paywalled: Gynecologic Oncology Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer

Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer

 Abstract

Background  

To analyze the impact of radical cytoreductive surgery—as part of primary tumor debulking—on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery.

Methods  

Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC–IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected.

Results  

Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients..........

Conclusions  

No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.

 

Time to Ovarian Cancer Return Not Tied to BMI - in Meeting Coverage, ASCO from MedPage Today

Medical News: Time to Ovarian Cancer Return Not Tied to BMI - in Meeting Coverage, ASCO from MedPage Today

Action Points

• Note that this study was published as an abstract and will be presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• A study found that obesity did not affect recurrence, time to recurrence, or progression-free survival in women with epithelial ovarian cancer following surgery and adjuvant chemotherapy without evidence of disease during treatment.
• Note that the approximately one-third of patients who had BMI >30 kg/m² had similar recurrence rates and time to recurrence as the two-thirds of non-obese patients.

paywalled: Early Postoperative CT as a Prognostic Biomarker in Patients With Advanced Ovarian, Tubal, and Primary Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery

Early Postoperative CT as a Prognostic Biomarker in Patients With Advanced Ovarian, Tubal, and Primary Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery

CONCLUSION:

Our study showed that residual disease larger than 1 cm was present on early postoperative CT in almost half of the patients deemed to have optimally debulked disease at primary cytoreduction.

Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals - Can J Surg. 2012 Jun 1

Blogger's Note: surgical site infections safety checklist: WHO (World Health Organization) program in patient safety

Surgical site infection prevention: a survey to identifythe gap between evidence and practice in University of Toronto teaching hospitals

 "Surgical site infections (SSIs) are the most common
complication following surgery, with reported rates
ranging from 5% to 30%.1 The attributable morbidity
and mortality is significant, with patients who experience
SSIs being 60% more likely to spend time in the
intensive care unit, 5 times more likely to be readmitted to
hospital and twice as likely to die than patients without
SSIs.2 Whereas many risk factors for the development of
SSIs are related to patient characteristics that cannot be easily
modified, there are a variety of system or hospital factors
that can be manipulated. These include improper selection
and administration of antibiotic prophylaxis, intraoperative
hypothermia and intraoperative hyperglycemia.3
Despite clear evidence and guidelines to direct SSI prevention
strategies, compliance is uniformly poor......

open access: original paper - Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience - Cross - 2011 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience - Cross - 2011 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

Gynaecological oncology

Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience

1. PA Cross¹, et al

Article first published online: 6 SEP 2011

DOI: 10.1111/j.1471-0528.2011.03129.x

© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG

Correspondence: re - Intra-operative frozen section analysis for suspected early-stage ovarian cancer - Twigg - 2012 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

Intra-operative frozen section analysis for suspected early-stage ovarian cancer - Twigg - 2012 - BJOG: An International Journal of Obstetrics & Gynaecology

Correspondence

Volume 119, Issue 7, page 896, June 2012

Get PDF (44K)

Sir,

We read with interest the article by Cross et al.¹ on the use of intra-operative frozen section for suspected early ovarian cancer. We would like to commend the authors for their work in providing these data and we recognise the need for mechanisms that can be used to address the National Institute for Health and Clinical Excellence (NICE) Guidelines CG122, which recommend assessment of the para-aortic lymph nodes in women with early ovarian cancer.²

However, there are a number of areas of practice that we feel need to be examined further before frozen section procedures can be used to alter the management of women with suspected early-stage ovarian cancer.

First, we are perplexed that the authors deemed it necessary to undertake para-aortic lymphadenectomy for women with borderline ovarian tumours. These are by nature an unpredictable class of tumour with mostly good outcomes and little in the way of nonsurgical treatment options when there is disseminated disease. Further, they are usually early-stage tumours and so the utility of a para-aortic lymph node dissection is questionable. If the authors had described the rate of disease in lymph nodes and the difference in outcome this provided for the woman with positive nodes their data would lend stronger support for more widespread implementation.

