- Email: [email protected]
Robotic hysterectomy in obese and morbidly obese women
Abstracts / Gynecologic Oncology 116 (2010) 593–598
Conclusions. Our results indicate a significant difference in BRCA1 expression between uterine leiomyosarcomas and benign uterine leiomyomas. Further, our findings implicate epigenetic modification via DNA methylation as the mechanism of BRCA1 inactivation in ULMS. Our results provide a rationale for investigation of targeted therapies tailored to take advantage of BRCA1 silencing. doi:10.1016/j.ygyno.2009.10.022
Patient perception of the chemotherapy experience A. Murdock, E. Gutierrez, E. Perry, W. Robinson Texas Tech University Health Sciences Center, Obstetrics and Gynecology Objectives. To assess gynecologic cancer patients' perception of the chemotherapy experience. Study methods. One hundred twenty-four women diagnosed with cancer at a regional cancer center from 2006 to 2008 participated in this prospective study. All subjects received outpatient chemotherapy and completed a validated questionnaire. The subjects were asked to record their own assessment of direct toxicities such as nausea/vomiting, hair loss, fatigue, neuropathy, diarrhea/constipation, memory loss or pain. They were also asked to appraise indirect effects including inconvenience/ travel, financial burden, and depression/anxiety. Other data collected included demographics and specifics of the diagnosis and treatment. Results. The mean age of the subjects was 59.6 years. (range 16–89) Diagnoses included: Ovarian cancer—67, endometrial cancer—20, cervix cancer—26, other—11. Treatments included: intravenous (IV) or intraperitoneal (IP) cis/carboplatin-paclitaxel—75 (61%), IV cis/carboplatin alone—22 (18%), IV ciplatin/topotecan—16 (13%),IV bevicizamab—11 (9%). Ethnicities included: Caucasian—99 (80%), Hispanic—22 (18%), African-American—2 (1.6%), and Asian—1 (1%). Financial status: insured —100 (79%); self-pay—24 (21%). Fatigue was the most commonly reported toxicity—87 (70%). 45/124 (36%) reported significant depression. Central line placement (12–10%), expense (6–5%), and inconvenience/time lost (6–5%) were not commonly reported as concerns. Married subjects were less likely to report depression than non-married subjects (p < 0.001). Subjects expressing a religious affiliation were less likely to report depression than those without religious affiliation (p = 0.005). Unmarried, non-religious subjects were at high risk for selfreported depression (12/16, 75%). Conclusions. In this population, fatigue is the most common selfidentified toxicity. Logistic issues (travel, time required, costs) are not commonly reported as concerns. Married and religiously affiliated women are less likely to report depression. Pre-treatment counseling should be guided by these findings. doi:10.1016/j.ygyno.2009.10.023
FOXP3+ regulatory t-cells are associated with vulvar Paget's disease and are increased in cases that are difficult to completely excise J. Press, K. Allison, K. Allison, R. Garcia, E. Everett, E. Pizer, R. Swensen, H. Tamimi, H. Gray, W. Peters III, B. Goff University of Washington, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology Objectives. To characterize clinical features of vulvar Paget's (VP) disease, and examine the quantity of immunosuppressive regulatory T-cells (Tregs) in VP tissue. Study methods. We reviewed all VP cases from our 2 institutions (1992–2007). Tregs among tumor infiltrating lymphocytes were quantified by immunohistochemistry using a Treg specific marker (FOXP3). Thirteen non-neoplastic inflammatory cases were stained for comparison (e.g. lichen sclerosis).
