Extended cytoreduction of intraabdominal metastatic ovarian cancer in the left upper quadrant utilizing en bloc resection.

OBJECTIVE: The objective of the study was to describe the development of and experience with a technique for en bloc resection of left upper quadrant intraperitoneal metastatic ovarian cancer. STUDY DESIGN: From May 7, 2002-August 14, 2004, 6 women underwent en bloc resection of extensive tumor contiguously involving the omentum, colon, gastrocolic ligament and spleen. This represents about 5% of all cytoreductive operations performed during that time. Four of the 6 had received neoadjuvant chemotherapy. RESULTS: A description of the technique is included in the text. Two women required partial gastrectomy and partial pancreatectomy. Separate segmental resection or subtotal colectomy was performed in 3 women. Cytoreduction was optimal in all 6 cases. Significant complications occurred in 3 of the women. Disease-free survival ranged from 2-12 months. CONCLUSION: In highly selected patients undergoing cytoreductive surgery for ovarian cancer, en bloc resection of extensive left upper quadrant intraabdominal tumor may be a reasonable method for accomplishing optimal cytoreduction.

Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma.

OBJECTIVE: This study aims to identify favorable preoperative characteristics and examine the impact of secondary cytoreductive surgery on survival for patients with recurrent epithelial ovarian carcinoma. METHODS: Patients who underwent cytoreductive surgery for recurrent epithelial ovarian cancer were identified in our surgical database for the period 1988-2004. Patient charts were reviewed and data collected regarding patient demographics, surgical management, preoperative evaluation, perioperative complications, and oncologic outcome. RESULTS: Eighty-five patients met eligibility criteria. Preoperative factors that correlated with improved survival were disease-free interval of greater than 12 months (p<0.01) and residual disease after primary surgery of <2 cm (p<0.02). Other preoperative factors evaluated but not found significant included radiographic findings, physical findings, previous histology, stage, grade, previous chemotherapy, prior recurrence, and serum CA-125 level. Optimal resection to <1 cm residual disease was achieved in 86% of patients who had secondary cytoreduction. Small bowel and colon resection for cytoreduction occurred in 7% and 51% of patients, respectively. Operative complications occurred in 14% and postoperative complications occurred in 21% of patients. The median survival of patients who were optimally cytoreduced to <1 cm was 30 months compared to 17 months for patients with residual disease>or=1 cm (p<0.05). Operative factors that were evaluated and did not significantly effect survival were location of recurrence, presence of ascites, and extent of recurrence. Recurrent or progressive disease occurred in 75% of patients during follow-up. CONCLUSION: When selecting patients for secondary cytoreduction, the most significant preoperative factors are disease-free interval and success of a prior cytoreductive effort. Once secondary cytoreductive surgery is attempted, the most important factor for improved survival is optimal cytoreduction. Of equal importance is counseling regarding the significant risk for bowel surgery, colostomy, and complications.

Subcutaneous management of vertical incisions with 3 or more centimeters of subcutaneous fat.

OBJECTIVE: This study was undertaken to determine the most appropriate management of the subcutaneous tissue of midline vertical incisions with 3 cm or more of subcutaneous fat. STUDY DESIGN: Patients undergoing surgery within the Division of Gynecologic Oncology at University of South Florida and East Tennessee State University with 3 cm or more of subcutaneous fat were randomly assigned to 1 of 3 groups: suture approximation of Camper's fascia, closed suction drainage of the subcutaneous space, or no intervention as a control group. Participants were evaluated daily during postoperative hospitalization and at 2 and 6 weeks postoperatively as an outpatient. Demographic information, perioperative data, and wound complications were recorded and then analyzed with chi2, t test, analysis of variance, and logistic regression where appropriate. RESULTS: Two hundred twenty-five patients were enrolled with 222 eligible for evaluation. Wound complications were observed in 34 (15.3%) patients, and 25 of these women also had wound disruption. Overall wound complication and wound disruption rates were not significantly different between groups: suture (12.8%, 7.7%), drain (17.9%, 14.9%), control (15.6%, 11.7%); P = .70 and P = .39, respectively. CONCLUSION: Suture approximation or drainage of the subcutaneous tissues of women with 3 cm or more subcutaneous fat measured in midline vertical incisions resulted in no significant change in the incidence of overall wound complications or superficial wound disruption.

