Investigator
Charit Universittsmedizin Berlin
Surgical outcomes of rectosigmoid colon resection versus rectosigmoid wall stripping for superficial rectal wall tumors at cytoreductions for advanced ovarian cancer
This study aimed to evaluate surgical outcomes of rectosigmoid resection versus rectosigmoid wall stripping for superficial tumor involvement during cytoreductive surgery for advanced ovarian cancer. This retrospective study included patients with the International Federation of Gynecology and Obstetrics stage III to IV ovarian cancer who underwent rectosigmoid resection or rectosigmoid wall stripping during primary or interval cytoreductive surgery between January 2021 and January 2024. Inverse probability of treatment weighting was used to balance baseline characteristics. Perioperative and oncologic outcomes were compared using appropriate statistical tests, including χ A total of 322 patients (rectosigmoid resection, n = 182; rectosigmoid wall stripping, n = 140) were included. A transition from rectosigmoid resection to rectosigmoid wall stripping began in mid-2022, resulting in an 83% reduction in rectosigmoid resection and a 900% increase in rectosigmoid wall stripping by late 2023. Rectosigmoid wall stripping was associated with shorter operation time (310 vs 400.8 minutes, p < .0001), lower blood loss (median, 489.4 vs 700 mL, p < .0001), fewer transfusions (31.3% vs 54.4%, p = .0002), shorter hospital stays (median, 11 vs 12 days, p = .0001), fewer thromboembolic events (6% vs 13.0%, p = .0356), and faster chemotherapy initiation (20 vs 22 days, p = .0002). Complete cytoreduction rates (72.6% vs 79.0%, p = .5152) and 6-month mortality (2.3% vs 1.7%, p = .6795) were similar. The rectosigmoid resection group showed a trend toward higher rates of bowel perforation (3.0% vs 0.8%) and fistula formation (2.0% vs 1.0%), although these differences were not statistically significant. For superficial and limited rectal serosal involvement, rectosigmoid wall stripping achieved macroscopic tumor clearance while reducing perioperative complications compared with rectosigmoid resection, which should be reserved for deeper or more extensive disease. Six-month follow-up showed comparable mortality rates between the 2 groups. Long-term and large-scale data are needed to ensure comparable oncologic safety.
The role of neoadjuvant chemotherapy in advanced ovarian cancer: The right treatment to the right patient – Ensuring optimal outcomes in advanced ovarian cancer
Lymphedema after pelvic and para-aortic lymphadenectomy—results of a systematic evaluation in patients with cervical and endometrial carcinoma
Abstract Background Lymphedema is a frequent complication after surgical treatment in gynecological oncology with substantial impact on patients´ Quality of Life (QoL). Little is known about screening instruments and prevention. Primary objective was to develop and validate the German version of a 13 items screening questionnaire (SQ) developed by Yost et al. to provide a valid instrument for early diagnosis of lower extremity lymphedema (LEL). Methods After translation the SQ was used in pt. with cervical or endometrial cancer who underwent pelvic/paraaortic Lymphadenectomy. Sensitivity and specifity were analysed regarding possible prediction and influencing factors of LEL. Results 67 pt. had LEL (N = 128). Nearly 50% of women in each group (38 in LEL + e 30 in LEL − ) had a body mass index (BMI) > 30 kg/m2. Number of removed lymphnodes, radiotherapy and were significantly associated with development of LEL. Translated Mayo Clinic questionnaire can be used with reliable specifity and sensitivity. Four additional questions improved the diagnostic accuracy of the SQ. Conclusions The translated SQ is a valuable and predictive tool for screening and early detection of LEL in Gynecological cancer surgery and can even improved by adding simple questions.
European Society of Gynaecological Oncology expanded quality indicators and accreditation for cervical cancer management
Ovarian cancer management in an ESGO ovarian cancer center of excellence: a systematic case study of the interprofessional and interdisciplinary interaction
Abstract Purpose With growing knowledge about ovarian cancer over the last decades, diagnosis, evaluation and treatment of ovarian cancer patients have become highly specialized, and an individually adapted approach should be made in each woman by interdisciplinary cooperation. The present study aims to show the variety and extent of medical specialties involved at our institution according to the European Society of Gynecologic Oncology (ESGO) Quality indicators (QI). Methods A woman, diagnosed with high-grade ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) class IVb was selected for a single case observational study. The observation period (total = 22d) comprised preoperative diagnostic procedures, including imaging, the in-patient stay for cytoreductive surgery, and the postoperative course and case discussion at our interdisciplinary tumor board. Data were obtained by self-reporting and by patient file review. Results Patient tracking demonstrated an interdisciplinary cooperation of 12 medical specialties [62 physicians (63% male, 37% female)], 8 different types of nursing staff [ n = 59 (22% male, 78% female)], and 9 different types of perioperative/administrative staff ( n = 23; male 17,4%, female n = 19, 82,6%). Contact with the patient was direct ( n = 199; 76%) or without face-to-face interaction ( n = 63; 24%). Conclusion The present study demonstrates the high diversity of physicians and the affiliated medical staff, as well as interdisciplinary intersections within teams of a specialized hospital. Matching the ESGO QIs, this report underlines the requirement of an adequate infrastructure for the complex management of advanced ovarian cancer patients. Future prospective studies are warranted to evaluate the specific procedures and actions to optimize the interprofessional and interdisciplinary workflows.
