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Jae Kwan Lee,
Jin Hwa Hong,
Sokbom Kang,
Dae-Yeon Kim,
Byoung-Gie Kim,
Sung-Hoon Kim,
Yong-Man Kim,
Jae-Weon Kim,
Jae-Hoon Kim,
Tae-Jin Kim, [......],
Jeong-Won Lee,
Taek Sang Lee,
Myong Cheol Lim,
Suk-Joon Chang,
Hyun Hoon Chung,
Woong Ju,
Hee Jae Joo,
Soo-Young Hur,
Sung-Ran Hong,
Joo-Hyun Nam
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ABSTRACT: The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.
Journal of Gynecologic Oncology 04/2013; 24(2):186-203. · 1.49 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary.
We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated.
SURGICAL STAGING YIELDED: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%) of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the para-aortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis.
A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Para-aortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.
Journal of Gynecologic Oncology 01/2013; 24(1):29-36. · 1.49 Impact Factor
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ABSTRACT: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer.
We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen.
Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237).
Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.
Journal of Gynecologic Oncology 10/2012; 23(4):235-41. · 1.49 Impact Factor
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ABSTRACT: BACKGROUND: To analyze the impact of radical cytoreductive surgery-as part of primary tumor debulking-on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery. METHODS: Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected. RESULTS: Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients. Advanced age (hazard ratio [HR] 1.04, 95 % confidence interval [CI] 1.02-1.06, P < 0.01), FIGO stage IV disease (HR 3.61, 95 % CI 1.48-8.83, P < 0.01), and grossly visible RD (HR 3.24, 95 % CI 1.90-5.53, P < 0.01) were identified as significant factors associated with poor prognosis in the entire cohort of 203 patients. Radical surgery (HR 0.56, 95 % CI 0.37-0.87, P = 0.01) was associated with improved survival. In the subgroup of patients with stage IIIC disease with peritoneal carcinomatosis, independent prognostic factors were advanced age (HR 1.04, 95 % CI 1.01-1.06, P = 0.01), radical surgery (HR 0.58, 95 % CI 0.35-0.96, P = 0.03), and grossly visible RD (HR 2.86, 95 % CI 1.55-5.30, P < 0.01). Patients with no gross RD had the longest overall survival (86 months) compared with RD 0.1-1 cm (46 months) and RD >1.0 cm (37 months) (P < 0.01). CONCLUSIONS: No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.
Annals of Surgical Oncology 07/2012; · 4.17 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the impact of systematic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer.
We retrospectively analyzed the data of 189 consecutive patients with FIGO stage IIIC ovarian cancer between 2000 and 2011, who underwent primary cytoreductive surgery followed by platinum- and taxane-based chemotherapy. All patients were classified into two groups - patients who underwent systematic pelvic and para-aortic lymphadenectomy and those who did not. Progression-free (PFS) and overall survival (OS) times were analyzed using Kaplan-Meier method and Cox proportional hazards model.
Patients who underwent systematic lymphadenectomy had significantly improved PFS (22 versus 9 months, p<0.01) and OS (66 versus 40 months, p<0.01). In patients with no gross residual disease (NGR) or residual disease 0.1-1cm (GR-1), the median OS time of those who had lymphadenectomy was significantly longer than those who did not (86 versus 46 months, p=0.02). However, in patients with residual disease >1cm (GR-B), there was no significant difference in OS according to lymphadenectomy (39 versus 40 months, p=0.50). Among patients with NGR, the median OS time of those who underwent systematic lymphadenectomy was significantly longer than those who did not undergo lymphadenectomy (not yet reached [>96] and 56 months, p<0.01). No significant difference of OS between patients with and without lymphadenectomy was observed in the subgroup of patients with GR-1 (50 versus 38 months, p=0.44). The performance of lymphadenectomy was a statistically significant and independent predictor of improved OS in addition to the status of residual disease and the performance of radical cytoreductive procedures (hazard ratio, 0.34; [95% CI, 0.23-0.52]; p<0.01).
