[Show abstract][Hide abstract] ABSTRACT: Laparoscopy is the standard procedure to clarify undefined ovarian masses. However, laparoscopy could induce tumor spread in ovarian cancer (OC). The aim of this study was to assess the incidence, the risk factors, and the complications of abdominal wall metastases (AWM) in patients with OC after laparoscopy.
Retrospective study of patients with primary diagnosis of OC who had laparoscopy before cytoreductive surgery and resected port sites in laparotomy between 1999 and 2008 at our institution. Patients with borderline or nonepithelial ovarian tumors were excluded.
Of 537 patients with a first diagnosis of OC, 101 had laparoscopy before definitive operation after a median of 31 days. Histological examination at final cytoreductive surgery of the port sites was conducted in 66 patients, whereas 31 patients (47%) showed AWM. Patients experiencing AWM had higher tumor stages and peritoneal carcinomatosis. Ascites with more than 500 mL was a further independent risk factor for AWM (odds ratio: 7.2; 95% confidence interval, 1.5-35.8; P = 0.016). Abdominal wall metastasis did not impact on survival in our cohort; however, affected patients showed significant larger abdominal wall resections (mean [SD]): 41.0 (angled brace 13.1) cm versus 9.1 (angled brace 1.4) cm in comparison with patients without AWM (P = 0.013), and 2 patients developed abdominal wall recurrences.
The incidence of AWM in patients experiencing OC was considerably high when laparoscopic surgery was conducted before cytoreductive surgery. Patients experiencing AWM seem to have more surgical burden. However, our series did not show a dramatic impact of AWM on long-term outcome. Patients with highly suspected advanced OC and ascites with more than 500 mL should be referred directly to a gynecologic oncologist who is able to balance risks of laparoscopic staging and direct cytoreductive surgery.
International Journal of Gynecological Cancer 01/2010; 20(1):41-6. · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Carboplatinum-based retreatment can be regarded as a standard option in the so-called platinum-sensitive ovarian cancer, but its use can be limited by the occurrence of sometimes severe hypersensitivity reactions (HSRs). This study analyzes the value of carboplatin skin testing and desensitization.
Between 2004 and 2006, all patients with carboplatin reinduction chemotherapy received an intradermal injection of 0.2 microL of carboplatin and saline as negative control before chemotherapy. Carboplatin was administered in the standard way if the test was negative. If positive, carboplatin was administered after an already published desensitization protocol.
Fifty-four patients received retreatment with carboplatinum and were submitted to skin test. Seven patients (13%) had positive skin test, whereas 4 patients developed HSRs although they had negative skin test (8.5% false-negative rate). Skin test predicted HSRs in only 64% of the afflicted patients. Desensitization was performed in all patients with positive skin test, and 5 (71%) of 7 could receive 3 to 11 further carboplatinum courses. Repeated HSRs occurred in 2 of 7 patients despite desensitization; however, none of the HSRs after desensitization were severe.
Skin test did not reliably predict carboplatinum-induced HSR, but desensitization was demonstrated to be a rather successful strategy. Taking the low predictive value into account, we started another prospective series of administering antiallergic medication to all patients with carboplatinum retreatment and offer desensitization if any HSR occurs.
International Journal of Gynecological Cancer 10/2009; 19(7):1284-7. · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: State-of-the-art surgical staging and adjuvant chemotherapy in early-stage ovarian carcinoma have an impact on patient's outcome, but compliance to guidelines and consensus recommendations is still poor. This article reports on our results before and after introduction of a quality assurance and management program in our clinic in 2001. Patients with ovarian carcinoma limited to the pelvis who underwent primary surgery in our hospital from 1997 to October 2007 were eligible for this study. Univariate and multivariate logistic regression analyses were performed to evaluate the impact of compliance with our management program and physician's experience in ovarian carcinoma surgery on achieving both standards of surgery and chemotherapy. In a total of 117 women, a significant impact on adherence to guideline-defined comprehensive surgical staging was found for poor Eastern Cooperative Oncology Group performance status (odds ratio [OR], 22.16; confidence interval [CI] 3.2-152.0; P = 0.002) and year of surgery before 2001 (OR, 47.60; CI, 9.20-245.22; P < 0.001). Tumor grading less than G3 (OR, 4.14; CI, 1.20-14.22; P = 0.02) was a statistically significant predictor for receiving standard adjuvant chemotherapy. Survival analyses showed a trend toward improved survival for patients having received guideline-adopted therapy, but event numbers were too low for adequate analyses. The introduction of a quality assurance program for treatment of ovarian carcinoma represents a major improvement of patient care. It led to a higher compliance with consensus recommendations and showed already a trend toward improved outcome. Further outcome research should focus on methods for implementation of guidelines in daily practice in institutions caring for patients with ovarian carcinoma.
International Journal of Gynecological Cancer 05/2009; 19(4):787-93. · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The treatment guidelines in the last decade have shown a trend towards increasing surgical radicality in endometrial cancer. Little information is available on the implementation of standards into clinical reality. We evaluated the adherence to standard therapy before and after introduction of an internal quality management system and determined the reasons for non-adherence.
A retrospective analysis of the inhouse tumor registry was performed. Included were all patients with Federation of Gynecology and Obstetrics (FIGO) I-III endometrial cancer and therapy at the Dr. Horst Schmidt Klinik (HSK) from 1997 to 2007.
206 patients with epithelial endometrial cancer in stage FIGO I-III underwent primary surgery at the HSK. 140 (68%) patients were operated as recommended by the guidelines. 20% of patients were operated less radically (17% vs. 22% before and after introduction of guidelines; p = 0.33) and 12% more radically. The latter was significantly reduced after implementation of quality management (21% vs. 7%; p = 0.004). Comorbidities and age played an important role in less-than-standard treatment.
Adherence to guideline-based therapy for endometrial cancer can be achieved in most patients. Implementation of standards and quality assurance primarily helps to avoid surgical overtreatment but failed to reduce less-than-standard treatment radicality. The latter seemed to be more defined by patient characteristics than by institution standards.