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1.
Deffieux X Touboul C Uzan C Faivre E Frydman R Fernandez H Morice P 《Journal de gynecologie, obstetrique et biologie de la reproduction》2007,36(8):756-763
Introduction
Ovarian cancer is the leading cause of death from gynaecological malignancy, especially because of late diagnosis. The objective of the study was to provide the clinician with current concepts regarding prevention of ovarian cancer.Material and methods
A computerized search of articles published was performed using the Medline database We performed a review of the literature (PubMed, Embase) using the following search terms (MeSH and non-MeSH): prevention, chemoprevention, chimioprevention, ovarian cancer, ovarian, ovary, carcinoma, tumor, tumour.Results
Oral contraceptive and acetaminophen use may provide substantial protection against ovarian cancer, whereas aspirin, carotenoids and non-steroidal anti-inflammatory agents do not decrease the risk. However, to date, there is no recommendation concerning low risk population. At the opposite, young women (< 35–40 years old) presenting with BRCA1 or 2 mutation or Lynch syndrome may be counseled for chemoprevention using oral contraceptive. For high risk women over 35–40 years old, prophylactic bilateral salpingo-oophorectomy should be performed. Indeed, it has been showed that prophylactic surgery significantly decrease mortality rates in high risk women.Conclusion
Large randomized studies are required to assess the efficacy of ovarian cancer chemoprevention in low risk women. High-risk women over 35–40 years old should be counseled for prophylactic salpingo-oophorectomy or for chemoprevention using oral contraceptive. 相似文献2.
Geneviève Bouchard-Fortier William H. Geerts Allan Covens Danielle Vicus Rachel Kupets Lilian T. Gien 《Gynecologic oncology》2014
Objectives
Current recommendations for the use of venous thromboprophylaxis in patients undergoing minimally invasive surgery (MIS) for a gynecologic malignancy are derived from patients undergoing open surgery. Our objective was to determine the 30-day prevalence of symptomatic venous thromboembolism (VTE) after laparoscopic gynecologic oncology procedures in patients who received no thromboprophylaxis.Methods
Between January 2006 and September 2013, women who underwent MIS for endometrial, cervical or ovarian cancer at a single institution were included. Data on patient demographics, diagnosis, comorbidities, perioperative characteristics, use of thromboprophylaxis, and diagnosis of VTE were collected retrospectively.Results
Of the 419 patients who underwent MIS for a gynecologic cancer, 352 (84%) received no VTE prophylaxis. At least a total laparoscopic hysterectomy (simple or radical) or pelvic lymph node dissection was performed in 95% of these patients. The median length of surgery was 137 min and 95% of patients were discharged home within 1 day of surgery. The rate of VTE in the 352 untreated patients was 0.57% (1 pulmonary embolism and 1 deep vein thrombosis). There were no VTE diagnosed within 30 days of surgery in the 67 patients who received anticoagulant thromboprophylaxis.Conclusion
The rate of VTE is low in patients undergoing minimally invasive surgery for a gynecologic malignancy despite no VTE prophylaxis. The benefits of routine use of VTE prophylaxis in this population are questionable. 相似文献3.
Koah R. Vierkoetter Asia R. Ayabe Maya VanDrunen Hyeong Jun Ahn David M. Shimizu Keith Y. Terada 《Gynecologic oncology》2014
Objective
Patients with Lynch Syndrome are at an increased risk for a variety of malignancies, including ovarian cancer. Ovarian cancers associated with Lynch Syndrome are predominantly clear cell or endometrioid in histology. Lynch Syndrome is characterized by germline mutations in mismatch repair (MMR) genes. The current study aims to assess the prevalence of loss of MMR expression in patients with endometrioid and clear cell ovarian carcinoma.Methods
A retrospective review identified 90 patients with endometrioid and/or clear cell carcinomas. Slides made from tumor tissue microarray blocks were evaluated using immunohistochemical stains with antibodies against MLH1, PMS2, MSH2, and MSH6. Statistical analysis was performed.Results
Seven of the 90 cases (7.8%) had loss of MMR expression. The mean age of patients with loss of MMR expression (47 years) was significantly younger than those with retained MMR expression (p = 0.014). Loss of MMR expression was present in 20% of patients under the age of 53 with clear cell or endometrioid cancers. Genetic studies found that 3 of the 5 patients with loss of MMR expression carried mutations consistent with Lynch Syndrome; acquired hypermethylation of MLH1 was noted in one patient. Six of 7 patients (86%) whose tumors lacked MMR expression had synchronous or metachronous primary malignancies, a significantly greater prevalence than those with retained MMR expression (p < 0.001).Conclusion
Patients under the age of 53 with clear cell or endometrioid ovarian carcinomas are at a clinically significant risk for loss of MMR expression and Lynch Syndrome; routine screening with immunohistochemical staining should be considered. 相似文献4.