Systematic lymphadenectomy may have a therapeutic value and be significantly associated with improved survival in stage IIIC ovarian cancer patients with grossly no visible residual disease.
Gynecologic Oncology 05/2012; 126(3):381-6. · 3.89 Impact Factor
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ABSTRACT: To investigate the survival of patients with intermediate-risk endometrial cancer treated with comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy and adjuvant vaginal brachytherapy (VBT).
Between January 2000 and December 2009, we retrospectively reviewed the medical records of 156 patients who underwent comprehensive surgical staging consisting of total hysterectomy, adnexectomy, peritoneal cytology, and complete pelvic/para-aortic lymphadenectomy. There were 122 low-risk and 34 intermediate-risk patients, and intermediate-risk patients received adjuvant VBT.
During the follow-up period, 7 (4.5%) of the 156 patients developed recurrent disease: 3 (2.5%) of the 122 low-risk and 4 (11.8%) of the 34 intermediate-risk patients. Among the 7 patients with recurrent disease, only 1 intermediate-risk patient died of disease and 6 stayed alive for the rest of the follow-up period. Disease-free survival at 5 years was 95.7% in the low-risk patients and 81.6% in the intermediate-risk patients, and this difference was statistically significant (p = 0.009). There was no statistically significant difference in overall survival at 5 years between the two groups (100% in low-risk patients vs. 96.7% in intermediate-risk patients, p = 0.061). Overall, grade 3 toxicities were seen in 1 (2.9%) patient.
Comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy followed by adjuvant VBT improves survival rates for intermediate-risk endometrial cancer patients, which are comparable with those of low-risk patients.
Gynecologic and Obstetric Investigation 05/2012; 74(1):68-75. · 1.28 Impact Factor
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Gynecologic Oncology 05/2012; 126(2):277-8. · 3.89 Impact Factor
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ABSTRACT: We present the unique case of a 55-year old endometrial cancer patient with a left-sided inferior vena cava (IVC) who underwent laparoscopic staging procedures with total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy, and para-aortic lymphadenectomy. On preoperative evaluation, endometrial biopsy revealed grade 3endometrioid adenocarcinoma, and magnetic resonance imaging (MRI) showed uterine corpus tumor with deep (≥ 50%) myometrial invasion and no suspicious extrapelvic metastases. After removal of the uterus and bilateral adnexae, retroperitoneal lymphadenectomy was performed. During para-aortic lymphadenectomy, a left-sided IVC was observed. Para-aortic lymphadenectomy was performed using conventional laparoscopic electrosurgical instruments without complications. The postoperative recovery was uneventful. The patient was found to have FIGO stage IB disease, and received adjuvant radiation therapy. The IVC is formed through a very complicated embryologic process - selective development, anastomosis, and regression of posterior cardinal, subcardinal, and supracardinal veins - between 5-8th gestational weeks, and several congenital anomalies of the IVC can occur [1]. The left-sided IVC results from persistence of the left supracardinal vein with regression of the right supracardinal vein, and its incidence is 0.2 - 0.5% [1,2]. The left-sided IVC is usually asymptomatic and mostly an incidental finding [2]. Multiple renal veins, gonadal vein anomaly, and IVC duplication are common anomaly associated with the left-sided IVC. In our case, no anomalies were found. In the preoperative imaging studies, the left-sided IVC may be misinterpreted as para-aortic nodal disease such as cancer metastasis or lymphadenitis, retroperitoneal cyst, or dilated uteter [2,3]. The preoperative MRI of our case showed the left-sided IVC, but the radiologist missed it. The clinical significance of this anomaly is the potential risk of vascular injury during surgery [3]. Endometrial cancer is a surgically staged disease, and para-aortic lymphadenectomy is performed as part of systematic surgical staging procedures. The operating surgeon must consider the possibility of IVC anomalies and take a cautious approach to avoid iatrogenic surgical injury due to misidentification of these findings.
Gynecologic Oncology 04/2012; 126(1):147-8. · 3.89 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the potential risk factors associated with parametrial invasion and to identify preoperatively a subgroup of patients at low risk for parametrial involvement who could be appropriate candidates for less radical surgery in FIGO stage IB1 cervical cancer.
