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1.
Anticancer Res ; 41(9): 4417-4422, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475063

RESUMO

BACKGROUND/AIM: Ovarian carcinoma is the fifth leading cause of cancer-related deaths in women in the United States. Serous papillary carcinoma is the most common histological type of ovarian carcinoma that often goes undetected until it has spread within the pelvis and abdomen leading to poor prognosis. Translation of next-generation sequencing (NGS) technology into personalized medicine and identification of new potential targets for therapeutic applications may be helpful. CASE REPORT: We report a case of a 59-year-old female who initially presented in the emergency department with increasing abdominal girth, and bloating. Computed tomography showed ascites and omental and pelvic masses. Fine needle biopsy of the omental mass showed high-grade papillary adenocarcinoma consistent with high-grade ovarian serous carcinoma. She was treated with chemotherapy followed by debulking surgery. Primary ovarian serous carcinoma and synchronous primary fallopian tube serous carcinoma with multiple leiomyomas were identified in the surgical specimen. Pleural biopsy was also positive for carcinoma. NGS and programmed death-ligand 1 (PD-L1) expression testing were performed in the ovarian serous carcinoma. The results showed mutations of breast cancer type 1 (BRCA1) and type 2 (BRCA2), tumor protein p53 (TP53) (c.524G>A at pR175H), and heat shock protein 90 alpha family class B member 1 (HSP90AB1) (p.R456C), as well as low RNA expression score of PD-L1. CONCLUSION: Identification of these mutations and PD-L1 abnormality at the diagnosis of ovarian carcinoma may shed light for clinicians to provide targeted therapy with poly (ADP-ribose) polymerase (PARP) inhibitors and immune checkpoint inhibitors for ovarian serous carcinoma. This is the first documented case of ovarian serous carcinoma to have found a HSP90AB1 (p.R456C) mutation.


Assuntos
Cistadenocarcinoma Seroso/genética , Neoplasias das Tubas Uterinas/genética , Proteínas de Choque Térmico HSP90/genética , Leiomiomatose/genética , Neoplasias Primárias Múltiplas/genética , Neoplasias Ovarianas/genética , Biópsia por Agulha Fina , Cistadenocarcinoma Seroso/tratamento farmacológico , Cistadenocarcinoma Seroso/cirurgia , Procedimentos Cirúrgicos de Citorredução , Tratamento Farmacológico , Neoplasias das Tubas Uterinas/tratamento farmacológico , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Leiomiomatose/tratamento farmacológico , Leiomiomatose/patologia , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Mutação , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Análise de Sequência de DNA , Tomografia Computadorizada por Raios X , Estados Unidos
2.
Anticancer Res ; 41(9): 4483-4488, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475073

RESUMO

BACKGROUND: Perivascular epithelioid cell tumors (PEComa)s are mesenchymal neoplasms located at various anatomic sites, which usually express both melanocytic and myogenic markers. CASE REPORT: A 60-year-old woman underwent laparotomy for a huge, heterogeneous, right ovarian mass. The histological examination of the surgical specimen revealed a neoplasm consisting of both cells with clear or eosinophilic cytoplasm and spindle cells in a myxoid stroma. Immunostaining was positive for human melanoma black-45, h-caldesmon, desmin, actin, and transcription factor 3. Cell atypias were moderate, mitoses were 4/10 high power fields (HPF) and margins were focally infiltrative. These findings pointed to a diagnosis of ovarian PEComa. Twenty-five months later, two subcutaneous lesions were surgically removed on the left trapezius muscle and the median subumbilical area, respectively. The former was a desmoid fibromatosis, whereas the latter was a recurrence of PEComa with greater nuclear pleomorphism and higher number of mitoses (26/50 HPF) compared to the primary tumor. The patient was free of disease 11 months later. CONCLUSION: A long-term follow-up of gynecological PEComas is strongly recommended.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Neoplasias de Células Epitelioides Perivasculares/metabolismo , Neoplasias de Células Epitelioides Perivasculares/patologia , Resultado do Tratamento
3.
J Coll Physicians Surg Pak ; 31(9): 1108-1110, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500532

RESUMO

High-grade serous carcinoma (HGSC) of ovary is the commonest of all ovarian malignant tumours and is associated with high mortality rate. Serous tubal intraepithelial carcinoma (STIC) is believed to be the precursor lesion. In literature, only 40-50% of HGSC shows concurrent STIC, even after thorough sampling. We, herein, present a case of a 40-year female, who underwent staging laparotomy for bilateral ovarian carcinoma. She was diagnosed as HGSC of both ovaries. Left ovary capsule was focally ruptured. Peritoneal washings showed metastatic carcinoma. Provisional FIGO stage was IC. During sampling, concurrent finding of STIC was documented in right fallopian tube. No invasive carcinoma was present in both entirely submitted fallopian tubes. Key Words: High grade serous carcinoma, Ovary, Serous tubal intraepithelial carcinoma, TP53.