Molly S. Daniels Diana L. Urbauer Azadeh Zangeneh Brittany A.L. Batte Katherine M. Dempsey Karen H. Lu 《Gynecologic oncology》2013
Objective
The aims of this study were to implement a patient-administered checklist designed to identify endometrial cancer patients at elevated risk for Lynch syndrome; measure subsequent genetic counseling and testing; and identify differences between those who attended genetic counseling and those who did not.Methods
We developed a 4-item yes/no checklist of personal and family history risk factors for Lynch syndrome-associated endometrial cancer and recommended referral for genetic counseling for patients meeting any of the criteria. Retrospective chart review was performed to determine subsequent genetic counseling and testing outcomes over a 15 month period.Results
6/387 (1.6%) of endometrial cancer patients tested positive for a Lynch syndrome mutation. 4/24 (17%) of endometrial cancer patients who met referral criteria and attended genetic counseling tested positive. 38/70 (55%) of patients who met referral criteria were not seen for genetic counseling. Patients who were diagnosed with endometrial cancer at younger ages, who had primary surgery at our institution, or who met more than one referral criteria were more likely to be seen for genetic counseling.Conclusions
Endometrial cancer patients who met referral criteria and attended genetic counseling comprised a population enriched for Lynch syndrome. This approach allowed Lynch syndrome evaluation resources to be targeted to a population of patients that is high risk and interested in the information. The referral rate of at-risk patients needs to be improved, and allocating resources towards this goal could increase the identification of Lynch syndrome while avoiding some of the pitfalls of universal screening. 相似文献5.
Jonathan D. Boone Janelle M. Fauci Eleanor S. Barr Jacob M. Estes Kerri S. Bevis 《Gynecologic oncology》2013
Objectives
The incidence of port site hernia and/or dehiscence using bladeless trocars is 0–1.2%. Robotic surgery uses additional port sites and increases manipulation of instruments, raising the concern for more complications. We sought to characterize the incidence of port site complications following robotic surgery when fascia was not routinely closed.Methods
Robotically-assisted (RA) procedures performed for suspected gynecologic malignancy between 1/2006 and 12/2011 were retrospectively reviewed. Bladeless 12 mm and 8 mm robotic trocars were used. Fascial closure was not routinely performed except after specimen removal through the port site. The decision to close the fascia remained at the discretion of the surgeon.Results
Data from 842 procedures were included. Mean patient age was 55.6 years. Mean Body Mass Index was 33.6 kg/m2. RA-total laparoscopic hysterectomy (TLH) ± unilateral or bilateral salpingo-oophorectomy (BSO) ± lymphadenectomy (LND) accounted for 91.6% of procedures. Final pathology confirmed malignancy in 58.6% of cases, primarily endometrial cancer. In 35 cases, the specimen was removed through the port site; fascia was closed in 54.3% of them and no port site hernias or dehiscences occurred. Only one patient underwent a RA-TLH/BSO/LND for endometrial adenocarcinoma and had a port site dehiscence of the 8 mm trocar site. No port site hernias occurred.Conclusion
Port site hernias and dehiscences are rare in RA gynecologic oncology procedures. When bladeless dilating trocars are used, routine closure of even up to a 12 mm port site is unnecessary, even in cases requiring removal of the specimen through the trocar sites. 相似文献6.