We retrospectively reviewed the medical records of 317 FIGO stage IB1 cervical cancer patients undergoing class III radical hysterectomy and bilateral pelvic lymphadenectomy. Clinocopathologic factors associated with parametrial invasion were analyzed and the risk criteria predicting parametrial involvement were calculated using a logistic regression model.
Of 317 patients, 17 patients (5.4%) had parametrial involvement. Tumor size >3 cm (OR, 3.80; [95% CI, 1.19-12.06]; p=0.02) and pelvic lymph node metastasis (OR, 3.02; [95% CI, 1.04-8.79]; p=0.04) were independent pathologic factors for parametrial invasion on multivariate analysis. Significant preoperative factors associated with parametrial involvement were tumor size >3 cm (OR, 4.29; [95% CI, 1.43-12.89]; p<0.01) and serum SCC Ag level >1.40 ng/mL (OR, 3.27; [95% CI, 1.11-9.69]; p=0.03). We identified 185 low-risk (tumor size ≤ 3 cm and SCC ≤ 1.4 ng/mL) and 132 high-risk (tumor size>3 cm and/or SCC>1.4 ng/mL) patients. The rates of parametrial involvement in low- and high-risk patients were 1.1% and 11.4%, respectively (p<0.01).
In this dataset, a model using tumor size and SCC Ag level is highly predictive of parametrial involvement in patients with stage IB1 cervical cancer and may identify candidates for less radical parametrial resection.
Gynecologic Oncology 04/2012; 126(1):82-6. · 3.89 Impact Factor
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Gynecologic Oncology 02/2012; 125(3):518-9. · 3.89 Impact Factor
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ABSTRACT: To describe the sonographic findings for malignant mixed Müllerian tumors (MMMTs) of the uterus with particular emphasis on their features on saline contrast sonohysterography (SCSH) and color Doppler sonography, and to determine how they relate to pathological findings.
The SCSH and color Doppler findings in 29 histologically proven cases of uterine MMMT were reviewed retrospectively and their relationship to gross and histological findings were investigated.
Of the 29 uterine tumors, 16 were located only in the corpus, nine only in the fundus and four in both the corpus and fundus. Mean tumor size was 5.4 cm. The most common appearance was a polypoid mass projecting into the endometrial cavity, found in 23 cases. Twenty-eight tumors had an irregular surface, which was papillary in 20 cases and lobulated in eight. Most appeared heterogeneously isoechoic (n = 16) or hypoechoic (n = 12), occasionally with a trabecular appearance, and they often had clefts or fissure-like cystic areas (n = 10), necrosis (n = 4) or hemorrhagic areas (n = 7). Myometrial invasion was present in 27 cases and dilatation of the endometrial cavity was seen in 11. Color Doppler sonography showed moderate to marked vascularity in 20 out of the 24 cases in which it was performed, with a mean resistance index of 0.41, and appeared as feeding (n = 15) or randomly dispersed (n = 9) vessels.
Uterine MMMTs have distinct sonographic features that are related to pathological findings. Knowledge of the sonographic appearance of MMMTs may facilitate diagnosis.
Ultrasound in Obstetrics and Gynecology 09/2011; 39(3):348-53. · 3.01 Impact Factor
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ABSTRACT: A prospective multicenter trial has been commenced in Korea to investigate the treatment efficacy of the levonorgestrel-releasing intrauterine system in patients with endometrial hyperplasia. The levonorgestrel-releasing intrauterine system is an alternative to oral progesterone without the disadvantages of oral progestogens. Therefore, we hypothesize that if the therapeutic efficacy of the levonorgestrel-releasing intrauterine system is similar to or greater than that of oral progesterone, the levonorgestrel-releasing intrauterine system could become the standard treatment for endometrial hyperplasia patients who do not want a hysterectomy. The levonorgestrel-releasing intrauterine system is inserted into uteri of patients with histologically confirmed endometrial hyperplasia. An office endometrial aspiration biopsy and transvaginal ultrasound are conducted every 3 months at an outpatients clinic. The primary endpoint is the response rate. The secondary endpoint is to estimate the consistency of the results of the office endometrial aspiration biopsy during the levonorgestrel-releasing intrauterine system being placed in uterus and a dilatation and curettage procedure.
