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Personalized surgical therapy for advanced ovarian cancer
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Abstracts / Gynecologic Oncology 137 (2015) 2–91
alternative to complete lymphadenectomy in endometrial cancer but has not been described using the single-port robotic platform. In this video, we describe a 67-year-old patient with FIGO grade 1 endometrial cancer undergoing robotic LESS hysterectomy and sentinel lymph node mapping. The video highlights our initial experience combining these innovative techniques, with an emphasis on set-up, operative techniques to improve visualization and tissue handling, and patient selection. doi:10.1016/j.ygyno.2015.01.019
18 — Surgical Forum Sentinel lymph node mapping using robotic-assisted fluorescence imaging J.J. Mueller, M.M. Leitao. Memorial Sloan Kettering Cancer Center, New York, NY, USA Objectives: Sentinel lymph node mapping is an increasingly accepted method of assessing nodal disease in early-stage gynecologic malignancies. Methods: This teaching video was created for those who are refining this method using the robotic platform. Conclusions: We use our experience in early endometrial cancer to emphasize an evidence-based algorithm that assists in the successful adaptation of the sentinel lymph node mapping technique. doi:10.1016/j.ygyno.2015.01.020
Scientific Plenary IV: The Farr Nezhat Surgical Innovation Session Sunday, March 29, 2015 Moderators: Farr Nezhat, MD, FACOG, FACS, St. Luke’s-Roosevelt Hospital, New York, NY, USA Anna Fagotti, MD, PhD, Catholic University of the Sacred Heart, Rome, Italy; St. Maria Hospital, University of Perugia, Terni, Italy 19 — Scientific Plenary Robotic versus Open Type III radical hysterectomy: A multi-institutional experience for early stage cervical cancer B.M. Serta, J.F. Boggessb, S. Ahmadc, A.L. Jacksond, N.M. Stavitzskic, A.A. Dahle, R.W. Hollowayc. aThe Norwegian Radium Hospital, Oslo, Norway, bUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA, cFlorida Hospital Cancer Institute, Orlando, FL, USA, dUniversity of Cincinnati, UC Health Medical Arts Building, Cincinnati, OH, USA, e Oslo University Hospital, Oslo, Norway Objectives: Despite the rapid adoption of robotic-assisted radical hysterectomy (RRH) in gynecologic oncology, long-term survival outcomes data are limited. The aim of this study was to determine the comparative long-term recurrence-free and overall survival outcomes of RRH vs. open radical hysterectomy (ORH) for early-stage cervical cancer. Methods: This retrospective multicenter study abstracted data from medical records for demographics, operative data, and long-term outcomes of 517 patients treated surgically for cervical cancer (RRH = 260 and ORH = 257) between 2005 and 2011. The association between operative technique, margin status, lymph node status, and long-term oncologic outcomes (recurrence, survival) was examined using chi square tests and univariate and multivariate logistic regression models to adjust for the confounding variables. Results: Mean (±SD) follow-up time was 34.4 ± 21.6 months for RRH and 44.4 ± 28.1 months for ORH (P b 0.001). Recurrence and death rate were not statistically different for the two groups (P = 0.97 vs. P = 0.60, respectively). The groups did not differ significantly in age, body mass index, histology, postoperative complications, or postoperative
chemotherapy. Mean operative time was significantly longer for RRH than ORH (3.40 vs. 2.37 h, P b 0.001). Mean estimated blood loss (EBL) and transfusion rate were significantly less for RRH than ORH (97 mL vs. 429 mL, P b 0.001) (3% vs. 8%, P = 0.009). Preoperative conization rate was significantly higher for RRH than ORH (67% vs. 42%, P b 0.001). Neoadjuvant chemotherapy was used significantly more for ORH than RRH (10% vs. 0.4%, P b 0.001). Postoperative adjuvant treatment was administered in 30% of patients after RRH and in 55% after ORH (P b 0.001). In multivariate regression analyses, longer operative time, less EBL, fewer perioperative complications, and more preoperative conization were significantly associated with RRH compared with ORH. Although overall complications were similar (P = 0.49), perioperative complications were less in the RRH than the ORH group (P = 0.002). Conclusions: Recurrence and death rates for RRH were comparable to that of ORH, with statistically significant less blood loss and perioperative complications. doi:10.1016/j.ygyno.2015.01.021