Assuntos
Carcinoma in Situ , Carcinoma , Cistadenocarcinoma Seroso , Neoplasias das Tubas Uterinas , Neoplasias Ovarianas , Carcinoma in Situ/cirurgia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Humanos , Neoplasias Ovarianas/cirurgia
4.
Acta Biomed ; 92(4): e2021319, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487069

RESUMO

Juvenile ovarian granulosa cell tumors (JGCTs) are described infrequently in pediatrics, and their finding in infants is exceptional. We highlight the presenting symptoms, radiologic images, operative management, and histopathologic findings of a 9-month-old female with isosexual pseudopuberty. An updated revision of literature in infants below the age of 12 months is also reported.


Assuntos
Tumor de Células da Granulosa , Neoplasias Ovarianas , Puberdade Precoce , Criança , Feminino , Tumor de Células da Granulosa/complicações , Tumor de Células da Granulosa/diagnóstico por imagem , Tumor de Células da Granulosa/cirurgia , Humanos , Lactente , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Puberdade
5.
Ceska Gynekol ; 86(4): 250-257, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34493050

RESUMO

OBJECTIVE: Description of the case of recurrence of a rare malignant Brenner ovarian tumour. METHODS: Author observation and literature resources. RESULTS: Occurrence of a rare malignant Brenners tumor in a 66-year-old patient. After radical surgery (abdominal hysterectomy with bilateral adnexectomy, pelvic and paraaortic lymphadenectomy, omentectomy and appendectomy) and after adjuvant chemotherapy, recurrence of the disease was observed after 30 months. CONCLUSIONS: The case report describes rare occurrence of a malignant Brenner tumour and its relapse.


Assuntos
Tumor de Brenner , Neoplasias Ovarianas , Idoso , Tumor de Brenner/cirurgia , Feminino , Humanos , Histerectomia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia
6.
J Pak Med Assoc ; 71(8): 2014-2017, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34418022

RESUMO

OBJECTIVE: To compare peri-operative practices and complications in ovarian cancer patients undergoing upfront surgery for primary disease under enhanced recovery after surgery protocol and traditional practices. METHODS: The retrospective cross-sectional study was done at the gynaecology departments of St Georges Hospital, United Kingdom, and the Aga Khan Hospital, Pakistan, and comprised data of an equal number of ovarian cancer patients from each centre who underwent ovarian cancer surgery from January 2015 to December 2016. The former centre practiced the enhanced recovery after surgery protocol, while the latter centre followed traditional practices. Data was analysed using SPSS 19. RESULTS: Of the 100 patients, there were 50(50%) in each group. Baseline variables were comparable except for diabetes which was more prevalent in the local group (p=0.03). Mechanical bowel preparation was performed in 47(94%) of local patients compared to 1(2%) in the other group, while the duration for nil-per-mouth status as well as the use of nasogastric tube and peritoneal drain were significantly different (p<0.05). Epidural anaesthesia was used in 39(78%) of patients in Pakistan compared to 4(8%) in the United Kingdom. The duration of thromboprophylaxis was also significantly different (p<0.05). CONCLUSIONS: Implementation of enhanced recovery after surgery protocol was found to have the potential to improve postoperative outcomes and good functional recovery without compromising patient safety.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Neoplasias Ovarianas , Tromboembolia Venosa , Anticoagulantes , Estudos Transversais , Feminino , Humanos , Neoplasias Ovarianas/cirurgia , Paquistão , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Reino Unido
7.
Chirurgia (Bucur) ; 116(eCollection): 1-5, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34463241

