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ABSTRACT: The purpose of this study was to evaluate the feasibility and safety of 2-port access (TPA) laparoscopy in gynecologic oncology.
This was a retrospective review of 81 consecutive patients who underwent TPA laparoscopic surgery for various gynecologic cancers from March 2009 to September 2011. The TPA system consisted of a single multichannel port at the umbilicus and an ancillary 5-mm port in the suprapubic area.
The surgical procedures included comprehensive ovarian cancer staging (33 patients), radical hysterectomy with pelvic lymph node dissection (19 patients), and endometrial cancer staging (29 patients). All surgical procedures were completed laparoscopically with no conversion to laparotomy. Two cases required 1 or 2 additional ports. The mean operating time, estimated blood loss, and number of lymph nodes were 253.8 minutes, 170.7 mL, and 34.9, respectively. Three patients (9.1%) with ovarian cancer and 4 patients (13.8%) with endometrial cancer were upstaged after surgery. The mean postoperative hospital stay was 6.6 days, and the mean postoperative pain scores (0-10 scale) were 3.4 at 6 hours, 3.0 at 24 hours, and 2.5 at 48 hours. Postoperative complications occurred at a low incidence (4.9%) and included one umbilical hernia, one vault dehiscence, and one lumbosacral nerve injury.
Two-port access laparoscopic surgery using a single multichannel port system is a feasible and safe procedure in selected patients with gynecologic cancers. Prospective randomized trials will permit the evaluation of the potential benefits of this minimally invasive surgical technique.
International Journal of Gynecological Cancer 06/2013; 23(5):935-42. · 1.65 Impact Factor
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ABSTRACT: OBJECTIVE: To perform a quantitative analysis on operative outcomes of laparoscopic staging surgery (LSS) in patients with presumed early-stage ovarian cancer (EOC) using a meta-analysis STUDY DESIGN: Electronic searches for studies of LSS in patients with ovarian cancer were performed within three electronic databases (MEDLINE, EMBASE and the Cochrane library) using the keywords "ovarian cancer", "early stage", "laparoscopy", "staging surgery", "staging laparoscopy", and "recurrence". Two authors independently screened articles, and those meeting the defined inclusion/exclusion criteria were included in the meta-analysis. RESULTS: We identified 11 observational studies. The combined results of three retrospective studies showed that the estimated blood loss in laparoscopy was significantly lower than that for laparotomy (p<0.001). The overall upstaging rate after laparoscopic surgery was 22.6% (95% confidence interval [CI]: 18.1-27.9%) without significant heterogeneity among all study results. The overall incidence of conversion from laparoscopy to laparotomy was 3.7% (95% CI: 2.0-6.9%). The overall rate of recurrence in studies with a median follow-up period of ≥19 months was 9.9% (6.7-14.4%). CONCLUSION: Through our quantitative analysis, we concluded that the operative outcomes of a laparoscopic approach in patients with EOC could be compatible with those of laparotomy. In the future, further randomized controlled trials may be needed.
American journal of obstetrics and gynecology 04/2013; · 3.28 Impact Factor
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ABSTRACT: To analyze patterns of abdominopelvic failures and to define subgroups for the use of adjuvant radiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer (EOC).
We reviewed 149 patients treated with debulking surgery followed by intravenous taxane and platinum chemotherapy between 1999 and 2008. Patient characteristics, patterns of failure, abdominopelvic failure APF-free survival (APFFS) and overall survival (OS) were analyzed.
The median age of the patients was 51 years. Thirty-two patients (21.5%) were found to have residuum >2 cm after surgery. The median pretreatment CA-125 was 604 and 54.4% of patients had a decline in CA-125 ≥90% between pretreatment and at postoperative 1 month. With a median follow-up of 50 months, 79 patients (53.0%) experienced abdominopelvic failure (APF). The 5-year APF-free survival rate was 41.1%. Lymph node metastasis, size of residual disease, and decline in CA-125 were found to be significant prognostic factors for APF upon multivariate analysis. The group of patients in whom abdominopelvic irradiation was indicated as definitive postoperative treatment comprised 55% of the overall patient population and their 5-year survival rate was 68%.
