical complications, and para-aortic lymphadenectomy difficulty.
Results: In phase one, all measurements showed good inter-rater
and intra-rater agreement. Umbilical SAD was the most reliable one. In
phase two, we included 136 patients. Umbilical SAD had a good diagnostic
accuracy to predict surgical morbidity in patients undergoing
transperitoneal laparoscopic lymphadenectomy (0.73 in ROC curve). It
performed better than BMI and other anthropometric measurements. We
calculated a cut-off point of 246 mm (sensitivity: 0.56 and specificity:
0.80). Conclusions: Umbilical SAD is a simple, reliable, and
potentially useful measurement to predict surgical morbidity in
endometrial cancer patients undergoing minimally invasive surgical
staging, especially when facing transperitoneal aortic lymphadenectomy.
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