Accepting this and examining the authors data for ‘all comers’ (Table 1) we calculate that 28.8% (415) of women had an appropriate para-aortic lymph node dissection on the basis of the frozen section prediction, which represents the real-world scenario for the gynaecological oncology surgeon waiting in theatre for a frozen section analysis to be phoned back.

If the authors changed their protocol to only using dissection in women with malignancy on frozen section, 63.8% (918) of women would appropriately not undergo a para-aortic dissection. The total number of women correctly triaged by frozen section analysis would be 92.6%. Of the remainder, 7% would not undergo a para-aortic dissection that should and 0.35% would have a dissection they do not need. Such a protocol change compares with the authors’ figures who, when including a policy of para-aortic dissection for borderline tumours on frozen section, overtreated 8% of the women and undertreated 1.3%.

The answer to deciding which strategy one would wish to take up must come down to the differences in outcome for these women, defined by morbidity and mortality comparisons from overtreatment or undertreatment by surgery or chemotherapy, respectively, and any subsequent influence this has on overall survival. Unfortunately the authors do not provide this information, and only allude to data in preparation that indicate their ability to increase the stage of a woman’s disease. However, this figure can be calculated from their data in Table 1 to equate to 82 women (5.7%) who had a frozen section showing borderline disease but whose final paraffin section report showed a malignancy. Until other centres can validate their techniques and such practice can be shown to translate into a survival benefit for women, it is unlikely that their data will change surgical practice in women with early ovarian cancer.

References

• 1
  Cross P, Naik R, Patel A, Nayar A, Hemming J, Williamson S, et al. Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012;119:194–201.
  

  Direct Link:

  • Abstract
  • Full Article (HTML)
  • PDF(281K)
  • References
• 2
  National Institute for Health and Clinical Excellence. The recognition and initial management of ovarian cancer. [http://www.nice.org.uk/CG122]. Accessed 20 January 2012. 
  • References
  • Cited By

   
  

paywalled - Outcomes of Primary Surgical Cytoreduction in Patients with BRCA-associated High-grade Serous Ovarian Carcinoma

 Outcomes of Primary Surgical Cytoreduction in Patients with BRCA-associated High-grade Serous Ovarian Carcinoma

Objective

BRCA-associated and sporadic ovarian cancers have different pathologic and clinical features. Our goal was to determine if BRCA mutation status is an independent predictor of residual tumor volume following primary surgical cytoreduction.

Highlights

► Differences in the biology of BRCA-associated and sporadic ovarian cancers do not result in differences in primary surgical outcomes.
► The improved survival of BRCA-associated ovarian cancers is not confounded by differences in primary surgical outcome.

paywalled: Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling

Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling: Publication year: 2012


Source: Gynecologic Oncology

Objective We sought to determine whether prophylactic oophorectomy rates changed after the introduction of a 2007 health plan clinical guideline recommending systematic referral to a genetic counselor for women with a personal or family history suggestive of an inherited susceptibility to breast/ovarian cancer.

Methods We conducted a retrospective cohort study of female members of Group Health, an integrated delivery system in Washington State. Subjects were women aged ≥35years during 2004–2009 who reported a personal or family history consistent with an inherited susceptibility to breast/ovarian cancer. Personal and family history information was collected on a questionnaire completed when the women had a mammogram. We ascertained oophorectomies from automated claims data and determined whether surgeries were prophylactic by medical chart review.....

Results Prophylactic oophorectomy rates were relatively unchanged after compared to before the guideline change, 1.0 versus 0.8/1,000 person-years, (IRR=1.2; 95% CI: 0.7-2.0), whereas bilateral oophorectomy rates for other indications decreased. Genetic counseling receipt rates doubled after the guideline change (95% CI: 1.7-2.4) from 5.1 to 10.2/1,000 person-years. During the study, bilateral oophorectomy rates were appreciably greater in women who saw a genetic counselor compared to those who did not regardless of whether they received genetic testing as part of their counseling.

