A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Çukurova technique)

PubMedID: 28720378Objective Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: R0) is one of the main factors affecting survival [1–3. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases. Methods A 55 year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intra-abdominal disease. Upon laparotomy, omental cake adherent to pelvis-filling mass, disseminated implants on the diaphragm, meso of the descending colon and small intestine were observed. The mass invaded the rectosigmoid colon, uterus, adnexa and the bladder resulting in frozen pelvis. Palpable retroperitoneal pelvic and para-aortic lymph nodes were detected. On the other side, stomach, anti-mesenteric surfaces and mesentery root of the small bowel were tumor-free. Hence, upon these perioperative and preoperative imaging findings, complete cytoreduction was thought to be achievable. Therefore, primary cytoreduction was performed. Total omentectomy, hysterectomy with bilateral salpingo-oophorectomy, rectosigmoid low anterior resection and retroperitoneal lymphadenectomy were performed. With the assistance of an injector needle connected to the insufflator tube (as in laparoscopic surgery), carbon dioxide gas was blown into the right retroperitoneal area and subsequently peritoneum was rapidly stripped up to the right diaphragm. The same procedure was then applied to the diaphragm and meso of the bowels, respectively. Owing to this technique, total stripping of all involved peritoneal surfaces was clearly facilitated and R0 goal was reached. Results Gas insufflation caused convenient detachment of the peritoneal surfaces along their anatomical line which led to concluding the stripping procedures easily, rapidly and safely without bleeding. Thus, according to our experience, about 10 to 15 min per procedure are saved in such cases. Potential complications of CO 2 gas used here are not superior to those in transperitoneal or retroperitoneal laparoscopic procedures. During the operation, patient was followed-up for potential complications such as subcutaneous emphysema and CO 2 gas embolism.Thus, hourly blood gas was monitored. Another potential complication is injury of the vessels while inserting the needle which can be avoided by cautious inserting under the peritoneal surfaces superficially and using transillumination. In case such injuries happen, tamponing is a sufficient measure. In our serial, no perioperative complications belonging to this technique were encountered. However, long term outcomes such as precise time difference, difference in blood loss, complication rates, adhesions, morbidity associated with this technique and its impact on survival of the patients with advanced ovarian cancer have yet to be investigated. Therefore, a prospective study to validate this technique's long-term usefulness has been initiated in our clinic. Conclusion We believe that this practical and effective technique will offer significant improvements in efforts to achieve complete cytoreduction. © 2017 Elsevier Inc

Ovarian pregnancy after intrauterine insemination: A case report [Intrauterin inseminasyon sonrasi ovaryan gebelik: Olgu sunumu]

Ectopic pregnancy is defined as implantation of a fertilized ovum in an area other than endometrial lining of uterus. The most common localization for ectopic pregnancy is the ampuller portion of the tuba uterina, but it can be to exist anywhere in the intraabdominal space. Ovarian pregnancy is a rare form of ectopic pregnancy and represents 1-3% of all the ectopic pregnancies. The incidence is 1 per 7000 to 1 per 60,000 deliveries Pregnancy was determined at the right ovary after intrauterine insemination(IUI). Laparoscopy performed and ectopic ovarian pregnancy was removed by protecting the ovary

Unusual adnexal masses in adolescents and young women: Massive ovarian oedema

PubMedID: 23919873[No abstract available

Prognostic factors determining recurrence in early-stage endometrial cancer

PubMedID: 23327055Objective: This study aimed to determine the clinically important prognostic factors for loco-regional or distant recurrence in early-stage endometrial cancer. Materials and Methods: This study complied with the Declaration of Helsinki, and the local ethics committee approved the study. Cases who underwent primary surgery of early-stage endometrial cancer at the Institution from 2000 to 2012 were reviewed retrospectively. Patients who did not detect recurrence were classified as group 1 (n = 200); those who detected recurrence were classified as group 2 (n = 23). Clinically prognostic factors were evaluated by univariate analyses. Results: The average age for group 2 (LUSI) was 63.8 years (p = 0.0001). Patients with grade 3 histology were all detected within group 2 (p = 0.0001). Endometrioid adenocarcinoma displaying squamous differentiation was found with a rate of 58.3% in group 2 (p = 0.0001). Lower uterine segment involvement (LUSI) and lymphovascular space invasion (LVSI) rates were 86.9% in group 2 (p = 0.0001). The rate of tumor size > 2 cm was 56.6% in group 2 (p = 0.0001). The median depth of myometrial invasion (DMI) was 5.1 mm (p = 0.034) and the average in myometrial thickness was 14.5 mm in group II (p = 0.0001). The percentage of myometrial invasion was 35.8% in Group II (p = 0.0001). Tumor free-distance was 9.4 mm in group II (p = 0.0001). Conclusion: Age and clinicopathological parameters of the tumours are significant predictors for recurrence in early-stage endometrial cancer

