Journal
The role of sarcopenia in the development of early complications in patients with advanced epithelial ovarian carcinoma undergoing cytoreductive surgery
Abstract Purpose Sarcopenia has been identified as a prognostic factor in various cancers. The aim of the study is to investigate the role of sarcopenia in the development of early complications following Primary Cytoreductive Surgery in advanced stage ovarian cancer patients. Methods A total of 57 patients who underwent Cytoreductive Surgery due to advanced stage ovarian cancer at the Surgical Oncology Clinic of…………. University Hospital between January 2013 and June 2021 were retrospectively analyzed. Routine preoperative Computed Tomography(CT) images were used to measure the cross-sectional areas of the paraspinal muscles, abdominal wall muscles at the L3 level in cm2. The Skeletal Muscle Index (SMI) and Psoas Muscle Index (PMI) values were calculated. Postoperative early complications were classified as Clavien-Dindo grade 3 and above major complications. Results Based on SMI measurements, 23 patients with SMI < 38.5 were classified as sarcopenic, while 34 patients with SMI ≥ 38.5 were classified as nonsarcopenic; based on PMI measurements, 19 patients with PMI < 4.3 were classified as sarcopenic, while 38 patients with PMI ≥ 4.3 were classified as nonsarcopenic. Major complications occurring in the early postoperative period were significantly more common in the sarcopenic group. High Peritoneal Carcinomatosis Index (PCI) score and FIGO 3 C stage were associated with a significantly higher incidence of early complications. High PCI score and SMI < 38.5 value were identified as risk factors for postoperative early complications. Conclusions The quantitative measurements of sarcopenia using routine CT imaging for preoperative staging are a useful and cost-effective method. Determining the sarcopenic status of patients before treatment offers an advantage in predicting treatment complications.
Aggressive surgical intervention may improve prognosis in patients with ovarian metastasis from colorectal cancer
The current study aimed to investigate the prognostic clinicopathological factors of synchronous and metachronous ovarian metastasis (OM) from colorectal cancer (CRC) in patients with and without oophorectomy. Female patients with OM from CRC who underwent primary tumor resection at our institution from January 2013 to December 2020 were evaluated. Of 661 female patients, 22 (3.3%) were diagnosed with OM. Among 22 patients with OM, 12 underwent OM resection. Twenty (91%) patients had extra OM upon diagnosis. Thirteen (59%) patients in the non-surgery group had peritoneal dissemination at surgery or on computed tomography scan or positron emission tomography-computed tomography. Two patients in the OM surgery group had emergency surgery because of abdominal pain. Four patients had postoperative complications, and the median duration of hospital admission was 16.5 days. The median survival time from OM diagnosis to mortality was 20.9 months. Then, the association between the clinicopathological factors and overall survival (OS) was investigated. Tumor location and surgery were found to be related to OS (p = 0.03, 0.006, respectively) in the univariate analysis. However, only surgery was associated with OS (p = 0.02) in the multivariate analysis. Surgery is an important prognostic clinicopathological factor of OM from CRC. OM tumors should be resected because OM surgery is less likely to cause complications and symptoms.
Comparison of robotic vs. laparoscopic treatment in pediatric ovarian benign tumors
To compare the differences in surgical outcomes of robot-assisted treatment and laparoscopy for benign ovarian tumors among pediatric patients. A total of 39 patients underwent robot-assisted surgery, and their outcomes were compared with 55 patients treated with laparoscopy during the same period by the same surgeons. There were no significant differences between the two groups in terms of age (7.5 ± 4.5 vs. 8.8 ± 3.8 years, p = 0.2496), weight (29.3 ± 17.7 vs. 31.7 ± 14.6 kg, p = 0.4383), or tumor size (5.0 ± 3.3 vs. 5.1 ± 3.8 cm, p = 0.8541). However, the operative time was significantly longer in the robotic surgery group (102.7 ± 33.5 vs. 89.3 ± 50.9 min, p = 0.0112). There was no significant difference in intraoperative blood loss. Fewer patients in the robotic surgery group opted for day surgery compared to the laparoscopy group (15.4% vs. 54.5%, p < 0.001). There was no significant difference in the length of hospital stay between the two groups of patients who chose inpatient surgery (5.6 ± 3.4 vs. 4.4 ± 2.9 d, p = 0.1213). There was no conversion to open surgery and no early postoperative complications in both groups. Robot-assisted surgery and laparoscopy yield comparable outcomes for the treatment of benign ovarian tumors in children, although robotic surgery has a longer operative time.