20 — Scientific Plenary Personalized surgical therapy for advanced ovarian cancer A.M. Nick, R.L. Coleman, P.T. Ramirez, K.M. Schmeler, P.T. Soliman, K.H. Lu, J.K. Burzawa, A.K. Sood. The University of Texas MD Anderson Cancer Center, Houston, TX, USA Objectives: Patients who have no gross postoperative residual disease (R0) appear to benefit the most from attempted cytoreduction. We sought to evaluate disease distribution by diagnostic laparoscopy (LS) as a means of assessing R0 resectability in patients with presumed advanced ovarian cancer. Methods: Using a previously described triage algorithm, preoperatively defined parameters were analyzed with LS among women with presumed advanced ovarian cancer over a 1-year period. Disease distribution was described independently by two surgeons using the Fagotti score, with scores N8 resulting in triage to neoadjuvant chemotherapy (NACT). Patient outcomes and faculty compliance were tracked prospectively and R0 rates were compared to historical practice. Results: A total of 99 patients with suspected advanced ovarian cancer presented during the study time period. Eleven were not offered LS due to medical comorbidities, including seven with active venous thromboembolism and 20 with extra-abdominal metastases. Two were not offered LS by their primary surgeon (98% compliance). Median age was 66 years (range, 39–90 years) and 90% had serous histology. Sixty-five patients underwent LS with a median operating room time of 36 min (range, 11– 102 min) and median estimated blood loss of 5 mL (range, 0–50 mL). There was 99% concordance between the two surgeons (k = 0.97 [95% CI: 0.89–0.99]). Forty (63%) patients had a score b8 and 37 underwent primary TRS (3 opted for NACT secondary to risk of bowel resection). The remaining 25 underwent NACT. The accuracy of laparoscopic assessment for predicting R0 resection was 86% (compared to a historical R0 resection rate of 40% from 2007 to 2012, P b 0.001). Fourteen of 18 (78%) patients dispositioned to NACT have subsequently undergone interval TRS and achieved R0 resection. Median CA-125 values were greater in patients triaged to NACT by LS (893 vs. 161, P b 0.01). Similarly, median platelet counts prior to treatment were greater among those triaged to NACT (379 vs. 289.5, P b 0.01). Among those patients who underwent primary TRS, a postlaparotomy score sheet correlated with the primary surgeon's laparoscopic score 96% of the time (R = 0.66, P b 0.01). Conclusions: Laparoscopy is a highly reliable and reproducible method of determining ovarian cancer disease distribution. We anticipate that improved R0 rates will result in reciprocal improvements in survival among patients with advanced ovarian cancer. doi:10.1016/j.ygyno.2015.01.022
Abstracts / Gynecologic Oncology 137 (2015) 2–91
alternative to complete lymphadenectomy in endometrial cancer but has not been described using the single-port robotic platform. In this video, we describe a 67-year-old patient with FIGO grade 1 endometrial cancer undergoing robotic LESS hysterectomy and sentinel lymph node mapping. The video highlights our initial experience combining these innovative techniques, with an emphasis on set-up, operative techniques to improve visualization and tissue handling, and patient selection. doi:10.1016/j.ygyno.2015.01.019
18 — Surgical Forum Sentinel lymph node mapping using robotic-assisted fluorescence imaging J.J. Mueller, M.M. Leitao. Memorial Sloan Kettering Cancer Center, New York, NY, USA Objectives: Sentinel lymph node mapping is an increasingly accepted method of assessing nodal disease in early-stage gynecologic malignancies. Methods: This teaching video was created for those who are refining this method using the robotic platform. Conclusions: We use our experience in early endometrial cancer to emphasize an evidence-based algorithm that assists in the successful adaptation of the sentinel lymph node mapping technique. doi:10.1016/j.ygyno.2015.01.020
Scientific Plenary IV: The Farr Nezhat Surgical Innovation Session Sunday, March 29, 2015 Moderators: Farr Nezhat, MD, FACOG, FACS, St. Luke’s-Roosevelt Hospital, New York, NY, USA Anna Fagotti, MD, PhD, Catholic University of the Sacred Heart, Rome, Italy; St. Maria Hospital, University of Perugia, Terni, Italy 19 — Scientific Plenary Robotic versus Open Type III radical hysterectomy: A multi-institutional experience for early stage cervical cancer B.M. Serta, J.F. Boggessb, S. Ahmadc, A.L. Jacksond, N.M. Stavitzskic, A.A. Dahle, R.W. Hollowayc. aThe Norwegian Radium Hospital, Oslo, Norway, bUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA, cFlorida Hospital Cancer Institute, Orlando, FL, USA, dUniversity of Cincinnati, UC Health Medical Arts Building, Cincinnati, OH, USA, e Oslo University Hospital, Oslo, Norway Objectives: Despite the rapid adoption of robotic-assisted radical hysterectomy (RRH) in gynecologic oncology, long-term survival outcomes data are limited. The aim of this study was to determine the comparative long-term recurrence-free and overall survival