ABSTRACT
STUDY OBJECTIVE: To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma. DESIGN: Prospective, cohort pilot study. SETTING: Multiple centers, Spain. PATIENTS: Forty patients with suspected ovarian endometrioma identified by US, with a maximum diameter of 35 to 100 mm, of whom 33 met inclusion criteria. INTERVENTIONS: The study group (nâ¯=â¯17) underwent US-guided aspiration plus sclerotherapy with ethanol, and the control group (nâ¯=â¯14) underwent laparoscopic cystectomy. MEASUREMENTS AND MAIN RESULTS: Recurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (odds ratio 0.18, 0.01-1.53). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; 1 patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than those in the surgery group-266 euros versus 2189 euros. CONCLUSION: Ethanol sclerotherapy seems to be cost-effective for endometrioma and also appears to reduce complications. In this pilot study, recurrence was not higher than with conventional surgery.
Subject(s)
Endometriosis/therapy , Ethanol/therapeutic use , Laparoscopy/methods , Ovarian Diseases/therapy , Sclerotherapy/methods , Adolescent , Adult , Biopsy, Needle/adverse effects , Biopsy, Needle/economics , Biopsy, Needle/methods , Case-Control Studies , Cohort Studies , Cost-Benefit Analysis , Endometriosis/pathology , Endometriosis/surgery , Female , Humans , Laparoscopy/adverse effects , Laparoscopy/economics , Ovarian Diseases/pathology , Ovarian Diseases/surgery , Pilot Projects , Prospective Studies , Recurrence , Sclerotherapy/adverse effects , Sclerotherapy/economics , Spain , Ultrasonography, Interventional/adverse effects , Ultrasonography, Interventional/economics , Ultrasonography, Interventional/methods , Young AdultABSTRACT
Large-cell neuroendocrine carcinoma (LCNEC) is an uncommon histological subtype of cervical cancer that is associated with poor survival and its occurrence during pregnancy is particularly rare. We herein present the case of a female patient who was diagnosed with cervical LCNEC during pregnancy. The patient declined pregnancy termination and was treated with neoadjuvant chemotherapy with cisplatin and etoposide, without associated toxicity and with good fetal development. At 31.4 weeks of gestation, the fetus was delivered by caesarean section, and the patient underwent radical nerve-sparing hysterectomy with bilateral adnexectomy, along with pelvic and inframesenteric para-aortic lymphadenectomy. The patient received adjuvant chemoradiotherapy and there was no evidence of recurrence or metastasis at 38 months postoperatively. The baby has also been followed up, without any signs of neurodevelopmental disorders. To the best of our knowledge, the present report describes the first case of LCNEC with pregnancy-preserving management in the literature to date.