Laura L. Holman Sue Friedman Molly S. Daniels Charlotte C. Sun Karen H. Lu 《Gynecologic oncology》2014
Objective
Given the emerging evidence for the fimbria as the site of origin for many serous carcinomas in BRCA mutation carriers, consideration is being given in studying prophylactic salpingectomy with delayed oophorectomy (PSDO) as a risk-reducing surgery. We aimed to determine the interest in a study of PSDO among these women.Methods
We evaluated the results of an online survey conducted by Facing Our Risk of Cancer Empowered (FORCE), a patient advocacy group, from October 2010 to August 2012. Premenopausal BRCA mutation carriers with no history of ovarian cancer or prior bilateral salpingo-oophorectomy (BSO) were included.Results
Of the 204 women meeting inclusion criteria, median age was 35 years, 92.5% were white, 25.7% were Jewish, and 16.7% had a history of breast cancer. Overall, 34.3% reported interest in a study of salpingectomy, 35.3% were unsure, and 30.4% were not interested in the study. Women noted the possibility of lowering ovarian cancer risk without menopause as a compelling reason to participate (83.8%). Reasons for not participating in a salpingectomy study included surgical complications (46.6%), potential ovarian damage (42.2%), planning BSO soon (32.4%), and surgical costs (32.8%). Acceptable study risks included the need for two surgeries (77.2%), possibility of not lowering ovarian cancer risk (68%), and disruption of ovarian blood supply (66.5%).Conclusions
One-third of BRCA mutation carriers indicated definite interest in a PSDO study. Potential study risks were acceptable to most women. These findings suggest that patient accrual for a clinical trial of prophylactic salpingectomy with delayed oophorectomy is possible. 相似文献7.
Eran Ben-Arye Elad Schiff Orit G. Raz Noah Samuels Ofer Lavie 《International journal of gynaecology and obstetrics》2014
Objective
To explore oncology healthcare providers’ (HCPs’) patterns of referral of women undergoing chemotherapy to a complementary medicine (CM) consultation integrated within a conventional oncology service.Methods
Oncology HCPs used a structured referral system for referral to an integrative physician (IP) for CM consultation. Referral goals were in accordance with a specified list of quality-of-life (QOL) outcomes.Results
In total, the study HCPs referred 282 female patients, of whom 238 (84.4%) underwent CM consultation by the study IP: 59 (24.8%) with gynecologic cancer and 179 (75.2%) with non-gynecologic cancer. Use of CM for cancer-related outcomes was significantly higher among referred patients with gynecologic cancer than those with non-gynecologic cancer (69.5% vs 46.9%; P = 0.003). Oncologists initiated most of the referrals in the gynecologic oncology group, whereas oncologic nurses referred most patients in the non-gynecologic oncology group. Among patients with gynecologic cancer, the correlation between HCP indication and patient expectation was high for gastrointestinal concerns (κ 0.41).Conclusion
The integration of a structured and informed process of referral to CM consultation may enhance patient-centered care and QOL during chemotherapy. 相似文献8.
William Stroud Jenny M. Whitworth Margaret Miklic Kellie E. Schneider Michael A. Finan Jennifer Scalici Eddie Reed Lisa Bazzett-Matabele J. Michael Straughn Jr. Rodney P. Rocconi 《Gynecologic oncology》2014
Objectives
Gynecologic oncology patients undergoing surgery are at an increased risk for venous thromboembolism (VTE). We attempted to validate a VTE risk assessment model in gynecologic oncology patients.Methods
All gynecologic oncology patients who underwent a laparotomy for the diagnosis or suspicion of gynecologic malignancy from 2004 to 2010 were included. Demographic, surgicopathologic, and complication data were collected. VTE was based on the symptomatic diagnosis. Data for the Caprini risk assessment model (RAM) was used to score and stratify patients on their risk for VTE.Results
1123 gynecologic oncology patients were included within this study. Ovarian cancer was the most common diagnosis (39%) with a median age of 56.1. All patients received SCDs with 40% receiving double prophylaxis. The overall incidence of VTE was 3.3%, with lower extremity deep venous thrombosis (DVT) n = 17 and pulmonary embolism (PE) n = 20. Complication rates were similar in each group. Based on the Caprini scoring model 92% of patients scored in the “Highest Risk” category. The Caprini RAM accurately predicted all 37 VTEs, all of which scored in the “Highest Risk” category. The percentage of patients that received double prophylaxis increased with time from 12% in 2004 to 63% in 2010. Importantly, 25 of the 37 VTEs (68%) did not receive double prophylaxis.Conclusions
The use of the Caprini RAM accurately predicted patients at the highest risk of experiencing VTE. Considering accurate identification of patients allows proper administration of double prophylaxis, we recommend the use of this scoring model preoperatively in patients undergoing surgery for gynecologic malignancies. 相似文献9.