outcomes of RRH vs. open radical hysterectomy (ORH) for early-stage cervical cancer. Methods: This retrospective multicenter study abstracted data from medical records for demographics, operative data, and long-term outcomes of 517 patients treated surgically for cervical cancer (RRH = 260 and ORH = 257) between 2005 and 2011. The association between operative technique, margin status, lymph node status, and long-term oncologic outcomes (recurrence, survival) was examined using chi square tests and univariate and multivariate logistic regression models to adjust for the confounding variables. Results: Mean (±SD) follow-up time was 34.4 ± 21.6 months for RRH and 44.4 ± 28.1 months for ORH (P b 0.001). Recurrence and death rate were not statistically different for the two groups (P = 0.97 vs. P = 0.60, respectively). The groups did not differ significantly in age, body mass index, histology, postoperative complications, or postoperative
chemotherapy. Mean operative time was significantly longer for RRH than ORH (3.40 vs. 2.37 h, P b 0.001). Mean estimated blood loss (EBL) and transfusion rate were significantly less for RRH than ORH (97 mL vs. 429 mL, P b 0.001) (3% vs. 8%, P = 0.009). Preoperative conization rate was significantly higher for RRH than ORH (67% vs. 42%, P b 0.001). Neoadjuvant chemotherapy was used significantly more for ORH than RRH (10% vs. 0.4%, P b 0.001). Postoperative adjuvant treatment was administered in 30% of patients after RRH and in 55% after ORH (P b 0.001). In multivariate regression analyses, longer operative time, less EBL, fewer perioperative complications, and more preoperative conization were significantly associated with RRH compared with ORH. Although overall complications were similar (P = 0.49), perioperative complications were less in the RRH than the ORH group (P = 0.002). Conclusions: Recurrence and death rates for RRH were comparable to that of ORH, with statistically significant less blood loss and perioperative complications. doi:10.1016/j.ygyno.2015.01.021
20 — Scientific Plenary Personalized surgical therapy for advanced ovarian cancer A.M. Nick, R.L. Coleman, P.T. Ramirez, K.M. Schmeler, P.T. Soliman, K.H. Lu, J.K. Burzawa, A.K. Sood. The University of Texas MD Anderson Cancer Center, Houston, TX, USA Objectives: Patients who have no gross postoperative residual disease (R0) appear to benefit the most from attempted cytoreduction. We sought to evaluate disease distribution by diagnostic laparoscopy (LS) as a means of assessing R0 resectability in patients with presumed advanced ovarian cancer. Methods: Using a previously described triage algorithm, preoperatively defined parameters were analyzed with LS among women with presumed advanced ovarian cancer over a 1-year period. Disease distribution was described independently by two surgeons using the Fagotti score, with scores N8 resulting in triage to neoadjuvant chemotherapy (NACT). Patient outcomes and faculty compliance were tracked prospectively and R0 rates were compared to historical practice. Results: A total of 99 patients with suspected advanced ovarian cancer presented during the study time period. Eleven were not offered LS due to medical comorbidities, including seven with active venous thromboembolism and 20 with extra-abdominal metastases. Two were not offered LS by their primary surgeon (98% compliance). Median age was 66 years (range, 39–90 years) and 90% had serous histology. Sixty-five patients underwent LS with a median operating room time of 36 min (range, 11– 102 min) and median estimated blood loss of 5 mL (range, 0–50 mL). There was 99% concordance between the two surgeons (k = 0.97 [95% CI: 0.89–0.99]). Forty (63%) patients had a score b8 and 37 underwent primary TRS (3 opted for NACT secondary to risk of bowel resection). The remaining 25 underwent NACT. The accuracy of laparoscopic assessment for predicting R0 resection was 86% (compared to a historical R0 resection rate of 40% from 2007 to 2012, P b 0.001). Fourteen of 18 (78%) patients dispositioned to NACT have subsequently undergone interval TRS and achieved R0 resection. Median CA-125 values were greater in patients triaged to NACT by LS (893 vs. 161, P b 0.01). Similarly, median platelet counts prior to treatment were greater among those triaged to NACT (379 vs. 289.5, P b 0.01). Among those patients who underwent primary TRS, a postlaparotomy score sheet correlated with the primary surgeon's laparoscopic score 96% of the time (R = 0.66, P b 0.01). Conclusions: Laparoscopy is a highly reliable and reproducible method of determining ovarian cancer disease distribution. We anticipate that improved R0 rates will result in reciprocal improvements in survival among patients with advanced ovarian cancer. doi:10.1016/j.ygyno.2015.01.022