Postoperative acute renal failure in patients with gynecologic malignancies: analysis of 10 cases and review of the literature / 부인종양

OBJECTIVE: Postoperative acute renal failure (PO-ARF) is an important cause of mortality among surgical patients. Although there have been many reports on PO-ARF after cardiac surgery and liver transplantation, less is known about the risk of PO-ARF after gynecologic operations. We aimed to investigate the risk of PO-ARF on gynecologic malignancy operations. METHODS: 1,155 patients' medical charts were reviewed who underwent therapeutic surgery for gynecologic malignancies from January 1, 2005 to December 31, 2007, at the Asan Medical Center, Seoul, Korea. RESULTS: Of these, 10 patients, comprising 0.89% of those who underwent radical hysterectomies and 0.86% of those who underwent debulking operations, were diagnosed with PO-ARF. Their mean age was 61.9+/-10.1 years. Five patients had preoperative risk factors. Mean operating time was 360.8+/-96.2 minutes. Five patients experienced intra-operative hypotension and all patients were given blood transfusions during surgery. Eight patients underwent hemodialysis, with two continuing on dialysis to date. Only two patients fully recovered. CONCLUSION: Patients undergoing surgery for gynecologic malignancies may be at high risk for PO-ARF, because of old age, long operation times, and profuse bleeding. It is necessary to monitor these patients for postoperative renal function and urine output. If a postoperative oliguric state is detected, aggressive volume expansion should be started immediately, followed by hemodialysis.

The effect of lymphadenectomy on the survival rate of clinical stage I endometrial cancer / 부인종양

OBJECTIVE: To evaluation of the effect of pelvic or paraaortic lymphadenectomy on survival rates in the management of clinical stage I endometrial cancer METHODS: A retrospective analysis was performed on a total 303 clinical stage I endometrial cancer patients from 1989 to 2004 at Asan Medical Center. Two hundred-sixty-three (86.8%) underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic or paraaortic lymphadenectomy, while forty (13.2%) underwent a total hysterectomy and bilateral salpingo-oophorectomy only. Characteristics of patients and 5-year survival rate of each patients group were analyzed. RESULTS: Seventeen (6.5%) showed lymph node metastases and overall 5-year survival rate of clinical stage I endometrial cancer was 96.9%. The 5-year and 10-year survival rate of a group with lymphadenectomy were 96.4% and 86.6%, and those of a group without lymphadenectomy were 100% and 75.2%, respectively (p=0.48). The 5-year survival rate of a group with positive lymph nodes was 73.3%, that of a group with negative lymph nodes was 97.7% (p<0.05). CONCLUSION: The complete staging operation including lymphadenectomy did not improve the survival rates in a group with lymphadenectomy significantly. But the debates regarding the necessarity of lymphadenectomy in clinical stage I endometrial cancer still remains and a large randomized prospective study is needed.

Relationship between long-term use of tamoxifen and endometrial cancer in patients with breast cancer / 부인종양

OBJECTIVE: To assess the relationship between long-term use of tamoxifen and endometrial cancer in patients with breast cancer. METHODS: A retrospective review of the 897 patients treated with tamoxifen after surgery at Asan Medical Center for primary breast cancer between January 1997 and December 2002 was done. All patients had received tamoxifen 20 mg/day for longer than 1 year. In this case-control study, there were 5 patients with endometrial cancer and 15 patients without endometrial cancer. Following variables including age, parity, body mass index, medical illnesses (e.g., diabetes, hypertension), family history of breast and gynecologic cancer, and duration of tamoxifen treatment were analyzed. RESULTS: The mean duration of tamoxifen treatment was 59 months in patients with endometrial cancer and 33 months in patients without endometrial cancer (p=0.003). There was no difference between two groups in other variables. CONCLUSION: It seems that long-term use of tamoxifen is associated with secondary endometrial cancer in primary breast cancer patients.

Clinicopathologic analysis of patients with uterine papillary serous carcinoma / 부인종양

OBJECTIVE: The aims of this study were to identify clinical and pathologic characteristics of patients with uterine papillary serous carcinoma (UPSC) and to evaluate the overall survival. METHODS: Sixteen patients with FIGO stage I-IV UPSC who were surgically staged except one at the Asan medical Center between 1995 and 2004 were identified. For each patient, medical records, pathology reports and treatment modality were reviewed. The Kaplan-Meier method was used to generate survival data. RESULTS: There were 8 patients with stage I disease, 1 with stage II, 3 with stage III, and 4 with stage IV. The median age at the time of diagnosis was 64 years (range, 38-81 years). It occurred in 14 postmenopausal women who usually present with abnormal vaginal bleeding. Obesity, diabetes, hypertension, or a history of hormone replace therapy, known as risk factor of endometrial cancer, were not usually seen. Of the 15 patients who had surgical staging, 12 patients received adjuvant therapy, 2 patients no adjuvant therapy and 1 patient chemotherapy before and after surgery. 1 patient with advanced stage received chemotherapy without surgical staging. The 3-year survival rate was 21.4% and the median survival time for patients with early stage and advanced stage was 31.0 and 14.6 months respectively. CONCLUSION: In this patients with UPSC, there was a high proportion with abdominal metastasis and poor prognosis compared to endometrioid adenocarcinoma. Therefore, complete surgical staging like in case of ovarian cancer is vital in determining their prognosis and vigorous adjuvant therapies are required.

FIGO stage IB clear cell carcinoma and adenocarcinoma of uterine cervix / 부인종양

OBJECTIVE: To compare the clinical features and prognosis of patients with clear cell carcinoma (CCA) and adenocarcinoma (ACA)of the uterine cervix. METHODS: We have performed retrospective clinical study on 5 patients diagnosed as CCA and 55 patients diagnosed as ACA from November 2000 to December 2004. Demographic data, pathologic findings, treatments and survival time were reviewed. RESULTS: The mean age of patients with CCA and ACA was 31.5 or 30.4 years respectively and all patients were FIGO stage IB. Among the 5 patients of CCA, 4 patients have underwent radical hysterectomy (RH) and one patient have treated with radiotherapy only. Among the 55 patients of ACA, 50 patients have underwent RH and pelvic lymph node dissection (PLND), paraaortic lymph node sampling (PALNS) and the other have underwent only bilateral salphingoophorectomy (BSO) and PLND. There are no significant difference on age, tumor size, depth of invasion, parametrial involvement, vaginal involvement and pelvic lymph node metastasis (p>0.05). The mean survival time of CCA and ACA was 42.5 and 43.2 months respectively (p=0.32). The recurrent rate of CCA and ACA are 25% and 5.45% (p=0.30) and the disease free survival of CCA and ACA are 18.7 months and 43.6 months respectively (p=0.054). CONCLUSION: There were no significant difference on clinical features and prognosis of FIGO stage Ib CCA and ACA. Large scaled prospective multicenter trials will be able to provide a decision for prognosis and proper therapy.