World Journal of Surgery

Ovarian Metastasis from Pancreatic Ductal Adenocarcinoma

AbstractBackgroundPancreatic ductal adenocarcinoma (PDAC) has a high propensity for systemic dissemination. Ovarian metastases are rare and poorly described.MethodsWe identified PDAC cases with ovarian metastasis from a prospectively maintained registry. We reported on the association between outcomes and clinicopathologic factors. Recurrence‐free (RFS) and overall survival (OS) were calculated using Kaplan–Meier analysis.ResultsTwelve patients with PDAC and synchronous or metachronous ovarian metastases were identified. Nine patients (75%) underwent pancreatectomy for localized PDAC and developed metachronous ovarian recurrence. The median OS for all patients was 25.4 (IQR:15.4–82.9) months. For the nine patients with metachronous ovarian metastasis, the median RFS and OS were 14.2 (IQR:7.2–58.3) and 44.6 (IQR:18.6–82.9) months, respectively. Nodal disease, poor grade, vascular invasion in the pancreatic primary, and bilateral ovarian disease tended to confer worse outcomes.ConclusionPatients with resected PDAC and ovarian recurrence tend to have a comparable disease course to more common patterns of recurrence. Primaries with nodal disease, poorer grade, vascular invasion, and bilateral ovarian disease were indicative of more aggressive disease biology. The ideal management remains largely unknown, and future collaborative efforts should optimize therapeutic strategies.

Cytoreductive surgery plus hyperthermic intraoperative peritoneal chemotherapy for people with peritoneal metastases from colorectal, ovarian or gastric origin: A systematic review of randomized controlled trials

AbstractBackgroundThere is uncertainty in the relative benefits and harms of hyperthermic intraoperative peritoneal chemotherapy (HIPEC) when added to cytoreductive surgery (CRS) +/− systemic chemotherapy or systemic chemotherapy alone in people with peritoneal metastases from colorectal, gastric, or ovarian cancers.MethodsWe searched randomized controlled trials (RCTs) in the medical literature until April 14, 2022 and applied methods used for high‐quality systematic reviews.FindingsWe included a total of eight RCTs (seven RCTs included in quantitative analysis as one RCT did not provide data in an analyzable format). All comparisons other than ovarian cancer contained only one trial. For gastric cancer, there is high uncertainty about the effect of CRS + HIPEC + systemic chemotherapy. For stage III or greater epithelial ovarian cancer undergoing interval cytoreductive surgery, CRS + HIPEC + systemic chemotherapy probably decreases all‐cause mortality compared to CRS + systemic chemotherapy. For colorectal cancer, CRS + HIPEC + systemic chemotherapy probably results in little to no difference in all‐cause mortality and may increase the serious adverse events proportions compared to CRS +/− systemic chemotherapy, but probably decreases all‐cause mortality compared to fluorouracil‐based systemic chemotherapy alone.InterpretationThe role of CRS + HIPEC in gastric peritoneal metastases is uncertain. CRS + HIPEC should be standard of care in women with stage III or greater epithelial ovarian cancer undergoing interval CRS. CRS + systemic chemotherapy should be standard of care for people with colorectal peritoneal metastases, with HIPEC given only as part of a RCT focusing on subgroups and regimes.PROSPERO RegistrationCRD42019130504.

Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta‐analysis

AbstractBackgroundInguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to systematically evaluate perioperative adverse events (AEs) in patients undergoing ILND and its reporting.MethodsA systematic review was conducted according to PRISMA. PubMed, MEDLINE, Scopus, and Embase were queried to identify studies discussing perioperative AEs in patients with melanoma, penile, and vulvar cancer following ILND.ResultsOur search generated 3.469 publications, with 296 studies meeting the inclusion criteria. Details of 14.421 patients were analyzed. Of these studies, 58 (19.5%) described intraoperative AEs (iAEs) as an outcome of interest. Overall, 68 (2.9%) patients reported at least one iAE. Postoperative AEs were reported in 278 studies, combining data on 10.898 patients. Overall, 5.748 (52.7%) patients documented ≥1 postoperative AEs. The most reported ILND‐related AEs were lymphatic AEs, with a total of 4.055 (38.8%) events. The pooled meta‐analysis confirmed that high BMI (RR 1.09; p = 0.006), ≥1 comorbidities (RR 1.79; p = 0.01), and diabetes (RR 1.81; p =  < 0.00001) are independent predictors for any AEs after ILND. When assessing the quality of the AEs reporting, we found 25% of studies reported at least 50% of the required criteria.ConclusionILND performed in melanoma, penile, and vulvar cancer patients is a morbid procedure. The quality of the AEs reporting is suboptimal. A more standardized AEs reporting system is needed to produce comparable data across studies for furthering the development of strategies to decrease AEs.

Prognostic significance of surgically treated malignant struma ovarii with or without adjuvant thyroid‐related therapy: A systematic review and meta‐analysis

AbstractAimsThe aims of this study are to determine the long‐term overall survival (OS) after surgically treated malignant struma ovarii (MSO) and to evaluate prognostic effect of adjuvant thyroid‐related therapy (ATRT) in this setting.MethodsA systematic review in compliance with Preferred Reporting Items for Systematic reviews and Meta‐Analyses standards was conducted. MEDLINE, CINAHL, CENTRAL, Scopus, trial registries, and gray literature were searched. Due to rarity of the disease, all case reports including patients with surgically treated MSO were pooled to create a single cohort which was then compared with the eligible case series. The OS and survival time were primary outcomes. The OS was determined using Kaplan–Meier survival statistics, and the predictors of OS were determined using the stepwise Cox proportional‐hazards regression model.ResultsThe study included 376 patients (95 from case reports and 281 from case series). The median age was 44 years; 79% (75/95) were symptomatic. In terms of ATRT, 39% (37/95) received thyroidectomy, 28% (27/95) radioactive iodine, 28% (27/95) hormone suppression therapy, and 55% (52/95) received no therapy. Recurrence occurred in 27% (26/95) with the median time to recurrence of 4 years. The pooled OS was 91% at 10 years and 87% at 20 years. The OS was not predicted by age (p = 0.320), symptomatic status (p = 0.371), follicular histology (p = 0.934), metastatic disease (p = 0.981); omentectomy (p = 0.523), total thyroidectomy (p = 0.371), radioactive iodine therapy (p = 0.285), and thyroid hormone therapy (p = 0.994).ConclusionsSurgically treated MSO may have excellent long‐term prognosis with or without ATRT. It is possible that thyroid‐specific treatments in MSO constitute overtreatment, with no demonstrable survival benefit. Limitations in the evidence base limit the ability to produce definitive conclusions.