The place of secondary complete cytoreductive surgery in advanced ovarian cancer

2019 ◽  
Vol 41 (3) ◽  
Author(s):  
Asmar Jennifer ◽  
Naoura Iptissem ◽  
Revaux Aurélie ◽  
Kadhel Philippe ◽  
Ayoubi Jean Marc
Keyword(s):  
Public Health ◽  
Ovarian Cancer ◽  
Robotic Surgery ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Complete Cytoreduction ◽  
Health Issue ◽  
Late Relapse ◽  
Public Health Issue ◽  
Type Of Surgery

AbstractDespite optimal treatment, three-quarters of the patients with advanced ovarian cancer, experiment relapse and its treatment has become a public health issue. Initially debated, surgery is gaining legitimacy in the treatment of late relapse patients, compared to chemotherapy alone. Secondary complete cytoreduction should be proposed only to a highly selected population. The type of surgery depends on the recurrence localization and the relapse extension in the pelvis and to other organs. Innovating techniques of surgery have become widespread including heated intra peritoneal chemotherapy (HIPEC), laparoscopy and robotic surgery. These specialized treatments should only be carried out in reference centers by oncological surgeons.

scholarly journals An update on preoperative assessment of the resectability of advanced ovarian cancer

2019 ◽  
Vol 41 (3) ◽  
Author(s):  
Philippe Kadhel ◽  
Aurélie Revaux ◽  
Marie Carbonnel ◽  
Iptissem Naoura ◽  
Jennifer Asmar ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Preoperative Assessment ◽  
Complete Cytoreduction ◽  
Sufficient Information ◽  
Positron Emission ◽  
Composite Models ◽  
Improving Accuracy

AbstractThe best prognosis for advanced ovarian cancer is provided by no residual disease after primary cytoreductive surgery. It is thus important to be able to predict resectability that will result in complete cytoreduction, while avoiding unnecessary surgery that may leave residual disease. No single procedure appears to be sufficiently accurate and reliable to predict resectability. The process should include a preoperative workup based on clinical examination, biomarkers, especially tumor markers, and imaging, for which computed tomography, as well as sonography, magnetic resonance imaging and positron-emission tomography, can be used. This workup should provide sufficient information to determine whether complete cytoreduction is possible or if not, to propose neoadjuvant chemotherapy which is preferable in this case. For the remaining patients, laparoscopy is broadly recommended as an ultimate triage step. However, its modalities are still debated, and several scores have been proposed for standardization and improving accuracy. The risk of false negatives requires a final assessment of resectability as the first stage of cytoreductive surgery by laparotomy. Composite models, consisting of several criteria of workup and, sometimes, laparoscopy have been proposed to improve the accuracy of the predictive process. Regardless of the modality, the process appears to be accurate and reliable for predicting residual disease but less so for predicting complete cytoreduction and thus avoiding unnecessary surgery and an inappropriate treatment strategy. Overall, the proposed procedures are heterogeneous, sometimes unvalidated, or do not consider advances in surgery. Future techniques and/or models are still needed to improve the prediction of complete resectability.

scholarly journals Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

2019 ◽  
Vol 29 (9) ◽  
pp. 1341-1347 ◽  
Author(s):  
Jeremie Abitbol ◽  
Walter Gotlieb ◽  
Ziggy Zeng ◽  
Agnihotram Ramanakumar ◽  
Roy Kessous ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Robotic Surgery ◽  
Neoadjuvant Chemotherapy ◽  
Minimally Invasive ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Stage Iii ◽  
Time Period ◽  
Interval Cytoreduction

IntroductionWith the rapid uptake of robotic surgery in surgical oncology, its use in the treatment of epithelial ovarian cancers is being evaluated. Complete cytoreduction represents the goal of surgery either at primary cytoreduction or after neoadjuvant chemotherapy in the setting of interval cytoreduction. In selected patients, the extent of disease would enable minimally invasive surgery. The objective of this study was to evaluate the impact of introducing robotic surgery for interval cytoreduction of selected patients with stage III–IV ovarian cancer.MethodsAll patients who underwent surgery from November 2008 to 2014 (concurrent time period when robotic and open surgery were used simultaneously) after receiving neoadjuvant chemotherapy for advanced ovarian cancer (stage III–IV) were compared with all consecutive patients who underwent cytoreductive surgery by laparotomy after neoadjuvant chemotherapy between January 2006 and November 2008. Inclusion criteria included an interval cytoreductive surgery by laparotomy or robotic assistance for stage III–IV non-mucinous epithelial ovarian, fallopian tube, or primary peritoneal cancer. Exclusion criteria included patients treated concurrently for a non-gynecologic cancer, as well as secondary cytoreductive surgeries and diagnostic surgeries without an attempt at tumor reduction. Overall survival, progression-free survival, and peri-operative outcomes were compared for the entire patient cohort with those with advanced ovarian cancer who received neoadjuvant chemotherapy immediately before and after the introduction of robotic surgery.ResultsA total of 91 patients were selected to undergo interval cytoreduction either via robotic surgery (n=57) or laparotomy (n=34) after the administration of neoadjuvant chemotherapy. The median age of the cohort was 65 years (range 24–88), 78% had stage III disease, and the median follow-up time was 37 months (5.6–91.4 months). The median survival was 42.8±3.1 months in the period where both robotic surgery and laparotomy were offered compared with 37.9±9.8 months in the time period preceding when only laparotomy was performed (p=0.6). All patients selected to undergo interval robotic cytoreduction following neoadjuvant chemotherapy had a reduction of cancer antigen 125 by at least 80%, resolution of ascites, and CT findings suggesting the potential to achieve optimal interval cytoreduction. All these patients achieved optimal cytoreduction with <1 cm residual disease, including 82% with no residual disease. The median blood loss was 100 mL (mean 135 mL, range 10–1250 mL), and the median hospital stay was 1 day.ConclusionRobotic interval cytoreductive surgery is feasible in well-selected patients. Future studies should aim to define ideal patients for minimally invasive cytoreductive surgery.

Identifying changes in trends in the age standardized incidence of melanoma in Australia

2019 ◽  
Vol 3 (4) ◽  
pp. 250-252 ◽  
Author(s):  
David M Hille
Keyword(s):  
Public Health ◽  
Linear Regression ◽  
Iterative Process ◽  
Linear Trend ◽  
Piecewise Linear ◽  
Health Issue ◽  
Public Health Issue ◽  
Piecewise Linear Regression ◽  
Significant Public Health ◽  
Males And Females

ObjectiveTo identify changes in the linear trend of the age-standardized incidence of melanoma in Australia for all persons, males, and females. MethodsA two-piece piecewise linear regression was fitted to the data. The piecewise breakpoint varied through an iterative process to determine the model that best fits the data.ResultsStatistically significant changes in the trendof the age-standardized incidence of melanoma in Australia were found for all persons, males, and females. The optimal breakpoint for all persons and males was at 1998. For females, the optimal breakpoint was at 2005. The trend after these breakpoints was flatter than prior to the breakpoints, but still positive.ConclusionMelanoma is a significant public health issue in Australia. Overall incidence continues to increase. However, the rate at which the incidence is increasing appears to be decreasing.

Sign in / Sign up

Export Citation Format

Share Document