- Email: [email protected]
Free Floating Malignant Cells during Laparoscopy for Gynecologic Malignancy
S42
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
Design: A 13-year review was conducted of laparoscopic staging procedures performed by the gynecologic oncology service for early stage ovarian and fallopian tube cancers from 1995 to May 2008. Setting: Single university-based hospital with a gynecologic oncology fellowship. Patients: A total of 41 patients underwent laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Intervention: Total laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Measurements and Main Results: A total of 41 patients underwent laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Mean age of the patients was 48.09 (17-90). Twenty cases were invasive epithelial tumors, 13 were low malignant potential tumors and the others included 5 granulosa cells, one Sertoli cell, one dysgerminoma, and one neuroendocrine tumor. Mean operation time was 236 min and mean EBL was 201 (25-500) ml. In terms of postoperative complications, one patient with small bowel obstruction and two patients with pelvic lymphocele were successfully managed conservatively. One patient developed a lymphocele cyst requiring drainage. The average length of hospital stay was 2.2 (1-5) days. Mean number of peritoneal biopsies was 5.4, mean number of para-aortic nodes was 12.45 and mean number of pelvic nodes was 14.25. All patients had laparoscopic omentectomy. On final pathology, 6 patients were upstaged; 5 to stage IIB-IIC and one to IIIA. Mean duration of follow-up is 123.5 months. Four patients had recurrences. Two patients with borderline tumors recurred in the remaining contralateral ovary. One clear cell carcinoma recurred 11 months postoperatively in the pelvis and one papillary serous recurred 19 months postoperatively. No trocar-site metastases were noted. All patients are alive without evidence of the disease. Conclusion: This represents one of the largest series and longest follow-ups of laparoscopic staging for early stage adnexal tumors. Laparoscopic stagings of these cancers appear to be feasible and comprehensive when performed by gynecologic oncologists experienced with advanced laparoscopy.
156
Plenary Session 13dOncology (11:57 AM d 12:07 PM)
Laparoscopy for Endometrial Cancer, the Gold Standard Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Studies Zullo F, Palomba S, Falbo A, Russo T, Oppedisano R, Mocciaro R, Sacchinelli A, D’Alessandro P. Department of Obstetrics & Gynecology, University ‘‘Magna Graecia’’ of Catanzaro, Catanzaro, Italy Study Objective: To evaluate effectiveness and safety of the laparoscopic approach to endometrial cancer. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs) available in literature. Setting: Academic Department of Obstetrics and Gynecology Italy. Patients: Women with endometrial cancer treated with laparoscopic or laparotomic approach. Intervention: A bibliographic search was performed using the following bibliographic databases: Medline, EMBASE, Biological Abstracts, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Reference lists of included studies, other relevant review articles and textbooks were checked for additional citations of interest. Measurements and Main Results: Four RCTs comparing laparoscopic and laparotomic approaches to endometrial cancer were identified. No significant differences were observed in both overall and disease free survival between laparoscopic and laparotomic approaches were observed without data heterogeneity. Operative time and blood loss were significantly (P!0.05) higher and lower, respectively, in patients treated with laparoscopy than those treated with laparotomy, furthermore, a significant (P!0.05) heterogeneity was observed. No difference in pelvic and para-aortic nodes yield was detected between groups. Finally, similar intraoperative complications, even if a
significant (P!0.05) heterogeneity was observed. Whereas, postoperative complications were (P!0.05) lower in laparoscopic approach to endometrial cancer. Conclusion: In patients with endometrial cancer, laparoscopic approach is safe and effective as well as laparotomic one. Well powered and long-term follow-up RCTs, having as primary end-point the overall survival, are needed before to drawn definitive conclusions.
157
Plenary Session 13dOncology (12:08 PM d 12:18 PM)
Free Floating Malignant Cells during Laparoscopy for Gynecologic Malignancy Hibner M,1,2 Magrina JF,1 Magtibay PM.1 1Gynecologic Surgery, Mayo Clinic Scottsdale, Scottsdale, Arizona; 2Gynecologic Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona Study Objective: To assess the presence of free floating malignant cells during laparoscopy for gynecological malignancy. Design: Three sites were evaluated: CO2 exiting the abdominal cavity was filtered through normal saline and the cell content examined; all trocars and the tubing connecting trocars to saline and were flushed at the completion surgery of to collect any retained malignant cells. Setting: Tertiary referral center for minimally invasive procedures in patients with gynecologic malignancy. Patients: Twenty eight patients with advanced stage ovarian carcinoma, six patients with endometrial carcinoma, one patient with choriocarcinoma, one patient with cervical carcinoma, one patient with lymphoma, one patient with leiomyosarcoma and one patient with poorly differentiated metastatic intraabdominal tumor. Intervention: All patients underwent laparoscopic procedures appropriate for their malignancy. Adjuvant therapy was administered as indicated. Patients were followed for port site recurrences at postoperative visit and for one year after the procedure. Measurements and Main Results: Filtered smoke saline container, as well as saline from flushed trocars and tubing was examined separately by pathologists for the presence of malignant cells and correlated with length of surgery. Conclusion: Malignant cells are noted in saline flushed trocars of almost half of patients undergoing laparoscopy for metastatic ovarian cancer. This finding is less common in patients with endometrial malignancy. This finding does not correlate with port site recurrence.
