Safety and Efficacy of Supradiaphragmatic Lymph Node Dissection in Advanced Ovarian Cancer.

Objective: Postoperative gross residual disease after cytoreductive surgery for advanced ovarian cancer impacts patient survival negatively. Specifically, unresected enlarged, metastatic supradiaphragmatic lymph nodes (SDLNs) may worsen progression-free survival (PFS) and overall survival (OS). Multiple studies have shown that upper abdominal debulking during primary cytoreductive surgery improves survival outcomes, but the evidence for resection of SDLN metastasis is less definitive. This review focuses on the feasibility, safety, and efficacy of SDLN resection for metastatic disease in advanced-stage ovarian cancer and explores emerging data on survival outcomes. Materials and Methods: A literature review from January 2004 to December 2021 identified 4 relevant studies, all published after 2016. Eligible studies included patients with advanced ovarian, tubal, or peritoneal cancer who had undergone SDLN resection using a transdiaphragmatic approach or video-assisted thorascopy, and had evaluated SDLN dissection for diagnoses and treatment or assessed the benefits of SDLN resection as it relates to prognosis. Results: All 4 studies demonstrated the feasibility and safety of SDLN resection. Three of the studies reported a low intrathoracic recurrence rate after intrathoracic debulking. Cowan et al. described an impressive median PFS and OS of 17.2 months and 70.1 months, respectively, in patients who had undergone SDLN resection. Conclusions: Resection of enlarged SDLNs in carefully selected patients has the potential to confirm intrathoracic disease spread, help achieve maximal cytoreduction without delaying adjuvant treatment, and improve survival. More studies are needed to quantify the survival benefit of SDLN resection. (J GYNECOL SURG 38:202).

Cutaneous metastasis of PD-L1 positive cervical carcinoma.

•Cutaneous metastases in cervical cancer are rare and associated with a poor prognosis.•Treatment is typically palliative, utilizing chemotherapy and radiation.•We report a case of PD-L1 positive cervical cancer with cutaneous metastases that developed after initial recurrence.•For patients on checkpoint inhibitor therapy who develop skin toxicity, it is important to rule out cutaneous metastases.

Effect of SARS-CoV-2 Infection on Pregnancy Outcomes in an Inner-City Black Patient Population.

While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation. Demographic factors and comorbidities were compared between the SARS-CoV-2 positive and negative groups. A retrospective cohort study was conducted in hospitalized patients who gave birth at Kings County Hospital from April 10 through June 10, 2020. Demographic and clinical data were obtained from the electronic medical record. Patients were categorized based on SARS-CoV-2 infection status and peripartum outcomes were analyzed. We used the Fisher exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. P < 0.05 was considered significant. There were no differences in obstetric or neonatal outcomes between the SARS-CoV-2 positive and negative cohorts. Most SARS-CoV-2 positive patients were asymptomatic on admission. The rates of maternal comorbidities were similar in the SARS-CoV-2 positive and negative groups. In this predominantly Black population in Brooklyn, SARS-CoV-2 infection did not confer increased risk of adverse obstetric or neonatal outcomes, despite the prevalence of comorbidities. The impact of SARS-CoV-2 infection on pregnancy outcomes is complex and may differ on a community level. Determining how COVID-19 is associated with perinatal outcomes in this minoritized patient population will augment our understanding of health disparities in order to improve care.

Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the National Cancer Data Base.

