Editorial: Primary surgery or neoadjuvant chemotherapy in ovarian cancer: What is the value of comparing apples with oranges?

(adverse event) abstract: Inadvertent cystotomy at laparoscopic hysterectomy – Sydney West Advanced Pelvic Surgery (SWAPS)

Conclusion: 
Inadvertent cystotomy is a recognised complication at hysterectomy. The rate in the SWAPS unit is comparable to that of other published series. Overall, there has been a decline in the rate of bladder injury, which appears attributable to more experience gained with an acquisition of increased skill levels and improved techniques.

Radical fimbriectomy: A reasonable temporary risk-reducing surgery for selected women with a germ line mutation of 1 or 2 genes? Rationale and preliminary development

Research Highlights

►Radical fimbriectomy is a new kind of temporary prophylactic operation in BRCA mutation carriers. ►It removes both fallopian tubes including the frimbrio-ovarian junctions. ►It reduces the risk of high-grade pelvic serous cancer while preserving ovarian function.

full free access: Wound complications after gynecologic cancer surgery

Definitions of adhesiolysis:
Scar tissue can form as a result of prior surgery or infections involving reproductive tact, urinary tract or vaginal canal causing severe pain. Adhesiolysis is the surgical procedure used to remove this scar tissue.
www.urogyncenter.com/ug-glossary.htm

Research highlights

► Retrospective review of patients undergoing abdominal surgery for suspected cancer.
► Wound complications correlated with BMI, prior surgery, albumin, adhesiolysis, length of surgery.
► A nomogram predicting post-operative wound complications was created and validated.

Platinum-based adjuvant chemotherapy on moderate - and high-risk stage I and II epithelian ovarian cancer patients. Long-term single institution exper

Background Although the optimal management of women with FIGO stages I and II epithelial ovarian cancer (EOC) is still controversial, platinum-based adjuvant chemotherapy (CT) is the mainstay of treatment. Suboptimal survival results have led to major efforts to identify prognostic factors, improve surgical staging and develop adjuvant therapies to improve patients' outcomes.

Patients and methods We evaluate in a retrospective study clinical efficacy and the toxicity profile of a platinum-based adjuvant CT in FIGO stages I and II EOC treated at our institution from March 1984 to December 2006. Grade I FIGO stages IA-IB were excluded from the analysis. In the first period (1984-1997), patients received a platinum-based regimen without taxanes. In the second period from 1997 onwards, patients were treated with carboplatin and paclitaxel. Four to six cycles of adjuvant CT were administered. Potential predictive factors of efficacy and the role of paclitaxel addition were also analysed.

Results One hundred and fifty-eight patients (60 treated with paclitaxel) met inclusion criteria and were evaluable. Median age at diagnosis was 53.7 years (range 19-81) and most patients had an Eastern Cooperative Oncology Group performance status score (ECOG) of 0-1 (91.8%); 82.9% patients had pathological stage I and 17.1% pathological stage II. With a median follow up of 8.34 years (range 4.4-11.6), 103 patients (74.1%) were free of disease and 110 of them were alive (79.1%). Median relapse-free survival (RFS) and median overall survival (OS) had not been reached at the time of the analysis. No survival difference was found between paclitaxel and carboplatin combination or non-paclitaxel-containing regimens. Statistically significant prognostic factors for better RFS in the multivariate analysis were: ECOG 0 (p=0.023; HR 0.32; 95% CI 0.17-0.57); FIGO I stage (p<0.001; HR 0.30; 95% CI 0.15-0.58); I-II histological grade (p=0.005; HR 0.38; 95% CI 0.19-0.75); mucinous histology (p=0.013; HR 0.28; 95% CI 0.13-0.53); non-surgical adherences (p<0.002, HR 0.32; 95% CI 0.15-0.54); paracolic gutters inspection (p=0.033; HR 0.50; 95% CI 0.26-0.95) and liver surface biopsies (p=0.048; HR 0.64; 95% CI 0.41-0.98).Toxicity was generally mild and non-haematologic events were the most commonly found (62.9% of the total). The most frequent haematologic toxicities were neutropenia (41.7% in all grades, 9.5% grade 3-4) and anaemia (29.1% in all grades, 3.2% grade 3-4).

Conclusions The long-term outcome of this series is comparable to the published evidence and reflects the limited activity of platinum-based CT in the adjuvant setting. The potential survival advantage of the addition of paclitaxel to carboplatin cannot be definitively answered due to the small number of patients, the limited follow-up and the retrospective nature of the study. More effective and specific treatments are clearly required, in particular for those patients with stage II and undifferentiated tumours. Quality of surgery entails prognostic value.

abstract: Comparison of diaphragmatic surgery at primary or interval debulking in advanced ovarian carcinoma: An analysis of 163 patients

Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery Gut - abstract (Lynch Syndrome)

Define: metachronous:  Multiple separate occurrences, such as multiple primary cancers developing at intervals.
Conclusions: Patients with Lynch syndrome with first colon cancer treated with more extensive colonic resection have a lower risk of metachronous CRC than those receiving less extensive surgery. This finding will better inform decision-making about the extent of primary surgical resection.

