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OBJECTIVE: To analyze the surgical outcomes and diaphragmatic involvement in stage III and IV ovarian cancer. PATIENTS AND METHODS: All patients with stage III-IV ovarian cancer between January 2013 and January 2016 were included. The outcomes of interest reviewed were as follows: surgical (complications, mortality), peritoneal carcinomatosis index (PCI), rate of complete resection, and disease-free interval and survival. RESULTS: Fifty-seven patients were included, 38 (67%) with diaphragmatic involvement; in 10 cases (18%), diaphragmatic resection was required. Optimal cytoreduction (OCR) was obtained in 49 cases (86%). The PCI was >10 in 31 cases (54%). Respiratory complications occurred in 10 cases (18%) and mortality in 3 (5%). Disease-free survival rate in 3 years was 53%, being 87% in cases without diaphragmatic involvement. The overall survival rate in 3 years is 46%, 83% in the cases without diaphragmatic involvement and 27% in cases with affectation (p<0.05). In cases of OCR, 3 year survival rate was 65%. In the multivariate analysis for the overall survival of cases with OCR, the only independent prognostic factor found was the operative PCI. A strong correlation was found between the total PCI and the diaphragmatic PCI (p<0.001). With a PCI >10, virtually all cases will present diaphragmatic involvement (p<0.05). CONCLUSION: The tumor burden is different in stages III and IV of advanced ovarian cancer and the PCI is an effective method to quantify it. The PCI constitutes an independent prognostic factor for the advanced stages of ovarian cancer. A PCI >10 constitutes a useful prognostic factor of the affectation and forces the surgeon to thoroughly review both diaphragms.
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INTRODUCTION: Vulvar cancer has a lower incidence in high income countries, but is rising, in part, due to the high life expectancy in these societies. Radical vulvectomy is still the standard treatment in initial stages. Wound dehiscence contitututes one of the most common postoperative complications. PRESENTATION OF CASE: A 76year old patient with a squamous cell carcinoma of the vulva, FIGO staged, IIIb is presented. Radical vulvectomy and bilateral inguinal lymph node dissection with lotus petal flaps reconstruction are performed as the first treatment. Wound infection and dehiscence of lotus petal flaps was seen postoperatively. Initial management consisted in antibiotics administration and removing necrotic tissue from surgical wound. After this initial treatment, negative wound pressure therapy was applied for 37days with good results. DISCUSSION: Wound dehiscence in radical vulvectomy remains the most frequent complication in the treatment of vulvar cancer. The treatment of this complications is still challenging for most gynecologic oncologist surgeons. CONCLUSION: The utilization of the negative wound pressure therapy could contribute to reduce hospitalization and the direct and indirect costs of these complications.
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INTRODUCTION: Struma ovarii is a rare ovarian tumor, representing 0.5-1% of all ovarian tumors and 2-5% of ovarian teratomas. It is defined as an ovarian teratoma composed mostly of thyroid tissue. The symptoms are nonspecific, and the imaging studies can help in characterize the mass; however, the definitive diagnosis is usually given by the Pathologist. Classically, the treatment is the surgical resection of the ovarian mass, however there is no consensus regarding the follow-up. PRESENTATION OF CASE: An asymptomatic malignant struma ovarii in a 43 year-old patient is presented. The diagnosis was postoperatively following a laparoscopic adnexectomy due to an apparently benign ovarian teratoma. The histopathology results revealed a mature ovarian cystic teratoma with papillary carcinoma with immunohistochemical characteristics suggesting a thyroid origin. Seeing that there was no thyroid affectation or metastatic disease, we decided a conservative management. A yearly follow-up with CT scan and tumor markers was performed. The endocrinologist also performed annual controls with thyroid ultrasound and serum tests. The patient has remained asymptomatic during these last four years. DISCUSSION: There is little evidence in literature on the conservative management in cases with evidence of malignancy. If fertility preservation is desired, an unilateral oophorectomy could be performed, along with levels of serum thyroglobulin as a marker of relapse. Other authors claim for aggressive ovarian cancer surgery followed by a total thyroidectomy. There is still no established management for struma ovarii patients and the choice for a conservative or radical approach depends only on the professional decision.