Ureteral surgery performed by a university gynecologic oncology service.

OBJECTIVE: The purpose of this study is to describe the incidence and types of ureteral surgical procedures that are necessitated during the course of surgical treatment of a population of patients who are cared for by a gynecologic oncology training program. STUDY DESIGN: From 1997 through 2004, the University of South Florida Division of Gynecologic Oncology database was accessed to extract the specifics of ureteral surgery that had been done during the course of the fellowship training program. RESULTS: Forty-six of 4844 major operations included ureteral surgery. Thirty of 46 procedures were repair of injury; all were recognized intraoperatively. The method of repair was simple closure (1 procedure), ureteroureterostomy (7 procedures), or direct ureteroneocystostomy (22 procedures). Two of the 7 ureteroureterostomies strictured. Ureteral resection was done for gynecologic malignancy in 15 of 16 patients. All 16 patients underwent reconstruction with direct ureteroneocystostomy. Seven of 16 patients underwent concomitant rectosigmoid colectomy. One of 16 patients who underwent en-bloc partial cystectomy had a postoperative vesicovaginal fistula. All 36 ureteroneocystostomies with short-term follow-up had radiologically normal upper urinary tracts. Eighteen patients had subsequent follow-up evaluations; all of them had radiologically normal upper urinary tracts at 5 to 42 months (mean, 19 months). CONCLUSION: When significant injury to the pelvic ureter occurs during radical pelvic surgery, ureteroneocystostomy may be the repair of choice. After resection of a portion of the pelvic ureter for gynecologic malignancy, the urinary tract was reconstructed successfully with direct ureteroneocystostomy. In those patients who underwent ureteral resection for malignancy, the extent of the disease process necessitated concomitant rectosigmoid colectomy 47% of the time.

Colorectal resection in patients with ovarian and primary peritoneal carcinoma.

OBJECTIVE: This study examines the operative details and complications of colorectal resection in patients with ovarian and primary peritoneal carcinoma. STUDY DESIGN: Patients who underwent colorectal resection for ovarian and primary peritoneal cancer were identified in our surgical database for the period 1988 through 2002. RESULTS: Of the 125 patients who were identified, 73% were undergoing primary cytoreduction; 18% were undergoing secondary cytoreduction, and 7% were undergoing interval cytoreduction. The mean length of colon that was removed was 15.7 cm. The method of anastomosis was stapler in 63% and hand sewn in 22%; 15% patients had no anastomosis performed. A protective ostomy was used in 13% of patients. Optimal cytoreduction (<1 cm) was achieved in 74%. Operative complications occurred in 37% of patients, with the most common being hemorrhage (25%). Anastomotic leaks occurred in 2.5% of the patients, and the most common postoperative complication was ileus (28%). Postoperative bowel function returned to normal in 71% of patients. CONCLUSION: To obtain optimal cytoreduction in patients with ovarian cancer, colorectal resection often is necessary. Colorectal resection can be performed with a low risk of anastomotic complications, and patients frequently have the return of normal bowel function.

The genesis of RNA interference, its potential clinical applications, and implications in gynecologic cancer.

OBJECTIVE: This review will discuss the discovery and development of RNA interference (RNAi) technology, small interfering RNA (siRNA) design and delivery, and the implications of RNAi on gynecologic cancers. METHODS: Systematic review of English language literature using searches for RNAi and gynecologic cancers in established databases, including Pubmed and Ovid, was employed. RESULTS: The high degrees of efficiency and specificity are the main advantages of RNAi. Consequently, RNAi is used in functional genomics and developing therapies for the treatment of viral infection, dominant disorders, neurological disorders, and cancers, including gynecologic cancers. CONCLUSION: RNAi represents an exciting technology for functional genomics by selective targeting of genes. While issues regarding delivery remain, the therapeutic advantages of siRNA in cancer treatment warrant further investigation.