Optimal surgical debulking in uterine papillary serous carcinoma affects survival

Patsavas, Kristia; Woessner, Jessica; Gielda, Benjamin T.; Rotmensch, Jacob; Yordan, Edgardo; Bitterman, Pincas; Guirguis, Alfred

doi:10.1016/j.ygyno.2010.11.048

Cited by 32 publications

(17 citation statements)

References 38 publications

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“…18 For patients with advanced disease, optimal debulking is associated with an improved OS rate. 19,20 Regarding adjuvant treatment, recommendations are similar to those for treatment of high-risk endometrial cancer and radiotherapy and/or chemotherapy is usually recommended even in stage IA disease. 2,21 The aims of this study were to determine the role of omental sampling in staging of USC and to evaluate its impact on patient outcomes including survival, progression, and recurrence patterns.…”

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confidence: 99%

Omental Biopsy for Surgical Staging of Uterine Serous Carcinoma

Luz¹,

MacDonald²,

Mould³

2016

Int J Gynecol Cancer

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confidence: 99%

Omental Biopsy for Surgical Staging of Uterine Serous Carcinoma

Luz¹,

MacDonald²,

Mould³

2016

Int J Gynecol Cancer

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“…Prognosis is usually poor except for the isolated vaginal recurrence [20]. There is some evidence that more radical surgery may lower locoregional recurrence, not only in the pelvis [17,21] but also with respect to periaortic nodes [22,23]. However, it is difficult to compare results from clinical studies due to the large variety of surgical strategies and quality.…”

Section: Discussionmentioning

confidence: 99%

Definition of compartment-based radical surgery in uterine cancer: modified radical hysterectomy in intermediate/high-risk endometrial cancer using peritoneal mesometrial resection (PMMR) by M Höckel translated to robotic surgery

et al. 2013

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BackgroundThe technique of compartment-based radical hysterectomy was originally described by M Höckel as total mesometrial resection (TMMR) for standard treatment of stage I and II cervical cancer. However, with regard to the ontogenetically-defined compartments of tumor development (Müllerian) and lymph drainage (Müllerian and mesonephric), compartments at risk may also be defined consistently in endometrial cancer. This is the first report in the literature on the compartment-based surgical approach to endometrial cancer. Peritoneal mesometrial resection (PMMR) with therapeutic lymphadenectomy (tLNE) as an ontogenetic, compartment-based oncologic surgery could be beneficial for patients in terms of surgical radicalness as well as complication rates; it can be standardized for compartment-confined tumors. Supported by M Höckel, PMMR was translated to robotic surgery (rPMMR) and described step-by-step in comparison to robotic TMMR (rTMMR).MethodsPatients (n = 42) were treated by rPMMR (n = 39) or extrafascial simple hysterectomy (n = 3) with/without bilateral pelvic and/or periaortic robotic therapeutic lymphadenectomy (rtLNE) for stage I to III endometrial cancer, according to International Federation of Gynecology and Obstetrics (FIGO) classification. Tumors were classified as intermediate/high-risk in 22 out of 40 patients (55%) and low-risk in 18 out of 40 patients (45%), and two patients showed other uterine malignancies. In 11 patients, no adjuvant external radiotherapy was performed, but chemotherapy was applied.ResultsNo transition to open surgery was necessary. There were no intraoperative complications. The postoperative complication rate was 12% with venous thromboses, (n = 2), infected pelvic lymph cyst (n = 1), transient aphasia (n = 1) and transient dysfunction of micturition (n = 1). The mean difference in perioperative hemoglobin concentrations was 2.4 g/dL (± 1.2 g/dL) and one patient (2.4%) required transfusion. During follow-up (median 17 months), one patient experienced distant recurrence and one patient distant/regional recurrence of endometrial cancer (4.8%), but none developed isolated locoregional recurrence. There were two deaths from endometrial cancer during the observation period (4.8%).ConclusionsWe conclude that rPMMR and rtLNE are feasible and safe with regard to perioperative morbidity, thus, it seems promising for the treatment of intermediate/high-risk endometrial cancer in terms of surgical radicalness and complication rates. This could be particularly beneficial for morbidly obese and seriously ill patients.

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“…9,11,12 This report, however, focuses on elective ureteric resections to achieve cytoreduction to less than 1-cm visible tumor in gynecologic malignancies and complete excision of deep infiltrating endometriosis. The profound, well-documented survival benefit associated with complete primary and secondary cytoreductive surgery in ovarian cancer 1,9,13,14 suggests that excision of tumor involving the urinary tract should be encouraged if it will reduce patients to no macroscopic residual tumor. In addition, surgical reconstruction of the urinary tract may maintain renal function, which also is of paramount importance for adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%