The aim of this retrospective study was to examine the incidence and prognostic significance of abdominal wall metastases in patients with ovarian cancer present at the primary debulking at the entry sites of previous laparoscopy or paracentesis. The clinical records of 219 patients were studied. In 7 of 43 patients (16%) who had undergone laparoscopy and 3 of 30 patients (10%) who had undergone paracentesis previous to the primary debulking, an abdominal wall metastasis had developed at the entry sites. All metastases occurred in patients with FIGO stage IIIC-IV including ascites. Survival analysis using the Cox proportional hazards model showed that after adjustment for age, FIGO stage, histology, grade, ascites, and residual disease after primary debulking, the presence of abdominal wall metastases in the entry sites of previous laparoscopy or paracentesis was negatively, although not statistical significantly, correlated with survival (P = 0.14).

/pdf/incidence-and-effect-on-survival-of-abdominal-wall-59k83yox27.pdf

Incidence and Effect on Survival of Abdominal Wall Metastases at Trocar or Puncture Sites Following Laparoscopy or Paracentesis in Women With Ovarian Cancer

The authors conducted a retrospective review of the medical charts of all patients who underwent surgical treatment of invasive adenocarcinoma of the endometrium between 1998 and 2000 at the James Cancer Hospital of Ohio State University College of Medicine. Data from the records of 366 patients who had surgical evaluation of the pelvic lymph nodes were evaluated to investigate the association of lymphvascular space involvement (LVSI) and lymph node metastases from endometrial cancer. The median age at diagnosis was 62 years (range, 27-90). The histological diagnosis was adenocarcinoma in 316 women; 52 patients also had areas of nonendometrioid histology, including uterine papillary serous adenocarcinoma (N = 21 ), clear-cell carcinoma (N = 14), and mixed epithelial adenocarcinoma (N = 17). Forty-four percent of patients were grade 1, 29% were grade 2, and 27% grade 3. Tumor invasion was confined to the inner third of the myometrium in 25% of the women, to the middle third in 43%, and to the outer third in 32%. LVSI was seen in one fourth of the cases, and the mean number of lymph nodes removed was 21.6. Forty-six women (13%) had metastases to the pelvic nodes (pelvic nodes only, N = 32; pelvic and para-aortic nodes, N = 14). More than one third of the patients (245 of 366) had stage 1 disease, 29 had stage II, 80 had stage III, and 12 women were stage IV. Ninety-two patients (25%) had tumor emboli in the lymphvascular spaces of the myometrium, and 46 of these patients had metastatic disease in the pelvic lymph nodes (P <.001). After statistical analysis, the association of LVSI with lymph node metastases remained significant (P <.001). Myometrial invasion was also found to have a significant association with positive pelvic nodes (P <.05 for invasion into the inner third of the myometrium, P <.01 for invasion into the middle third, and P <.001 in the outer third). When both variables were compared, LVSI was significantly associated with deeply invasive tumors (P <.001). Multivariate analysis, which included LVSI, tumor grade, patient age, depth of tumor invasion, and lymph node yield, found depth of invasion and LVSI to be significant predictors of metastatic disease in the pelvic lymph nodes (P <.004 and P <.04, respectively).

Should the Presence of Lymphvascular Space Involvement Be Used to Assign Patients to Adjuvant Therapy Following Hysterectomy for Unstaged Endometrial Cancer

In previous studies of laparoscopic surgery for women with ovarian cysts, most patients had small cysts. The present prospective study evaluated the laparoscopic approach in 33 consecutive women operated on during a 7-year period for ovarian cysts having a maximum diameter of 10 cm or more. All had laboratory and radiological features suggesting benign disease. Participants ranged in age from 17 to 73 years, averaging 45 years. The mean body mass index was 30, with a range of 21 to 42. Prospective patients whose maximum cyst diameter exceeded 30 cm were excluded from the study. Laparoscopic surgery proved effective in all but 2 instances, for a success rate of 94%. Two patients with adhesions were converted to laparotomy. No surgical or postoperative complications were recorded. Operating time averaged 82 minutes, and estimated blood loss, 89 mL. The hospital stay averaged just under 1 day; more than two-thirds of patients were discharged on the day of surgery. The procedures most frequently performed were unilateral salpingo-oophorectomy (SO) and laparoscopically assisted vaginal hysterectomy with bilateral SO. Cysts were extracted by aspiration through the vagina in 11 cases, by a lower quadrant incision in 5, and via an umbilical incision in 15. The most common pathologic finding was serous cystadenoma, followed by mucinous cystadenoma, dermoid, endometriosis, benign epithelial-lined cyst, and-in 2 cases-borderline ovarian tumor. All 4 women who were pregnant at the time of laparoscopic surgery, from 14 to 18 estimated weeks of gestational age, had a good outcome. These findings support accumulating evidence that laparoscopic surgery is an effective and safe procedure for removing large benign ovarian cysts.