The stratification was suggested to predict APF based on lymph node metastasis, size of residual tumor, and decline in CA-125. Adjuvant radiotherapy covering the whole abdominopelvis using the intensity modulation technique may be considered to reduce APF in FIGO stage III EOC patients with intermediate risk.
Journal of Gynecologic Oncology 04/2013; 24(2):146-53. · 1.49 Impact Factor
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ABSTRACT: OBJECTIVE: This study aimed to evaluate the influence of intrauterine manipulation on the surgical outcome in patients with early-stage endometrial cancer treated with 2 different laparoscopic approaches. METHODS: In a randomized parallel trial, 110 patients with clinical stage I endometrial cancer were randomly assigned for laparoscopic staging surgery with (group A, 55) or without (group B, 55) the use of a uterine manipulator (RUMI), between June 2009 and June 2011. Two sets of peritoneal washings were obtained, 1 before and 1 after the insertion of the uterine manipulator. Primary end points were the rates of positive cytology and lymphovascular space invasion. RESULTS: No difference was detected in patient characteristics between the groups. Mean operative time, estimated blood loss, and postoperative complications were similar between the groups. Group A had a similar incidence of lymphovascular space invasion compared with group B (12.7% vs 9.1%, respectively; P = 0.761). Four patients (7.3%) in group A had positive peritoneal cytology in the initial washing. One of these patients was classified as stage IIIA. One patient in group B was positive in the second washing. The agreement rate between the 2 sets of washings for both groups was 98.2%. During the median follow-up of 19 months, 6 patients had tumor recurrence without significant difference between the groups. CONCLUSIONS: Despite concerns that the use of uterine manipulators may predispose the spread of early-stage disease, insertion of such uterine-manipulating systems did not increase rate of positive peritoneal cytology or lymphovascular space invasion in this study.
International Journal of Gynecological Cancer 12/2012; · 1.65 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the prognostic significance of NANOG expression in ovarian serous carcinoma.
The expression of NANOG was evaluated in 6 ovarian carcinoma cell lines, paclitaxel-resistant SKOV3 cells, and SKOV3 spheroid cells with semiquantitative reverse transcription-polymerase chain reaction and Western blotting. NANOG expression was also measured immunohistochemically in a tissue microarray containing ovarian tissues from 74 patients with ovarian serous carcinoma and 24 with ovarian serous cystadenoma. Each sample was scored based on signal intensity and proportion, and a score greater than 4 was considered "positive."
NANOG mRNA expression was variable in different ovarian cancer cell lines. The mRNA level of NANOG was increased in the paclitaxel-resistant SKOV3 cells and SKOV3 spheroid cells compared with that in the SKOV3 cells. NANOG expression was positive in 21.6% of 74 ovarian serous carcinoma tissues, but none of the ovarian serous cystadenoma tissues were positive. Positive NANOG expression was associated with residual tumor size after surgery (P = 0.032). The overall survival of the patients with positive NANOG expression was poorer than that of the patients with negative NANOG expression (P = 0.020). In patients with stage I and II disease, positive NANOG expression was independently associated with shorter overall survival compared with negative NANOG expression (40 vs 120 months, respectively; P = 0.031).
Positive NANOG expression is associated with poor prognosis of ovarian serous carcinoma. NANOG has potential as a predictor of survival for patients with ovarian carcinomas and may be involved in the mechanism of chemoresistance.
International Journal of Gynecological Cancer 11/2012; 22(9):1489-96. · 1.65 Impact Factor
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ABSTRACT: To assess the effectiveness of high-dose-rate intracavitary radiotherapy (HDR-ICR) in patients with cervical intraepithelial neoplasia 3 (CIN 3) and carcinoma in situ (CIS) presenting with poor histologic factors for predicting residual disease after undergoing diagnostic excisional procedures.
This study was a retrospective analysis of 166 patients with CIN 3 (n=15) and CIS (n=151) between October 1986 and December 2005. They were diagnosed by conization (n=158) and punch biopsy (n=8). Pathologic analysis showed 135 cases of endocervical gland involvement (81.4%), 74 cases of positive resection margins (44.5%), and 52 cases of malignant cells on endocervical curettage (31.3%). All patients were treated with HDR-ICR using Co⁶⁰ or Ir¹⁹² at a cancer center. The dose was prescribed at point A located 2 cm superior to the external os and 2 cm lateral to the axis of the tandem for intact uterus.