Japanese Journal of Clinical Oncology 06/2011; 41(6):817-9. · 1.78 Impact Factor
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ABSTRACT: The aim of this study was to assess various treatment options in stage IB2 cervical cancer patients.
Between January 1995 and May 2007, 63 patients with stage IB2 were treated by radical hysterectomy (n = 28), primary concurrent chemoradiation (CCRT, n = 16) or radiation therapy (RT, n = 19). Disease-free survival (DFS) and overall survival (OS) were compared between these treatment modalities.
The 3-year DFS of the surgical approach group was 67.5% compared to 70.3% of the primary RT/CCRT group (p = 0.603). The 5-year OS of all patients was 75.9%. The 5-year OS of the surgical approach group was 81.6% compared to 76.2% of the primary RT/CCRT group (p = 0.578). Twelve (42.8%) of 28 surgically treated patients had high-risk pathologic factors. Out of 20 premenopausal patients who underwent the surgical approach, ovarian preservation was possible in 13 patients without adjuvant CCRT. Of these 13 patients, 7 patients did not experience disease recurrence and continued normal ovarian function.
Both radical hysterectomy and primary RT/CCRT are effective treatment options in IB2 cervical cancer. In addition, the surgical approach can be considered for preserving ovarian function in premenopausal IB2 cervical cancer patients.
Gynecologic and Obstetric Investigation 01/2011; 71(1):19-23. · 1.28 Impact Factor
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ABSTRACT: The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.
We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.
Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P < .001), tumor size (P = .003), depth of myometrial invasion (P < .001), cervical invasion (P < .001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P < .001), serosal/adnexal invasion (P < .001), positive cytology (P = .002), peritoneal seeding (P < .001), and pelvic LNM (P < .001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.
LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients.
Annals of Surgical Oncology 01/2011; 18(1):58-64. · 4.17 Impact Factor
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ABSTRACT: The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy.
A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.
Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of ≥ 31 U/ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis.
Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of > 31 U/ml and deep myometrial invasion by MRI.
Annals of Surgical Oncology 12/2010; 17(12):3234-40. · 4.17 Impact Factor
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Dong Hoon Suh,
Jae Weon Kim,
Mohamad Farid Aziz,
Uma K Devi,
Hextan Y S Ngan,
Joo-Hyun Nam,
Seung Cheol Kim,
Tomoyasu Kato, Hee Sug Ryu,
Shingo Fujii, [......],
Kung-Liahng Wang,
Taek Sang Lee,
Kimio Ushijima,
Sang-Goo Shin,
Yin Nin Chia,
Sarikapan Wilailak,
Sang Yoon Park,
Hidetaka Katabuchi,
Toshiharu Kamura,
Soon-Beom Kang
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ABSTRACT: This workshop was held on July 31-August 1, 2010 and was organized to promote the academic environment and to enhance the communication among Asian countries prior to the 2nd biennial meeting of Australian Society of Gynaecologic Oncologists (ASGO), which will be held on November 3-5, 2011. We summarized the whole contents presented at the workshop. Regarding cervical cancer screening in Asia, particularly in low resource settings, and an update on human papillomavirus (HPV) vaccination was described for prevention and radical surgery overview, fertility sparing and less radical surgery, nerve sparing radical surgery and primary chemoradiotherapy in locally advanced cervical cancer, were discussed for management. As to surgical techniques, nerve sparing radical hysterectomy, optimal staging in early ovarian cancer, laparoscopic radical hysterectomy, one-port surgery and robotic surgery were introduced. After three topics of endometrial cancer, laparoscopic surgery versus open surgery, role of lymphadenectomy and fertility sparing treatment, there was a special additional time for clinical trials in Asia. Finally, chemotherapy including neo-adjuvant chemotherapy, optimal surgical management, and the basis of targeted therapy in ovarian cancer were presented.