RESUMO

Introduction: Meigs syndrome consists of the presence of a benign ovarian tumor, ascites and pleural effusion, and the latter two subdued after surgical excision of the ovarian tumor. Elevated Ca-125 in this context is confusing and is reported only in a handful of cases. A rare but striking case with the above features is presented herein. Case Presentation: A 46-year-old woman with a giant pelvic/abdominal mass originating from her right adnexa, ascites and pleural effusion, with elevated Ca-125 (938 IU/mL) was treated with the presumptive diagnosis of stage IV ovarian cancer. Imaging modalities showed a 22 cm solid adnexal mass and the patient underwent total abdominal hysterectomy and bilateral salpigooophorectomy, omentectomy and drainage of 4L of ascetic fluid. Surprisingly, final histopathology was negative for malignancy, characterizing the primary tumor as ovarian thecoma. Ascites and pleural effusion resolved by the seventh postoperative day, setting the diagnosis of Meigs syndrome. Discussion: Meigs syndrome accounts for 1% of all ovarian tumors, however it should be considered in the differential diagnosis when clinicians come across the classic triad of the syndrome, even when Ca-125 is elevated. These patients have normal life expectancy with meticulous management, while pathophysiology of this condition remains uncertain in various points.


Assuntos
Síndrome de Meigs , Neoplasias Ovarianas , Tecoma (Neoplasia) , Ascite/etiologia , Antígeno Ca-125 , Feminino , Humanos , Síndrome de Meigs/complicações , Síndrome de Meigs/diagnóstico , Síndrome de Meigs/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Tecoma (Neoplasia)/complicações , Tecoma (Neoplasia)/diagnóstico , Tecoma (Neoplasia)/cirurgia , Resultado do Tratamento
10.
J Int Med Res ; 49(8): 3000605211032781, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34340578

RESUMO

OBJECTIVE: To investigate the clinical characteristics and treatment of large ovarian masses in adolescents. METHODS: Adolescents with large ovarian masses (≥10 cm in diameter) who were treated in Beijing Obstetrics and Gynecology Hospital from March 2010 to December 2018 were retrospectively assessed. RESULTS: Fifty-two female patients (mean age: 16.17±2.04 years [11-19 years]) were included and 19 (36.5%) presented with abdominal pain. The blood flow signal rate in ultrasonography was significantly different among benign, borderline and malignant ovarian masses, unlike strong echo, dotted echo and septation rates. Carbohydrate antigen 125 positivity rates were significantly different among pathological types and the endometriotic cyst group showed the highest value (75.0%). Alpha-fetoprotein positivity rates were also different among pathological types. For ovarian cystectomy, 14 and 32 patients underwent laparotomy and laparoscopy, respectively. Mass diameters were significantly higher in the laparotomy group and the operative duration was significantly shorter in the laparoscopy group. There were no significant differences in intraoperative blood loss or postoperative recurrence rates between the two groups. CONCLUSION: Teratomas constitute the greatest group of large ovarian masses in adolescents. Benign tumors should be treated by laparoscopic resection, while borderline or malignant tumors require individualized treatment of tumors and fertility-sparing treatments.


Assuntos
Laparoscopia , Neoplasias Ovarianas , Teratoma , Adolescente , Feminino , Humanos , Laparotomia , Recidiva Local de Neoplasia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Estudos Retrospectivos , Teratoma/diagnóstico por imagem , Teratoma/cirurgia
11.
BMC Womens Health ; 21(1): 282, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348686

RESUMO

AIM: We aim to evaluate the reproductive outcome of fertility-sparing surgery and chemotherapy among young women diagnosed with MOGCT of any stage. METHODS: In the current retrospective study we evaluated 79 patients with malignant ovarian germ cell tumors (MOGCT) who visited at Imam Center, Vali-e-asr Hospital, Gynecologic Oncology department during 2001-2016. Reproductive outcomes (menstruation status and childbearing) followed fertility-preserving surgery and adjuvant chemotherapy by filling questionnaires. Statistical analysis was done with SPSS software, Chi-Square Tests were done, and significance was determined at P ≤ 0.05. Results among 79 young women who underwent fertility-sparing treatment, 72 patients followed up for reproductive outcome, and 7 patients excluded because of death (3 cases), XY genotyping (3 cases), and bilateral ovarian involvement (1 case). The mean age at presentation was 23 years. (Range: 19-33 years). The 5 and 10-year disease-free survival rate was 87% and 94.4%, respectively. The overall survival rate (OSR) was 94.4% at 5 and 10 years. Regular menstruation recovered in 60 of 72 patients after treatment (83%). All patients without adjuvant chemotherapy experienced regular menstruation, while normal menstruation was retrieved in 78% in the adjuvant chemotherapy group at the end of treatment. This retrieval of regular menstruation was not dependent on the age or number of chemotherapy cycles. 19 of 26 patients who attempted pregnancy were led to delivery (73%). No one required infertility treatments. The mean of chemotherapy cycles is related to a successful pregnancy. CONCLUSION: We showed patients with MOGCT could become pregnant and give birth if they desire. The advanced tumor stage wasn't the convincing factor for avoiding fertility preservation. Fertility sparing surgery with adjuvant chemotherapy is a safe treatment and results in a high fertility rate.