Acute renal disease in patients with ovarian peritoneal carcinomatosis treated with cytoreduction and HIPEC: the influence of surgery and the cytostatic agent used
The main objective of this study was to evaluate the differences between cisplatin and paclitaxel in the development of postoperative renal toxicity, using as a reference the RIFLE (Risk, Injury, Insufficiency, Loss, and End-stage renal function) and AKIN (Acute Kidney Injury Network) criteria in patients with primary or recurrent ovarian cancer with peritoneal dissemination treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). One hundred fifty-two patients who were treated between December 2007 and June 2017 were analyzed. Patients who received previous platinum-based chemotherapy had higher baseline creatinine levels than those who had not (p = 0.05). A total of 11 (7.2%) and 4 (2.6%) patients developed an acute renal dysfunction (ARD) during the postoperative period of cytoreduction and HIPEC according to the RIFLE and AKI criteria respectively. RIFLE detects a higher rate of ARD due to different parameters such as GFR (7.2% versus 2.6%, p = 0.016). Performing ostomy (p = 0.007; OR: 39.320; 95% CI = 2.74-56.13) and using of cisplatin during HIPEC treatment (p = 0.017; OR = 13.619; 95% IC = 1.600-25.95) were factors independently related to a higher rate of ARD. ARD has a multifactorial origin. Cisplatin was associated with the development of a higher rate of ARD than paclitaxel. Diagnosis of ARD did not correlate with worse survival figures.
Frequency and therapeutic strategy for patients with ovarian metastasis from gastric cancer
This study aimed to analyze the clinicopathological features and treatment outcomes of ovarian metastasis from gastric cancer. This study included 155 female patients with unresectable advanced or recurrent gastric cancer at the Kochi Medical School between January 2007 and December 2021. A review of patients with ovarian metastasis was conducted, and their clinicopathological information and survival outcomes were compared with respect to ovarian metastasis. Fifteen patients were diagnosed with ovarian metastasis from gastric cancer with a median age of 54 years (range: 30-87 years) and an incidence of 9.7%. The median age of patients who developed ovarian metastasis was significantly lower those without ovarian metastasis (54 years vs. 71 years, P = 0.014). The median survival time (MST) for 15 patients with unresectable advanced gastric cancer who developed ovarian metastasis was 21.4 months (range: 0.2-41.4 months). The MST for 15 patients who underwent surgical resection and systemic drug treatment including chemotherapy to ovarian metastasis was significantly higher than those who received systemic drug treatment alone (28.1 months vs. 10.0 months; P = 0.021). Ovarian metastasis was found in 9.7% of female patients with unresectable advanced or recurrent gastric cancer and in younger patients than in those without ovarian metastasis. Multidisciplinary treatment, including surgical resection and systemic drug treatment for ovarian metastasis from gastric cancer, may benefit selected patients.
Risk factors for blood transfusion in patients undergoing hysterectomy for stage I endometrial cancer
Abstract Purpose To highlight the risk factors contributing to blood transfusion among patients undergoing surgical intervention for Stage I Endometrial Cancer (EC). Method Using the American College of Surgeons National Surgical Quality Improvement Program database, a nationally validated database dedicated to improving surgical care, females over the age of 18 who underwent surgery for EC stage I between the years 2016–2022 were queried. The cohort was then characterized based on those who received blood transfusion 72 h postoperatively. Results 27,183 patients with endometrial cancer who received surgical management were identified. 668 (2.5%) of those patients received blood transfusions. A multivariate logistic model found that a medical factor low preoperative Hct % (aOR 22.4, 95% CI[17.7, 28.3]; p < 0.001) and surgical factors such as 180 min or more of operative time (aOR 3.38, 95% CI[2.77, 4.14]; p < 0.001), larger uteri of 250–500 g (aOR 1.93, 95% CI[1.48, 2.49]; p < 0.001) and ≥ 500 g (aOR 2.35, 95% CI[1.77, 3.12]; p < 0.001), and abdominal approach compared to laparoscopic (aOR 6.36,95% CI[4.95, 8.18]; p < 0.001) were significantly associated with receiving blood transfusion. Conclusion Many significant risk factors were found to be associated with blood transfusions in patients with Stage I endometrial cancer. These findings allow surgeons to proactively prepare adequate measures for patients who may require blood transfusions when they undergo surgery for endometrial cancer.
Springer Science and Business Media LLC
1435-2451