Journal of Gynecologic Oncology 09/2010; 21(3):137-50. · 1.49 Impact Factor
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ABSTRACT: Upregulation of syndecan-1, a member of the transmembranous proteoglycans that serves as a coreceptor for a wide pool of extracellular ligands, has been well documented in enabling the promotion of growth and invasion of endometrial cancer. As a step toward understanding a potential role for syndecan-1 in this process, we questioned whether syndecan-1 upregulates tumor-promoting characteristics, particularly, angiogenesis in an in vivo human xenograft tumor model.
Human syndecan-1 was stably transfected into human endometrial adenocarcinoma 1A cells, and resulting transfectants were subcutaneously grafted into athymic mice; their outcomes were examined with respect to the enhancement of tumor growth and angiogenesis by immunohistochemistry, immunoblotting, and zymography.
Overexpression of syndecan-1 promoted tumor growth concomitant with increased angiogenesis in tumor xenografts as evidenced by an increase in immunoreactivity for vascular endothelial growth factor and vascular endothelial cell marker CD34. Furthermore, zymographic studies revealed that syndecan-1 overexpression markedly enhanced activities of matrix metalloproteinases 2 and 9.
This is the first in vivo xenograft analysis providing evidence that supports that syndecan-1 has a critical role in carcinogenic progression, particularly, contributing to the development of angiogenesis and invasive phenotype in association with matrix metalloproteinases 2 and 9 activations in endometrial cancer.
International Journal of Gynecological Cancer 07/2010; 20(5):751-6. · 1.65 Impact Factor
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ABSTRACT: The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer.
A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed.
Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0+/-28.8 minutes, which showed significant difference from the 208.1+/-46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3+/-92.4 mL. This was significantly less than that of the laparotomy group (301.9+/-156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate.
Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.
Journal of Gynecologic Oncology 06/2010; 21(2):106-11. · 1.49 Impact Factor
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ABSTRACT: The aims of this study were to compare the diagnostic performance of sonohysterography (SH) with that of magnetic resonance imaging (MRI) in estimation of myometrial invasion and to evaluate the influence of SH on peritoneal cytologic results for patients with endometrial cancer.
Seventy-four patients with endometrial cancer were included. Sonohysterography and MRI were performed before surgery. All patients had complete staging procedures, including peritoneal cytologic analyses. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for SH and MRI.
The concordance rates of myometrial invasion for SH and MRI were 82.4% and 81.1%, respectively. The sensitivity, specificity, PPV, and NPV for identification of deep myometrial invasion were 64.7%, 87.7%, 61.1%, and 89.3% on SH and 70.6%, 84.2%, 57.1%, and 90.6% on MRI. Two patients (2.7%) were found to have positive results for malignant cells on peritoneal cytologic analyses.
Sonohysterography appears to be a useful preoperative method for predicting myometrial invasion, comparable to MRI.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2010; 29(6):923-9. · 1.25 Impact Factor
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ABSTRACT: To evaluate the efficacy of cold knife conization with electrocauterization and the feasibility of conservative management in patients with stage IA1 carcinoma of the cervix according to margin status after conization.
Medical and histopathological records of 108 patients with stage IA1 cervical carcinoma were reviewed retrospectively. Patients underwent cold knife conization with electrocauterization or conization followed by hysterectomy. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher grade lesion.
Forty patients underwent conization followed by hysterectomy; of 27 women with positive margins, 14 (35%) had a residual lesion. Sixty-eight patients underwent conization without further surgical intervention. Forty patients had a negative resection margin without recurrence, while 28 had a positive resection margin: positive exocervical (n=11), positive endocervical (n=17). Among these, there were 7 cases of recurrence: positive exocervical (n=1); positive endocervical (n=6).
Cold knife conization with electrocauterization appears to be a safe treatment option for patients with stage IA1 cervical carcinoma if careful follow-up is guaranteed for patients with CIN 3 exocervical resection margins. However, patients with CIN 3 endocervical resection margins should be managed surgically with repeat conization or hysterectomy.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2010; 109(2):110-2. · 1.41 Impact Factor
