Laparoscopic Adnexectomy with Peritonectomy for an Ovarian Tumor Adhered to the Pelvic Sidewall

Aim: To evaluate the effects of CO₂ pneumoperitoneum during gynecologic laparoscopy on patients' postoperative cognitive function. Methods: This prospective clinical study included 225 adult female patients with American Society of Anesthesiologists physical status I or II. Patients underwent conventional open surgery (group I, n = 115) or gynecologic laparoscopy using abdominal insufflation with CO₂ to an intra-abdominal pressure of 15 mm Hg (group II, n = 110). Serum S100β and neuron-specific enolase (NSE) concentrations were measured, both immediately before surgery and before the patient awoke after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery as well as 1, 6, 12, 24 and 72 h after surgery and before discharge. Results: MMSE scores were significantly lower relative to baseline at 1, 6 and 12 h post surgery, but returned to baseline by 48 h (group I) or 72 h (group II) post surgery. One hour after surgery, S100β serum levels were higher in group II than in group I (p < 0.05). NSE levels did not differ between the groups. In group II, the MMSE score significantly correlated with serum S100β or NSE concentrations. Conclusion: CO₂ pneumoperitoneum influences postoperative cognitive function in patients undergoing gynecologic laparoscopy.

Section: Discussionsupporting

confidence: 85%

Effects of CO<sub>2</sub> Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy

Liu

Bao²,

Lu³

2015

“…However, there is a growing body of evidence suggesting its effectiveness and safety as compared to the open approach [24,25,26]. …”

Section: Discussionmentioning

confidence: 99%

Different Patterns of Disease Spread between Advanced-Stage Type I and II Epithelial Ovarian Cancer

Bergamini

Candiani

Taccagni

et al. 2015

Background and Aims: Two types of epithelial ovarian carcinoma (EOC) have been recently distinguished. Type I comprises low-grade serous, endometrioid and clear-cell tumors. High-grade endometrioid and serous tumors belong to type II. The aim of this study was to compare patterns of disease spread in advanced-stage type I and II EOCs at primary surgery. Methods: Surgical and pathological data of 233 patients with advanced-stage EOCs were collected, 42 with type I and 191 with type II. The two groups were compared for tumor localization at primary surgery. Intraoperative mapping of ovarian cancer (IMO) was used to assess tumor dissemination. Results: Tumor involvement was significantly higher in the type II group for the following: peritoneum (68.1 vs. 40.5%, p < 0.001), pouch of Douglas (60.2 vs. 40.5%, p = 0.06), vesicouterine ligament (40.8 vs. 19%, p = 0.027), diaphragm (45.0 vs. 11.9%, p < 0.001), serosa of liver (17.2 vs. 4.8%, p = 0.05), omentum (81.1 vs. 59.5%, p = 0.007), mesentery (42.9 vs. 16.7%, p = 0.005), pleural effusions (19.4 vs. 4.6%, p = 0.01) and ascites (60.7 vs. 21.4%, p < 0.001). IMO levels were different between the two groups (p = 0.001). Conclusions: This study provides clinical evidence in favor of the dualistic model of carcinogenesis, since types I and II are characterized by different findings at primary surgery.

“…Staging laparoscopy has proved to offer a reliable evaluation of occult peritoneal carcinosis, and a good prediction of the possibility of optimal cytoreduction in primary and recurrent ETOC patients [24,25,26]. Conversely, retroperitoneal and intraparenchymal localizations of disease may be missed by laparoscopic exploration.…”

Section: Discussionmentioning

confidence: 99%

“…Searching the literature database (PubMed, Embase, Medscape) using the criteria of recurrence, solitary, splenic, ovarian cancer and tubal cancer and the references of retrieved articles, we found 35 cases of splenectomy for recurrent TOC (table 1) [5,6,8,26,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44]. Splenectomy was mainly part of secondary cytoreductive surgery and only in one case of tertiary cytoreduction [43].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Splenectomy as Quaternary Cytoreduction for Isolated Parenchymal Splenic Recurrence of Epitelial Tubo-Ovarian Cancer: Report of a Case and Literature Review

Sorbi¹,

Prosperi²,

Villanucci³

et al. 2015

Isolated parenchymal splenic lesions are very rare and may occur as recurrences in the form of epithelial tubo-ovarian cancer (ETOC). We report a case of solitary parenchymal splenic recurrence of ETOC, which developed 50 months after the initial treatment. A 66-year-old woman underwent laparotomic primary cytoreduction in 2008. After platinum-based chemotherapy, she developed recurrences; thus, she underwent secondary and tertiary cytoreduction in 2011 and 2012 respectively. In April 2013, CT scan documented a solitary parenchymal splenic lesion and it was confirmed by FDG PET/CT. She underwent quaternary cytoreduction by laparoscopic splenectomy. Histopathological evaluation revealed metastatic parenchymal disease consistent with recurrent ETOC. She was alive and disease-free for ten months since splenectomy. In literature there are 35 cases of isolated spleen parenchymal metastasis of ETOC and our report is the first case of laparoscopic splenectomy in the setting of quaternary cytoreduction. Laparoscopic splenectomy as quaternary cytoreduction is safe and feasible and could be congruent to the well-established experiences already reported for the primary, secondary or even tertiary cytoreduction where the absence of residual disease has been translated in a significant survival benefit.