597
Results. Cases included 33 women treated for primary VP, and 7 referred at recurrence. Recurrence was documented in 11/33 (33%) primary cases. Eight women recurred multiple times, but no recurrences were invasive. Significantly more patients with positive surgical margins developed recurrent disease (56% vs. 12%, p = 0.01). Secondary neoplasms occurred in 11/40 (25%). FOXP3+ cells at the dermalepidermal junction were quantified in 29 primary and 14 recurrent tissue samples. FOXP3+ cells were absent in surrounding normal vulvar skin. FOXP3+ cells averaged 66/HPF in primary VP and 67/HPF in recurrent VP, compared to 23/HPF in non-neoplastic inflammatory cases (p = 0.0004). Primary cases with positive surgical margins had more FOXP3+ cells than those with negative margins (85 vs. 49, p = 0.014). Recurrent cases with positive margins had more FOXP3+ cells than negative cases (85 vs. 33, p = 0.03). FOXP3 levels in primary specimens were not independently associated with recurrence (76 vs. 62, p = 0.3). Conclusions. Increased Tregs may be associated with more extensive cases of vulvar Paget's disease that result in positive surgical margins and are associated with persistent disease, suggesting immunosuppression as a key factor. doi:10.1016/j.ygyno.2009.10.027
Robotic hysterectomy in obese and morbidly obese women H. Muntz, S. Rebeles, C. Wieneke-Broghammer, E. Vason, K. McGonigle Women's Cancer Care of Seattle Northwest Hospital & Medical Center Objectives. To compare total laparoscopic hysterectomies using the da Vinci robotic system in non-obese and obese patients. Study methods. Data were prospectively collected on patient characteristics, total operative time (time from placement of vaginal instruments to skin closure), hysterectomy time (start of hysterectomy to vaginal cuff closure), estimated blood loss, length of stay, and complications for 100 consecutive robotic hysterectomies performed from 6/18/07 to 11/12/08 by 2 surgeons (KFM and HGM). Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function for Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Statistical analysis was performed with Kruskall–Wallis, Spearman's correlation, chi-square, or Fisher's exact tests. Results. The median age, weight, and BMI of the 100 patients who underwent robotic hysterectomy was 57.6 years (range 30.0–90.6), 82.1 kg (range 51.9–159.6 kg), and 30.2 kg/m2 (range 19.3–60.2), respectively. Fifty (50%) patients were obese (BMI >30); 22 (22%) patients were morbidly obese (BMI > 40). Robotic surgery was completed for 98% of non-obese and 94% of obese patients (p = NS). There was also no increase in complications or blood loss with increasing BMI. There was a trend towards longer total operative times (but not hysterectomy times) with morbidly obese patients. Median length of stay was 1 day for all weight categories. Conclusions. Robotic hysterectomy can be safely performed in obese patients. doi:10.1016/j.ygyno.2009.10.028
Low grade serous ovarian cancer: A descriptive study of patient characteristics, patterns of treatment and long-term outcomes M. Tenney, E. Tuller, D. McMeekin, K. Moore University of Oklahoma, Gynecologic Oncology Objectives. To compare patient characteristics, treatment patterns and long-term outcomes in low-grade versus high-grade serous epithelial ovarian cancer. Study methods. Retrospective chart review of ovarian cancer patients treated from 1991 to present at OUHSC.
Conclusions. Our results indicate a significant difference in BRCA1 expression between uterine leiomyosarcomas and benign uterine leiomyomas. Further, our findings implicate epigenetic modification via DNA methylation as the mechanism of BRCA1 inactivation in ULMS. Our results provide a rationale for investigation of targeted therapies tailored to take advantage of BRCA1 silencing. doi:10.1016/j.ygyno.2009.10.022
Patient perception of the chemotherapy experience A. Murdock, E. Gutierrez, E. Perry, W. Robinson Texas Tech University Health Sciences Center, Obstetrics and Gynecology Objectives. To assess gynecologic cancer patients' perception of the chemotherapy experience. Study methods. One hundred twenty-four women diagnosed with cancer at a regional cancer center from 2006 to 2008 participated in this prospective study. All subjects received outpatient chemotherapy and completed a validated questionnaire. The subjects were asked to record their own assessment of direct toxicities such as nausea/vomiting, hair loss, fatigue, neuropathy, diarrhea/constipation, memory loss or pain. They were also asked to appraise indirect effects including inconvenience/ travel, financial burden, and depression/anxiety. Other data collected included demographics and specifics of the diagnosis and treatment. Results. The mean age of the subjects was 59.6 years. (range 16–89) Diagnoses included: Ovarian cancer—67, endometrial cancer—20, cervix cancer—26, other—11. Treatments included: intravenous (IV) or intraperitoneal (IP) cis/carboplatin-paclitaxel—75 (61%), IV cis/carboplatin alone—22 (18%), IV ciplatin/topotecan—16 (13%),IV bevicizamab—11 (9%). Ethnicities included: Caucasian—99 (80%), Hispanic—22 (18%), African-American—2 (1.6%), and Asian—1 (1%). Financial status: insured —100 (79%); self-pay—24 (21%). Fatigue was the most commonly reported toxicity—87 (70%). 45/124 (36%) reported significant depression. Central line placement (12–10%), expense (6–5%), and inconvenience/time lost (6–5%) were not commonly reported as concerns. Married subjects were less likely to report depression than non-married subjects (p < 0.001). Subjects expressing a religious affiliation were less likely to report depression than those without religious affiliation (p = 0.005). Unmarried, non-religious subjects were at high risk for selfreported depression (12/16, 75%). Conclusions. In this population, fatigue is the most common selfidentified toxicity. Logistic issues (travel, time required, costs) are not commonly reported as concerns. Married and religiously affiliated women are less likely to report depression. Pre-treatment counseling should be guided by these findings. doi:10.1016/j.ygyno.2009.10.023
FOXP3+ regulatory t-cells are associated with vulvar Paget's disease and are increased in cases that are difficult to completely excise J. Press, K. Allison, K. Allison, R. Garcia, E. Everett, E. Pizer, R. Swensen, H. Tamimi, H. Gray, W. Peters III, B. Goff University of Washington, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology Objectives. To characterize clinical features of vulvar Paget's (VP) disease, and examine the quantity of immunosuppressive regulatory T-cells (Tregs) in VP tissue. Study methods. We reviewed all VP cases from our 2 institutions (1992–2007). Tregs among tumor infiltrating lymphocytes were quantified by immunohistochemistry using a Treg specific marker (FOXP3). Thirteen non-neoplastic inflammatory cases were stained for comparison (e.g. lichen sclerosis).
