Surgical anatomy of the common iliac veins during para-aortic and pelvic lymphadenectomy for gynecologic cancer

Kazuyoshi Kato,Shinichi Tate,Kyoko Nishikimi,Makio Shozu 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.1

Objective: Compression of the left common iliac vein between the right common iliac artery and the vertebrae is known to be associated with the occurrence of left iliofemoral deep vein thrombosis (DVT). In this study, we described the variability in vascular anatomy of the common iliac veins and evaluated the relationship between the degree of iliac vein compression and the presence of DVT using the data from surgeries for gynecologic cancer. Methods: The anatomical variations and the degrees of iliac vein compression were determined in 119 patients who underwent systematic para-aortic and pelvic lymphadenectomy during surgery for primary gynecologic cancer. Their medical records were reviewed with respect to patient-, disease-, and surgery-related data. Results: The degrees of common iliac vein compression were classified into three grades: grade A (n=28, 23.5%), with a calculated percentage of 0%-25% compression; grade B (n=47, 39.5%), with a calculated percentage of 26%-50% compression; and grade C (n=44, 37%), with a calculated percentage of more than 50% compression. Seven patients (5.9%) had common iliac veins with anomalous anatomies; three were divided into small caliber vessels, two with a flattened structure, and two had double inferior vena cavae. The presence of DVT was associated with the elevated D-dimer levels but not with the degree of iliac vein compression in this series. Conclusion: Although severe compression of the common iliac veins was frequently observed, the degree of compression might not be associated with DVT in surgical patients with gynecologic cancer. Anomalous anatomies of common iliac veins should be considered during systematic para-aortic and pelvic lymphadenectomy in the gynecologic cancer patients.

Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

Shinichi Tate,Kyoko Nishikimi,Kazuyoshi Kato,Ayumu Matsuoka,Michiyo Kambe,Takako Kiyokawa,Makio Shozu 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.3

Objective: This study aimed to evaluate the presence of pathological residual tumor (pRT) in each initial disseminated site after neoadjuvant chemotherapy (NACT) to assess the appropriate surgical margins during interval debulking surgery (IDS) for a favorable prognosis. Methods: This prospective descriptive study included patients with stage IIIC–IV epithelial ovarian, fallopian tubal, and peritoneal cancer. One hundred eleven patients underwent diagnostic exploratory laparotomy, and their initial intra-abdominal dissemination statuses were recorded. Any tumor >1 cm in diameter found during the exploratory laparotomy was resected during IDS even if it was macroscopically invisible after NACT. The pRT rate after NACT and negative predictive value (NPV; probability that sites with macroscopically invisible tumors have no pRT) during IDS were assessed in each disseminated site. Results: A median of 5 NACT cycles were performed. Sites with a high incidence of pRT and low NPV included the rectosigmoid colon (71.4%, 38.6%), transverse mesentery (70.3%, 50.0%), greater omentum (68.3%, 51.7%), right diaphragm (61.9%, 48.1%), paracolic gutters (61.1%, 50.0%), and vesicouterine pouch (56.6%, 50.0%). Organs/tissues with a high incidence of pRT featured a low NPV. The median progression-free survival and overall survival in this cohort were 27.7 and 71.9 months, respectively. Conclusion: Even if a disseminated site >1 cm in diameter before NACT is invisible during IDS, microscopic disease remains present within it. The appropriate surgical margins for IDS with a favorable prognosis could be secured by resecting a lesion of >1 cm before NACT even if it is invisible during IDS.

Well-trained gynecologic oncologists can perform bowel resection and upper abdominal surgery safely

Kyoko Nishikimi,Shinichi Tate,Kazuyoshi Kato,Ayumu Matsuoka,Makio Shozu 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.1

Objective: This study was performed to examine the safety of bowel resection and upper abdominal surgery in patients with advanced ovarian cancer performed by gynecologic oncologists after training in a monodisciplinary surgical team. Methods: We implemented a monodisciplinary surgical team consisting of specialized gynecologic oncologist for advanced ovarian cancer. In the initial learning period in 65 patients with International Federation of Gynecology and Obstetrics (FIGO) III/IV, a gynecologic oncologist who had a certification as a general surgeon trained 2 other gynecologic oncologists in bowel resection and upper abdominal surgery for 4 years. After the initial learning period, the trained gynecologic oncologists performed surgeries without the certificated general surgeon in 195 patients with FIGO III/IV. The surgical outcomes and perioperative complications during the 2 periods were evaluated. Results: The rates of achieving no gross disease after cytoreductive surgery were 80.0% in the initial learning period and 83.6% in the post-learning period (p=0.560). The incidence of anastomotic leakage after rectosigmoid resection, symptomatic pleural effusion or pneumothorax after right diaphragm resection, and pancreatic fistula after splenectomy with distal pancreatectomy in the 2 periods were 2 of 34 (6.0%), 1 of 33 (3.0%), and 3 of 15 (20.0%) patients in the initial learning period, and 12 of 147 (8.2%), 1 of 118 (0.8%), and 11 of 84 (13.1%) patients in the post-learning period, respectively. There were no significant differences between the 2 groups (p=0.270, p=0.440, p=0.520, respectively). Conclusion: Bowel resection and upper abdominal surgery can be performed safely by gynecologic oncologists.

