Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer

Abstract

This study was conducted to identify the method of laparoscopic entry used by practicing gynecologists and learn whether they are following new recommendations for improvement of the safety of laparoscopic gynecologic surgery. Several international societies of endoscopy have endorsed new guidelines for safe laparoscopic entry techniques. Physicians are advised to place the primary incision in the base of the umbilicus when performing closed laparoscopy. If adhesions are suspected, the incision can be made in Palmer's point. Intraabdominal pressure should be 25 mm Hg for trocar insertion. In open laparoscopy, the incision should be made at the lower border of the umbilicus and care taken to elevate the deep fascia to separate the abdominal wall from its contents. Secondary trocars should be inserted under direct laparoscopic guidance.The authors mailed an anonymous questionnaire about laparoscopic techniques to all gynecologists in the United Kingdom and Ireland (n ϭ 1190). They received 764 (64%) responses.A large majority (90%) of responders used a closed entry technique with a Veress needle, 8% preferred a direct entry technique without a pneumoperitoneum, and 1% each used Hasson's method or a combination of open and closed laparoscopy. The patient positions used in performing laparoscopy were lithotomy with Trendelenburg tilt (61%), the flat position (29%), or a combination of positions (10%).Over half of respondents (54%) used a subumbilical entry point, 44% preferred an intraumbilical entry point, 2% used a suprapubic entry, and 2% used a combination of sites. Only 44% indicated that they performed a check test to assure correct positioning of the Veress needle; when used, Palmer's aspiration technique was used most often (90%).Sixty-two percent of responders used volume (range, less than 2.0-3.5) and 38% used the intraabdominal pressure technique (range, 15-25 mm Hg) to establish a satisfactory pneumoperitoneum before trocar insertion.Half of the responding gynecologists (53%) said that they would use their preferred techniques for all patients, regardless of a patient's history. Forty-seven percent would change their techniques for obese patients or those who had prior abdominal surgery. One third (34%) indicated that their techniques had changed in the past 5 years.Thirty-four percent of the responders had attended a laparoscopic or endoscopic surgery course in the past and 66% had not. Those who had attended a course were more likely to follow the new recommendations for safe laparoscopy (69%). Only 26% of responders were aware of the new guidelines, whereas 74% were not aware of these recommendations. GYNECOLOGY ABSTRACTTo identify the preoperative and intraoperative factors that might affect the outcome from a tension-free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence (SUI), 809 participants were recruited from women scheduled to undergo TVT between March 2000 and September 2001. Patients with recurrent urinary tract infections, symptoms of urge incontinence greater tha...

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

“…Grade ¾ toxicity was significantly greater and quality of life scores significantly worse in the IP arm. [26] Elit et al published a meta-analysis of 7 randomized controlled trials for adjuvant intraperitoneal chemotherapy. A pooled analysis from 6 of the 7 studies confirmed the survival benefit of IP chemotherapy compared with IV chemotherapy alone (Relative risk, 0.88; 95 % confidence interval, 0.81-0.95) Adverse events and catheter related problems were more common in the IP chemotherapy group and often led to discontinuation of therapy.…”

“…[13,14,25,26,[51][52][53][54][55][56][57]. Thus, most of the results obtained with the addition of HIPEC to standard frontline therapy seem to be similar or inferior to the results obtained without the use of HIPEC.…”

BRCA1 and BRCA2 mutations correlate with TP53 abnormalities and presence of immune cell infiltrates in ovarian high-grade serous carcinoma

“…The median progression-free survival and overall survival from landmark phase III trials range between 12 and 24 months and 29-65 months, respectively. 1,2 Factors that are believed to impact survival include patient age, performance status, preoperative CA125, volume of ascites, stage, grade, extent of cytoreductive surgery, chemotherapeutic agents, route of delivery, duration of treatment, histological subtype, host immune response, and specific genetic alterations, including BRCA mutations. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] There remains, however, limited ability to accurately prognosticate in patients with advanced stage high-grade serous carcinoma based on features of the primary tumor at the time of diagnosis.…”

A phase II randomised clinical trial comparing cisplatin, paclitaxel and ifosfamide with cisplatin, paclitaxel and epirubicin in newly diagnosed advanced epithelial ovarian cancer: long-term survival analysis

“…Since the introduction of platinum compounds in first-line chemotherapy, PFS has not improved much over the years, but OS has risen from about 20 months in the 1980s (Conte et al, 1986;Alberts et al, 1992;Rothenberg et al, 1992;Swenerton et al, 1992;Alberts et al, 1996) to 30 months in the 1990s (McGuire et al, 1996;ICON Collaborators, 1998;Muggia et al, 2000) and 40 months in the last few years (Markman et al, 2001;ICON Collaborators, 2002;Du Bois et al, 2003;Armstrong et al, 2006). In our series, PFS was slightly better than is commonly reported and considering the composition of our population, OS of 54 months is remarkable.…”

“…In our series, PFS was slightly better than is commonly reported and considering the composition of our population, OS of 54 months is remarkable. Comparable results are reported only in trials that enrolled only patients with minimal or no residual disease after the first surgery (Alberts et al, 1996;Markman et al, 2001;ICON Collaborators, 2002;Armstrong et al, 2006), and in other studies that considered the subgroup of patients with this positive prognostic factor (du Bois et al, 2006;Pfisterer et al, 2006).…”