Open abdomen technique used in complications of major gynecological oncology surgery.

OBJECTIVE: To evaluate the open abdomen technique (laparostomy) used in complications of major gynecological oncology surgery. METHODS: We analyzed retrospectively the surgical database of all patients who had undergone major open surgery by the same gynecologic oncologist over a 5-year period. All patients who had had open abdomen procedure were identified; demographic data and indications of primary surgery, temporary abdominal closure procedure details, fascia closure and morbidity, mortality rates were evaluated. Intraabdominal infection and intraoperative massive hemorrhage were the major indications for all open abdomen cases. Mannheim Peritonitis Index was used perioperatively to determine open abdomen decision in intraabdominal infections. Vacuum Assisted Abdominal Closure system and Bogota Bag were used for temporary abdominal closure techniques. RESULTS: Out of the total 560 patients who had undergone major oncological surgery, 19 patients (3.3%) had open abdomen procedure due to surgical complications. Eleven patients had intraabdominal infection, six patients had hemodynamic instability due to peri and postoperative hemorrhage, two patients had gross fecal contamination during posterior pelvic exenteration surgery. The fascia was closed totally in 15 (78%), partially in 3 (15%) and could not be closed in 1 patient who had died secondary to multiorgan failure. Total morbidity and mortality rates were 26% (5/19) (two intrabdominal abscess, one pulmonary embolism, one skin necrosis, one enteroatmospheric fistula) and 5.2% (1/19) respectively. CONCLUSION: Open abdomen is a life-saving procedure when applied with correct indications and timing. Gynecological oncologic surgeries are candidates to serious complications and gynecologic oncologists dealing with such surgery should be as experienced as general surgeons in this regard.

Comparison of stage III mucinous and serous ovarian cancer: a case-control study.

BACKGROUND: The purpose of this case-control study was to compare the prognoses of women with stage III mucinous ovarian carcinoma (MOC) who received maximal or optimal cytoreduction followed by paclitaxel plus carboplatin chemotherapy to those of women with stage III serous epithelial ovarian cancer (EOC) treated in the similar manner. METHODS: We performed a multicenter, retrospective review to identify patients with stage III MOC at seven gynecologic oncology departments in Turkey. Eighty-one women with MOC were included. Each case was matched to two women with stage III serous EOC in terms of age, tumor grade, substage of disease, and extent of residual disease. Survival estimates were measured using Kaplan-Meier plots. Variables predictive of outcome were analyzed using Cox regression models. RESULTS: With a median follow-up of 54 months, the median progression-free survival (PFS) for women with stage III MOC was 18.0 months (95% CI; 13.8-22.1, SE: 2.13) compared to 29.0 months (95% CI; 24.04-33.95, SE: 2.52) in the serous group (p = 0.19). The 5-year overall survival rate of the MOC group was significantly lower than that of the serous EOC group (44.9% vs. 66.3%, respectively; p < 0.001). For the entire cohort, presence of multiple peritoneal implants (Hazard ratio [HR] 2.39; 95% confidence interval [CI], 1.38-4.14, p = 0.002) and mucinous histology (HR 2.28; 95% CI, 1.53-3.40, p < 0.001) were identified as independent predictors of decreased OS. CONCLUSION: Patients with MOC seem to be 2.3 times more likely to die of their tumors when compared to women with serous EOC.

Evaluation of Factors Affecting Lymph Node Metastasis in Clinical Stage I-II Epithelial Ovarian Cancer.

BACKGROUND: Systematic lymphadenectomy is useful for accurate staging of early-stage ovarian cancer and has obvious prognostic value. Accurate staging may prevent unnecessary postoperative chemotherapy. The aim of this study was to evaluate the rate of lymph node involvement and factors affecting it in clinically early-stage epithelial ovarian cancer (EOC; stages I, II). PATIENTS AND METHODS: The study included 163 patients who underwent surgery at our hospital between January 2004 and April 2017 and who were diagnosed with early-stage EOC based on preoperative and intraoperative examination. Patient data were retrospectively analyzed. The rate of lymph node involvement and factors affecting it were analyzed. RESULTS: Of 163 patients, 21 (12.9%) had lymph node metastasis, whereas 16 (16.3%) of 98 patients who underwent comprehensive lymphadenectomy had lymph node metastasis. According to the univariate results for patients undergoing any type of lymphadenectomy, the rate of positive lymph nodes was significantly higher (37.1%) in those with bilateral ovarian involvement (p < 0.001). The rate was significantly higher in patients with positive intraabdominal fluid cytology (25.9%; p < 0.001), serous histology (20.5%; p = 0.02), and grade 3 disease (33.3%; p < 0.001). In multivariate logistic regression analysis, the rate was significantly higher in patients with bilateral adnexal involvement (p = 0.012). The risk of positive lymph nodes was significantly higher in patients with grade 3 disease (p = 0.016). CONCLUSION: Comprehensive lymphadenectomy increases the detection rate for metastatic lymph nodes in patients with clinically early-stage EOC. The rate of lymph node involvement is significantly higher in grade 3 tumors, serous cytology, bilateral adnexal involvement, and positive intraabdominal fluid cytology.

A modified technique for the laparoscopic management of large gastric bezoars.

Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal.

Comparison of the measurement methods of bursting pressure of intestinal anastomoses.

BACKGROUND/AIMS: This study was designed to determine whether there exists a difference between in vivo and in vitro measurements of bursting pressure (BP) of experimental intestinal anastomosis studied in Wistar-albino rats. METHODOLOGY: In the first group (n=8), the BP was measured using in vivo method without detaching the adhesions around the anastomosis. BP was determined with digital manometer, and then anastomotic region was removed to measure tissue hydroxyproline (HP) levels. In the second group (n=8), the BP was measured with in vitro method after the segment of intestine including the anastomosis was dissected and isolated. The isolated specimen was then submerged in a normal saline bath. BP was determined with a digital manometer and anastomotic region was removed to measure tissue HP levels. RESULTS: While HP value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 121.11 +/- 16.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.195). The BP was determined as 240.71 +/- 11.65 mmHg in the first group, 144.71 +/- 16.41 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found to be statistically different whereas tissue HP levels were normal between the groups. CONCLUSIONS: These results make us consider that mechanical changes occur about the isolated anastomotic line and dissection of adhesions weakens the anastomosis.

Comparison of the experimental intestinal anastomoses performed by different surgeons.

BACKGROUND/AIMS: This study was designed to determine the effects of different surgeons on the experimental anastomosis studied in rats. METHODOLOGY: Sixteen Wistar-albino rats were equally separated into two groups. The rats operated on by the first surgeon were coded Group 1 and operated on by the other surgeon were coded Group 2. Both surgeons were trained on the gastrointestinal surgery. The procedure of the study were standardized and dictated to the surgeons. Bursting pressure and tissue hydroxyproline content were determined as parameters of the anastomotic strength and healing on the seventh day postoperatively. RESULTS: The bursting pressures were measured with a digital manometer and anastomotic lines were removed to measure tissue hydroxyproline level. While hydroxyproline value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 104.02 +/- 17.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.521). The bursting pressure was determined as 240.71 +/- 11.65 mmHg in the first group, 190.75 +/- 14.09 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found statistically different whereas tissue hydroxyproline levels were normal between the groups. CONCLUSIONS: These results make us to consider mechanical differences occur related to the surgeons in the studies performed with the same technical detail.