Osseous metaplasia of the endometrium

PubMedID: 22766572Osseous metaplasia of the endometrium is very rare finding, and usually these cases presented with secondary infertility. Other symptoms are pelvic pain, dyspareunia, menstrual irregularities, vaginal discharge and the passage of bony fragments in menstrual blood. Suspicious lesion could see by hysterosalpingography or by ultrasonography; however, conclusive diagnosis and treatment tool is hysteroscopy. The aetiology is unknown, but theories include retained fetal bone and osseous metaplasia of endometrial tissue. We present a patient with osseous metaplasia who had treated with hysteroscopy

Adenosine deaminase activity in patients with ovarian neoplasms

PubMedID: 22395862Purpose The aim of this study was to investigate the serum and peritoneal fluid adenosine deaminase (ADA) activity in patients with benign and malignant ovarian neoplasms. Methods This is a prospective cross-sectional study performed in Cukurova University, Department of Gynecologic Oncology. Eighty-four patients with ovarian mass were included in this study within 13 months. The levels of serum and peritoneal fluid ADA levels were measured and compared in patients with benign and malignant ovarian neoplasms and also low- and high-grade malignant tumors. Results Serum and peritoneal fluid ADA levels were found to be significantly higher in patients with ovarian cancers as compared with benign ovarian tumors (p = 0.001). Additionally, ADA levels were found to be significantly different according to the histopathological subtypes and grade of ovarian cancers. However, there was no significant difference for ADA levels between the benign and low-grade malignant tumors. There was an important correlation between the peritoneal fluid and serum ADA levels. Conclusions Serum and peritoneal fluid ADA levels were found to be higher in malignant ovarian neoplasms. This finding may be useful to understand the biochemically characteristics of malignant ovarian tumors and ADA may be a useful biomarker in diagnosis and management of ovarian tumors. © 2012 Springer-Verlag

Clinicopathological features and prognostic factors of the uterine sarcomas: 20 Years of experience at Çukurova University

PubMedID: 25556269Objective: Uterine sarcomas (US) are rare, malignant, and aggressive tumors of the uterus. In this study the authors aimed to evaluate retrospectively the clinical and pathologic features and to investigate the prognostic factors of the US patients who were treated in their department in the last 20 years. Materials and Methods: The archive files, medical, and pathological records of the 132 US patients who were operated on and regularly followed up in the clinic between March 1991 - March 2011 were reviewed. Clinical features, operation characteristics, pathological findings, adjuvant therapies, and follow-up data of the patients and their effects on survival were investigated. Analysis of disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier and Cox regression tests. The p value was taken < 0.05 to maintain the statistical significance level for all results. Results: Seventy of the patients were diagnosed with leiomyosarcomas (LMS), 33 were with carcinosarcomas, 12 were with endometrial stromal sarcomas (ESS), nine were with undifferentiated endometrial sarcomas, five were with adenosarcomas, and three were with botryoid rhabdomyosarcomas. The average patients' age was 53,7±12,6 (17-78). Aboutywo-thirds of the patients were in postmenopausal and one-third were in premenopausal period. Vaginal bleeding was detected as the most common reason for patients' admission (68,9%). All cases underwent surgery and a procedure of total abdominal hysterectomy + bilateral salpingo-oophorectomy (TAH + BSO) was performed for most of them (88%). The mean duration of follow-up was 36 months (4-198). The two- and five-year OS rates were 65% and 36%, respectively, with a median time of 37 months (95% CI, 28-45). The two- and five-year DFS rates were 59% and 33%, respectively, with a median time of 29 months (95% CI, 18-40). Conclusion: As a result of multivariate analysis, while age, stage, lymphovascular space invasion (LVSI), and lymphadenectomy were found to be independent prognostic factors affecting DFS, only stage was detected as an independent prognostic factor for OS

