Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma.

OBJECTIVE: This study aims to identify favorable preoperative characteristics and examine the impact of secondary cytoreductive surgery on survival for patients with recurrent epithelial ovarian carcinoma. METHODS: Patients who underwent cytoreductive surgery for recurrent epithelial ovarian cancer were identified in our surgical database for the period 1988-2004. Patient charts were reviewed and data collected regarding patient demographics, surgical management, preoperative evaluation, perioperative complications, and oncologic outcome. RESULTS: Eighty-five patients met eligibility criteria. Preoperative factors that correlated with improved survival were disease-free interval of greater than 12 months (por=1 cm (p CONCLUSION: When selecting patients for secondary cytoreduction, the most significant preoperative factors are disease-free interval and success of a prior cytoreductive effort. Once secondary cytoreductive surgery is attempted, the most important factor for improved survival is optimal cytoreduction. Of equal importance is counseling regarding the significant risk for bowel surgery, colostomy, and complications

Superior vena cava syndrome during chemotherapy for stage 3c fallopian tube adenocarcinoma.

BACKGROUND: Superior vena cava syndrome is most often encountered in patients with malignancies. The diagnosis constitutes an oncologic emergency with prompt treatment indicated to manage the acute symptoms. There are few reports describing the syndrome in patients with gynecologic malignancies and central venous catheters. Management has included treatment of the metastatic disease and anticoagulation/thrombolysis with catheter removal early in therapy. CASE REPORT: The case described is the first report of a patient with fallopian tube carcinoma complicated by SVC syndrome. The complication was attributed to an implanted venous access port being utilized to give adjuvant combination chemotherapy. CONCLUSIONS: Superior vena cava syndrome is rarely encountered in gynecologic oncology patients and constitutes a medical emergency. When encountered in the setting of an implanted catheter, thrombolysis and anticoagulation is an alternative to catheter removal in selected patients

Delay in treatment of invasive cervical cancer due to intimate partner violence.

BACKGROUND: Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. CASE: A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. CONCLUSIONS: Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs

Sepsis Leading to Emergent Hysterectomy After Uterine Artery Embolization.

Background: Uterine artery embolization (UAE) is a minimally invasive radiologic procedure in which microspheres of polyvinyl alcohol particles are injected into the uterine artery to occlude blood flow. This paper reports a case of life-threatening sepsis requiring emergent hysterectomy following the therapeutic use of UAE to treat uterine hemorrhage. Case: This is a 42-year-old patient who had been referred to our center for uterine hemorrhage and was treated with UAE. The patient subsequently developed pyometria, leading to a lifethreatening gram-negative septicemia. She ultimately required an emergent surgery. Conclusion: This case demonstrates that uterine infection and sepsis may develop following uterine artery embolization for leiomyomata uteri. Early identification and treatment with intensive care unit (ICU) management, antibiotics, and, possibly, surgical intervention are important components in the management of sepsis following UAE. (J GYNECOL SURG 21:173

Upper vaginectomy for the treatment of vaginal intraepithelial neoplasia.

OBJECTIVE: The purpose of this study was to evaluate the use of upper vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN). STUDY DESIGN: We conducted a retrospective review. Between August 1, 1985 and April 30, 2004, 105 patients were identified who had undergone upper vaginectomy for VAIN. RESULTS: Thirty-six patients had previously been treated for VAIN. Mean operative time and estimated blood loss were 55 minutes and 113 mL, respectively. Ten percent had intraoperative complications. Twenty-three (22%) patients had negative findings on final pathologic examination, and invasive cancer was found in 13 (12%) patients. Four patients had postoperative complications. Follow-up was available in 52 patients; 46 (88%) remain without recurrence at a mean follow-up of 25 months. CONCLUSION: In our patients, upper vaginectomy was efficacious for the treatment of VAIN. The procedure led to the diagnosis of occult invasive cancer in 12% of these women

The Incidence of Pulmonary Embolism after Gynecologic Oncologic Surgery.

5089 Background: Pulmonary embolism is a major morbidity following surgery for malignancy. The purpose of this study was to determine the risk of developing a pulmonary embolism in patients having major abdominal surgery during the peri and post-operative period (6 weeks) and to compare cancer and benign subgroups. Methods: The H. Lee Moffitt Cancer Center database was reviewed retrospectively to identify gynecologic oncology patients who had surgery between July 2001-June 2003. These patients were sorted by major or minor procedure, and further by malignant versus benign diagnosis. Pulmonary embolism in post-operative patients was determined from the time of surgery through 6 weeks post-operatively. The diagnosis of pulmonary embolism was confirmed by either a CTPA or V/Q scan. All patients received prophylaxis with sequential compression devices (SCD) and early ambulation. Benign and malignant groups were compared with chi square analysis. This study was IRB approved. Results: A total of 1374 patients were identified between July 2001-June 2003. Chart review identified 1009 major cases and 365 minors. Of the 1009 major surgical cases 836 were exploratory laparotomies with 523 cancer cases and 313 benign cases. In patient with a diagnosis of cancer, 23/523 (4.4%) were diagnosed with pulmonary embolism. In patients with a benign diagnosis, 1/313(0.3%) were diagnosed with a pulmonary embolism. The difference between those with and without cancer was determined to be significant. (p=.0006) Conclusion: We determined the rate of post-operative pulmonary embolism in patients with cancer who have major abdominal surgery to be 4.4%. This rate persisted despite vigorous use of SCD’s and early ambulation. Preventative measures are needed in this subgroup of patients to attempt to decrease this high rate of post-operative pulmonary embolism

Pulmonary embolism after major abdominal surgery in gynecologic oncology.

OBJECTIVE: To estimate the incidence and prognostic significance of postoperative pulmonary embolism after gynecologic oncology surgery. METHODS: All patients who underwent gynecologic oncology surgery from June 2001 to June 2003 and received venous thromboembolism prophylaxis with only intermittent pneumatic compression and early ambulation were identified from our database. Patients were grouped by procedure (major/minor abdominal or nonabdominal surgery), diagnosis (malignant/nonmalignant), and cancer subtype. Groups were compared by chi2 analysis and logistic regression. Survival was studied with the Kaplan-Meier method and Mantel-Byar test. RESULTS: A total of 1,373 surgical patients were identified over the 2-year period, including 839 major abdominal surgery cases and 534 minor abdominal surgery or nonabdominal surgery cases. Of the 839 patients, 507 had a diagnosis of cancer, and 332 were benign. The incidence of pulmonary embolism among cancer patients undergoing major abdominal surgery was 4.1% (21/507) compared with 0.3% (1/332) among patients undergoing major abdominal surgery with benign findings (P \u3c .001, odds ratio [OR] 13.8, 95% confidence interval [CI] 1.9-102.1). The incidence of pulmonary embolism among patients undergoing minor/nonabdominal surgery was 0.4% (2/536). Cancer diagnosis and age more than 60 years were identified as risk factors for pulmonary embolism (P = .009, OR 0.31, 95% CI 0.13-0.74). One-year survival for patients with and those without pulmonary embolism were 48.0% +/- 12% and 77.0% +/- 2%, respectively. CONCLUSION: Patients with cancer undergoing major abdominal surgery and using pneumatic compression for thromboembolic prophylaxis had a 14-fold greater odds of developing a pulmonary embolism compared with patients with benign disease. Randomized studies are needed to determine whether additional prophylactic measures may benefit this high-risk group of patients. LEVEL OF EVIDENCE: II-3