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Review : Surgical treatment for apparent early stage endometrial cancer
( Yukio Sonoda ) 대한산부인과학회 2014 Obstetrics & Gynecology Science Vol.57 No.1
Most experts would agree that the standard surgical treatment for endometrial cancer includes a hysterectomy and bilateral salpingo-oophorectomy, however, the benefit of full surgical staging with lymph node dissection in patients with apparent early stage disease remains a topic of debate. Recent prospective data and advances in laparoscopic techniques have transformed this disease into one that can be successfully managed with minimally invasive surgery. This review will discuss the current surgical management of apparent early stage endometrial cancer and some of the new techniques that are being incorporated.
( Dennis S. Chi ),( Nadeem R. Abu-Rustum ),( Yukio Sonoda ),( Joseph Ivy ),( Eunice Rhee B. A. ),( Kathleen Moore ),( Douglas A. Levine ),( Richard R. Barakat ) 대한산부인과학회 2007 서울심포지움 Vol.12 No.-
Objective: To compare the safety and efficacy of laparoscopic (LSC) staging of ovarian or fallopian tube cancers to staging via laparotomy (LAP) for epithelial ovarian carcinoma (EOC). Study Design: We performed a case-control study of all patients (pts) with apparent stage I adnexal cancers who had LSC staging from 10/00-3/03. The control group consisted of all pts with apparent stage I EOC who had staging via LAP during the same time period. Results: Staging was LSC in 20 pts and via LAP in 30.There were no differences in mean age and body mass index. There were also no differences in omental specimen size and number of lymph nodes removed. Estimated blood loss and hospital stay were lower for LSC, while operating time was longer. There were no conversions to LAP or complications in the LSC group compared with 3 minor complications in the LAP group. Conclusion: In this preliminary analysis, it appears that pts with apparent stage I ovarian or fallopian tube cancer can safely and adequately undergo LSC surgical staging.
Ying L. Liu,Olga T. Filippova,Qin Zhou,Alexia Iasonos,Dennis S. Chi,Oliver Zivanovic,Yukio Sonoda,Ginger J. Gardner,Vance A. Broach,Roisin E. OCearbhaill,Jason A. Konner,Carol Aghajanian,Kara Long Roc 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.1
Objective: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS)confers similar outcomes as primary debulking surgery and chemotherapy. Little is knownabout patients who receive NACT but do not undergo debulking surgery. Our aim was tocharacterize these patients. Methods: We prospectively identified patients with newly diagnosed stage III/IV ovariancancer treated with NACT from 7/1/15–12/1/17. Fisher exact and Wilcoxon rank-sum tests wereused to compare clinical characteristics by surgical status. The Kaplan-Meier method wasused to estimate survival outcomes. Log-rank test and Cox proportional hazards model wereapplied to assess the relationship of covariates to outcome, and time-dependent covariateswere applied to variables collected after diagnosis. Results: Of 224 women who received NACT, 162 (72%) underwent IDS and 62 (28%) didnot undergo surgery. The non-surgical group was older (p<0.001), had higher Charlsoncomorbidity index (CCI; p<0.001), lower albumin levels (p=0.007), lower Karnofskyperformance scores (p<0.001), and were more likely to have dose reductions in NACT(p<0.001). Reasons for no surgery included poor response to NACT (39%), death (15%),comorbidities (24%), patient preference (16%), and loss to follow-up (6%). The nosurgery group had significantly worse overall survival (OS) than the surgery group (hazardratio=3.34; 95% confidence interval=1.66–6.72; p<0.001), after adjustment for age, CCI, anddose reductions. Conclusions: A significant proportion of women treated with NACT do not undergo IDS, andthese women are older, frailer, and have worse OS. More studies are needed to find optimaltherapies to maximize outcomes in this high-risk, elderly population.