Laparoscopic Surgery for Large Benign Ovarian Cysts

Purpose of investigation To evaluate whether lymphvascular space involvement (LVSI) is a risk factor for relapse of disease and lymph node metastasis in endometrial cancer Methods From 1978 till 2003, 609 patients with epithelial endometrial cancer were treated at the Groningen University Medical Center The association of LVSI and relapse of disease was evaluated in the total group of 609 patients and in a ‘ low' and ‘ high' risk stage I endometrial cancer group In 239 surgically staged patients, the relation of LVSI and lymph node metastasis was investigated Results The median age at diagnosis was 63 years (range 27- 92 years) with a median follow- up of 58 months (range 0- 236 months) More than half of the patients (56% ) received adjuvant radiotherapy LVSI was present in 123 patients (25,6% ), and a prognostic factor for relapse of disease (multivariate analysis, P 00001) In the ‘ low' and ‘ high' risk stage I endometrial cancer patients an increase of 26 times in relapse of disease was observed in the presence of LVSI LVSI positive tumors were more likely to have metastasized to the pelvic lymph nodes (multivariate analysis, P = 0001) In patients with proven negative nodes, LVSI was a prognostic factor for relapse of disease (univariate analysis, P = 002) Conclusion LVSI is a predictor of nodal disease and an independent prognostic factor for relapse of disease in all stages of endometrial cancer Patients with stage I endometrial cancer with positive LVSI are at risk for relapse of disease and might therefore benefit from adjuvant therapy Content The presence of lymphvascular space involvement (LVSI) in endometrial cancer is significantly and independently associated with an increased risk of pelvic lymph node metastases and/or relapse of disease

Lymphvascular space involvement:An independent prognostic factor in endometrial cancer

Aim

The aim of the present study was to evaluate the surgical and obstetric results of laparoscopy versus laparotomy in the management of ovarian cyst during pregnancy.



Material and Methods

Sixty-nine eligible patients who met our criteria were randomly divided into the laparoscopy group (n = 33) and the laparotomy group (n = 36). The two groups were compared for their surgical and obstetric outcomes and the extent of pelvic adhesion discovered in later cesarean section (CS).



Results

The laparoscopy group had less blood loss (43 ± 15 vs 51 ± 13 mL, P = 0.02), shorter postoperative hospital stay (2.9 ± 0.5 vs 5.8 ± 0.6 days, P   0.05). Sixteen patients in the laparoscopy group, and 15 patients in the laparotomy group underwent cesarean section. The filmy and dense type adhesion rate was significantly different between the laparoscopy group and the laparotomy group (6.25% vs 53.3%, and 0% vs 20%, respectively).



Conclusions

The present results suggest that laparoscopy is a better choice than laparotomy for ovarian cyst during pregnancy, with less blood loss, less postoperative pain and less postoperative hospital stay. It offers a faster recovery, results in less pelvic adhesion and does not affect the fetus; however, studies encompassing larger numbers of cases are needed.

Comparative analysis of laparoscopy versus laparotomy in the management of ovarian cyst during pregnancy.