158
Plenary Session 13dOncology (12:19 PM d 12:29 PM)
Laparoscopic Versus Laparotomic Approach for Early Stage Endometrial Cancer: A Long-Term Follow-Up Study Palomba S, Falbo A, Russo T, Oppedisano R, Mocciaro R, Annunziata G, Fasolino L. Department of Obstetrics and Gynecology, University ‘‘Magna Graecia’’ of Catanzaro, Catanzaro, Italy Study Objective: To compare the long-term safety and efficacy of laparoscopic and laparotomic approaches to early stage endometrial cancer. Design: Randomized controlled trial. Setting: Academic Department of Obstetrics and Gynecology, Italy. Patients: Eighty-four women with clinical stage I endometrial cancer. Intervention: Patients were randomly allocated in two groups, laparoscopic (n 5 40) and laparotomic (n 5 38) group. Measurements and Main Results: Safety and efficacy outcomes at a very long-term follow-up were evaluated. After a follow-up period of 80 (7 IQR; 16e86 range) and 82 (6 IQR; 16e86 range) months for laparoscopic and laparotomic groups, respectively, no difference in the cumulative rate of recurrences [7/40 (17.5%) and 6/38 (15.8%); P 5 0.839] and deaths [11/ 40 (27.5%) and 7/38 (18.4%); P 5 0.342] was detected between groups. By Kaplan-Meier analysis, no significant differences in overall (P 5 0.129) and disease free (P 5 0.433) survival were observed between two groups. Conclusion: The laparoscopic approach to early stage endometrial cancer is not significantly different from the laparotomic one in terms of long-term safety and effectiveness.
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
Design: A 13-year review was conducted of laparoscopic staging procedures performed by the gynecologic oncology service for early stage ovarian and fallopian tube cancers from 1995 to May 2008. Setting: Single university-based hospital with a gynecologic oncology fellowship. Patients: A total of 41 patients underwent laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Intervention: Total laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Measurements and Main Results: A total of 41 patients underwent laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Mean age of the patients was 48.09 (17-90). Twenty cases were invasive epithelial tumors, 13 were low malignant potential tumors and the others included 5 granulosa cells, one Sertoli cell, one dysgerminoma, and one neuroendocrine tumor. Mean operation time was 236 min and mean EBL was 201 (25-500) ml. In terms of postoperative complications, one patient with small bowel obstruction and two patients with pelvic lymphocele were successfully managed conservatively. One patient developed a lymphocele cyst requiring drainage. The average length of hospital stay was 2.2 (1-5) days. Mean number of peritoneal biopsies was 5.4, mean number of para-aortic nodes was 12.45 and mean number of pelvic nodes was 14.25. All patients had laparoscopic omentectomy. On final pathology, 6 patients were upstaged; 5 to stage IIB-IIC and one to IIIA. Mean duration of follow-up is 123.5 months. Four patients had recurrences. Two patients with borderline tumors recurred in the remaining contralateral ovary. One clear cell carcinoma recurred 11 months postoperatively in the pelvis and one papillary serous recurred 19 months postoperatively. No trocar-site metastases were noted. All patients are alive without evidence of the disease. Conclusion: This represents one of the largest series and longest follow-ups of laparoscopic staging for early stage adnexal tumors. Laparoscopic stagings of these cancers appear to be feasible and comprehensive when performed by gynecologic oncologists experienced with advanced laparoscopy.