Conclusion A doubling in genetic counseling receipt rates lends support to the idea that the guideline issuance contributed to sustained rates of prophylactic oophorectomies in more recent years.

paywalled: Evaluation of Society of Gynecologic Oncologists (SGO) Ovarian Cancer Quality Surgical Measures

Evaluation of Society of Gynecologic Oncologists (SGO) Ovarian Cancer Quality Surgical Measures: Publication year: 2012

Source: Gynecologic Oncology



Objectives
The Society of Gynecologic Oncologists has developed two measures to assess & improve the surgical care of patients with ovarian cancer (1) description of residual disease following cytoreduction and (2) adequacy of surgical staging. Our aim was to establish baseline surgeon compliance with these two measures.

Methods
A retrospective review of patients with ovarian, fallopian tube or peritoneal cancer undergoing surgery between 7/1/2006 and 7/1/2011 for the purposes of staging and/or cytoreduction was performed at the University of Washington and Geisinger Medical Center. Operative and pathology reports were reviewed to obtain information pertaining to stage, histology, residual disease after surgery and the extent of surgical staging.

Results 
537 cases were identified; 91% with ovarian cancer. 61% of patients had at least stage IIIC disease; 15% had recurrent disease and 16% had neoadjuvant therapy. For patients with stage I-IIIB disease, 74% had full surgical staging, 10% did not have full surgical staging but documented the reason for this in the operative report; 15% did not have full surgical staging, no reason was noted. 25% of all operative reports lacked documentation of residual disease with 40% documenting no gross residual disease, 18% with residual disease<1cm and 18% had suboptimal debulking with>1cm disease remaining. There was a statistically significant increase in appropriate documentation of amount of residual disease over time (p<0.001).

Conclusions
 Our study sets benchmarks for evaluation of documentation in gynecologic oncology centers. Improved documentation and staging will allow for equivalent standards of care across institutions.

press release: New surgical technique for removing inoperable tumors of the abdomen

New surgical technique for removing inoperable tumors of the abdomen

New surgical technique for removing inoperable tumors of the abdomen

Abdominal tumors involving both roots of the celiac and superior mesenteric artery (SMA) are deemed unresectable by conventional surgical methods, as removal would cause necrosis of the organs that are supplied by those blood vessels.

A case report published in the journal American Journal of Transplantation presents a novel surgical technique that enables surgeons to remove tumors that are unresectable by the usual surgical techniques.

video/text: Leftover ovarian tissue after surgery can cause serious complications | Medical Alert-media

Blogger's Note: short video; not specific to ovarian cancer but note absence of menopausal symptoms

Leftover ovarian tissue after surgery can cause serious complications | Medical Alert - WBAL Home

Transcript: Debulking Surgery and HIPC (hyperthermia) to Treat Ovarian Cancer (Bristow/ReachMD)

Blogger's Note: requires registration

Transcript: Debulking Surgery and HIPC to Treat Ovarian Cancer

paywalled: Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma?

Blogger's Note:  a repost

Is comprehensive surgical staging needed... [Am J Obstet Gynecol. 2012] - PubMed - NCBI

 Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma?

Abstract

OBJECTIVE:

Patients with ovarian cancer may have occult metastasis at the time of surgery. Our purpose was to determine the prevalence and sites of occult metastasis in epithelial ovarian cancer grossly confined to the ovary and examine the significance of routine omentectomy and peritoneal biopsies as part of a comprehensive staging procedure.

STUDY DESIGN:

Data were retrospectively abstracted from patients presenting to University of Texas Southwestern Medical Center Hospitals from 1993 through 2009 with ovarian cancer without gross spread beyond the ovary who underwent comprehensive surgical staging.

RESULTS:

A total of 86 patients with ovarian cancer grossly confined to the ovary who underwent complete surgical staging were identified. Of patients, 29% were upstaged following comprehensive surgical staging; 6% had metastatic disease in uterus and/or fallopian tubes, 6% in lymph nodes, and 17% in peritoneal, omental, or adhesion biopsies.

