Long term complications after radical hysterectomy with pelvic lymphadenectomy.

OBJECTIVE: To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy. MATERIAL AND METHOD: A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema. RESULTS: Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema. CONCLUSION: Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.

Outcome of ovarian cancer patients who underwent incomplete surgical staging.

OBJECTIVE: To determine outcomes of patients with early stage epithelial ovarian cancer (EOC) who underwent incomplete surgical staging with those who had complete surgical staging. MATERIAL AND METHOD: Retrospective chart reviews were performed on early EOC (FIGO Stage I-II) patients who had registered in the Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital between 1994 and 2003. Two groups of patients were identified, patients who underwent incomplete surgical staging (n = 51) and those who had complete surgical staging (n = 50). Recurrence rate and disease free interval were demonstrated. The 5 years survival was estimated using Kaplan-Meire method RESULTS: Between 1994 and 2003, 101 patients presented with early EOC. The median age at presentation was 48 years (range, 24-86). Histology distribution showed clear cell carcinoma in 35 cases (34.7%), mucinous carcinoma in 25 cases (24.8%), endometrioid carcinoma in 22 cases (21.8%), mixed epithelial cancer in 10 cases (9.9%), and serous carcinoma in nine cases (8.9%). Fifty-one cases (50.5%) underwent incomplete surgical staging initially. Recurrent rate in the incomplete surgical staging group was 11.8% compared with 14% in complete surgical staging group (p = 0.257). At the median follow up of 60 months, 50.5% of patients survived The 5 years survival rate of incomplete surgical staged was 82.4% and 94.6%, in complete surgical staged (p = 0.404), when focused in the subgroup analysis, incomplete staging group with histology grade 3 compared to complete staging group. They had overall 5 years survival rate 81.1% vs. 88.4% (p = 0.037). Patients with stage II who underwent incomplete staging or complete staging had an overall survival rate 63% vs. 92.3% (p = 0.012). CONCLUSION: In King Chulalongkorn Memorial Hospital, overall outcome of patients with early stage epithelial ovarian cancer who had incomplete staging was no different from patients who had complete staging. However, patients who had incomplete staging with grade 3 or stage II tended to have less recurrent rate and survival time.

Transient cortical blindness during chemotherapy (PVB) for ovarian germ cell tumor.

A 17 year-old female with stage IIIc endodermal sinus tumor of the ovary developed transient cortical blindness and severe hypertension after 5 cycles of PVB regimen consisting of cisplatin, vinblastine and bleomycin. Clinical and radiological findings were compatible with Posterior LeukoEncephalopathy (PLE). Her visual acuity and blood pressure completely recovered within a few days after supportive treatment with antihypertensive drug. This condition is unpredictable but it can be reversible without long term sequelae. Most reports suggested that this rare toxicity was from cisplatin therapy. However, the exact pathophysiogenesis of this condition was not known precisely. Prompt reduction in blood pressure and withdrawal of immunosuppressive agents might lead to rapid reversal of this syndrome and prevent permanent brain damage.

Outcome of recurrent and persistent disease of malignant ovarian germ cell tumor: a retrospective analysis at King Chulalongkorn Memorial Hospital.

Malignant ovarian germ cell tumor has one of the most successful treatment outcomes in gynecological malignancy. More than 80% of the patients can be cured from this rare type of tumor However, patients with recurrent and persistent disease after primary treatment are still the problem of management. The present study has reviewed the treatment outcome of this cancer in King Chulalongkorn Memorial Hospital during the 12 years periodfrom 1993 to 2004. The overall cases of malignant ovarian germ cell tumor were 71 cases, 8 cases had recurrent disease after primary treatment and all cases received platinum-based chemotherapy for the salvage treatment. All patients in this group received long-term survival with median survival time of 87 months. In patients with persistent disease, 10 cases that resisted to first line adjuvant chemotherapy. Cisplatin and Etoposide regimen was applied as second line treatment, but none of these patients received long term response. The survival outcomes in these 2 groups are significantly different. The overall survival from the treatment of malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital was 85.1%. In conclusion, the outcome of treatment in patients with recurrent disease after non-platinum chemotherapy is excellent. Salvage therapy in this group should contain platinum-based regimen. Patients whose disease persisted after platinum-containing regimen had a poor survival outcome.

Malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To determine the frequency, characteristics, treatment and outcome of patients with malignant ovarian germ cell tumor (MOGCT) in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000. STUDY DESIGN: Retrospective descriptive study MATERIAL AND METHOD: All patients with malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000 were analyzed by the characteristics of patients, treatment and outcome. RESULTS: Sixty-six patients with MOGCT were demonstrated in that period with a mean age of 22.6 years old. Most of the patients were nulliparous and premenopausal status. Primary surgery was done in all patients. Forty-two patients (63.6%) received conservative surgery. Eight patients received no adjuvant treatment after surgery due to stage 1A dysgerminoma and immature teratoma stage I grade I. Fifty-six patients received chemotherapy for adjuvant treatment. VAC regimen was given in 27 cases (40.9%) and PVB regimen was given in 25 cases (37.9%). Salvage therapy in the patients with persistent and recurrent disease was treated in 9 patients, who received a platinum-base of regimen. Two-year survival was 88% with the median time to follow up 24 months. Overall five-year survival in the present study was 85%. CONCLUSION: MOGCT in King Chulalongkorn Memorial Hospital had clinical characteristics similar to other studies in malignant ovarian germ cell tumor Treatment by VAC regimen still has benefit in selected group.