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RISS 인기검색어
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- 저자 : Berta Díaz-Feijoo (검색결과 2 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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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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