Evaluation of complications of different operation modes in endometrial cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the postoperative complications in patients with endometrial carcinoma undergoing surgical operation in different modes and to explore the surgical safety of retroperitoneal lymph node dissection.</p><p><b>METHODS</b>Two hundred and nineteen patients with endometrial cancer treated in our hospital between May 2006 and April 2012 were included in this study. Their clinicopathological data were retrospectively analyzed. Among them, 65 patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO group), 54 patients received TAH and BSO and pelvic lymph node dissection (PLX group), and 100 patients received TAH and BSO and PLX and para-aortic lymph node dissection (PALX group). The surgical procedures and postoperative complications in different operation modes were analyzed.</p><p><b>RESULTS</b>The operation time was (114.84 ± 6.45) min in the TAH+BSO group, (182.94 ± 6.62) min in the PLX group, and (188.27 ± 5.77) min in the PALX group. The operation time in the TAH+BSO group was significantly shorter than that in the PLX and PALX group (P < 0.001). The amount of blood loss was (222.97 ± 38.42) ml in the TAH+BSO group, (311.80 ± 21.62) ml in the PLX group, and (391.51 ± 53.20) ml in the PALX group. respectively. The amount of blood loss in the TAH+BSO was significantly less than that in the PLX and PALX group (P = 0.009). Lymphedema of the lower extremities was the most frequent complication of retroperitoneal lymph node dissection and the incidence rate was 31.8%. Lymphocyst was the second frequent complication, with an incidence rate of 27.3%. The incidence rate of ileus in the PALX group was significantly higher than that in the PLX group (P = 0.001). There were no significant differences in the incidence rate of lymphedema, lymphocyst and deep vein thrombosis between the PALX and PLX groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Retroperitoneal lymph node dissection is an acceptable operation mode, although slightly increasing the incidence of ileus, compared with the TAH+BSO group. It is needed to choose appropriate indication in order to decrease the post-operative complications.</p>

Laparoscopic versus open surgery for D2 gastrectomy in advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer.</p><p><b>METHODS</b>The clinical data of 210 cases of laparoscopic gastrectomy and 180 cases of open gastrectomy for radical (D2) gastrectomy from May 2007 to Dec 2010 were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 206 cases underwent laparoscopic-assisted surgery with 4 conversions. Compared to the open group, the laparoscopic group was associated with less bleeding [(208±38) ml vs. (300±52) ml, P<0.05], quicker postoperative recovery of bowel function [(2.9±0.7) d vs. (3.9±1.8) d, P<0.05], shorter postoperative length of hospital stay[(12.8±6.2) d vs. (15.6±6.8) d, P<0.05], longer operative time [(258±42) min vs. (193±30) min, P<0.05]. The number of lymph node harvested was 20.5±1.9 in the laparoscopic group and 25.8±1.5 in the open group, and the postoperative complication rate was 8.1% (17/201) vs. 8.5% (15/180), and differences were not statistically significant (both P>0.05). The recurrence rate was 2.9% (6/210) and 2.8% (5/180), and the 3-year overall survival rate was 35.6% and 37.8%, the differences were not statistically significant (both P>0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic radical gastrectomy for gastric cancer is safe and effective, which can reach the same range of lymph node dissection as open gastric cancer surgery and similar survival rate.</p>

Significance of hepatic resection in the treatment of hepatic parenchymal metastasis of recurrent epithelial ovarian carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the validity of hepatic resection as a treatment option for hepatic parenchymal metastasis in patients with recurrent epithelial ovarian cancer.</p><p><b>METHODS</b>A retrospective review of the clinicopathological and follow up data of 39 patients treated in our hospital from 1996 to 2008 was conducted.</p><p><b>RESULTS</b>Ten patients underwent partial hepatic resection for metastatic ovarian cancer. All the 10 patients underwent surgery were with unilobar metastasis and the number of tumors was lower than 3(P < 0.05). No significant difference existed in patient age, the primary pathology type and tumor grade, the rate of optimal primary cytoreductive surgery, the disease free survival after the primary therapy and the serum CA125 level at the liver metastasis when compared with the 29 patients accepted salvage chemotherapy (P > 0.05). There were 7 patients who achieved optional surgery. The operation complication was 3/10 and there was no perioperative mortality. There were 2 patients without postoperative chemotherapy in the 8 recurrent patients with microscopic negative margins. The median recurrence time was 12 (5 - 24) months after the hepatic resection. The overall median survival periods after hepatic metastasis were 26 and 9 months and the 3-years cumulative survival rates were 60.0% and 16.8% for the optimal surgery patients including hepatic surgery and the salvage chemotherapy patients, respectively (P < 0.05).</p><p><b>CONCLUSION</b>Hepatic resection for liver metastatic epithelial ovarian cancer is safe and may achieve long-term survival in patients after optimal second cytoreductive surgery.</p>

