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The Adnexal Mass
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Connie D. Cao, Norman G. Rosenblum
If the disease appears confined to the pelvis, comprehensive surgical staging is indicated. The staging procedure includes peritoneal cytology, multiple peritoneal biopsies, omentectomy, and pelvic and paraaortic lymph node sampling. Rarely is a hysterectomy indicated. For more advanced disease, cytoreductive surgery should be attempted. The timing of initiation of chemotherapy depends on fetal viability and maternal choice and should be managed by a gynecologic oncologist. Returning for staging after completion of pregnancy is not thought to adversely affect survival, though late stage of disease harbors a poor prognosis.
Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Robert D. Morgan, Andrew R. Clamp, Gordon C. Jayson
The earliest indicator of disease relapse is often a rise in the serum CA 125 level in the absence of both symptoms and signs on physical examination and/or CT scan.104 Frequently, the development of disease-related symptoms is delayed, by a median of approximately 5 months, after a doubling of CA 125 levels, and one important decision facing the patient and the oncologist is when to start further chemotherapy. The MRC OVO5 trial,105 which randomized women in complete remission after platinum-based first-line therapy to receive second-line treatment on the basis of CA 125 marker-defined progression or clinical/symptomatic relapse, has provided important information to guide this decision. This study showed no OS advantage to commencing chemotherapy early, and those women who received chemotherapy while they were asymptomatic had inferior quality of life. Although some centers have interpreted this study to indicate that it is not necessary to monitor CA 125 during follow-up, many institutions continue to do this to avoid missing patients who present with an isolated site of disease relapse and therefore may gain benefit from secondary cytoreduction. The value of secondary cytoreductive surgery is the subject of ongoing clinical trials.
Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
How would your management plan change if the histology report confirmed a goblet-cell carcinoid tumour?This is a more malignant variant, also called an ‘atypical’ carcinoid.It does not express somatostatin receptors.Cannot be visualised by an octreotide scan.There is a possibility of aggressive spread in the mesoappendix and intraperitoneally. This patient needs a completion extended ileocolic and mesenteric resection and may need chemotherapy.They have a less favourable survival (60% 10-year survival rate).For aggressive tumours, cytoreductive surgery can be offered (omentectomy, splenectomy and peritonectomy).
Association between Serum Biomarkers with Postoperative Complications and Delay of Adjuvant Chemotherapy Initiation in Ovarian Cancer Patients Undergoing Primary Cytoreductive Surgery: A Pilot Study
Published in Nutrition and Cancer, 2023
Carl J. Ade, Lauren Dockery, Adam C. Walter, Doris M. Benbrook, Sara K. Vesely, Stephen T. Hammond, Kathleen N. Moore, Laura L. Holman
Ovarian cancer is the most lethal gynecologic malignancy with nearly half of new diagnoses occurring in patients over the age of 65 yrs. (24). This advanced age presents a significant challenge given that most cancer-related deaths occur in this age group (7, 14, 15), due in part to current limitations in identifying a patient’s risk of adverse outcomes associated with the potentially curative treatment that is typically afforded to younger patients. The findings of the present study confirm previous work that primary cytoreductive surgery complications are associated with age and that no additional prediction comes from the selected serum biomarkers. Importantly however, post-surgical delays in adjuvant chemotherapy initiation of >1 week were inversely associated with and predicted by vitamin D status (as reflected by serum 25(OH) Vitamin D) among older ovarian cancer patients after controlling for patient age, tumor stage and BMI. In our study, this equated to a 7% decrease in the odds of delayed chemotherapy initiation with each 1 unit increase in serum 25-OH Vitamin D when also controlling for age and BMI.
Serum Albumin as a Predictor of Survival after Interval Debulking Surgery for Advanced Ovarian Cancer (AOC): A Retrospective Study
Published in Journal of Investigative Surgery, 2022
Dairui Dai, Janos Balega, Sudha Sundar, Sean Kehoe, Ahmed Elattar, Andrew Phillips, Kavita Singh
Cytoreductive surgery and platinum-basedchemotherapy remain the international gold-standard for the treatment of AOC.Increasing use of platinum-based chemotherapy has been attributed as the main driver increasing survival in AOC over the last 40 years [2]. The intention of cytoreductive surgery is to achieve complete macroscopic clearance using both standard and extensive surgical techniques. Cytoreductive outcome is defined as complete (R0),<1 cm (R1) or > 1 cm (R2), as per du Bois et al. [3]. Following two large-scale randomized control trials (RCTs) showing non-inferiority of neoadjuvant chemotherapy (NACT) compared to primary debulking surgery (PDS), there has been an increasing utilization of NACT over the previous gold-standard of primary cytoreductive surgery [4, 5]. However, the optimal treatment strategy for AOC still remains an area of significant debate and it is likely that the optimum treatment approach is dependent upon multiple patient-specific factors [6]. Therefore, prognostic markers are highly valuable for risk stratifying patients, predicting outcomes and selecting the treatment approach. Retrospectively, they also allow patient stratification for research purposes, to identify the best investigation and treatment modalities.
Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter?
Published in Journal of Investigative Surgery, 2021
Ciro Pinelli, Matteo Morotti, Jvan Casarin, Roberto Tozzi, Fabio Ghezzi, Vasileios K. Mavroeidis, Moiad Alazzam, Hooman Soleymani majd
The need for ultraradical surgery, particularly the incorporation of upper abdominal surgery [22] in elderly patients, has been considered an obstacle in the treatment of advanced OC. Several series comparing young and older patients have described lower rates of complete cytoreductive surgery for elderly patients without a clear hypothesis to explain this difference. In a recent analysis of 3 phase III clinical trials, only 10% (359/3333) of the patients were aged ≥70 years. This study, which included patients who underwent PDS followed by adjuvant chemotherapy, showed that almost half of the elderly patients (>70 y) had a residual tumor burden of >1 cm after surgery [23]. Langstraat et al. [24] showed that patients ≥75 years old who underwent PDS had a pooled 39% rate of poor perioperative outcomes such as grade 3–4 complications, 90-day mortality or postoperative ineligibility for chemotherapy. There was a 90-day mortality rate of 12.7% with only an 18% rate of complete surgical resection. Similar results were observed in a USA cohort of 5475 women aged 65 and older who experienced 30-day mortality of 8.2% [25]. A recent meta-analysis showed a strong association between age and perioperative mortality after PDS for OC. Each 1-year increase in median age was associated with an estimated 8.8% increase in the incidence rate of mortality [26].