The relationship between ovarian volume and serum CA-125 levels

PubMedID: 24984541Purpose: The aim of this study was to investigate the relationship between ovarian volume and serum CA-125 levels. Materials and Methods: Serum CA-125 levels and ovarian volume were compared among the cases with benign ovarian neoplasms, primary epithelial ovarian cancer (EOC), controlled ovarian hyperstimulation, and ovarian hyperstimulation syndrome (OHSS). Also, the correlation between CA-125 levels and ovarian volume were evaluated in the presence of peritoneal fluid and/or peritoneal carcinomatosis. Results: Although ovarian volume was not different among the groups, CA-125 levels were higher in the cases with EOC than with benign ovarian tumors (p = 0.001). Baseline CA-125 levels were not found to have increased while ovarian volume went up with controlled hyperstimulation in the infertile group (p = 0.555). However, uncontrolled hyperstimulation of the ovaries and the presence of peritoneal fluid caused an increase in the levels of CA-125 (p = 0.001). There was no correlation between ovarian volume and CA-125 levels in the cases with malignant ovarian tumors (r = 0.083). Conclusions: The results of this study have confirmed that CA-125 is a peritoneal marker and increased ovarian volume with benign ovarian neoplasms or controlled hyperstimulation does not increase CA-125 levels in the same way. The presence of peritoneal carcinomatosis and/or peritoneal fluid seems to be an important factor for high CA-125 levels in patients with epithelial ovarian cancer (EOC)

Laparoscopic surgery for low, intermediate and high-risk endometrial cancer

PubMedID: 30740955Objective: The aim of the present study was to compare the long-term outcomes of the laparotomy (LT) and laparoscopic surgery and to evaluate the results according to low, intermediate, and high-risk groups of endometrial cancer (EC). Methods: We identified 801 patients with EC and these patients were classified as group 1, who underwent LT (n=515); and group 2, who underwent laparoscopy (LS) (n=286). Patient’s demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion, myometrial invasion, lymph node involvement, and risk groups, peri- and post-operative outcomes, and survival outcomes were compared between the groups according to risk classification. Survival outcomes were assessed using Kaplan-Meier method. Results: The demographic characteristics of both groups were similar except age. Shorter hospital stay and fewer complications were observed in group 2. The overall survival (OS) were similar in the low, low-intermediate, high-intermediate and high-risk groups (p=0.269, 0.476, 0.078, and 0.085; respectively) for LS compared to LT. The covariate analysis revealed that the death and recurrence risks were approximately twice higher in the LT group than in the LS group (odds ratio [OR]=1.9; 95% confidence interval [CI]=1.2-3.1 for OS; OR=2.0; 95% CI=1.2-3.3 for disease-free survival). Conclusion: The results of our study support the well-known positive aspects of LS as well as safe and effective use in cases of intermediate and high-risk EC. © 2019. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

Clinicopathological features and prognostic factors of ovarian sex-cord stromal tumors

Objective: In this study the authors aimed to evaluate the clinicopathological features and prognostic factors of sex-cord stromal tumors (SCST). Materials and Methods: The medical and pathological records of patients with SCST who were operated and followed up in a tertiary university clinic between March 1991 and October 2013 were reviewed. Clinical, surgical and pathological characteristics, follow-up data of the patients, and the effect of this parameters on survival were investigated. Results: One hundred and three women with a mean age of 45±12.8 (range 16-78) were included. Histopathological diagnosis was found as granulosa cell tumor in 95 (92.2%), Sertoli-Leydig cell tumor (SLCT) in six (5.8%), Leydig cell tumor (LCT) in one, and Sertoli cell tumor (SCT) in one of the cases. Sixty-eight percent of the patients had Stage I, 8.7% Stage II, 15.5% Stage III, and 6.8% had Stage IV disease. On univariate analysis; stage, age greater than 50 years, suboptimal cytoreduction, bilaterality, and non-BEP chemotherapy were determined as poor prognostic indicators. On multivariate analysis, age, stage, and optimal cytoreduction were found to be independent prognostic factors for overall survival, while only optimal cytoreduction was detected as an independent prognostic factor for disease-free survival (DFS). Fertility-sparing surgical procedures (FSS) were performed in 22 patients (21.4%). Among these 22 cases 16 (72.7%) pregnancies (13 resulted in a live birth and three in abortion) were achieved through a median period of 72 months (24-240). Conclusion: It was concluded that the most effective parameters on survival were stage and optimal cytoreduction. FSS is an effective approach for preserving the reproductive functions of young patients with SCST