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RISS 인기검색어
- 검색키워드
- 저자 : Dennis S. Chi (검색결과 9 건)
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( 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.
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Lindsey Finch,Dennis S. Chi 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.5
The standard of care for treatment of advanced-stage epithelial ovarian cancer is primarily surgery followed by platinum-based chemotherapy, with the operative goal to achieve complete gross resection. Cytoreductive surgeries for epithelial ovarian cancer historically were performed via open laparotomy; however, as minimally invasive techniques became more widely accepted within gynecologic oncology, interest in employing this approach in the setting of cytoreductive surgery for epithelial ovarian cancer has grown. The purpose of this review was to examine the current debate between the use of minimally invasive surgery versus laparotomy as an approach to interval cytoreductive surgery in advanced epithelial ovarian cancer. While numerous retrospective and feasibility studies have found comparable outcomes with respect to complete gross residual disease, progression-free survival, and overall survival between minimally invasive and laparotomy approaches to interval cytoreductive surgery for epithelial ovarian cancer, methodological challenges limit the utility of these data. Given potential risks of underestimating disease burden and failing to achieve complete resection using a minimally invasive approach, further rigorous studies are needed to evaluate the safety and efficacy of minimally invasive surgery in this setting and to better define the subset of patients who would receive the greatest benefit from a minimally invasive approach.
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Role of aggressive surgical cytoreduction in advanced ovarian cancer
장석준,Robert E. Bristow,Dennis S. Chi,William A. Cliby 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4
Ovarian cancer is the eighth most frequent cancer in women and is the most lethal gynecologic malignancy worldwide. The majority of ovarian cancer patients are newly diagnosed presenting with advanced-stage disease. Primary cytoreductive surgery and adjuvant taxane- and platinum-based combination chemotherapy are the standard treatment for advanced ovarian cancer. A number of studies have consistently shown that successful cytoreductive surgery and the resultant minimal residual disease are significantly associated with survival in patients with this disease. Much has been written and even more debated regarding the competing perspectives of biology of ovarian cancer versus the value of aggressive surgical resection. This review will focus on the current evidences and outcomes supporting the positive impact of aggressive surgical effort on survival in the primary management of ovarian cancer.
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Maximal cytoreductive effort in epithelial ovarian cancer surgery
Karin K. Shih,Dennis S. Chi 대한부인종양학회 2010 Journal of Gynecologic Oncology Vol.21 No.2
The surgical management of advanced epithelial ovarian cancer involves cytoreduction, or removal of grossly-evident tumor. Residual disease after surgical cytoreduction of ovarian cancer has been shown to be strongly associated with survival. The goal of surgery is “optimal” surgical cytoreduction, which is generally defined as residual disease of 1 cm or less. However, the designation of “optimal” surgical cytoreduction has evolved to include maximal surgical effort and no gross residual disease. In order to achieve this, more aggressive surgical procedures such as rectosigmoidectomy,diaphragm peritonectomy, partial liver resection, and video-assisted thoracic surgery are reported and increasingly utilized in the surgical management of advanced ovarian cancer. The role of maximal surgical effort also extends to the recurrent setting where the goal of surgery should be complete cytoreduction. Patient selection is important in identifying appropriate candidates for surgical cytoreduction in the recurrent setting. The purpose of this article is to review the role of maximum surgical effort in primary and recurrent ovarian cancer.
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Oleg Mironov,Evis Sala,Svetlana Mironov,Harpreet Pannu,Dennis S. Chi,Hedvig Hricak 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.4
Objective: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. Methods: This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT ≤30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. Results: In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho= -0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. Conclusion: In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy. Objective: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. Methods: This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT ≤30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. Results: In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho= -0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. Conclusion: In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.
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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.
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