RESUMEN
The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.
Asunto(s)
Neoplasias Ováricas/cirugía , Neoplasias Peritoneales/cirugía , Adenocarcinoma de Células Claras/tratamiento farmacológico , Adenocarcinoma de Células Claras/mortalidad , Adenocarcinoma de Células Claras/cirugía , Adenocarcinoma Mucinoso/tratamiento farmacológico , Adenocarcinoma Mucinoso/mortalidad , Adenocarcinoma Mucinoso/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/tratamiento farmacológico , Carcinoma Papilar/mortalidad , Carcinoma Papilar/cirugía , Quimioterapia Adyuvante , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/mortalidad , Cistadenocarcinoma Seroso/cirugía , Femenino , Mortalidad Hospitalaria , Humanos , Metástasis Linfática/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/mortalidad , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Sobrevivientes , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: The purpose of the study is to report two long-term survivors with ovarian carcinosarcomas, which are rare intrapelvic malignancies with unfavorable prognosis. METHODS: Two middle-aged women with palpable abdominal tumors underwent complete cytoreductive surgery and no macroscopic tumor was left behind. Early postoperative intraperitoneal chemotherapy with doxorubicin was used as an adjuvant treatment. RESULTS: The patients are disease-free 2 and 3 years, respectively after the initial therapy. CONCLUSION: Complete cytoreduction combined with early postoperative intraperitoneal chemotherapy seems to be an effective treatment for ovarian carcinosarcoma with peritoneal spread. Further studies are required to define the value of intraperitoneal chemotherapy in ovarian carcinosarcoma.
Asunto(s)
Antibióticos Antineoplásicos/uso terapéutico , Carcinosarcoma/cirugía , Doxorrubicina/uso terapéutico , Neoplasias Ováricas/cirugía , Carcinosarcoma/tratamiento farmacológico , Quimioterapia Adyuvante , Femenino , Humanos , Infusiones Parenterales/métodos , Persona de Mediana Edad , Neoplasias Ováricas/tratamiento farmacológico , Pronóstico , Sobrevivientes , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: Non-radical surgery is the preferred method of treatment of hydatid liver disease, and is associated with low mortality and recurrence rate. The purpose of the study is the retrospective analysis of the outcome of patients who were treated surgically in a single institution. MATERIAL AND METHODS: Between 1987 and 2005, 59 patients, mean age 58.2 +/- 15.9 (13-83) years, underwent surgery for liver hydatid disease. The patients were reassessed with physical examination, serological tests and radiological examination for the evaluation of the recurrence rate. RESULTS: Most cysts were solitary, the more frequently affecting the right lobe of the liver. Radical surgery was possible in four cases (6.8%) that were classified as PNM stage I. Partial cystectomy and omentoplasty was performed in 37 patients (62.7%) and external drainage with partial cystectomy in 18 patients (30.5%). The hospital morbidity was 27.2% and was found to be related to ASA class (p = 0.019). Hospital mortality was 5.1%. The median follow-up time was 94 (1-228) months and 45 out of 59 patients (76.3%) were reassessed, but no recurrence was recorded. There was no significant difference in morbidity, mortality, and hospital stay between partial cystectomy combined with external drainage or omentoplasty (p > 0.05). CONCLUSIONS: PNM staging seems to be a reliable tool in selecting patients with liver hydatid disease for non-radical or radical surgery. Omentoplasty is an easy and effective surgical method for the treatment of hepatic echinococcosis but is not different than partial cystectomy and external drainage in regard to morbidity, mortality, and recurrence.
Asunto(s)
Equinococosis Hepática/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colecistectomía , Coledocostomía , Drenaje , Equinococosis Hepática/clasificación , Equinococosis Hepática/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Masculino , Persona de Mediana Edad , Epiplón/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of the study is to identify the effect of synchronous prophylactic oophorectomy in women undergoing colorectal cancer surgery on long-term survival, recurrences and sites of failure. PATIENTS AND METHODS: From 1987 to 2003, 124 women, mean age 69+/-10 (35-91) years, with colorectal carcinoma were retrospectively reviewed. In 70 (56.5%) women the ovaries were preserved during surgery and 54 (43.5%) women underwent synchronous prophylactic oophorectomy during primary tumour resection. Univariate and multivariate analysis were used to assess the effect of oophorectomy on long-term survival, recurrences and sites of failure. RESULTS: By univariate analysis it was demonstrated that synchronous oophorectomy had no effect on long-term survival (p=0.7294). By multivariate analysis it was demonstrated that stage was the only factor independently influencing survival (p=0.0061). Twenty-eight patients (23%) developed recurrence and 10 of them developed locoregional recurrence. By univariate analysis it was demonstrated that the number of recurrences was not different between women with or without oophorectomy (p=0.259). Distant and locoregional recurrences were not different between women undergoing resection of primary colorectal carcinoma with or without oophorectomy (p=0.611). CONCLUSIONS: Oophorectomy does not appear to influence long-term survival, the total number of recurrences or the sites of failure.