Median age was 61 years (range, 29-77). The median total dose of HDR-ICR was 30 Gy/6 fractions (range, 30-52). At follow-up (median, 152 months), 2 patients developed recurrent diseases: 1 CIN 2 and 1 invasive carcinoma. One hundred and forty patients survived and 26 patients died, owing to nonmalignant intercurrent disease. Rectal bleeding occurred in one patient; however, this symptom subsided with conservative management.
Our data showed HDR-ICR is an effective modality for CIN 3 and CIS patients presenting with poor histologic factors after excisional procedures. HDR-ICR should be considered as a definitive treatment in CIN 3 and CIS patients with possible residual disease after undergoing excisional procedures.
International journal of radiation oncology, biology, physics 09/2012; 84(1):e19-22. · 4.59 Impact Factor
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ABSTRACT: To construct a novel prognostic index (PI) model of early-stage epithelial ovarian cancer (EOC).
The PI model was constructed through meta-analyses. The methodological quality of the studies was assessed using the modified Jadad scale for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale for non-RCTs. The prognosis factors of the PI model that had a significant impact on the recurrence-free survival (RFS) of patients with early-stage ovarian cancer were chosen. A total of 177 patients with early-stage ovarian cancer who were treated at Severance Hospital were analyzed using the new PI model to test its utility.
The equation PI=2 × age+86 (if grade 2) or 105 (if grade 3)+53 (if stage Ib or Ic) or 130 (if stage II)+53 (if no lymphadenectomy)-43 (for adjuvant chemotherapy of 3 times or more)+10 (calibrating constant) was derived. Based on PI values, the high-risk group showed a significant 5 year-RFS difference compared to the low-risk group (P-value<0.01 by log-rank test) and a borderline significance in comparison to the intermediate-risk group (P-value=0.08). When the cutoff level of PI values was set at 211, the low- and high-risk groups of recurrence within 5 years were also identified by Cox regression analysis (HR=7.25, 95% CI: 2.98-17.65).
Our PI model was predictive in this study and may be effective in clinical practice. Further prospective studies should be conducted to confirm the predictive ability of the new PI model for early-stage EOC recurrence.
Gynecologic Oncology 06/2012; 126(3):357-63. · 3.89 Impact Factor
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ABSTRACT: Cancer stem cells (CSCs) are thought to be a source of tumor recurrence due to their stem cell-like properties. MicroRNAs (miRNAs) regulate both normal stem cells and CSCs, and dysregulation of miRNAs has an important role in tumorigenesis. Cluster of differentiation (CD) 133+ and spheroid formation have been reported to be one of the main features of ovarian CSCs. Therefore, we determined the miRNA expression profile of a CD133+ spheroid-forming subpopulation of the OVCAR3 human ovarian cancer cell line.
Initially, we confirmed the enrichment of the OVCAR3 CD133 subpopulation by evaluating in vitro anchorage-independent growth. After obtaining a subpopulation of CD133+ OVCAR3 cells with > 98% purity via cell sorting, miRNA microarray and real-time reverse transcription-polymerase chain reaction (RT-PCR) were performed to evaluate its miRNA profile.
We found 37 differentially expressed miRNAs in the CD133+ spheroid-forming subpopulation of OVCAR3 cells, 34 of which were significantly up-regulated, including miR-205, miR-146a, miR-200a, miR-200b, and miR-3, and 3 of which were significantly down-regulated, including miR-1202 and miR-1181.
Our results indicate that dysregulation of miRNA may play a role in the stem cell-like properties of ovarian CSCs.