Lauren S. Lewis Patricia A. Convery Corey S. Bolac Fidel A. Valea William J. Lowery Laura J. Havrilesky 《Gynecologic oncology》2014
Objective
We wished to determine the reduction in the rate of wound complications that would render the use of prophylactic negative pressure wound vacuum therapy (NPWT) cost saving compared to routine incision care (RC) following laparotomy for gynecologic malignancy.Methods
A decision tree was designed from a payer perspective to compare strategies for incision management following laparotomy for gynecologic malignancy: (1) RC; (2) prophylactic NPWT. Rates of wound complication, antibiotic use, re-hospitalization, re-operation, and home health use were obtained from a published cohort of 431 women who underwent laparotomy for endometrial cancer 2002–2007. Costs were estimated using Medicare reimbursements; cost of NPWT ($200) was obtained from hospital financial department. A 50% reduction in wound complications using NPWT was assigned initially and varied for sensitivity analysis.Results
The mean BMI was 36. The wound complication rate was 31% (37% for BMI > 30, 41% for BMI > 40). The overall cost of incision care was $104 lower for NPWT than for RC. At the lowest cost of NPWT ($200), the risk of wound complication must be reduced by 33% (relative risk = 0.67) for NPWT to achieve cost savings in this cohort. Modeling obese and morbidly obese cohorts, the NPWT resulted in overall cost savings of $163 and $203, respectively, and the risk of wound complication must be reduced by 28% and 25%, respectively, for NPWT to achieve cost savings.Conclusion
If the wound complication rate can be reduced by one-third, prophylactic NPWT is potentially cost saving in high-risk women undergoing laparotomy for gynecologic malignancy. 相似文献10.
Shiozaki T Tabata T Motohashi T Kondo E Tanida K Okugawa T Ikeda T 《European journal of obstetrics, gynecology, and reproductive biology》2012,164(1):85-88
Objectives
In treating gynecologic malignancies, we sometimes encounter patients in whom venous thromboembolism (VTE) has developed before surgery. Few reports exist on preoperative management of VTE. We conducted a study to determine the optimum preoperative management strategy for patients with gynecologic malignancy and existing VTE.Study design
We reviewed the clinical records of patients treated between April 2004 and March 2010 in the Department of Obstetrics and Gynecology at Mie University Hospital. During this period, 654 exploratory or therapeutic laparotomies were performed for gynecologic malignancy. All patients were assessed by ultrasound for VTE before and after surgery. Twenty-five of the 654 patients (3.8%) had preoperative VTE. We reviewed the 25 cases and evaluated the management method and outcomes in terms of VTE.Results
Most preoperative VTEs were located in a crural vein (23 cases; 92%); only 2 (8%) were in a pelvic vein. Three patients were excluded from the study because they had only a small organized thrombus and were treated with VTE prophylaxis according to American College of Chest Physicians (ACCP) guidelines. The other 22 patients were given graduated compression stockings and began anticoagulation therapy with heparin (unfractionated heparin or heparin calcium) immediately after the VTE diagnosis. Anticoagulation therapy was continued until a mean 8.5 h before surgery and then restarted 10 h (mean) after surgery. Sixteen of the 22 patients were treated by intermittent pneumatic compression during and after surgery. This management strategy resulted in six cases (27%) of diminished VTE, 10 cases (46%) without remarkable change, and six cases (27%) of deterioration. Clinical deterioration occurred in two of the 22 cases (9%), i.e., PE or pelvic VTE developed.Conclusions
Our preoperative management of existing VTE appears to be insufficient. Shorter or no interruption of antithrombotic therapy and/or another intervention such as inferior vena cava filter placement may be necessary in patients with preoperative VTE. 相似文献11.
