ABSTRACT
BACKGROUND: Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS: Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS: Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION: The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.
Subject(s)
Hospitals, University/organization & administration , Outcome Assessment, Health Care , Robotics , Surgery Department, Hospital/organization & administration , HumansABSTRACT
BACKGROUND AND OBJECTIVE: To investigate the prognostic value of p53 and HER2/neu overexpression in epithelial ovarian cancer (EOC). PATIENTS AND METHOD: p53 and HER2/neu immunostaining were performed in 198 tissue samples, 124 EOC, 44 benign ovarian tumors and 30 normal ovaries. Nuclear p53 and membranous HER2/neu immunostaining were evaluated. RESULTS: Neither p53 nor HER2/neu overexpression was seen in the benign ovarian tumors. HER2/neu immunostaining was observed in one normal ovary. P53 overexpression was found in 25% EOC and was related with advanced stage, endometrioid, clear cell and undifferentiated types, grade G3, and sub-optimal surgery. HER2/neu immunostaining was observed in 24.2% and it was associated with advanced stage, clear cell and undifferentiated types, and suboptimal surgery. Both, p53 and HER2/neu overexpression decreased overall and progression-free survival, but in the multivariant analysis, only HER2/neu overexpression was an independent prognostic factor of overall survival (RR = 2.8; 95% confidence interval [CI], 1.2-5.6) and recurrence (RR = 2.8; 95% CI, 1.1-7.1). Simultaneous p53 and HER2/neu overexpression made the prognosis worse (p < 0.01). CONCLUSIONS: HER2/neu overexpression (but not p53 overexpression) is a major prognostic factor in EOC.
Subject(s)
Cystadenoma, Mucinous/genetics , Cystadenoma, Serous/genetics , Ovarian Neoplasms/genetics , Receptor, ErbB-2/genetics , Teratoma/genetics , Tumor Suppressor Protein p53/genetics , Aged , Biomarkers, Tumor , Confidence Intervals , Cystadenoma, Mucinous/diagnosis , Cystadenoma, Mucinous/pathology , Cystadenoma, Mucinous/surgery , Cystadenoma, Serous/diagnosis , Cystadenoma, Serous/pathology , Cystadenoma, Serous/surgery , Endometriosis/genetics , Endometriosis/pathology , Endometriosis/surgery , Female , Follow-Up Studies , Genes, p53 , Humans , Immunohistochemistry , Middle Aged , Multivariate Analysis , Neoplasm Recurrence, Local , Neoplasm Staging , Ovarian Diseases/genetics , Ovarian Diseases/pathology , Ovarian Diseases/surgery , Ovarian Neoplasms/mortality , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Prognosis , Proportional Hazards Models , Risk , Survival Analysis , Teratoma/diagnosis , Teratoma/pathology , Teratoma/surgery , Time FactorsABSTRACT
Fundamento y objetivo: Determinar la expresión de las proteínas p53 y HER2/neu en el tejido ovárico y analizar su valor pronóstico en el cáncer de ovario. Pacientes y método: Se estudió a un total de 198 pacientes, 124 con cáncer epitelial de ovario (CEO), 44 con tumores benignos y 30 con ovarios normales. Se midió la expresión nuclear de p53 y en membrana de HER2/neu mediante técnicas inmunohistoquímicas. Resultados: No se observó sobreexpresión de p53 o HER2/neu en los tumores benignos de ovario. Sólo hubo sobreexpresión de HER2/neu en un ovario normal. El 25% de los casos de CEO mostró sobreexpresión de p53 y ésta se relacionó con los estadios avanzados, con los tipos histológicos endometrioides, de células claras e indiferenciados, con el grado G3 y con la citorreducción subóptima. El 24,2% de los CEO sobreexpresó HER2/neu y se relacionó con los tumores en estadio avanzado, con los tipos histológicos de células claras e indiferenciado y con una citorreducción subóptima. Tanto la sobreexpresión de p53 como la de HER2/neu se asociaron a una reducción de la supervivencia global y libre de enfermedad de las pacientes con CEO; sin embargo, en el estudio multivariable sólo la sobreexpresión de HER2/neu fue un factor independiente predictivo de menor supervivencia, tanto global (riesgo relativo [RR] = 2,8; intervalo de confianza [IC] del 95%, 1,2-5,6) como libre de enfermedad (RR = 2,8; IC del 95%, 1,1-7,1). La sobreexpresión conjunta de ambas proteínas empeoró aún más el pronóstico de estas pacientes (p < 0,01). Conclusiones: La sobreexpresión de HER2/neu es un factor pronóstico importante en el CEO, no así la sobreexpresión de p53
Background and objetive: To investigate the prognostic value of p53 and HER2/neu overexpression in epithelial ovarian cancer (EOC). Patients and method: p53 and HER2/neu immunostaining were performed in 198 tissue samples, 124 EOC, 44 benign ovarian tumors and 30 normal ovaries. Nuclear p53 and membranous HER2/neu immunostaining were evaluated. Results: Neither p53 nor HER2/neu overexpression was seen in the benign ovarian tumors. HER2/neu immunostaining was observed in one normal ovary. P53 overexpression was found in 25% EOC and was related with advanced stage, endometrioid, clear cell and undifferentiated types, grade G3, and sub-optimal surgery. HER2/neu immunostaining was observed in 24.2% and it was associated with advanced stage, clear cell and undifferentiated types, and suboptimal surgery. Both, p53 and HER2/neu overexpression decreased overall and progression-free survival, but in the multivariant analysis, only HER2/neu overexpression was an independent prognostic factor of overall survival (RR = 2.8; 95% confidence interval [CI], 1.2-5.6) and recurrence (RR = 2.8; 95% CI, 1.1-7.1). Simultaneous p53 and HER2/neu overexpression made the prognosis worse (p < 0.01). Conclusions: HER2/neu overexpression (but not p53 overexpression) is a major prognostic factor in EOC