BMC Medical Genomics 05/2012; 5:18. · 3.69 Impact Factor
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ABSTRACT: Objective. This study aimed to compare postoperative pain and surgical outcomes after transumbilical single-port access (SPA) and conventional multiport laparoscopic surgery for adnexal lesions. Methods. A retrospective case-control study was conducted matched by age, body mass index, and frequency of previous abdominal surgery. A total of 110 SPA laparoscopy patients (cases) were matched with a cohort of 107 patients who underwent conventional laparoscopy (controls) for benign adnexal lesions. SPA system consisted of a wound retractor, surgical glove, two 5-mm trocars, and one 11-mm trocar. Postoperative pain scores were measured immediately after surgery and at 6, 24, and 48 hours postsurgery using the numerical rating scale. Results. Postoperative pain scores did not differ between the 2 groups (P = .552). However, higher number of painkiller administrations was observed in the SPA laparoscopy group (median 3 vs 1, P < .001). The type of surgery and intraoperative blood loss were the significant factors influencing the number of painkiller administrations after controlling for other parameters by linear regression (P < .0001). The SPA laparoscopy group had less intraoperative blood loss (45.3 vs 87.5 mL, P < .001) and shorter hospital stay (2.1 ± 0.8 vs 2.7 ± 1.0 days, P < .001) compared with the conventional laparoscopy group. Operative time and perioperative complications did not differ between groups. Conclusions. There was no difference in pain intensity between the SPA and conventional laparoscopic group in this study. Future trials are warranted to better define the benefits of SPA surgery in terms of postoperative pain.
Surgical Innovation 03/2012; · 2.13 Impact Factor
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ABSTRACT: The purpose of this study was to compare surgical outcomes of 2-port access (TPA) and conventional laparoscopy in staging operations for endometrial cancer. The ultimate goal of TPA system was to perform proper cancer operation with less invasive access and to complement technical limitations of minimally invasive surgery.
The TPA system consisted of a single multi-channel port system at the umbilicus and an ancillary 5-mm trocar in the suprapubic area. Twenty-one consecutive patients who underwent TPA staging laparoscopy for endometrial cancers were enrolled in the study. Data coming from this group of patients were prospectively collected and compared with those coming from 42 consecutive patients who underwent conventional staging laparoscopy for the same period. The selected patients were matched (1:2 ratio) to control patients based on age (± 5 years), body mass index, and tumor stage.
Patient status was estimated in operative morbidity and surgical outcomes. All operations were completed laparoscopically, with no conversion to laparotomy. The TPA group had a significantly longer operating time (238 ± 51 minutes vs 188 ± 65 minutes; P = 0.001), more retrieved para-aortic lymph nodes (13 vs 5; P < 0.001), shorter postoperative hospital stay (5 vs 8 days; P = 0.001), and less postoperative pain (P = 0.045). There were no postoperative complications requiring further management.
Two-port access staging laparoscopy using a single multi-channel port system could be a feasible procedure in selected patients with endometrial cancer with only minimal skin incisions. Prospective randomized trials will permit the evaluation of potential benefits of this minimally invasive surgical technique.
International Journal of Gynecological Cancer 03/2012; 22(3):515-20. · 1.65 Impact Factor
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ABSTRACT: This study aimed to investigate the clinical value of pre-treatment leukocyte differential counts and the prediction of endometrial cancer using leukocyte markers.
Medical records of 238 women with pathologically confirmed endometrial cancer between March 2000 and June 2009 at two Korean hospitals were reviewed and compared to 596 healthy people visiting the Health Promotion Center in Gangnam Severance Hospital. For all study subjects, leukocyte differential counts and CA125 levels in serum obtained prior to operation were recorded. Multiplication of neutrophil and monocyte (MNM) was determined by multiplying neutrophil and monocyte counts then dividing by 10000. Differences between endometrial cancer patients and healthy controls were compared. The sensitivity and specificity for each marker as well as the combined use of CA125 and other leukocyte markers were assessed using receiver operating characteristic curves.
Mean white blood cell (WBC) counts were 6676 (6440-6913) cells/µL in endometrial cancer patients compared to 5663 (5542-5784) cells/µL in healthy controls (P<0.001). The area under curve (AUC) for CA125 was 0.689 with a sensitivity of 49.13% and specificity of 83.1% using an optimal cut-off value of 18.7U/mL. The AUC for MNM was 0.696 with a sensitivity of 62.9% and specificity of 69.1%. The combination of CA125 and MNM showed a higher AUC of 0.760 than use of CA125 or MNM alone.
The combination of MNM and CA125 is a simple and cost-effective method for predicting endometrial cancer.
Journal of Obstetrics and Gynaecology Research 12/2011; 38(1):48-56. · 0.94 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the use of single-port laparoscopic surgery in benign gynecologic diseases and to examine its impact on surgical outcomes.