Gynecologic cancer prevention in Lynch syndrome/hereditary nonpolyposis colorectal cancer families 总被引:1,自引:0,他引:1
OBJECTIVE: Women from Lynch syndrome/hereditary nonpolyposis colorectal cancer (Lynch/HNPCC) families have an increased lifetime risk of developing endometrial and ovarian cancer. This study models a comparison of management strategies for women who carry a Lynch/HNPCC mutation. METHODS: A decision analytic model with three arms was designed to compare annual gynecologic examinations with annual screening (ultrasonography, endometrial biopsy, CA 125) and with hysterectomy with bilateral salpingo-oophorectomy at age 30 years The existing literature was searched for studies on the accuracy of endometrial and ovarian cancer screening using endometrial biopsy, transvaginal ultrasonography, and serum CA 125. The Surveillance, Epidemiology and End Results database from 1988 to 2001 was used to estimate cancer mortality outcomes. RESULTS: In the surgical arm, 0.0056% of women were diagnosed with ovarian cancer and 0.0060% of women with endometrial cancer. These numbers increased to 3.7% and 18.4% in women being screened, and 8.3% and 48.7% in women undergoing annual examinations, respectively. Surgical management led to the longest expected survival time at 79.98 years, followed by screening at 79.31 years, and annual examinations at 77.41 years. If starting at age 30 and discounting life years at 3%, surgery still leads to the greatest expected life years. When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman's entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively. CONCLUSION: Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities. 相似文献
12.
Finch A Metcalfe KA Chiang JK Elit L McLaughlin J Springate C Demsky R Murphy J Rosen B Narod SA 《Gynecologic oncology》2011,121(1):163-168
Objective
Prophylactic salpingo-oophorectomy is recommended to women who carry a BRCA1 or BRCA2 mutation to reduce the risks of breast, ovarian and fallopian tube cancer. We measured the impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual functioning in women with a BRCA mutation.Methods
Women who underwent prophylactic salpingo-oophorectomy between October 1, 2002 and June 26, 2008 for a known BRCA1 or BRCA2 mutation were invited to participate. Participants completed questionnaires before prophylactic surgery and again one year after surgery. Measures of sexual functioning and menopausal symptoms before and after surgery were compared. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy was evaluated.Results
114 women who underwent prophylactic surgery completed questionnaires before and one year after surgery. Subjects who were premenopausal at the time of surgery (n = 75) experienced a significant worsening of vasomotor symptoms (hot flashes, night sweats and sweating) and a decline in sexual functioning (desire, pleasure, discomfort and habit). The increase in vasomotor symptoms and the decline in sexual functioning were mitigated by HRT, but symptoms did not return to pre-surgical levels. HRT decreased vaginal dryness and dyspareunia; however, the decrease in sexual pleasure was not alleviated by HRT. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy remained high regardless of increased vasomotor symptoms and decreased sexual function.Conclusions
Women who undergo prophylactic salpingo-oophorectomy prior to menopause experience an increase in vasomotor symptoms and a decrease in sexual functioning. These symptoms are improved by HRT, but not to pre-surgical levels. 相似文献13.
Joseph T. Santoso Leslie Evans Lauren Lambrecht Jim Wan 《European journal of obstetrics, gynecology, and reproductive biology》2009
Objective
Cancer patients have increased risks of leg deep venous thrombosis (DVT). We studied the incidence, risk factors and most predictive symptoms of leg DVT in gynecologic oncology patients.Study designs
Gynecologic oncology patients with any leg DVT symptoms were recruited and screened using Doppler sonogram. All hospitalized surgery and non-ambulating patients received thigh-high sequential compression devices (SCDs) without heparin as a prophylactic method against thrombosis. Statistical analysis was done using chi-square or Fisher's exact tests.Results
Out of 1974 patients, 134 complained of lower limb symptoms. Doppler studies found 38 patients with leg DVT. Incidence of leg DVT was 36/853 (4.2%) in patients with cancer and 2/1121 (0.2%) in patients without cancer (odds ratio 2.8 with a diagnosis of cancer). Leg edema, erythema, fever, and warm leg were significant symptoms in diagnosing leg DVT (p < 0.01). The cost of finding a leg DVT was $747.54.Conclusions
Clinical exam is less accurate than Doppler sonogram in diagnosing leg DVT. The incidence of leg DVT using SCD seems to be comparable with other studies. Finally, the cost of identifying leg DVT seems reasonable. 相似文献14.
