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ABSTRACT: The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Baranoski AS, Tandon R, Weinberg J, et al. Risk factors for abnormal anal cytology over time in HIV-infected women. Am J Obstet Gynecol 2012;207:107.e1-8.
American journal of obstetrics and gynecology 08/2012; 207(2):142-3. · 3.28 Impact Factor
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ABSTRACT: A 10-point "Surgical Apgar Score" (SAS) for predicting postoperative complications after general and vascular operations has recently been developed and validated. We sought to estimate the ability of this metric to predict major postoperative complications in women undergoing ovarian cancer cytoreductive procedures.
All eligible patients with stage III and IV epithelial ovarian, fallopian tube and primary peritoneal cancer undergoing surgical cytoreduction at our institution between 1999 and 2005 were included. Medical records were reviewed and demographic data, clinicopathologic characteristics, comorbidities and intra and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest mean arterial pressure and lowest heart rate as previously described. Descriptive statistics, univariable and multivariable analyses were used as appropriate. Occurrence of major postoperative complications represented the primary outcome.
A total of 232 cases were analyzed. Mean age was 62 years. Most patients were Caucasian (92%) and diagnosed with stage III disease (83%). Mean duration of surgical procedure was 171 (70-350) minutes. Median SAS was 6 points (range 1-9). On multivariable analyses, occurrence of major postoperative complications was associated with multiple comorbidities (OR 2.2; 95% CI:1.5-3.1; p<0.0001), stage IV disease (OR 2.5; 95% CI:1.1-5.7; p=0.03), ASA class (OR 2.4; 95% CI:1.2-4.7; p=0.01) and SAS<or=4 (OR 7.4; 95% CI:2.9-18.8; p<0.0001).
Lower SAS (<or=4) is the most powerful predictor of postoperative complications in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer. This prognostic tool may prove helpful for triaging such patients to optimal postoperative levels of care and directing counseling, monitoring and management in the postoperative period.
Gynecologic Oncology 12/2009; 116(3):370-3. · 3.89 Impact Factor
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ABSTRACT: Heritable polymorphisms modulate metastatic efficiency in Cancer Single nucleotide polymorphisms (SNPs) in MMP9 (rs17576) and SIPA1 (rs746429, rs931127) have been associated with nodal metastases in multiple cancers. We investigated the association of these SNPs with nodal metastases in early-stage cervical cancer.
Consecutive patients with stage IB cervical cancer who underwent a pelvic lymph node (LN) dissection were included. Cases (>1 positive LN, n=101) were compared with controls (negative LN pathology, n=273). Genotyping was performed on genomic DNA in the 3 SNPs using a TaqMan assay and correlated with clinical variables.
The G allele at SIPA1 rs931127 was associated with an increased risk of nodal disease (OR 1.9, P=0.03) and approached significance at SIPA 1 rs746429 (OR 2.2, P=0.09) and MMP9 rs17576 (OR 1.5, 0.08). In patients with stage Ib1 lesions (n=304), the G allele at both SIPA1 SNPs was associated with LN metastases (rs746429 OR 10.1, P=0.01; rs931127 OR 2.4, P=0.01). In patients with no lymph vascular space invasion, SIPA1 SNPs were again associated with LN metastases, and all patients with nodal disease had at least one G allele at SIPA1 rs746429.
In this case-control study, SNPs in SIPA1 varied statistically in cervical cancer patients with and without nodal metastases and in MMP9 after controlling for stage and lymphvascular space invasion. Further work is needed to characterize inherited polymorphisms that provide a permissive background for the metastatic cascade.
Gynecologic Oncology 11/2009; 116(3):539-43. · 3.89 Impact Factor
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American journal of obstetrics and gynecology 07/2009; 200(6):e1-3. · 3.28 Impact Factor
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Bulletin of the American College of Surgeons 06/2009; 94(5):32-5.
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ABSTRACT: The argon beam coagulation (ABC) is a safe and effective tool for surgical cytoreduction of metastatic ovarian carcinomas.
A 66-year-old woman with newly diagnosed advanced stage epithelial ovarian cancer underwent primary cytoreductive surgery involving ABC of tumor implants. Intraoperatively, she experienced cardiac arrest during use of the ABC. She was successfully resuscitated. The etiology of the arrest was thought to be secondary to a venous gas embolism.
The risk associated with venous gas embolism in a laparotomy case is exceedingly low. This is the first case report of venous gas embolism during ABC in a surgical procedure for gynecologic malignancy. Proper monitoring and support services should always be immediately available when using ABC.
International Journal of Gynecological Cancer 19(2):237-8. · 1.65 Impact Factor
