Secondary cytoreductive surgery for patients with relapsed epithelial ovarian carcinoma: Who benefits?

Abstract

Background: Persistent infection following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) is a frustrating entity for the patient and rhinologist alike. Mupirocin nasal washes have been proposed as an efficacious treatment in such patients. Two small studies have reported excellent short‐term posttreatment outcomes; however, the long‐term microbiological outcomes following treatment are not known; likewise, the rate of mupirocin‐resistance following treatment has not been explored. Methods: This was a retrospective chart review of 61 patients with Staphylococcus aureus (S. aureus)‐positive surgically‐recalcitrant CRS having undergone 0.05% mupirocin nasal rinse treatment, twice daily for 4 weeks. Specific outcomes reported included posttreatment culture results, time to first posttreatment S. aureus culture, and mupirocin‐sensitivity following treatment. Results: Of 57 patients meeting minimal posttreatment follow‐up criteria, 42 (73.7%) progressed to microbiological failure by subsequently cultured S. aureus. Mean time to first positive culture was 144 days. Of the 42 patients who progressed to microbiological relapse, full antibiotic sensitivity data was available for 41; of these, only 1 was found to subsequently harbor a mupirocin‐resistant strain of S. aureus, thus yielding a posttreatment resistance rate of 2.4%. Conclusion: Treatment with mupirocin nasal washes in S. aureus–positive, surgically recalcitrant CRS has a high microbiological failure rate, with 73.7% of patients subsequently re‐culturing S. aureus. Our current treatment regime of 0.05% nasal washes twice daily for 4 weeks is associated with a posttreatment resistance rate that is consistent with other studies of topical mupirocin use, suggesting that mupirocin washes are no more likely to induce resistance than nasal vestibule decolonization in the high‐risk medical or surgical patient. © 2011 ARS‐AAOA, LLC.

Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection

“…Another possible reason is that Eisenkop et al (2000) and Tay et al (2002) did not analyse the number of recurrent tumours as a factor influencing survival, although they pointed out that this factor may influence SCS outcome. In concordance with our results, Zang et al (2004) reported that the number of recurrent tumours influenced both overall survival and SCS outcome. The current study revealed that liver metastasis is another important prognostic determinant.…”

“…Although we also analysed our patients with DFI 412 months using cutoff periods such as 24 and 36 months, there were no significant differences between patients with and without DFI 424 or 36 months (data not shown). Recently, Zang et al (2004) performed SCS even in patients with DFI of 3 months and reported negative influence of DFI on overall survival. However, their follow-up period was only 16 months.…”

“…Although only preoperative or intraoperative variables before starting SCS should be analysed for selection of the candidate, these variables have been analysed together with SCS outcome in most previous studies. In addition, the follow-up periods of living patients were rather short (the median or average follow-up periods were between 1 and 4 years) (Jänicke et al, 1992;Vaccarello et al, 1995;Cormio et al, 1999;Zang et al, 2000Zang et al, , 2004Munkarah et al, 2001;Scarabelli et al, 2001) in most of the previous reports.…”

“…Recently, several investigators have reported the significant value of secondary cytoreductive surgery (SCS) in a subset of patients with recurrent ovarian cancer (Jänicke et al, 1992;Eisenkop et al, 1995Eisenkop et al, , 2000Vaccarello et al, 1995;Cormio et al, 1999;Zang et al, 2000Zang et al, , 2004Munkarah et al, 2001;Scarabelli et al, 2001;Tay et al, 2002). The value of complete resection at the time of SCS for highly selected patients is in consensus in these recent reports.…”

A BTB/POZ protein, NAC-1, is related to tumor recurrence and is essential for tumor growth and survival

“…Thus, patients with NAC-1-positive ovarian serous carcinoma can be monitored more closely to detect recurrent tumor. It has been demonstrated that ovarian carcinoma patients can most benefit from secondary cytoreduction when the recurrent tumor is small and localized (20)(21)(22)(23)(24).…”