Porta hepatis peritonectomy and hepato–celiac lymphadenectomy in patients with stage IIIC–IV ovarian cancer: Diagnostic pathway, surgical technique and outcomes

Tozzi, Roberto; Traill, Zoë; Campanile, Riccardo Garruto; Ferrari, Federico; Majd, Hooman Soleymani; Nieuwstad, Joost; Hardern, Kieran; Gubbala, Kumar

doi:10.1016/j.ygyno.2016.08.232

Cited by 33 publications

(49 citation statements)

References 16 publications

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“…LPLNM R0 resection is an important part of R0 CRS. Compared with postoperative complication rate of CRS (30%), no LPLNM resection-related complications such as arterial hemorrhage and bile leakage were found (47). LPLNM was present in 15% of advanced OC patients.…”

Section: Lnmmentioning

confidence: 75%

Surgical treatment of ovarian cancer liver metastasis

Wang

Zhou

Zhang

et al. 2019

Hepatobiliary Surg. Nutr

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In addition to hepatocellular carcinoma, metastatic liver cancer (MLC) is another focus of hepatic surgeon. Good outcome of patients with liver metastasis (LM) from colorectal cancer or neuroendocrine tumor have been achieved. Ovarian cancer liver metastasis (OCLM) has its unique oncological characteristics and a variety of metastasis patterns, which brings a challenge to hepatic surgeon. Hepatic surgeons hold different views and techniques from gynecologists, which makes differences in the evaluation and treatment of the disease. We reviewed recent studies and, in combination with our own clinical experience, attempted to introduce the progress of surgical treatment of liver metastases from OC. In our experience, both preoperative imaging and surgical procedures are based on the assurance of R0 resection. R0 cytoreductive surgery (CRS) is the most favorable determinant for the prognosis of OC patients, and R0 liver resection (LR) is a component of R0 CRS. Gynecologists and hepatic surgeons should do their own preoperative and intraoperative evaluation for the extrahepatic and intrahepatic metastasis respectively. During the operation, regardless of the miliary nodules dissemination between the right hemidiaphragm and liver capsule, liver parenchymal infiltration (LPI) or liver parenchymal metastasis (LPM), 1-2 cm resection margin should be emphasized. For patients with liver portal lymph node metastasis (LPLNM), hepatic portal skeletonization should be performed, rather than portal lymph node dissection. The operation should be as radical as possible to ensure the patients to achieve good prognosis.

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Section: Lnmmentioning

confidence: 75%

Surgical treatment of ovarian cancer liver metastasis

Wang

Zhou

Zhang

et al. 2019

Hepatobiliary Surg. Nutr

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“…8 Nevertheless, the traditional open surgery approach still plays a relevant role in gynecology, particularly for advanced malignant disease. 9,10 Systematic application of ERAS protocol is difficult and cumbersome, because of the consolidated personal conviction of healthcare staff, resulting in slow implementation rates. 11,12 Furthermore, only a few prospective randomized trials have been conducted so far specifically addressing the impact of ERAS in gynecologic surgery.…”

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confidence: 99%

Validation of an enhanced recovery after surgery protocol in gynecologic surgery: an Italian randomized study