Assuntos
Preservação da Fertilidade , Neoplasias Embrionárias de Células Germinativas , Neoplasias Ovarianas , Quimioterapia Adjuvante , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Gravidez , Estudos Retrospectivos
12.
Medicina (Kaunas) ; 57(7)2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34356961

RESUMO

Background and Objectives: To introduce a new technique for fast leakage-proof, intraumbilical, single-incision laparoscopic ovarian cystectomy for huge ovarian masses (>10 cm) Materials and Methods: Seven consecutive, reproductive-aged women, including three adolescents, with huge ovarian masses (mature cystic teratoma, n = 4; endometrioma, n = 2; and mucinous cystadenoma, n = 1) who underwent transumbilical single-incision ovarian cystectomy with the new "hybrid cystectomy and reimplantation" method were included. The procedure was: (1) trans-umbilical single-incision laparoscopy; (2) inspection of the pelvic cavity and placing the mass in a laparoscopic endo-bag for cystic content leakage prevention; (3) in-bag resection using cold scissors and minimal cauterization of the cystectomy site; (4) in-bag tissue extraction; (5) rapid extracorporeal cystectomy with traction without electrocautery; (6) re-insertion of the retrieved ovarian cortex intracorporeally through the single port, and (7) intracorporeal suture of the retrieved tissue to the in situ ovary. Results: The mean patient age was 24.71 ± 6.56 (range 17-37) years and the mean maximal diameter of the masses was 17.71 ± 2.86 (range 13-22) cm. There was no case of unintended intracorporeal cyst rupture and no need for copious irrigation for washing and suctioning the leaked mass content. The mean total operating time was 76.42 ± 6.39 (range 65-85) min, the total volume of saline used for irrigation was 814.28 ± 331.35 (range 500-1500) mL, and the estimated blood loss was 107.14 ± 47.72 (range 50-200) mL. There were no perioperative complications. All patients except the two endometriosis patients had regular, normal menstruation. Conclusions: Our preliminary findings were encouraging in terms of the safety and efficiency of the new method. Future trials need to elucidate the benefits of this method in terms of fertility preservation.


Assuntos
Laparoscopia , Neoplasias Ovarianas , Adolescente , Adulto , Cistectomia , Feminino , Humanos , Neoplasias Ovarianas/cirurgia , Ovariectomia , Reimplante , Adulto Jovem
13.
Ulus Travma Acil Cerrahi Derg ; 27(4): 486-489, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212991

RESUMO

Rupture of gynecologic tumors secondary to trauma rarely occurs. Rupture can lead to acute abdominal pain due to hemorrhage from the ruptured area and organs; rupture can also lead to peritonitis, depending on the size of the tumor. We describe the case of giant epithelial ovarian tumor rupture exhibiting due to minor trauma and the development of hypovolemic shock. A 69-year-old female patient was admitted to the emergency room with complaints of acute abdominal pain and subsequent clouding of consciousness after falling down while walking. Emergency abdominal computed tomography scan revealed widespread hemorrhagic free fluid in the abdominal cavity and a mass measuring 27.5 cm × 21 cm × 15 cm, extending from the right quadrant of the abdomen to the left. The patient underwent an emergency operation due to hypovolemic shock. During surgery, a totally ruptured mass lesion arising from the right ovary was seen; the mass contained cystic components and measured approximately 30 cm × 20 cm × 15 cm. Hemostasis was achieved in the bleeding areas, and the right ovarian mass was totally resected. The patient was discharged as cured on the 6th post-operative day. Gynecologic tumor rupture due to trauma is a rare event. However, it is a clinical condition that should be kept in mind regardless of the type of trauma. This is especially true in patients who experienced trauma and were radiologically found to have intra-abdominal hemorrhage with normal-appearing solid organs, such as liver and spleen, that frequently cause bleeding.


