U. Acosta

Survival outcomes and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma

To review the diagnostic and therapeutic procedures of patients diagnosed with Endometrial Stromal Sarcoma (ESS) and Undifferentiated Uterine Sarcoma (USS) at our institution and investigate their clinical outcomes and factors affecting prognosis. We retrospectively collected demographic data, preoperative diagnostic methods and therapeutic management of patients treated for ESS and UUS between January 1995 and December 2019 at Vall d'Hebron Barcelona Hospital Campus, Spain. Overall survival and disease-free survival were calculated. Cox proportional-hazards regression models were calculated. Sixty-three patients were included in the study, of which 51(81%) had a diagnosis of ESS and 12(19%) of UUS. Twenty patients (31.7%) were diagnosed after a previous non-oncologic surgery, and 12 of them (60%) suffered from tumor disruption. Cytoreductive procedures were needed in 29 patients (46%), and optimal cytoreduction was achieved in 80.9% of the patients. The median follow-up was 7.6 years (IQR = 0.99-14.31). Five-year overall survival was 57.6% (44.2-68.8) and was significantly better for low-grade ESS (LG-ESS) patients (p < 0.01). Five-year disease-free survival was 57.1% (42.8-69.1) and was also significantly higher in LG-ESS cohort (p = 0.03). After multivariate analysis histological type, age, FIGO stage, optimal surgery and mitotic index were found significantly correlated with survival. For high-grade EES (HG-ESS) and USS patients adjuvant radiotherapy also correlated with improved survival. Overall survival and disease-free survival are significantly better in patients with LG-ESS cohort. HG-ESS and UUS show similar survival outcomes. Age, FIGO stage, optimal surgery and histological type were significantly correlated with survival in the global cohort, whilst adjuvant radiotherapy correlated with improved survival in HG-ESS and UUS patients.

Impact of enhanced recovery after surgery programs in the return to adjuvant chemotherapy in patients with advanced ovarian cancer

Advanced ovarian cancer treatment comprises cytoreductive surgery followed by chemotherapy. There is no established optimal time between surgery and chemotherapy initiation; however, delays can affect patient survival. Enhanced recovery after surgery (ERAS) programs aim to optimize post-operative recovery and may reduce delays in adjuvant treatment. This study investigated whether the implementation of the ERAS protocol reduces the time to chemotherapy after surgery for advanced ovarian cancer or influences the completion of planned chemotherapy cycles, evaluated the factors causing delays in chemotherapy, and examined the association between adherence to the ERAS protocol and the time to chemotherapy. This retrospective cohort study included patients with ovarian, tubal, or primary peritoneal cancer, International Federation of Gynecology and Obstetrics stages IIB to IV, who underwent debulking surgery and adjuvant chemotherapy at Vall d'Hebron Hospital. We compared the patients within the ERAS protocol with those under conventional management. The times from surgery to chemotherapy and completion of treatment were compared, in addition to the impact of ERAS adherence on the time to chemotherapy. Time to chemotherapy was measured both quantitatively and qualitatively (50 days cutoff). A total of 137 and 46 patients were included in the ERAS and conventional groups, respectively. Chemotherapy started at a median of 44.5 days in the ERAS and 48.5 in the conventional group (p = .63) and was completed in 81.8% and 89.1% of patients, respectively, without differences by type of surgery. Compliance with the ERAS protocol did not correlate with earlier initiation of chemotherapy. Surgical morbidity, including complications, small bowel re-section, and intensive care unit admission, was identified as an independent risk factor for delayed chemotherapy. Although ERAS programs improved post-operative recovery, they did not significantly reduce the time to chemotherapy or improve chemotherapy cycle completion in patients with advanced ovarian cancer, irrespective of adherence to the protocol.

Procalcitonin and C‐reactive protein as early markers of anastomotic leakage in intestinal resections for advanced ovarian cancer (EDMOCS)

AbstractIntroductionSerum levels of procalcitonin and C‐reactive protein (CRP) have been used to predict anastomotic leakage after colorectal surgery, but information is scarce in advanced ovarian cancer (AOC) surgery with bowel resection. This study aimed to assess the predictive value of procalcitonin and CRP in detecting anastomotic leakage after AOC surgery with bowel resection. The study also aimed to determine the optimal postoperative reference values and the best day for evaluating these markers.Material and methodsThis prospective, observational and multicentric trial included 92 patients with AOC undergoing debulking surgery with bowel resection between 2017 and 2020 in 10 reference hospitals in Spain. Procalcitonin and CRP levels were measured at baseline and on postoperative days 1–6. Receiver operating characteristic analysis was performed to evaluate the predictive value of procalcitonin and CRP at each postoperative day. Sensitivity, specificity, positive and negative predictive values were calculated.ResultsAnastomotic leakage was detected in six patients (6.5%). Procalcitonin and CRP values were consistently higher in patients with anastomotic leakage at all postoperative days. The maximum area under the curve (AUC) for procalcitonin was observed at postoperative day 1 (AUC = 0.823) with a cutoff value of 3.8 ng/mL (83.3% sensitivity, 81.3% specificity). For CRP, the maximum AUC was found at postoperative day 3 (AUC = 0.833) with a cutoff level of 30.5 mg/dL (100% sensitivity, 80.4% specificity).ConclusionsProcalcitonin and C‐reactive protein are potential biomarkers for early detection of anastomotic leakage after ovarian cancer surgery with bowel resection. Further prospective studies with a larger sample size are needed to confirm these findings.