Ferrari

Forte

Sbalzer

et al. 2020

American Journal of Obstetrics and Gynecology

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BACKGROUND: The enhanced recovery after surgery concept, which was introduced 20 years ago, is based on a multimodal approach to improve the functional rehabilitation of patients after surgery. OBJECTIVE: This study aimed to validate an enhanced recovery after surgery protocol in gynecologic surgery for both benign and malignant diseases (endometrial cancer and advanced ovarian cancer) and to measure the adherence to the enhanced recovery after surgery protocol items in a randomized trial setting. STUDY DESIGN: In this trial (NCT03347409), we randomly assigned patients to undergo standard perioperative care or enhanced recovery after surgery protocol. The primary outcome is a shorter length of stay in favor of the enhanced recovery after surgery protocol. Secondary outcomes include measurement of adherence to the enhanced recovery after surgery protocol items: comparison of postoperative pain, vomiting, and nausea; anesthesiologic and surgical complications up to 30 days after surgery; rate of readmissions; the time to event in hours for bowel movements, flatus, drinking, hunger, eating, and walking; and the quality of recovery using a validated questionnaire (QoR-15). Finally, we explored the length of stay in the prespecified subgroups at randomization, based on the type of surgical access and gynecologic disease. RESULTS: A total of 168 women were available for analysis: 85 women (50.6%) were assigned to the standard perioperative care group, and 83 women (49.4%) were assigned to the enhanced recovery after surgery protocol group. The 2 groups were similar for age, body mass index, comorbidities, anesthesiological risk, smoking habits, surgical access, and complexity of surgical procedures. Seventy-two patients (42.9%) underwent surgery for benign disease, 48 (28.6%) for endometrial cancer, and 48 (28.6%) for ovarian cancer. Women in the enhanced recovery after surgery protocol group had a shorter length of stay (median: 2 [interquartile range, 2e3] vs 4 [interquartile range, 4e7] days; P<.001). A decreased rate of postoperative complications was noted for the enhanced recovery after surgery protocol group, as well as an earlier time to occur for all the events. Mean adherence to protocol items was 84.8% (95% confidence interval, 79.7e89.8), and we registered a better satisfaction in the enhanced recovery after surgery protocol group. The shortening of the length of stay was confirmed also in the prespecified subgroup analysis. CONCLUSION: Application of the enhanced recovery after surgery protocol in gynecologic surgery translated to a shorter length of stay regardless of surgical access and type of gynecologic disease. Adherence to the enhanced recovery after surgery protocol items in the setting of a randomized trial was high.

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“…Before considering a diagnosis of a primary EC with IM/diff, careful pathological work-up should exclude a secondary involvement from cervical, ovarian, gastrointestinal, or pancreatobiliary tumors. When clinical information is unavailable or scarce, a mainly extra-uterine disease with extensive peritoneal spread, diffuse lymphovascular invasion, extrinsic uterine infiltration with minor endometrial involvement, and absence of AEH favors a metastasis from an extra-uterine carcinoma [3,21]. Immunohistochemistry is of limited value since intestinal metaplastic areas are usually negative for hormone receptors and present overlapping immunophenotype with extra-uterine mucinous tumors.…”

Section: Discussionmentioning

confidence: 99%

Endometrial Carcinomas with Intestinal-Type Metaplasia/Differentiation: Does Mismatch Repair System Defects Matter? Case Report and Systematic Review of the Literature

Ardighieri

Palicelli

Ferrari

et al. 2020

JCM

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Background: Intestinal metaplasia/differentiation in primary endometrial carcinomas is an uncommon phenomenon, with only few cases described. Material and Methods: We performed a systematic review of endometrial carcinomas with intestinal metaplasia/differentiation interrogating the electronic databases Pubmed, Web of Science, and Scopus, and we reported an additional case arising in a 49-year-old woman. Results: We identified only eight patients diagnosed with endometrial carcinomas exhibiting intestinal metaplasia/differentiation, and additionally our case. Endometrial carcinomas with intestinal-type features can present in pure or mixed forms in association with usual-type endometrioid carcinomas; in mixed forms, the two neoplastic components may derive from a common neoplastic progenitor, as evidenced by the concomitant loss of MSH2 and MSH6 protein expression in our case. Disease recurrences occur in a significant fraction of the cases, including patients diagnosed in low-stage disease. Conclusions: Endometrial carcinomas with intestinal metaplasia/differentiation are rare and they may represent a more aggressive tumor variant, thus requiring a proper treatment despite the low-tumor stage. The ProMise classification should be performed also in these unusual tumors, since they can be associated with mismatch repair system defects.

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Porta hepatis peritonectomy and hepato–celiac lymphadenectomy in patients with stage IIIC–IV ovarian cancer: Diagnostic pathway, surgical technique and outcomes

Cited by 33 publications

References 16 publications

Surgical treatment of ovarian cancer liver metastasis

Surgical treatment of ovarian cancer liver metastasis

Validation of an enhanced recovery after surgery protocol in gynecologic surgery: an Italian randomized study

Endometrial Carcinomas with Intestinal-Type Metaplasia/Differentiation: Does Mismatch Repair System Defects Matter? Case Report and Systematic Review of the Literature

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