Assuntos
Neoplasias Ovarianas , Choque , Idoso , Feminino , Humanos , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Ruptura Espontânea , Choque/diagnóstico , Choque/etiologia , Choque/cirurgia , Tomografia Computadorizada por Raios X
14.
World J Surg ; 45(10): 3157-3164, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34236477

RESUMO

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a high propensity for systemic dissemination. Ovarian metastases are rare and poorly described. METHODS: We 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. RESULTS: Twelve 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. CONCLUSION: Patients 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.


Assuntos
Adenocarcinoma , Carcinoma Ductal Pancreático , Neoplasias Ovarianas , Neoplasias Pancreáticas , Adenocarcinoma/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Neoplasias Ovarianas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos
15.
Cochrane Database Syst Rev ; 7: CD005343, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34328210

RESUMO

BACKGROUND: Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require a combination of surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. OBJECTIVES: To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy before debulking surgery (neoadjuvant chemotherapy (NACT)) compared with conventional treatment where chemotherapy follows debulking surgery (primary debulking surgery (PDS)). SEARCH METHODS: We searched the following databases up to 9 October 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), Embase via Ovid, MEDLINE (Silver Platter/Ovid), PDQ and MetaRegister. We also checked the reference lists of relevant papers that were identified to search for further studies. The main investigators of relevant trials were contacted for further information. SELECTION CRITERIA: Randomised controlled trials (RCTs) of women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III/IV) who were randomly allocated to treatment groups that compared platinum-based chemotherapy before cytoreductive surgery with platinum-based chemotherapy following cytoreductive surgery. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias in each included trial. We extracted data of overall (OS) and progression-free survival (PFS), adverse events, surgically-related mortality and morbidity and quality of life outcomes.  We used GRADE methods to determine the certainty of evidence. MAIN RESULTS: We identified 2227 titles and abstracts through our searches, of which five RCTs of varying quality and size met the inclusion criteria. These studies assessed a total of 1774 women with stage IIIc/IV ovarian cancer randomised to NACT followed by interval debulking surgery (IDS) or PDS followed by chemotherapy. We pooled results of the four studies where data were available and found little or no difference with regard to overall survival (OS) (Hazard Ratio (HR) 0.96, 95% CI 0.86 to 1.08; participants = 1692; studies = 4; high-certainty evidence) or progression-free survival in four trials where we were able to pool data (Hazard Ratio 0.98, 95% CI 0.88 to 1.08; participants = 1692; studies = 4; moderate-certainty evidence). Adverse events, surgical morbidity and quality of life (QoL) outcomes were variably and incompletely reported across studies. There are probably clinically meaningful differences in favour of NACT compared to PDS with regard to overall postoperative serious adverse effects (SAE grade 3+): 6% in NACT group, versus 29% in PDS group, (risk ratio (RR) 0.22, 95% CI 0.13 to 0.38; participants = 435; studies = 2; heterogeneity index (I2) = 0%; moderate-certainty evidence). NACT probably results in a large reduction in the need for stoma formation: 5.9% in NACT group, versus 20.4% in PDS group, (RR 0.29, 95% CI 0.12 to 0.74; participants = 632; studies = 2; I2 = 70%; moderate-certainty evidence), and probably reduces the risk of needing bowel resection at the time of surgery: 13.0% in NACT group versus 26.6% in PDS group (RR 0.49, 95% CI 0.30 to 0.79; participants = 1565; studies = 4; I2 = 79%; moderate-certainty evidence). NACT reduces postoperative mortality: 0.6% in NACT group, versus 3.6% in PDS group, (RR 0.16, 95% CI 0.06 to 0.46; participants = 1623; studies = 5; I2 = 0%; high-certainty evidence). QoL on the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) scale produced inconsistent and imprecise results in three studies (MD -0.29, 95% CI -2.77 to 2.20; participants = 524; studies = 3; I2 = 81%; very low-certainty evidence) but the evidence is very uncertain and should be interpreted with caution. AUTHORS' CONCLUSIONS: The available high to moderate-certainty evidence suggests there is little or no difference in primary survival outcomes between PDS and NACT. NACT probably reduces the risk of serious adverse events, especially those around the time of surgery, and reduces the risk of postoperative mortality and the need for stoma formation. These data will inform women and clinicians (involving specialist gynaecological multidisciplinary teams) and allow treatment to be tailored to the person, taking into account surgical resectability, age, histology, stage and performance status. Data from an unpublished study and ongoing studies are awaited.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Epitelial do Ovário , Procedimentos Cirúrgicos de Citorredução/métodos , Terapia Neoadjuvante/métodos , Neoplasias Ovarianas , Viés , Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/mortalidade , Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/cirurgia , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/mortalidade , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/mortalidade , Feminino , Humanos , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Intervalo Livre de Progressão , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Bull Cancer ; 108(9): 806-812, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34217437

