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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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Hervás Marta Soriano,Játiva-Porcar Rosa,Robles-Hernández Daniel,Rubert Anna Serra,Segarra Blanca,Oliva Cristina,Escrig Javier,Llueca José Antonio 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.1
BackgroundCytoreductive surgery was developed as a treatment for peritoneal carcinomatosis. However, this surgery is associated with important complications. The present study aimed to assess the relationship between lactacidemia and the rate of associated complications during the immediate postoperative period in the intensive care unit (ICU) in patients undergoing cytoreductive surgery.MethodsThis was a retrospective observational study. A total of 57 patients underwent cytoreductive surgery. All patients were admitted to the ICU immediately after the surgery. Data on lactic acid levels at the time of admission and discharge from the ICU were collected. Postsurgical complications that occurred during the ICU stay were recorded according to failure-to-rescue analysis and their severity stratified according to the Clavien-Dindo classification.ResultsThe lactic acid levels at admission to the ICU were significantly higher in patients who developed complications, with an almost tripled unadjusted relative risk (2.9, 95% CI: 1.6, 5.3), than in those who did not develop complications for the lactacidemia threshold established in the cumulative sum curve graphs. After adjustment for confounding effects, the relative risk became even higher (3.1, 95% CI: 1.8, 3.6). Lactic acid levels were still significantly higher in this group at the time of discharge from the ICU.ConclusionsSerum lactate level is a risk factor for postoperative complications in patients undergoing cytoreductive surgery for peritoneal carcinomatosis. This study suggests that the risk of developing severe complications almost triples with a lactic acid level of 2.5 mmol/L or higher at the time of admission in the ICU.
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