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RISS 인기검색어
- 검색키워드
- 저자 : Antonio Gil-Moreno (검색결과 4 건)
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The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival
Antoni Llueca,Javier Escrig,Antonio Gil-Moreno,Virginia Benito,Alicia Hernández,Berta Díaz-Feijoo 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1
Objective: The prognostic impact of surgical paraaortic staging remains unclear in patientswith locally advanced cervical cancer (LACC). The objective of our study was to evaluate theresults of the surgical technique of preoperative aortic lymphadenectomy in LACC related totumor burden and disease spread to assess its influence on survival. Methods: Data of 1,072 patients with cervical cancer were taken from 11 Spanishhospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aorticlymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excisedup to the left renal vein. The extent of the disease was performed evaluating the LNs bycalculating the geometric means and quantifying the log odds between positive LNs andnegative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Coxproportional hazards model was used to account for the influence of multiple variables. Results: A total of 394 patients were included. Pathological analysis revealed positiveaortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognosticindicator. CALS and LODDS <−2 were associated with better disease free survival and overallsurvival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariatemodel analysis, CALS is revealed as an independent prognostic factor in LACC. Conclusion: When performing preoperative surgical staging in LACC, it is not advisable totake simple samples from the regional nodes. Radical dissection of the aortic and pelvicregions offers a more reliable staging of the LNs and has a favorable influence on survival.
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Martina Aida Angeles,Bastien Cabarrou,Antonio Gil-Moreno,Asunción Pérez-Benavente,Emanuela Spagnolo,Agnieszka Rychlik,Carlos Martínez-Gómez,Frédéric Guyon,Ignacio Zapardiel,Denis Querleu,Claire Illac 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.6
Objective: We sought to evaluate the impact on survival of tumor burden and surgical complexity in relation to the number of cycles of neoadjuvant chemotherapy (NACT) in patients with advanced ovarian cancer (OC) with minimal (CC-1) or no residual disease (CC-0). Methods: This retrospective study included patients with International Federation of Gynaecology and Obstetrics IIIC–IV stage OC who underwent debulking surgery at 4 high- volume institutions between January 2008 and December 2015. We assessed the overall survival (OS) of primary debulking surgery (PDS group), early interval debulking surgery after 3–4 cycles of NACT (early IDS group) and delayed debulking surgery after 6 cycles (DDS group) with CC-0 or CC-1 according to peritoneal cancer index (PCI) and Aletti score. Results: Five hundred forty-nine women were included: 175 (31.9%) had PDS, 224 (40.8%) early IDS and 150 (27.3%) DDS. Regardless of Aletti score, median OS after PDS was significantly higher than after early IDS or DDS, but the survival difference was higher in women with an Aletti score <8. Among patients with PCI ≤10, median OS after PDS was significantly higher than after early IDS or DDS. In women with PCI >10, there were no differences between PDS and early IDS, but DDS was associated with decreased OS. Conclusion: The benefit of complete PDS compared with NACT was maximal in patients with a low complexity score. In patients with low tumor burden, there was a survival benefit of PDS over early IDS or DDS. In women with high tumor load, DDS impaired the oncological outcome.
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Hysteroscopic myomectomy without anesthesia
Nuria-Laia Rodríguez-Mias,Montserrat Cubo-Abert,Laura Gomila-Villalonga,Juanjo Gómez-Cabeza,Jose Luis Poza-Barrasús,Antonio Gil-Moreno 대한산부인과학회 2019 Obstetrics & Gynecology Science Vol.62 No.3
ObjectiveScarce literature about myoma removal without anesthesia has been published. The aim of this paper is to evaluatethe feasibility of a new alternative for a hysteroscopic myomectomy in a conventional office setting, without need foranesthesia. MethodsStep-by-step description of the surgical technique has been provided, based on video images. An office hysteroscopywas performed in a Gynecological Endoscopy Department of a tertiary European hospital. ResultsA 49-year-old woman was referred for management of severe hypermenorrhea. Consent and approval were receivedfrom the patient and the institutional review board, respectively. The introduction of a Truclear® hysteroscopicpolyp morcellator of 5.5 mm with optic of 0 degrees into the uterine cavity did not require any kind of anesthesia orcervical dilatation. The use of saline flow helped distend the cavity and identify a submucosal myoma. Under directvision, a full myomectomy was performed via mechanical energy with continuous cutting movements, without anycomplication. After the procedure was completed, the excised material was aspirated through the device into acollecting pouch. A successful complete morcellation of a Type-0 submucosal leiomyoma with a polyp morcellatordevice was performed in an outpatient setting. Good medical results, good tolerance by the patient besides lowersurgical risks due to mechanical instead of electrical energy are shown. ConclusionIn conclusion, this video demonstrates that a hysteroscopic myomectomy can be performed successfully in office withlower risk of complications from the procedure and without use of general anesthesia besides good tolerance by thepatient.
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Potential strategies for prevention of tumor spillage in minimally invasive radical hysterectomy
Vicente Bebia,Sonia Monreal-Clua,Assumpció Pérez-Benavente,Silvia Franco-Camps,Berta Díaz-Feijoo,Antonio Gil-Moreno 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: The publication of a prospective [1] and several retrospective [2,3] studiesdescribing a worse prognosis in patients affected with early-stage cervical cancer whounderwent a minimally invasive radical hysterectomy has raised a high concern in whatmeasures should be undertaken in order to revert these results. Potential strategies [4] toprevent tumor spillage have been previously proposed. Methods: In this video, we describe nine strategies that should be addressed in future trialsregarding this procedure. Results: These strategies are:1. Fallopian tubes should be coagulated prior to start the surgery. 2. All sentinel lymph nodes and lymphadenectomy specimens should be obtained withoutlymph nodes fragmentation. 3. All surgical specimens should be extracted within a containment bag. 4. Uterine manipulators must never be used. 5. Prior to vaginal section, a closed knotted ligature should be placed around the vagina,proximal to the section line, and the remaining vaginal cavity profusely washed. 6. Once the vagina is opened, the surgical specimen should be extracted vaginally within aspecimen retrieval bag. 7. After surgery, the pelvic cavity is profusely washed with physiological serum, and the vaginashould be washed with iodopovidone diluted to 10% [5]. 8. Port-site metastasis prevention measures should be performed. 9. Every action made to prevent tumor spillage should be recorded in the surgical report. Conclusion: As there is a biological rationale in these measures that would prevent tumorspillage and seeding, there is a need of prospectively exploring them within appropriatestudies in order to determine their own oncological outcome.
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