J.L. Lobato J. MorenoT. Arriba E. BeiroM. Lopez-Valverde 《Clínica e investigación en ginecología y obstetricia》2013
Objetive
The purpose was to evaluate the prevalence of carcinoma found at surgical biopsy of llesions identified as atypical ductal hyperplasia by percutaneous breast biopsy.Methods
We performed a retrospective study of all asymptomatic patients with a result of atypical ductal hyperplasia on percutaneous breast biopsy and who underwent surgical excision from January 2002 to December 2010.Results
Sixty-eight patients were found to have atypical ductal hyperplasia at percutaneous breast biopsy and were evaluated with surgical biopsy. Seventeen patients (25%) had carcinoma at surgical excision, 10 had ductal carcinoma in situ, and 7 patients had invasive carcinoma. The mammographic characteristics associated with malignancy were analyzed.Conclusions
A finding of atypical ductal hyperplasia at percutaneous breast biopsy frequently corresponds to cancer and is therefore an indication for surgical excision. 相似文献15.
Olga Güell Maria Francesca PerellóÁgata Rodríguez Aureli TornéJaume Pahisa 《Progresos de Obstetricia y Ginecología》2014
Background and objective
Paraneoplastic cerebellar degeneration (PCD) is a rare neurological complication that develops in patients with cancer and is associated with different antibodies. PCD associated with anti-Yo antibodies usually occurs in patients with gynecological cancer. There is no diagnostic method that would allow early detection and appropriate treatment.Methods
We describe three patients who presented with subacute cerebellar dysfunction and positive anti-Yo antibodies. After diagnosis and treatment, the patients were monitored to evaluate persistence of the neurological syndrome.Results
Imaging studies were performed when gynecologic cancer was suspected. In all patients, fluorodeoxyglucose-positron emission tomography/tomography computerized (FDG-PET/TC) was the only imaging test that led to suspicion of the primary lesion. Histological examination confirmed the diagnosis of ovarian carcinoma in two patients and carcinoma of the horn in the third patient. All patients underwent radical surgery and subsequent chemotherapy. Corticosteroids were administered with no improvement of the neurological syndrome in any of the patients.Conclusion
Oncologic treatment does not improve neurological symptoms. FDG-PET/TC with fluorodeoxyglucose could be useful in cases of PCD in which conventional imaging tests do not identify the underlying malignancy. 相似文献16.
Brittany A.L. Batte Amanda S. Bruegl Molly S. Daniels Kari L. Ring Katherine M. Dempsey Bojana Djordjevic Rajyalakshmi Luthra Bryan M. Fellman Karen H. Lu Russell R. Broaddus 《Gynecologic oncology》2014
Objective
Determine factors impacting the uptake of genetic counseling and results of genetic testing following universal tumor testing for Lynch syndrome in patients with endometrial cancer.Methods
The study population consisted of two unselected cohorts of endometrial cancer patients, 408 identified retrospectively and 206 identified prospectively. Immunohistochemistry for mismatch repair protein expression and/or microsatellite instability analysis was performed on these tumors. MLH1 methylation analysis was performed on tumors with loss of MLH1 protein. Tumor studies were considered suggestive of Lynch Syndrome if they showed immunohistochemical loss of MSH2, MSH6 or PMS2, loss of MLH1 without MLH1 promoter methylation, and/or microsatellite instability. Participants with suggestive tumor studies were contacted and offered genetic counseling and testing.Results
In the retrospective cohort, 11% had tumor studies suggestive of Lynch syndrome, and 42% was seen for genetic counseling. A germline mutation was detected in 40%, and one had a variant of uncertain significance. In the prospective cohort, 8.7% of patients had tumor testing suggestive of Lynch syndrome; 72% were seen for genetic counseling. Germline mutations were found in 40%, and one had a variant of uncertain significance. Common challenges included timing of re-contact, age, perceived lack of relevance, inability to travel and limited insurance coverage.Conclusions
There are several barriers to genetic counseling and testing follow-up after universal tumor testing, and uninformative genetic test results present a management challenge. It is important to consider these limitations when implementing an approach to screening endometrial cancer patients for Lynch syndrome. 相似文献17.