The medical records of 500 consecutive patients who underwent laparotomy or laparoscopic surgery performed by a single surgeon for benign disease from August 2008 to October 2010 were retrospectively reviewed.
The surgeries included hysterectomy (n = 239), adnexectomy (n = 212), and myomectomy (n = 51). The indications for surgery included adnexal lesions (48.1%), uterine fibroids (37.8%), preinvasive cervical disease (7.5%), and endometrial pathology (6.6%). Twenty-nine percent of the first 100 cases were single-port laparoscopic surgeries. The percentages increased in the second (62%), third (72%), fourth (71%), and last (86%) 100 cases. The percentages of laparotomy and multiport laparoscopy were 23% and 48%, respectively, in the first 100 cases; however, in the last 100 cases, the percentages dropped to 4% and 10%, respectively. A significant reduction in estimated blood loss and length of hospital stay was observed for all diseases. No differences were identified in the median operative time or complication rate over the study period.
Single-port laparoscopic surgery can be applied to most benign gynecologic surgery without detrimental effects on clinical outcomes.
Surgical Endoscopy 11/2011; 26(5):1318-24. · 4.01 Impact Factor
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ABSTRACT: The aim of this study was early prediction of postmolar gestational trophoblastic neoplasm (GTN) after evacuation of high-risk mole, by comparison of human chorionic gonadotrophin (hCG) regression rates.
Fifty patients with a high-risk mole initially and spontaneously regressing after molar evacuation were selected from January 1, 1996 to May 31, 2010 (spontaneous regression group). Fifty patients with a high-risk mole initially and progressing to postmolar GTN after molar evacuation were selected (postmolar GTN group). hCG regression rates represented as hCG/initial hCG were compared between the two groups. The sensitivity and specificity of these rates for prediction of postmolar GTN were assessed using receiver operating characteristic curves. Multivariate analyses of associations between risk factors and postmolar GTN progression were performed.
The mean regression rate of hCG between the two groups was compared. hCG regression rates represented as hCG/initial hCG (%) were 0.36% in the spontaneous regression group and 1.45% in the postmolar GTN group in the second week (p=0.003). Prediction of postmolar GTN by hCG regression rate revealed a sensitivity of 48.0% and specificity of 89.5% with a cut-off value of 0.716% and area under the curve (AUC) of 0.759 in the 2nd week (p<0.001). In patients with an hCG regression rate over 0.716% in the 2nd week, the hazard ratio for progression to postmolar GTN was 3.00 by multivariate analysis (p<0.001).
Differences in hCG regression rates between spontaneous regression and postmolar GTN groups became evident from the second week following molar evacuation. The occurrence of postmolar GTN could be predicted as early as the second week by comparing regression rates. hCG regression rate is easily obtainable and a predictive factor for postmolar GTN.
European journal of obstetrics, gynecology, and reproductive biology 11/2011; 160(1):100-5. · 1.97 Impact Factor
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ABSTRACT: To assess and compare the efficacy and toxicity of radiotherapy (RT) versus chemotherapy (CT) in patients with nodal and isolated nonnodal recurrence of ovarian cancer.
Records of 67 patients treated for nodal or isolated nonnodal ovarian cancer recurrence (50 treated with RT and 17 treated with CT) between 2001 and 2010 were retrospectively reviewed. Patients' responses to RT and CT were assessed by the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to the National Cancer Institute Common Toxicity Criteria, version 3.0. Progression-free survival and overall survival were calculated using the Kaplan-Meier method.
The overall response rate was 64.0% in the RT group and 16.7% in the CT group (P = 0.003). The median follow-up time was 38 months (range, 3-97 months) for RT and 18 months (range, 70-64 months) for CT. The median progression-free survival was 6 months for radiotherapy and 5 months for chemotherapy (P = 0.212). Median overall survival between the 2 groups was not significantly different (P = 0.246). There was no RT-mediated grade 3 or 4 hematologic toxicity, but overall toxicity was not significantly different between the 2 groups.
Radiotherapy resulted in a better response and tolerable toxicities compared to CT in patients with either nodal or isolated nonnodal ovarian cancer recurrence. However, progression-free survival and overall survival did not differ between RT and CT. A prospective, multicenter, randomized controlled study is needed to evaluate the survival benefits of RT for ovarian cancer.