Clinicopathological features and treatment of extremity bone metastasis in patients with endometrial carcinoma: a case report and review / 中华医学杂志(英文版)

Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woman with FIGO Stage IVb Grade 2 endometrial adenocarcinoma which metastasized to left lower extremity bone. She received an amputation of left lower extremity below the knees, and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by systemic chemotherapy, radiation therapy to the pelvis and progestational agent. She had a complete response to above treatments, and disease-free survival for 10 months. After recurrence, she received chemotherapy, radiotherapy and progestational agent once again. She had lived 56 months and is still alive by the time of report. Metastasis of endometrial carcinoma to extremity bone can rarely occur and should be considered when the patient with endometrial carcinoma complained of unexplained pain and swelling associated with extremity bone.

Impact of surgical resection extent on the prognosis of clinical stage I endometrial carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the impact of surgical resection extent and other clinicopathological characteristics on the prognosis in patients with clinical stage I endometrial carcinoma.</p><p><b>METHODS</b>The data of 135 surgically treated patients with clinical stage I endometrial carcinoma were retrospectively analyzed. Fifty-seven patients (group A) underwent simple hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The other 78 patients (group B) received sub-radical or radical hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The impact of surgery extent and other clinicopathological characteristics on the prognosis in patients with clinical stage I endometrial carcinoma were retrospectively analyzed.</p><p><b>RESULTS</b>There were no significant differences between two groups in the pathological stage, pathologic type, tumor grade, depth of myometrial invasion, vascular tumor emboli, ovary invasion, lymph node metastasis, positive peritoneal cytology and adjuvant therapy (P > 0.05). However, the patients in group A had a significantly shorter operating time (105 vs. 145 min), less estimated blood loss (150 vs. 300 ml) and blood transfusion (0 approximately 600 vs. 0 approximately 1200 ml), and a shorter postoperative hospital stay (12 vs. 13 days) than that in group B (all P < 0.05). The overall rates of post-operative complications were 15.8% in group A versus 26.9% in group B (P > 0.05). The recurrence rate in the group A was 14.0% versus 6.4% in group B (P > 0.05). Furthermore, the five-year survival rate in group A was 76.9% versus 85.8% in group B (P > 0.05). Multivariate analysis demonstrated that the important risk factors for clinical stage I endometrial carcinoma were deep myometrium invasion, high pathological grade, positive peritoneal cytology and ovarian metastasis, rather than surgical resection extent.</p><p><b>CONCLUSION</b>Surgery extent is not an important factor affecting the prognosis in patients with clinical stage I endometrial carcinoma, and extended surgery does not improve their survival. Therefore, excessive resection should be avoided in such cases.</p>

Impact of neoadjuvant chemotherapy on the survival of patients with stage IIIc and IV epithelial ovarian cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the survival of patients with stage IIc or IV epithelial ovarian cancer treated either with neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery or primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy.</p><p><b>METHODS</b>The clinical and pathological data of 160 patients with stage IIIc or IV epithelial ovarian cancer diagnosed pathologically between 1997 and 2005 were retrospectively reviewed. Forty-two patients were treated with NAC followed by cytoreductive surgery (NAC group) and 118 patients with PCS followed by adjuvant chemotherapy (PCA group).</p><p><b>RESULTS</b>The overall response rate of NAC group was 69.1%. No significant difference was observed between the NAC group and PCS group in operating time, intra-operative blood loss and units of blood-transfusion (P > 0.05). Optimal cytoreductive surgery was performed in 88.1% of NAC group versus in 71.2% of PCS group (P < 0.05). In those who had optimal cytoreductive surgery, the recurrent rate was 43.2% in NAC group versus 56.0% in PCS group without significant difference between two groups (P > 0.05). The disease-free survival and progression-free survival was 7 and 8 months in NAC group, which were significantly shorter than 13 and 18 months in PCS group (P < 0.05), however, the median overall survival (OS) was 34 months in NAC group versus 43 months in PCS group without significant difference (P > 0.05). In the patients with optimal cytoreductive surgery, it was 34 months in NAC group versus 48 months in PCS group without significant difference either between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Neoadjuvant chemotherapy followed by cytoreductive surgery can improve the rate of optimal cytoreductive surgery for the patients with stage IIIc or IVepithelial ovarian cancer, but this regimen may neither reduce the recurrent rate nor prolong the survival when compared with the patients treated with primary cytoreductive surgery followed by adjuvant chemotherapy.</p>