RESUMO

OBJECTIVE: In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies: the SFOG, the CNGOF, the SFCO and the SCGP supported by the CNU of Obstetrics & Gynaecology, and UNICANCER agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS: The national committee of certification in gynaecological oncology made up of ten members, representing the 6 concerned organizations, set itself five objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS: Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including twenty advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including four parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.


Assuntos
Institutos de Câncer/normas , Certificação/normas , Competência Clínica , Neoplasias dos Genitais Femininos/cirurgia , Ginecologia/educação , Comitês Consultivos/organização & administração , Institutos de Câncer/estatística & dados numéricos , Certificação/organização & administração , Lista de Checagem , Currículo , Educação Médica Continuada , Feminino , França , Neoplasias dos Genitais Femininos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/normas , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Editoração/estatística & dados numéricos , Pesquisa/estatística & dados numéricos , Sociedades Médicas , Ensino
17.
Biomed Res Int ; 2021: 5533134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34258265

RESUMO

Background: The mainstay of treatment for advanced ovarian cancer is debulking surgery followed by chemotherapy that includes carboplatin and paclitaxel, but the prognosis is poor. This study is aimed at evaluating the efficacy and safety of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) as first-line surgical treatment in patients with advanced ovarian cancer (AOC). Methods: FIGO stage III/IV AOC patients underwent CRS+HIPEC as first-line surgical treatment at our center from December 2007 to January 2020. The primary endpoint was survival, and the secondary endpoint was safety. Results: Among 100 patients, the median Karnofsky performance status (KPS) score was 80 (50-100), median peritoneal cancer index (PCI) was 19 (1-39), median completeness of cytoreduction (CC) score was 1 (0-3), number of organ regions removed was 4 (3-9), number of peritoneal regions removed was 4 (1-9), and number of anastomoses was 1 (0-4). The median follow-up was 36.8 months; 75 (75.0%) patients were still alive, and 25 (25.0%) had died. The median overall survival (mOS) was 87.6 (95% CI: 72.1-103.0) months, and the 1-, 2-, 3-, 4-, and 5-year survival rates were 94.1%, 77.2%, 68.2%, 64.2%, and 64.2%, respectively. Univariate analysis showed that better mOS correlated with an age ≤, KPS ≥ 80, ascites ≤ 1000 ml, PCI < 19, and CC score 0-1. Multivariate Cox analysis showed that CC was an independent factor for OS; patients who underwent CRS with a CC score 0-1 had a mPFS of 67.8 (95% CI: 48.3-87.4) months. The perioperative serious adverse event and morbidity rates were 4.0% and 2.0%, respectively. Conclusions: CRS+HIPEC improves survival for AOC patients with acceptable safety at experienced high-volume centers. Stringent patient selection and complete CRS are key factors for better survival.


Assuntos
Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica/efeitos adversos , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Neoplasias Peritoneais/patologia , Análise de Sobrevida , Resultado do Tratamento
18.
J Obstet Gynaecol Res ; 47(9): 3339-3351, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34219334