International Journal of Gynecological Cancer 08/2011; 21(6):1032-9. · 1.65 Impact Factor
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ABSTRACT: This study aimed to evaluate the feasibility of laparoscopic metastasectomy (LM) in the treatment of ovarian metastases from gastric cancer and to compare the surgical outcomes with patients who underwent open metastasectomy (OM).
The cases of 73 patients who underwent LM (n = 16) or OM (n = 57) were retrospectively reviewed. All patients were diagnosed with gastric cancer and, subsequently, underwent a metastasectomy at Yonsei University Health System between December 2002 and March 2011.
Sixteen operations were completed laparoscopically with no conversion to laparotomy. Complete cytoreduction surgery was achievable in 13 patients (81.3%). Operating time, complete cytoreduction, and occurrence of perioperative complications were comparable between the 2 groups. The LM group had less blood loss (25 vs 400 mL, P < 0.0001), earlier return to a general diet (3 vs 4 days, P = 0.005), shorter postoperative hospital stay (4.5 vs 7 days, P < 0.0001), and lower postoperative pain scores after 6, 24, and 48 hours than those in the OM group. There were no operative complications in the LM group.
As a surgical treatment for ovarian metastases from gastric cancer, LM is feasible and provides benefits to patients without detrimental effects on the clinical outcomes for selected patients.
International Journal of Gynecological Cancer 07/2011; 21(7):1306-11. · 1.65 Impact Factor
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ABSTRACT: To evaluate the feasibility of robotic single-port transumbilical total hysterectomy using a home-made surgical glove port system.
We retrospectively reviewed the medical records of patients who underwent robotic single-port transumbilical total hysterectomy between January 2010 and July 2010. All surgical procedures were performed through a single 3-4-cm umbilical incision, with a multi-channel system consisting of a wound retractor, a surgical glove, and two 10/12-mm and two 8 mm trocars.
Seven patients were treated with robotic single-port transumbilical total hysterectomy. Procedures included total hysterectomy due to benign gynecological disease (n=5), extra-fascial hysterectomy due to carcinoma in situ of the cervix (n=1), and radical hysterectomy due to cervical cancer IB1 (n=1). The median total operative time was 109 minutes (range, 105 to 311 minutes), the median blood loss was 100 mL (range, 10 to 750 mL), and the median weight of the resected uteri was 200 g (range, 40 to 310 g). One benign case was converted to 3-port robotic surgery due to severe pelvic adhesions, and no post-operative complications occurred.
Robotic single-port transumbilical total hysterectomy is technically feasible in selected patients with gynecological disease. Robotics may enhance surgical skills during single-port transumbilical hysterectomy, especially in patients with gynecologic cancers.
Journal of Gynecologic Oncology 06/2011; 22(2):120-6. · 1.49 Impact Factor
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ABSTRACT: To evaluate the impact of both pretreatment thrombocytosis, and platelet count reduction post-adjuvant chemotherapy, on survival in patients with advanced epithelial ovarian cancer.
Records of 179 women who underwent cytoreductive surgery for FIGO stage III or IV epithelial ovarian cancer and received six cycles of platinum/paclitaxel-based chemotherapy between July 1998 and March 2009 were retrospectively reviewed. Platelet ratio was defined as the preoperative platelet count divided by the platelet count after chemotherapy. The prognostic significance of thrombocytosis and platelet ratio, together with various clinicopathological factors, were evaluated by multivariate analysis.
Sixty-two of 179 (34.6%) patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis had greater elevations of CA-125 (p<0.0001) and a greater volume of ascites (p=0.007). On multivariate analysis, thrombocytosis and CA-125 elevation retained significance as indicators of poor prognosis in patients with stage III or IV disease. In patients with normal CA-125 after chemotherapy, a high platelet ratio was an independent risk factor for reduced survival (p=0.05).
Preoperative thrombocytosis and a high platelet ratio appear to be poor prognostic factors of survival in patients with advanced epithelial ovarian cancer who were treated with cytoreductive surgery and adjuvant platinum/paclitaxel-based chemotherapy.