CONCLUSION:

Patients with epithelial ovarian cancer should continue to undergo comprehensive surgical staging, since it identifies occult metastasis in a significant number of patients.

paywalled: ncreased risk of neoplasm in appendicitis treated w... [Am Surg. 2012] - PubMed - NCBI

Increased risk of neoplasm in appendicitis treated w... [Am Surg. 2012] - PubMed - NCBI

Am Surg. 2012 Mar;78(3):339-43.

Increased risk of neoplasm in appendicitis treated with interval appendectomy: single-institution experience and literature

Abstract

Appendicitis is a common diagnosis encountered by the acute care surgeon. Management of complicated appendicitis is controversial and often involves initial nonoperative therapy with interval appendectomy. This study reviews single-institutional experience with management of complicated appendicitis with interval appendectomy and addresses an unusually high occurrence of incidental appendiceal malignancies observed with a review of relevant literature. A retrospective review of all diagnoses of appendicitis was performed over 5 years at a tertiary care center. Patient demographics, time to surgery, operative technique, pathologic diagnosis, and clinical outcomes were examined. Three hundred fifteen patients were diagnosed with acute appendicitis. Of these, 24 (7.6%) were deemed complicated and did not undergo immediate appendectomy, and 18 ultimately underwent appendectomy at our institution and were included in analysis. There were no statistical demographic or symptomatic differences between the immediate and interval appendectomy patients. Ninety-nine per cent of the immediate appendectomy patients were treated laparoscopically; 78 per cent of the interval group underwent attempted laparoscopic treatment with 56 per cent completed without conversion to open (P < 0.01). Neoplasms were discovered in 1 per cent of the acute appendectomy group and 28 per cent of the interval appendectomy group (P < 0.0001). Two of the three neoplasms in the acute group were carcinoid, whereas three of the five neoplasms in the interval group were adenocarcinoma. Surgeons should consider appendiceal or colonic neoplasms in cases of complicated appendicitis when nonoperative management is considered. This is most important in patients older than 40 years, in those who forego interval appendectomy, or in those who could be lost to follow-up.

Utah: Surgical Trial Comparing LIGASURE Assisted Recto-Sigmoid Resection and Omentectomy Compared to Stand - Full Text View - ClinicalTrials.gov

Surgical Trial Comparing LIGASURE Assisted Recto-Sigmoid Resection and Omentectomy Compared to Stand - Full Text View - ClinicalTrials.gov

 Purpose

The objective of this prospective randomized surgical trial is to evaluate whether the use of the LIGASURE surgical device during omentectomy and/or recto-sigmoid resection for women with ovarian cancer will reduce the surgical time compared to standard surgical resection using clamps and surgical ligatures.

Reuters News: Should more patients continue aspirin therapy before surgery? - - ModernMedicine

Should more patients continue aspirin therapy before surgery? - - ModernMedicine

2011 Dec open access: Nuclear Medicine and Radiation Therapy - 18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies

Blogger's Note: investigative research; study of 27 gyn patients of whom 15 were ovarian cancer patients

18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies

 "As stereotactic body radiosurgery for abdominopelvic sites
of metastatic gynecologic cancers becomes more mainstream,
accumulated 18F-FDG PET and CT data will better guide treating
physician target contouring. Future research directions by our group
will study better radiosurgical target delineation, as modified by the
extent of respiratory motion, by four-dimensional (4D)-CT scanners
or by single 18F-FDG PET-magnetic resonance imaging (PET/MRI)
scanners."

Potentially Dangerous Complementary and Alternative Medicine (CAM) Use by Ovarian Cancer Patients | Abstract

Potentially Dangerous Complementary and Alternative Medicine (CAM) Use by Ovarian Cancer Patients

Abstract

Objective: 

The use of complementary or alternative medicine (CAM) has increased greatly over the last decade. Although many CAM activities are unlikely to increase a patient's risk for adverse events with conventional treatment for cancer, this is not necessarily true of ingestible CAM treatments such as herbal remedies, teas, and other supplements. This study surveyed women with ovarian cancer in order to evaluate the use of herbs and supplements that might place them at increased risk at the time of their surgery for ovarian cancer.  