Dr Huntsman - media/video interview regarding surgery/fallopian tubes

Research: Effect of Anaesthetic and Other Perioperative Factors on Cancer Recurrence: Abstract and Introduction

Note: in research; long article

abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology

How to follow-up patients with epithelial ovarian cancer
Miller, Rowan E; Rustin, Gordon JS

Abstract

Purpose of review: Despite optimal primary treatment most patients with advanced epithelial ovarian cancer will relapse. This review discusses the controversy regarding surveillance and the timing of treatment for recurrent disease.

Recent findings: Routine physical examination has a limited role in the detection of recurrent ovarian cancer. PET/computed tomography (CT) has been shown to be useful in detecting small volume disease not apparent on traditional imaging in patients with suspected recurrence based on symptoms and/or rising CA125. The results of PET/CT can alter treatment plans and have particular use in guiding site-directed therapy. The benefits of early detection and systemic treatment of recurrence are now in doubt following the presentation of the MRC/EORTC CA125 surveillance trial. The impact on survival of secondary cytoreductive surgery requires more investigation.

Summary: Uncertainties remain in the surveillance and timing of treatment for relapsed disease. Patients should be informed of these uncertainties and become involved in decisions regarding their follow-up.

J Surg Oncol. 2010 Aug 1;102(2):187-95.

Indications and approach to surgical resection of lung metastases.

Kaifi JT, Gusani NJ, Deshaies I, Kimchi ET, Reed MF, Mahraj RP, Staveley-O'Carroll KF.

Section of Surgical Oncology, Department of Surgery, Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania.

Abstract

Pulmonary metastasectomy is a curative option for selected patients with cancer spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration in a multidisciplinary setting when planning pulmonary metastasectomy include: adherence to established indications for resection, the surgical strategy including the use of minimally invasive techniques, pulmonary parenchyma preservation, and the role of lymphadenectomy.

J. Surg. Oncol. 2010;102:187-195. (c) 2010 Wiley-Liss, Inc.

PMID: 20648593 [PubMed - in process]

Cochrane Collaboration review: Palliative surgery versus medical management for bowel obstruction in ovarian cancer - Review

CONCLUSIONS:

We found only low quality evidence comparing palliative surgery and medical management for bowel obstruction in ovarian cancer. Therefore we are unable to reach definite conclusions about the relative benefits and harms of the two forms of treatment, or to identify sub-groups of women who are likely to benefit from one treatment or the other. However, there is weak evidence in support of surgical management to prolong survival.

The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas

Objective.

To assess the morbidity and mortality associated with extensive upper abdominal surgery (EUAS) performed during primary cytoreduction for advanced ovarian carcinoma.

The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm

Abstract

OBJECTIVE: To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer.
CONCLUSIONS: Hospital ovarian cancer surgical volume >/=21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume >/=21 cases/year was significantly predictive of improved overall survival outcome.

Perioperative morbidity and outcome of secondary cytoreduction for recurrent epithelial ovarian cancer.

CONCLUSION:
Secondary cytoreduction in relapsed ovarian cancer is safe and feasible and perioperative outcome is not inferior compared to primary cytoreduction. Surgery-associated morbidity should represent a minor aspect in the selection and counselling of patients regarding treatment options for recurrent ovarian cancer.

Systematic Lymphadenectomy for Survival in Epithelial Ovarian Cancer: A Meta-Analysis

Note: also see post of Dr Maurie Markman (blogger dat May 4th) for Editorial on this particular subject matter

Conclusions: These findings suggest the possibility that SL can improve OS in advanced-stage EOC. However, the efficacy of SL on OS is still unknown because of the lack of RCTs, which requires more relevant studies for investigating the role of SL in EOC

The role of initial maximal surgical cytoreduction in ovarian cancer still debated Dr Maurie Markman Editorial

"Although the world of surgery is not necessarily characterized by the utility of innovative clinical hypotheses being formally evaluated through the conduct of randomized phase-3 clinical trials, it will hopefully be the case that the gynecologic cancer surgical community will see the wisdom of further exploration of these important concepts in prospective well-designed and evidence-based clinical trials.
Our current and future patients deserve no less."

Surgeon Recommendations and Receipt of Mastectomy for Treatment of Breast Cancer

"These findings demonstrate the choice between BCS (breast conserving surgery) and mastectomy as initial treatment for breast cancer is a multifactorial decision with patient preference, surgical recommendation, and failure of BCS all playing an important role."