156
Plenary Session 13dOncology (11:57 AM d 12:07 PM)
Laparoscopy for Endometrial Cancer, the Gold Standard Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Studies Zullo F, Palomba S, Falbo A, Russo T, Oppedisano R, Mocciaro R, Sacchinelli A, D’Alessandro P. Department of Obstetrics & Gynecology, University ‘‘Magna Graecia’’ of Catanzaro, Catanzaro, Italy Study Objective: To evaluate effectiveness and safety of the laparoscopic approach to endometrial cancer. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs) available in literature. Setting: Academic Department of Obstetrics and Gynecology Italy. Patients: Women with endometrial cancer treated with laparoscopic or laparotomic approach. Intervention: A bibliographic search was performed using the following bibliographic databases: Medline, EMBASE, Biological Abstracts, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Reference lists of included studies, other relevant review articles and textbooks were checked for additional citations of interest. Measurements and Main Results: Four RCTs comparing laparoscopic and laparotomic approaches to endometrial cancer were identified. No significant differences were observed in both overall and disease free survival between laparoscopic and laparotomic approaches were observed without data heterogeneity. Operative time and blood loss were significantly (P!0.05) higher and lower, respectively, in patients treated with laparoscopy than those treated with laparotomy, furthermore, a significant (P!0.05) heterogeneity was observed. No difference in pelvic and para-aortic nodes yield was detected between groups. Finally, similar intraoperative complications, even if a
significant (P!0.05) heterogeneity was observed. Whereas, postoperative complications were (P!0.05) lower in laparoscopic approach to endometrial cancer. Conclusion: In patients with endometrial cancer, laparoscopic approach is safe and effective as well as laparotomic one. Well powered and long-term follow-up RCTs, having as primary end-point the overall survival, are needed before to drawn definitive conclusions.
157
Plenary Session 13dOncology (12:08 PM d 12:18 PM)
Free Floating Malignant Cells during Laparoscopy for Gynecologic Malignancy Hibner M,1,2 Magrina JF,1 Magtibay PM.1 1Gynecologic Surgery, Mayo Clinic Scottsdale, Scottsdale, Arizona; 2Gynecologic Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona Study Objective: To assess the presence of free floating malignant cells during laparoscopy for gynecological malignancy. Design: Three sites were evaluated: CO2 exiting the abdominal cavity was filtered through normal saline and the cell content examined; all trocars and the tubing connecting trocars to saline and were flushed at the completion surgery of to collect any retained malignant cells. Setting: Tertiary referral center for minimally invasive procedures in patients with gynecologic malignancy. Patients: Twenty eight patients with advanced stage ovarian carcinoma, six patients with endometrial carcinoma, one patient with choriocarcinoma, one patient with cervical carcinoma, one patient with lymphoma, one patient with leiomyosarcoma and one patient with poorly differentiated metastatic intraabdominal tumor. Intervention: All patients underwent laparoscopic procedures appropriate for their malignancy. Adjuvant therapy was administered as indicated. Patients were followed for port site recurrences at postoperative visit and for one year after the procedure. Measurements and Main Results: Filtered smoke saline container, as well as saline from flushed trocars and tubing was examined separately by pathologists for the presence of malignant cells and correlated with length of surgery. Conclusion: Malignant cells are noted in saline flushed trocars of almost half of patients undergoing laparoscopy for metastatic ovarian cancer. This finding is less common in patients with endometrial malignancy. This finding does not correlate with port site recurrence.
158
Plenary Session 13dOncology (12:19 PM d 12:29 PM)
Laparoscopic Versus Laparotomic Approach for Early Stage Endometrial Cancer: A Long-Term Follow-Up Study Palomba S, Falbo A, Russo T, Oppedisano R, Mocciaro R, Annunziata G, Fasolino L. Department of Obstetrics and Gynecology, University ‘‘Magna Graecia’’ of Catanzaro, Catanzaro, Italy Study Objective: To compare the long-term safety and efficacy of laparoscopic and laparotomic approaches to early stage endometrial cancer. Design: Randomized controlled trial. Setting: Academic Department of Obstetrics and Gynecology, Italy. Patients: Eighty-four women with clinical stage I endometrial cancer. Intervention: Patients were randomly allocated in two groups, laparoscopic (n 5 40) and laparotomic (n 5 38) group. Measurements and Main Results: Safety and efficacy outcomes at a very long-term follow-up were evaluated. After a follow-up period of 80 (7 IQR; 16e86 range) and 82 (6 IQR; 16e86 range) months for laparoscopic and laparotomic groups, respectively, no difference in the cumulative rate of recurrences [7/40 (17.5%) and 6/38 (15.8%); P 5 0.839] and deaths [11/ 40 (27.5%) and 7/38 (18.4%); P 5 0.342] was detected between groups. By Kaplan-Meier analysis, no significant differences in overall (P 5 0.129) and disease free (P 5 0.433) survival were observed between two groups. Conclusion: The laparoscopic approach to early stage endometrial cancer is not significantly different from the laparotomic one in terms of long-term safety and effectiveness.