Study of upfront surgery versus neoadjuvant chemotherapy followed by interval debulking surgery for patients with stage IIIC and IV ovarian cancer, SGOG SUNNY (SOC-2) trial concept

Rong Jiang,Jianqing Zhu,김재원,Jihong Liu,Kazuyoshi Kato,김희승,Yuqin Zhang,Ping Zhang,Tao Zhu,Daisuke Aoki,Aijun Yu,Xiaojun Chen,Xipeng Wang,Ding Zhu,Wei Zhang,Huixun Jia,Ting-Yan Shi,Wen Gao,Sheng Yin,Yan 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Background: Two randomized phase III trials (EORTC55971 and CHORUS) showed similarprogression-free and overall survival in primary or interval debulking surgery in ovariancancer, however both studies had limitations with lower rate of complete resection and lack ofsurgical qualifications for participating centers. There is no consensus on whether neoadjuvantchemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approachin the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. Methods: The Asian SUNNY study is an open-label, multicenter, randomized controlled,phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS instages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC). The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS inadvanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS inthe treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of nogross residual (NGR) in PDS group in all centers and participating centers should be nationalcancer centers or designed ovarian cancer section or those with the experience participatingsurgical trials of ovarian cancer. Any participating center should be monitored evaluatingthe proportions of NGR by a training set. The aim of the surgery in both arms is maximalcytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy orpositron emission tomography/computed tomography scan. Patients assigned to PDS groupwill undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal timeinterval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusioncriteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performancestatus of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as wellas borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456subjects. Primary endpoint is overall survival. Trial Registration: ClinicalTrials.gov Identifier: NCT02859038

Tailored-dose chemotherapy with gemcitabine and irinotecan in patients with platinum-refractory/resistant ovarian or primary peritoneal cancer: a phase II trial

Shinichi Tate,Kyoko Nishikimi,Ayumu Matsuoka,Satoyo Otsuka,Kazuyoshi Kato,Yutaka Takahashi,Makio Shozu 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1

Objective: We investigated the efficacy and toxicity of tailored-dose chemotherapy withgemcitabine and irinotecan for platinum-refractory/resistant ovarian or primary peritoneal cancer. Methods: We enrolled patients with ovarian or primary peritoneal cancer who received ≥2previous chemotherapeutic regimens but developed progressive disease during platinum based chemotherapy or within 6 months post-treatment. All patients received gemcitabine(500 mg/m2) and irinotecan (50 mg/m2) on days 1 and 8 every 21 days at the starting dose. Thedose was increased or decreased by 4 levels in subsequent cycles based on hematological ornon-hematological toxicities observed. The primary endpoint was progression-free survival(PFS), and secondary endpoints were disease control rate (DCR), overall survival (OS), andadverse events. Results: We investigated 25 patients who received 267 cycles (median 8 cycles/patient)between October 2008 and May 2011. Tailored-dose gemcitabine was administered up to the5th cycle as follows: 1,000 mg/m2in 1 (4%), 750 mg/m2in 16 (64%), 500 mg/m2in 6 (24%),and 250 mg/m2in 2 patients (8%). The median PFS and OS were 6.2 months (95% confidenceinterval [CI]=2.7–10.7) and 16.8 months (95% CI=9.4–30.7), respectively. The DCR was 76%,and PFS was >6 months in 12 of 25 patients (48%). Grade 3 hematological toxicities includedleukopenia (9.4%), neutropenia (11.2%), anemia (9.8%), and thrombocytopenia (1.1%). Grade 3/4 non-hematological toxicities did not occur except for fatigue in one patient. Conclusions: Tailored-dose chemotherapy with gemcitabine and irinotecan was effective andwell tolerated in patients with platinum-refractory/resistant ovarian or primary peritoneal cancer. Trial Registration: UMIN Clinical Trials Registry Identifier: UMIN000004449