Gynecologic Oncology 04/2011; 122(2):238-41. · 3.89 Impact Factor
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ABSTRACT: To identify specific proteins associated with chemotherapeutic responses, we analyzed protein expression patterns in stage IIIc primary serous epithelial ovarian cancer tissues displaying differential responses to first-line postoperative adjuvant chemotherapy. The expression profiles of five chemoresistant tissues [progression-free survival (PFS) ≤12 months] and five chemosensitive tissues (PFS ≥48 months) were analyzed with 2D electrophoresis, and the spot intensities of differentially expressed proteins were quantified. To validate these proteins as markers for chemoresistant disease, we analyzed tissues from an additional 17 patients. All the patients were allocated to the over- or underexpressing group according to protein spot intensity, and survival analysis was performed. In chemoresistant tissues, four proteins (thioredoxin domain containing four, similar to RIKEN cDNA 1700016G05, tubulin α 1A chain, and the pyruvate dehydrogenase E1-β subunit precursor) were overexpressed, and seven proteins [keratin 1, vitamin D-binding protein, creatine kinase B, annexin V, SH3-containing guanine nucleotide exchange factor (SGEF), tryptophan-aspartate repeat protein-1 (WDR 1), and WDR 1 isoform 1] were underexpressed. The underexpression of keratin 1, creatine kinase B, annexin V, SGEF, WDR1, and WDR1 isoform 1 were significantly correlated with poor overall survival. A combination of keratin 1 and SGEF showed the highest sensitivity of 0.800, specificity of 0.917, PPV of 0.800, and NPV of 0.917 in predicting chemoresistant disease. These proteins may be useful as predictive markers of chemoresistant disease. However, further analyses in large-scale should be performed before they can be considered reliable predictive markers of chemoresistant disease.
Omics: a journal of integrative biology 02/2011; 15(5):281-92. · 2.29 Impact Factor
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ABSTRACT: The purpose of this study was to compare surgical outcomes of robotic radical hysterectomy (RRH) using 3 robotic arms with those of abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer.
Thirty-two patients with stage IA2-IIB cervical carcinoma according to the International Federation of Gynecology and Obstetrics underwent RRH between June 2006 and February 2009. Patient outcomes were compared with those of a historic cohort of 32 patients who underwent ARH, who were matched for age, stage according to the International Federation of Gynecology and Obstetrics, and type of radical surgery.
All RRHs were completed robotically with no conversions to laparotomy. Robotic radical hysterectomy showed favorable outcomes over ARH in terms of the mean length of hospital stay (11.6 vs 16.9 days, P < 0.001) and the mean estimated blood loss (220 vs 531 mL, P = 0.002). The mean operating time and the number of lymph node retrievals were comparable. There were no significant differences in the incidence of postoperative complications between the 2 groups. The mean follow-up time was 15.3 months, and 2 patients in the RRH group had recurrences.
Robotic radical hysterectomy and pelvic lymphadenectomy using 3 robotic arms is feasible and preferable over ARH for the treatment of cervical cancer patients. Prospective randomized trials should be completed to confirm the potential benefits associated with RRH.
International Journal of Gynecological Cancer 10/2010; 20(7):1284-9. · 1.65 Impact Factor
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ABSTRACT: The objective of the study was to compare surgical outcomes and postoperative pain between transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) and conventional 4-port total laparoscopic hysterectomy (TLH).
We retrospectively reviewed 157 patients who underwent SPA-TLH (n = 52) or conventional TLH (n = 105). A single-port access system consisted of a wound retractor, surgical glove, 2 5 mm trocars, and 1 10/11 mm trocar.
The SPA-TLH group had less intraoperative blood loss (P < .001), shorter hospital stay (P = .001), and earlier diet intake (P < .001) compared with the conventional TLH group. There was no difference in perioperative complications. Immediate postoperative pain score was lower in the SPA-TLH group (P < .001). Postoperative pain after 6 and 24 hours was lower in SPA-TLH with marginal statistical significance.
SPA-TLH is a feasible method for hysterectomy with lower immediate postoperative pain and better surgical outcomes with respect to recovery time compared with conventional TLH.
American journal of obstetrics and gynecology 07/2010; 203(1):26.e1-6. · 3.28 Impact Factor