RESUMO

AIM: To evaluate the clinico-pathologic features, treatment options, prognostic factors, and survival outcomes of malignant struma ovarii based on a systematic literature review in association with our case study. METHODS: A systematic review of the medical literature was performed to identify articles about malignant struma ovarii from January 1983 until July 2020. We evaluated 178 cases. RESULTS: The 5-year progression-free survival (PFS) and overall survival (OS) of the entire cohort was 72.5% and 91%, respectively. In univariate analysis, younger age (<43 years), whole strumal cyst diameter >95 mm, presence of a histologic type other than papillary classic-type thyroid carcinoma within the tumor and lymphovascular space invasion were related to poor PFS. Patients who received radioactive iodine ablation (RIA) before the treatment failure had significantly higher PFS than those who did not receive RIA (94.9% vs. 64.8%, p = 0.041, respectively). In univariate analysis, PFS was significantly higher in patients who underwent gynecologic surgery followed by thyroidectomy and RIA compared with those who had surgical treatment only (94.5% vs. 64.3%, p = 0.05, respectively). However, this result could not be identified as an independent prognostic factor in multivariate analysis (p = 0.207). Younger age and absence of capsular involvement were related to significantly increased OS. Histologic type was the only independent prognostic factor for PFS (hazard ratio: 3.30, 95% confidence interval: 1.122-9.748; p = 0.030) CONCLUSION: The most common histologic subtype was the papillary classic type. The presence of a histologic type other than the classic papillary thyroid carcinoma within the tumor was an independent adverse prognostic factor.


Assuntos
Neoplasias Ovarianas , Estruma Ovariano , Neoplasias da Glândula Tireoide , Adulto , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/terapia , Estruma Ovariano/diagnóstico , Estruma Ovariano/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia
19.
J Laparoendosc Adv Surg Tech A ; 31(9): 1055-1060, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34252315

RESUMO

Background: In pediatric and adolescent gynecology, ovarian-sparing surgery (OSS) is an approach for preserving the ovaries affected by tumors and torsion during surgical treatment. Materials and Methods: We analyzed participants from a tertiary Gynecology and Obstetrics University Hospital. Participants were patients <19 years of age with adnexal tumors managed surgically with removal of pathologically confirmed ovarian tissue in the period from 2008 to 2017. Results: The average age of 38 patients who underwent surgery for adnexal tumors and were included in the study was 16.78 ± 2.15 years, from 12 to 19 years, with significantly younger patients in the salpingo-oophorectomy/oophorectomy and laparotomy group (P = .036 and P = .001). The laparoscopic approach was performed in 28 (73.68%) patients and laparotomy in 10 (26.31%) patients (P < .0001). Cystectomy was performed in 29 (76.31%), oophorectomy in 1 (2.63%), and salpingo-oophorectomy in 8 (21.05%) patients. A significantly higher number of patients underwent OSS with laparoscopy in scheduled surgical procedure and emergency surgery groups (P = .021 and P = .028). Benign ovarian tumors were found in 31 (81.57%), borderline in 3 (7.89%), and malignant in 4 (10.52%) patients. Conclusion: Our study has shown a high trend in OSS using the endoscopic approach in management of adnexal tumors despite the fact that the management was done by general gynecologists.


Assuntos
Ginecologia , Laparoscopia , Neoplasias Ovarianas , Adolescente , Adulto , Criança , Feminino , Humanos , Neoplasias Ovarianas/cirurgia , Ovariectomia , Ovário , Gravidez , Estudos Retrospectivos
20.
World J Surg Oncol ; 19(1): 220, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284773

RESUMO

PURPOSE: The aim of this study was to analyze prognostic factors for ovarian metastases (OM) in colorectal cancer (CRC) using data from a Chinese center. In addition, the study aimed at developing a new clinical scoring system for prognosis of OM of CRC patients after surgery. PATIENTS AND METHODS: Data of CRC patients with OM were collected from a single Chinese institution (n = 67). Kaplan-Meier analysis was used to evaluate cumulative survival of patients. Factors associated with prognosis of overall survival (OS) were explored using Cox's proportional hazard regression models. A scoring system to determine effectiveness of prognosis was developed. RESULTS: Median OS values for patients with or without surgery were 22 and 7 months, respectively. Size of OM, number of OM, peritoneal metastasis (PM), Peritoneal cancer index (PCI), and completeness of cytoreduction (CC) were associated with OS of patients through univariate analysis. Multivariate analysis using a Cox regression model showed that only CC was an independent predictor for OS. Three variables (the size of OM >15cm, PCI ≥ 10, and carcinoembryonic antigen (CEA) >30 ng/mL) assigned one point each were used to develop a risk score. The resulting score was used for prognosis of OS. CONCLUSION: Surgical treatment of metastatic sites is effective and safe for CRC patients with OM. CC-0 is recommended for improved prognosis. The scoring system developed in this study is effective for prediction of OS of patients after surgery.


Assuntos
Neoplasias Colorretais , Hipertermia Induzida , Neoplasias Ovarianas , Neoplasias Peritoneais , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
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