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Closing Discussion by Dr Mitchel Hoffman
588 Dr MITCHEL HOFFMAN (Closing statement). I thank Dr Anderson for his excellent review of this paper. The stage distribution of the 527 total patients was not available. For the 144 women who underwent bowel resection, 7 were stage IIB, 7 were stage IIIB, 116 were stage IIIC, and 14 were stage IV. The date of the first course of chemotherapy was known for only 54 of the 144 patients. The mean day of chemotherapy number 1 for these 54 patients was 18 (range 8-45). If one considers initiation of chemotherapy beyond 4 weeks from the time of surgery as delayed, then a total of 6 patients were known to have a delay. The 1 gastric leak was diagnosed initially as a left upper quadrant abscess in 1 of the women who had also undergone splenectomy. Radiologic work-up incidentally led to the diagnosis of gastric leak as the etiology of the fluid collection. The leak may have been related to unrecognized stapling of the stomach wall with a vascular stapler during the splenectomy. The leak resolved with conservative management using a combination of gastric decompression and percutaneous drainage. The colocutaneous fistula
Hoffman et al developed in a patient who had undergone a right hemicolectomy with ileotransverse enterocolostomy. This was successfully closed at a later date with reoperation. For clinical features that could assist the generalist in the decision to refer or not to refer a woman for initial surgical assessment of an ovarian tumor to a gynecologic oncologist, I would defer to the guidelines published jointly by the Society of Gynecologic Oncologists and the American College of Obstetricians and Gynecologists.1 These guidelines were studied by Im et al,2 who reported negative predictive values (for ovarian cancer) of more than 90%.
References 1. American College of Obstetricians and Gynecologists. ACOG committee opinion: number 280, December 2002. The role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer. Obstet Gynecol 2002;100:1413-6. 2. Im SS, Gordon AN, Buttin BM, Leath CA III, Gostout BS, Shah C, et al. Validation of referral guidelines for women with pelvic masses. Obstet Gynecol 2005;105:35-41.
Hoffman et al developed in a patient who had undergone a right hemicolectomy with ileotransverse enterocolostomy. This was successfully closed at a later date with reoperation. For clinical features that could assist the generalist in the decision to refer or not to refer a woman for initial surgical assessment of an ovarian tumor to a gynecologic oncologist, I would defer to the guidelines published jointly by the Society of Gynecologic Oncologists and the American College of Obstetricians and Gynecologists.1 These guidelines were studied by Im et al,2 who reported negative predictive values (for ovarian cancer) of more than 90%.
References 1. American College of Obstetricians and Gynecologists. ACOG committee opinion: number 280, December 2002. The role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer. Obstet Gynecol 2002;100:1413-6. 2. Im SS, Gordon AN, Buttin BM, Leath CA III, Gostout BS, Shah C, et al. Validation of referral guidelines for women with pelvic masses. Obstet Gynecol 2005;105:35-41.