Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta-analysis.

BACKGROUND: The proportion of women with mucinous ovarian carcinoma in whom nodal metastases are identified during staging remains unclear. OBJECTIVES: To review the literature on surgical lymph node assessment during staging of women diagnosed with mucinous ovarian carcinoma. SEARCH STRATEGY: A systematic search using synonyms of 'mucinous ovarian carcinoma' and 'lymph node assessment' was conducted in PubMed, Scopus, Embase and the Cochrane Library. SELECTION CRITERIA: When they covered ten or more mucinous ovarian carcinoma cases, staging surgery and minimally one of the following outcomes: prevalence of metastases, stage shift or survival data. DATA COLLECTION AND ANALYSIS: Studies were quality evaluated with the Cochrane risk-of-bias assessment tool for non-randomised studies of interventions. Outcomes were pooled using an inverse variance weighted random effects model. MAIN RESULTS: Sixteen studies were included. In 278 women with mucinous ovarian cancer suspected to be stage I-II, a pooled proportion of 0.8% (95% CI <0.1-2.9%) had lymph node metastases and were upstaged. In those suspected of stage I (n = 184), this proportion was 0.7% (95% CI <0.1-3.8%). No difference (P = 0.287) was found in metastases between sampling at 0.0% (95% CI 0.0-3.3%) and complete pelvic and/or para-aortic lymph node dissection at 1.2% (95% CI <0.1-4.2%). One study directly compared the survival of patients staged with and without lymph node dissection and reported no significant difference. CONCLUSIONS: Surgical lymph node assessment in women suspected of stage I-II mucinous ovarian carcinoma rarely identifies nodal metastases and consequently has no significant impact on staging. TWEETABLE ABSTRACT: Surgical lymph node assessment in women with stage I-II mucinous ovarian cancer rarely has staging consequences.

Failure to replicate negative effects of trace anaesthetics on mental performance.

Twenty-four male subjects individually undertook a selection of cognitive tasks during each of two different 2-h sessions in a climatic chamber. Twelve subjects breathed a mixture of air, nitrous oxide 1600 p.p.m. (v/v) and halothane 16 p.p.m. (v/v) during the first session, and air alone during the second session 1 week later. For the other 12 subjects the order was reversed. The tests comprised learning a list of word-number pairs, solving a set of anagram problems, recognizing words and numbers, recalling word-number pairs and performing a four-choice audiovisual reaction time task. Testing was commenced after 45 min of exposure to the atmospheric conditions. A strong learning effect both within and between sessions was observed on the audiovisual task. None of the tasks, however, reflected any adverse effect of the trace anaesthetics.