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Objetivo. El objetivo del presente trabajo fue describir de forma retrospectiva los resultados de nuestro centro, de una serie de pacientes a quienes se realizó histerectomía total laparoscópica. Material y métodos. Se realizó un estudio retrospectivo tras la revisión de las 120 pacientes a las que se les sometió a una histerectomía laparoscópica en el periodo comprendido entre enero de 2012 y diciembre de 2014. La edad media fue de 54 años (23-94), con un IMC medio de 27,6. Se analizaron las características generales, indicaciones, presencia de intervenciones previas, complicaciones intraoperatorias y postoperatorias, duración del procedimiento y tasa de conversión a laparotomía. Resultados. Las complicaciones intraoperatorias fueron: lesiones en la vejiga (0,8%) y lesión ureteral (1,7%). Hubo complicaciones postoperatorias en 6 pacientes (tres con síndrome febril, fístula ureterovaginal, dos dehiscencias de cúpula vaginal, dos sangrados vaginales y un hemoperitoneo). La tasa de conversión a histerectomía abdominal fue de 1,6%. Conclusión. La histerectomía laparoscópica es un proceso reproducible, con una tasa de complicaciones baja, aceptado por las pacientes por su calidad de vida, y con una recuperación postoperatoria rápida (AU)
Objective. To describe complications and clinical evolution of patients underwent to total laparoscopic hysterectomy. Material and method. A retrospective study was performed after reviewing 120 patients who were subjected to laparoscopic hysterectomy in the period between January 2012 and December 2014. Medium age was 54 years (23-94) and BMI 27.6. The general characteristics, indications, presence of previous surgery, perioperative complications were analyzed and postoperative duration of the procedure and rate of conversion to laparotomy. Results. The intraoperative complications were bladder injury (0.8%) and ureteral injury (1.7%). There were postoperative complications in 6 patients (three febrile syndrome, fistula ureterovaginal, two vaginal cuff dehiscence, two vaginal bleeding and hemoperitoneum). The conversion rate to abdominal hysterectomy was 1.6%. Conclusion. Laparoscopic hysterectomy is a reproducible process with a low complication rate accepted by the patients quality of life, and with rapid postoperative recovery (AU)
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Adulto , Anciano de 80 o más Años , Anciano , Femenino , Humanos , Persona de Mediana Edad , Histerectomía/métodos , Laparoscopía/métodos , Complicaciones Intraoperatorias/prevención & control , Complicaciones Intraoperatorias/terapia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Vejiga Urinaria/lesiones , Uretra/lesiones , Fístula/complicaciones , Fístula/cirugía , Hemorragia/complicaciones , Hemoperitoneo/complicaciones , Hemoperitoneo/diagnósticoRESUMEN
Objetivo: El objetivo del presente trabajo es describir de forma retrospectiva la técnica, eficacia y seguridad de la colposacropexia laparoscópica con malla en Y de macroporo y anclajes helicoidales de titanio para el tratamiento del prolapso de cúpula vaginal. Método: Catorce pacientes, desde enero de 2011 a enero de 2013, fueron intervenidas en el Servicio de Ginecología del Hospital General Universitario de Castellón. La técnica consistía en la fijación de la vagina al sacro con la ayuda de una malla de polipropileno y anclajes helicoidales de titanio. La paridad de las pacientes fue entre 1 y 3 partos vaginales con un rango de edad entre 49 y 78 años. Resultados: La técnica quirúrgica logró la corrección del defecto en las 14 pacientes. No se reportaron complicaciones intraoperatorias, ni postoperatorias, con rápida recuperación e incorporación a las actividades diarias. Conclusiones: La colposacropexia laparoscópica con malla de polipropileno es una técnica segura, efectiva y reproducible con excelentes resultados (AU)
Objective: To retrospectively analyze the technical feasibility, effectiveness and safety of laparoscopic sacrocolpopexy with Y wide-pore mesh and helical titanium anchorages for the treatment of vaginal vault prolapse. Method: Between January 2011 and January 2013, 14 laparoscopic colposacropexies were performed in the Gynecology Service of the General University Hospital of Castellón. The technique consisted of mesh joined to the sacropromontory with helical titanium anchorages. Parity was between one and three births. The age of the patients was between 49 and 78 years. Results: The surgical technique successfully corrected the defect in 14 patients. There were no interoperative or postoperative complications, with prompt recovery and reintegration to usual activities. Conclusions: Laparoscopic colposacropexy with polypropylene mesh is a safe, effective and reproducible technique with excellent results (AU)