BACKGROUND AND OBJECTIVES: Gallbladder carcinoma (GBC) has a poor prognosis. Studies demonstrated that teaching facilities may provide a lower risk of mortality in patients undergoing pancreatic and colon resection vs nonteaching facilities. We hypothesized that survival rates are higher in academic cancer centers (ACCs) vs community cancer centers (CCCs). METHODS: Patients with all stages of GBC were identified from the National Cancer Database (2007-2012). Propensity score matching adjusted for selection bias. Descriptive statistics were calculated for all variables. Overall survival (OS) was compared by facility type (ACC vs CCC) and case volume (low vs high) via multivariable Cox proportional hazards regression. RESULTS: A total of 7967 patients met the inclusion criteria. Following propensity matching, 2801 patients were analyzed from each facility type. Median OS following surgery was higher for ACC (20.99 months, 95% confidence interval [CI], 19.61-22.64, P = .002) than CCC (17.68 months, 95% CI, 16.46-19.25). Following Cox modeling, GBC treatment at ACCs was a protective factor for OS (adjusted hazard ratio 0.876, 95% CI, 0.801-0.958, P = .004). DISCUSSION: GBC treatment at ACCs is an independent predictor of OS. High volume ACCs are associated with improved OS compared with low volume ACCs. The site of care and case volume in ACCs may contribute to improved survival outcomes.

Gallbladder carcinoma: An analysis of the national cancer data base to examine hispanic influence.

BACKGROUND: Gallbladder cancer (GBC) is a lethal disease with high incidence among Hispanics. Overall survival (OS) among races/ethnicities has not been described using the most recent National Cancer Database. This study hypothesized that prognosis is worse for Hispanics compared to similar non-Hispanic populations. METHODS: Patients with GBC were identified from the National Cancer Database and categorized as White, Black, Hispanic, and Other. Descriptive statistics, OS, and Cox regression were examined. RESULTS: The study identified 12 952 patients. Median age was 71 years and 68.8% were female. The study characterized 69.8% White, 13.9% Black, 11.0% Hispanic, and 5.4% other patients. A 5-year OS curves differed, with survival highest in Hispanic patients (27% vs 23% Other, 18% White, and 17% Black, P < 0.001). Hispanics presented at younger ages (67 vs 72 years, P < 0.001), were more likely to be uninsured (17.3% vs 3.9% P < 0.001), had lower income (P < 0.001), and education levels (P < 0.001) compared to Whites. Following multivariable modeling, treatment at an academic facility (HR 0.90, 95%CI 0.84-0.97) and year of diagnosis (HR 0.90, 95%CI 0.88-0.92) related to survival. Hispanic ethnicity did not show significance (P = 0.207). DISCUSSION: Hispanic ethnicity exhibits the highest OS for GBC, but after adjusting for covariates, this influence is not significant.

Ablation approach for primary liver tumors: Peri-operative outcomes.

BACKGROUND AND OBJECTIVES: Ablation is a common treatment modality for malignant primary liver tumors(PLTs), outcomes following laparoscopic (LA) versus open ablation (OA) are ill-defined. This project compares peri-procedural outcomes of LA versus OA for PLTs. MATERIALS AND METHODS: Patients with PLTs undergoing radiofrequency ablation were queried from ACS NSQIP Database (2005-2013) using CPT codes. Patients undergoing percutaneous ablation or hepatic resection were excluded. Multivariable logistic regression analyses determined the association of ablation approach with 30-day morbidity and mortality. RESULTS: Of 5747 with PLTs, 655 (11.4%) ablations were identified: 177 (27.0%) underwent OA, 478 (73.0%) underwent LA. Patients undergoing LA had lower mortality (1.9% vs 5.1%, P = 0.026), lower minor morbidity (2.3% vs 5.7%, P = 0.031), and lower major morbidity (4.2% vs 17.0%, P < 0.001). Adjusting for demographics, disease-specific variables (preoperative ascites, total bilirubin, platelet count, albumin, and INR), 30-day mortality (OR 3.85, 95%CI: 1.38-10.80, P = 0.010), minor morbidity (OR 2.98, 95%CI: 1.16-7.67, P = 0.024), and major morbidity (OR 4.59 95%CI: 2.41-8.76, P < 0.001) were statistically lower in LA. OA demonstrated increased length of stay(LOS) (5 vs 2 days, P < 0.001), and longer operative time (152 vs 112 min, P < 0.001). CONCLUSION: LA offers decreased peri-procedural morbidity, mortality, and reduced LOS. LA should be the preferred method for hepatic ablation.