To assess the feasibility and short-term surgical outcome of laparoscopic surgery among women with large ovarian cysts. We retrospectively evaluated consecutive 81 patients who received laparoscopic management for ovarian cysts with diameter ≥ 10 cm and without radiologic features suggestive of malignancy, from March 2008 to September 2011. Laparoscopic surgery was successful in 77 (95.1 %) of the total patients. The mean (range) operative time, estimated blood loss (EBL) and hospital stay were 107.6 (55–250 min), 226.9 (10–1300 mL) and 6.1 (4–15 days), respectively. The surgical procedures performed included salpingooophorectomy (SO) (n = 44), ovarian cystectomy (OC) (n = 22), adhesiolysis (n = 1), salpingectomy (n = 2) and total laparoscopic hysterectomy (TLH) with SO (n = 8). Conversion to laparotomy occurred with four patients. One patient had postoperative bleeding and one had minor complications associated with wound oozing at the umbilical port site. Histopathological examination revealed benign tumors in 76 patients (93.8 %), borderline ovarian tumor in three patients (3.7 %) and invasive epithelial ovarian cancer in two patients (2.5 %). Clinicopathological variables according to tumor size were not statistically different. Complications did not appear in any patients during the follow-up period. With proper patient selection, laparoscopy is a feasible and safe treatment for women with large ovarian cysts and tumor size did not have effect on laparoscopic management. However, surgeons should carefully consider the potential risk of malignancy in such patients.

Is tumor size the limiting factor in a laparoscopic management for large ovarian cysts

Objective To detect the possible clinicopathologic factors associated with parametrial involvement in patients with stage IB1 cervical cancer and to identify a cohort of patients who may benefit from less radical surgery. Methods We retrospectively reviewed 120 patients who underwent radical hysterectomy and pelvic lymphadenectomy as treatment for stage IB1 cervical cancer. Results Overall, 18 (15.0%) patients had parametrial tumor involvement. Tumor size larger than 2 cm, invasion depth greater than 1 cm, presence of lymphovascular space involvement (LVSI), corpus involvement, and positive lymph nodes were statistically associated with parametrial involvement. Multivariate analysis for other factors showed invasion depth >1 cm (P=0.029), and corpus involvement (P=0.022) were significantly associated with parametrial involvement. A subgroup with tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Conclusion Tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Invasion depth >1 cm and corpus involvement were significantly associated with parametrial involvement in multivariate analysis. These finding may suggest that tumor size may a strong predictor of parametrial involvement in International Federation of Gynecology and Obstetrics stage IB1 cervical cancer, which can be used to select a subgroup population for less radical surgery.

/pdf/factors-associated-with-parametrial-involvement-in-patients-3y80rvrqxt.pdf

Factors associated with parametrial involvement in patients with stage IB1 cervical cancer: Who is suitable for less radical surgery?

Copyright © 2012. Korean Society of Obstetrics and Gynecology Endometrial cancer is the most common gynecological malignancy in the Western world. For patients with a uterine-confi ned earlystage endometrial carcinoma, the infl uence of prognostic factors such as patient age, the tumor grade, and the depth of invasion are well-recognized [1]. The presence of lymphovascular space involvement (LVSI) has also been shown to be an independent prognostic factor in several studies, yet its association with recurrence was not shown on the multivariate analysis in other studies [2]. LVSI was associated with compromised survival in patients who are at clinical stages I and II, but not in patients at surgical stages I or II [3]. LVSI has been described as a predictor for nodal metastases or ORIGINAL ARTICLE

/pdf/the-prognostic-significance-of-lymphovascular-space-2bw02skppr.pdf

The prognostic significance of lymphovascular space involvement in patients with uterine-confined endometrioid endometrial cancer.

Sertoli-Leydig tumors tend to relapse early and due to their rarity, limited data are available regarding a role of chemotherapy in the management of Sertoli-Leydig cell tumors. We present a case of recurrent ovarian Sertoli-Leydig cell tumor whose salvage treatment was successful with paclitaxel and carboplatin chemotherapy.

https://synapse.koreamed.org/upload/SynapseData/PDFData/3021ogs/ogs-56-198.pdf

A case of successful salvage chemotherapy of recurrent ovarian sertoli-leydig cell tumor.

In patients with gynecologic malignancies, bone metastases are unusual and generally occur in a more advanced stage of the disease with extended local invasion of the primary site and/or parenchymal metastasis. In ovarian cancer, the main route of spread is intraperitoneal implantation and loco-regional invasion, whereas extraperitoneal spread usually implies advanced disease. Bone metastasis from ovarian cancer is rare and occurs in approximately 1% of primary or recurrent disease. The prognosis of cases with bone metastasis is poor. We report a patient with metastases to the sternum and a rib after prolonged treatment and a patient with recurrent ovarian cancer metastatic to the sacrum 8 months after primary treatment.

Recurrent ovarian cancer metastatic to the bone: Case report

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