Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study / 부인종양

OBJECTIVE: To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. METHODS: From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. RESULTS: Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. CONCLUSION: Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.

Importance of Conservative Management in Borderline Malignancy of the Ovary / 대한부인종양콜포스코피학회잡지

OBJECTIVES: To clarify the clinicopathologic features of borderline malignancy of the ovary and analyze the treatment and survival characteristics through the study of our cases. Study METHODS: 102 patients with borderline tumors of the ovary, aged from 14 to 79 years, treated between 1982 and 1999 at Seoul National University Hospital, were analyzed retrospectively for clinicopathologic features. Most informations about stage, treatment modality and prognosis were obtained by hospital record or contacting patient with telephone. RESULTS: There were 77 patients (75.5%) with stage Ia, 5 stage Ib, 11 stage Ic, 4 with stage II and 5 with stage III by the classification of FIGO. 72 patients (70.6%) were mucinous type and 28 (27.5%) were serous type, 1 endometrioid type, 1 mixed. Total abdominal hysterectomy, bilateral adnexectomy, and omentectomy were performed in 43 (42.2%) patients and fertility saving surgery in 43 patients(cystectomy in 11 patients, USO in 32 patients). Twenty two patients (21.6%) were treated with postoperative adjuvant chemotherapy. The median duration of follow up was 54.0 months (1-204 months) and 6 patients developed recurrence after several years from the primary operation. The ten-year eumulative survival rate was 92.2% and the only independent prognostic factors evaluated by Cox analysis in regards to corrected survival were the FIGO stage (p=0.0197). There was no difference in the ten-year survival rate between surgery types - conservative surgery versus full surgical staging. And there was no difference in the 10-year survival rate between treatment groups - surgery only versus surgery followed by adjuvant chemotherapy. CONCLUSIONS: FIGO stage is the only independent prognostic factor in the borderline ovarian tumors. There was no difference in the 10-year survival rate of barderline ovarian tumors between surgery alone versus surgery followed by adjuvant chemothearpy. The slow clinical course, low recurrence rate and good prognosis in our patients explained again the reason for therapeutic approach relying on surgery alone.

The Inefficiency of Routine Performance of a Batch of Tests in the Clinical Staging Work-up of Cervical Carcinoma / 대한암학회지

PURPOSE: This study was to evaluate the efficiency of routine performance of a batch of tests in the clinical staging work-up of cervical carcinoma. MATERIALS AND METHODS: The medical records were reviewed for 1,393 consecutive cervical carcinoma patients who underwent pretreatment staging work-up in Seoul National University Hospital from January 1988 to December 1997. The impression stage -which is designated ten tatively by the findings of pelvic examination and biopsy-, the results of staging work-up, and the finally allotted FIGO clinical stage were reviewed. The annual trend of stage distribution and the positive yields of tests were evaluated. RESULTS: Annual trend shows that Ia is increasing. The positive yield of chest x-ray was 0.22% (3/1, 379; Ib: 1, IIa: 1, IIb: 1), intravenous pyelography (IVP) 2.50% (31/1, 242; Ib: 2, IIa: 4, IIb: 17, IIIb: 8), cystoscopy 0.55% (6/1, 093; IIb: 4, IIIb: 2), and proctosigmoidoscopy 0.086% (1/1, 157; Ib: 1). After completing the staging work-up, 29 patients (2.08%) were upstaged. The routine performance of IVP in impression stage Ia and cystoscopy in impression stage IIa or less was considered inefficient. The routine performance of proctosigmoidoscopy was considered inefficient because of its very low yield. CONCLUSION: The selective performance of tests according to the impression stage during staging work-up is recommended to minimize the unnecessary treatment delay, cost, and patients' discomfort.

Study on the Abnormal Karyotyping Detected by Cordocentesis in Korean Women / 대한산부인과학회잡지

Fetal umbilical blood was obtained by cordocentesis guided by transabdominal USG in 276 fetuses at more than 14 weeks gestation. Fetal daryotyping was carried out in 7 cases of cordocentesis-failed group by cardiocentesis (3 cases) and amniocntesis (4 cases). The 46 cases in 263 fetuses revealed abnormal karyotypes (17.5%). There were 24 cases of numerical abnormality, 14 cases of structural abnormality, 5 cases of mosaicism, and 3 miscellaneous abnormalities. In the numerical abnormalities, trisomies and sex chromosomal abnormalities were 22 and 2 case, respectively. In 22 trisomy cases, there were 16 cases of trisomy of 18 chromosome which is the most common single cytogenetic abnormality in cordocentesis. The most common associated anomalies in trisomy 18 was congenital heart anomaly, in which vetricular septal defect was the most common. Pregnancy outcome is as follows: 22 cases of termination of pregnancy, 9 cases of still-birth, 5 cases of neonatal death, three living babies and 7 cases lost to follow-up.