597
Results. Cases included 33 women treated for primary VP, and 7 referred at recurrence. Recurrence was documented in 11/33 (33%) primary cases. Eight women recurred multiple times, but no recurrences were invasive. Significantly more patients with positive surgical margins developed recurrent disease (56% vs. 12%, p = 0.01). Secondary neoplasms occurred in 11/40 (25%). FOXP3+ cells at the dermalepidermal junction were quantified in 29 primary and 14 recurrent tissue samples. FOXP3+ cells were absent in surrounding normal vulvar skin. FOXP3+ cells averaged 66/HPF in primary VP and 67/HPF in recurrent VP, compared to 23/HPF in non-neoplastic inflammatory cases (p = 0.0004). Primary cases with positive surgical margins had more FOXP3+ cells than those with negative margins (85 vs. 49, p = 0.014). Recurrent cases with positive margins had more FOXP3+ cells than negative cases (85 vs. 33, p = 0.03). FOXP3 levels in primary specimens were not independently associated with recurrence (76 vs. 62, p = 0.3). Conclusions. Increased Tregs may be associated with more extensive cases of vulvar Paget's disease that result in positive surgical margins and are associated with persistent disease, suggesting immunosuppression as a key factor. doi:10.1016/j.ygyno.2009.10.027
Robotic hysterectomy in obese and morbidly obese women H. Muntz, S. Rebeles, C. Wieneke-Broghammer, E. Vason, K. McGonigle Women's Cancer Care of Seattle Northwest Hospital & Medical Center Objectives. To compare total laparoscopic hysterectomies using the da Vinci robotic system in non-obese and obese patients. Study methods. Data were prospectively collected on patient characteristics, total operative time (time from placement of vaginal instruments to skin closure), hysterectomy time (start of hysterectomy to vaginal cuff closure), estimated blood loss, length of stay, and complications for 100 consecutive robotic hysterectomies performed from 6/18/07 to 11/12/08 by 2 surgeons (KFM and HGM). Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function for Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Statistical analysis was performed with Kruskall–Wallis, Spearman's correlation, chi-square, or Fisher's exact tests. Results. The median age, weight, and BMI of the 100 patients who underwent robotic hysterectomy was 57.6 years (range 30.0–90.6), 82.1 kg (range 51.9–159.6 kg), and 30.2 kg/m2 (range 19.3–60.2), respectively. Fifty (50%) patients were obese (BMI >30); 22 (22%) patients were morbidly obese (BMI > 40). Robotic surgery was completed for 98% of non-obese and 94% of obese patients (p = NS). There was also no increase in complications or blood loss with increasing BMI. There was a trend towards longer total operative times (but not hysterectomy times) with morbidly obese patients. Median length of stay was 1 day for all weight categories. Conclusions. Robotic hysterectomy can be safely performed in obese patients. doi:10.1016/j.ygyno.2009.10.028
Low grade serous ovarian cancer: A descriptive study of patient characteristics, patterns of treatment and long-term outcomes M. Tenney, E. Tuller, D. McMeekin, K. Moore University of Oklahoma, Gynecologic Oncology Objectives. To compare patient characteristics, treatment patterns and long-term outcomes in low-grade versus high-grade serous epithelial ovarian cancer. Study methods. Retrospective chart review of ovarian cancer patients treated from 1991 to present at OUHSC.