Methods: 

A total of 219 women with ovarian cancer, who had received care from one of two participating oncology practices, were surveyed. 

Results: 

Of the women who reported having had surgery to treat their ovarian cancer (n=209), 65 (31%) reporting using one or more herbs or supplements that have been hypothesized to increase their risk for adverse outcomes. In almost all cases the risks associated with these substances were elevated risks for excessive bleeding.  

Conclusions: 

The use of herbs and supplements that might increase risks associated with excessive bleeding during gynecologic cancer surgery is common. Further research is needed to better understand the risks associated with use of herbs and supplements among women approaching surgery

. (J GYNECOL SURG 28:1)

open access: What do surgical trainees think about patient safety culture, and is this different from their consultants?

What do surgical trainees think about patient safety culture, and is this different from their consultants?

Abstract

Introduction Little is known about the patient safety culture within surgical departments in UK hospitals. What has been done to date is to survey only permanent senior staff opinion of the safety culture in their institution. This study surveyed both consultant and trainee views on perceived patient safety and compared the results between these two groups. 

Material and methods The previously validated Team Work and Safety Climate Questionnaire was configured in Survey Monkey format and sent to all surgical trainees and consultant surgeons in the South West Strategic Health Authority. Two reminders were sent to achieve as high a return rate as possible. 

Results Two hundred and ninety-six replies were received. Forty-four percent of trainees and 30% of consultants responded to the survey. Consultants consistently rated a higher safety culture than surgical trainees. Only 2.9% of trainees believe their patient safety concerns would be acted upon by hospital management. There is notable variation in perceived patient safety culture between hospitals. 

Conclusion This study has suggested that the patient safety culture in hospitals, within a Strategic Health Authority, is variable and sub-optimal when viewed by surgical trainees and their consultants. This study also provides some evidence that the perception of patient safety in an organization varies according to clinical experience. As trainees deliver a great deal of clinical care, surveys of safety culture should include this group. As perceived patient safety culture is correlated to clinical outcomes, validated safety surveys might form part of the assessment of a hospital's performance, along with outcome and patient satisfaction.

Previous SectionNext Section

Introduction

Medical errors are a major cause of mortality and morbidity. The National Patient Safety Agency (NPSA) estimates that 10% of all hospital admissions suffer an adverse event defined as a medical error that results in harm to the patient. One percent of all admissions die as a result of an adverse event. In practice this means that in England and Wales 300,000 adverse events and 30,000 deaths are recorded every year. This figure of 30,000 deaths a year is a greater number of deaths than the combined annual mortality from colorectal, prostate and breast cancer.¹ Even these striking figures may be underestimating the extent of the problem because recent studies in the surgical literature² indicate the adverse event rate could even be as high as 20%...........

abstract: Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety - oncologic safety

Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety:

Abstract

The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety. A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) surgical staging at the Center for Uterine Cancer, National Cancer Center, Korea, between January 2001 and August 2006. During the study period, 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging. No cases were converted from laparoscopy to laparotomy. The two groups were similar in terms of age, body mass index, procedures performed, number of lymph nodes retrieved, and operating time. The laparoscopy group had less estimated blood loss (P = 0.001), faster return of bowel movement (P < 0.001), and a shorter postoperative hospital stay (P = 0.002) compared to the laparotomy group. Transfusions were required only in two laparotomy patients, and postoperative complications occurred only in four laparotomy patients. However, two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease. The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach, and the surgical outcomes were more favorable than laparotomic approach. However, the oncologic safety of laparoscopic staging was not certain. This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer. In the absence of a large prospective trial, this technique should be performed cautiously.