ABSTRACT
Objective@#To evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC). @*Methods@#Systematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay. @*Results@#Nine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65–1.20; p=0.43) and 0.80 (95% CI=0.50–1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19–2.82; p=0.006), 3.38 (95% CI=1.71–6.70; p<0.001), 7.23 (95% CI=3.40–15.36; p<0.0001), and 1.22 (95% CI=0.50–2.96; p=0.67). @*Conclusion@#Despite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications.
ABSTRACT
Objective@#To investigate current evidence on oncological, fertility and obstetric outcomes of patients with stage I cervical cancer of 4 cm or larger undergoing fertility-sparing surgery (FSS). @*Methods@#Systematic review of studies including women affected by stage I cervical cancer ≥4 cm who underwent FSS. Main outcome measures: disease-free survival (DFS), overall survival (OS), pregnancy rate, live birth rate, premature delivery rate. @*Results@#Fifteen studies met all eligibility criteria for this systematic review, involving 48 patients affected by cervical cancer ≥4 cm who completed FSS. Three patients (6.3%) experienced a recurrence and one of them (2.1%) died of disease. The 5-year DFS rate was 92.4%. The 5-year OS rate was 97.6%. A significantly shorter 5-year DFS was reported for high-risk patients (G3, non-squamous histotype, diameter ≥5 cm) compared with low-risk (74.7% vs. 100%; log-rank test, p=0.024). Data about fertility outcomes were available for 12 patients. Five patients out of 12 (41.7%) attempted to conceive with an estimated pregnancy rate of 80%, a live birth rate of 83.3% and a premature delivery rate of 20%. @*Conclusion@#Women with high tumor grade, aggressive histology and tumor size ≥5 cm have a higher risk of recurrence. Oncologic outcomes are encouraging among low-risk patients; however, the lack of high-quality studies makes it difficult to draw any firm conclusions. Prospective multicentric clinical trials with a proper selection of inclusion/exclusion criteria should be conducted in women with low-risk factors, strong desire to preserve their fertility and high likelihood to conceive.
ABSTRACT
Systolic and diastolic function is impaired in patients with hypertensive heart disease. Systolic hypertension induces a succession of LV hemodynamic changes and can be regarded as a spectrum from maladaptive hypertophy to heart failure. The left ventricular hemdynamic changes that occur can be measured non-invasively by Doppler echocardiography. The aim of the study was to hemodynamically characterize the different phases of left ventricular [LV] function in patients affected by systemic hypertension [SH]. 95 normotensive healthy controls [group I] and 94 hypertensives [group II] were enrolled. Hypertensive patients were divided in two sub-groups according to echocardiographic signs of left ventricular hypertrophy [LVH]. Other echocardiographic parameters measured using tissue Doppler were Isovolumic Relaxation Time [IRT], isovolumic contraction time [ICT], and systolic motion [Sm]. Myocardial Performance Index [MPI] using Tissue Doppler Echocardiography [TDE] was defined in both the control group and the two hypertensive subgroups. Ejection fraction [EF] was also calculated in all participants. An increased MPI derived from the rise of isovolumetric relaxation time [IRT] was found in hypertensives without LVH [sub-group II-a], whereas isovolumetric contraction time [ICT] and Systolic motion [Sm] were unchanged. Hypertensive patients with LVH demonstrated more prominent increase of MPI, increase in IRT-prolongation, ICT-increase and Sm-decrease. The results obtained indicate impaired relaxation in sub-group II-a. On the contrary, a systolo-diastolic LV dysfunction was found in sub-group II-b. E.F decreased in this same sub-group of hypertensives in comparison with controls and sub-group II-a, as a sign of maladaptive LVH evolving towards heart failure. Doppler echocardiography appears able to distinguish the different forms and degrees of LV dysfunction in SH in relation to the different phases of the hypertensive disease process
ABSTRACT
In this study, ejection fraction% [EF%] and myocardial performance index [MPI] were recorded in 67 survivors at early, intermediate and late phase of acute myocardial infarction [AMI] .EF% was echocardiographically obtained by the Simpson's method; MPI was calculated using Tissue Doppler Echocardiography [IDE] derived from isovolumetric contraction time [ICT]; isovolumetric relaxation time [IRT] and ejection time [ET]. Results were compared with those obtained in 70 controls matched for age and sex.At hospital discharge [early evaluation], EF% was < 50% with significant increase in MPI in respect to the healthy controls [increase in ICT, significant reduction in ET and IRT was unchanged]. Six months later [intermediate evaluation], EF% still resulted in < 50%, MPI was slightly reduced with further increase in ICT and IRT in comparison to the early evaluation, and slight reduction in ET Finally, one year later [late evaluation], in spite of increase in EF>50%, MPI was still increased, with slight rise in ICT, almost normalization in ET, but more evident increase in IRT. The outcomes of MPI demonstrate that in post-AMI patients, late prevalent diastolic ventricular dysfunction occurs following an early systolic dysfunction. In this study, EF% appears to be less sensitive than MPI in defining late post-AMI left ventricular dysfunction. Finally,TDE seems to be more sensitive than conventional Doppler method in measuring MPI