Amadeus Hornemann Marc Suetterlin Marcus J. Trunk Axel Gerhardt Georg Kaehler 《International journal of gynaecology and obstetrics》2014
Objective
Natural orifice transluminal endoscopic surgery (NOTES) is a surgical approach that uses natural orifices to gain access to areas of the body. In the present article, we describe the first transgastric pure NOTES salpingo-oophorectomy, which we call peroral endoscopic salpingo-oophorectomy (POESY).Methods
A woman with BRCA1 mutation presented for prophylactic bilateral salpingo-oophorectomy. We offered her the transgastric approach, having performed more than 25 transgastric appendectomies. After gastroscopic incision in the corpus wall, we advanced the gastroscope into the abdominal cavity. Salpingo-oophorectomy was performed with the help of an intrauterine manipulator and a transvaginally introduced 5-mm trocar. The posterior colpotomy was dilated and the specimens were extracted. The gastrotomy was closed with an over-the-scope clip, and the colpotomy with a running suture.Results
The gastroscope provided excellent optical control and good tissue preparation. Prophylactic bilateral salpingo-oophorectomy was performed successfully via POESY. The patient recovered quickly and was discharged on the third day, with an uneventful follow-up.Conclusion
The present case demonstrates the feasibility of transgastric access. The gastroscope provided excellent optical control and good tissue preparation. Therefore, we expect an increasing role of transgastric procedures for diseases in the pelvic region, particularly if new endoscopic platforms with better means of instrumentation and tissue management become available. 相似文献18.
Objective
To summarize the literature on quality of life for patients treated with definitive radiation for gynecologic cancers, with a specific focus on patient reported outcomes.Methods
A literature review was performed to summarize studies about patient-reported outcomes and quality of life in women with gynecologic malignancies who were treated with definitive radiation therapy. Summaries are by disease site, including endometrial, cervical and vulvar cancers.Results
Over 20 different survey instruments have been used to describe patient-reported outcomes for women treated with radiation for gynecologic cancer. Regardless of disease site, all patients describe a degree of compromise in physical and social functioning, as well as sexual dysfunction. Specific symptoms which are most bothersome for patients vary by disease site, such as bowel concerns predominating for endometrial cancer patients, while body image is more concerning for cervical cancer patients.Conclusions
Several quality of life concerns exist for women treated with radiation therapy for gynecologic malignancies. Significant overlap exists in the QOL issues affecting these patients. Whether to combine or separate surveys by diagnosis, treatment type, age, or time point should be explored further. Assessing patients' psychological, emotional, and physical concerns helps to understand long-term adjustment, enabling incorporation of these domains into future trials that will ultimately improve patient well-being. 相似文献19.
Volpi E Ferrero A Jacomuzzi ME Carus AP Fuso L Martra F Sismondi P 《European journal of obstetrics, gynecology, and reproductive biology》2006,124(2):232-236
Objective
The aim of this study was to compare laparoscopic and abdominal approach in the treatment of endometrial cancer in our department.Study design
From January 1999 to November 2002, 77 patients underwent surgery for stages I–III endometrial cancer. The first group of 36 patients had abdominal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy. The remaining 41 patients received laparoscopic assisted vaginal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy.In this retrospective study, we have compared the surgical results, the short- and long-term morbidity and the outcome of the two patient groups.Results
Body mass index (BMI) was significantly higher in the laparoscopic group (27.3 versus 24.6; p = 0.009). The average time for surgery was significantly longer for the laparoscopic group (143.6 min versus 109.7 min; p = 0.0001), but lymphadenectomy was performed in more patients (63.4% versus 25%; p = 0.001).Postoperative hospital stay was significantly longer in patients undergoing the abdominal approach (4.59 days versus 3.18 days; p < 0.0001). No blood transfusions were performed and the rates of complications were similar in the two groups. No differences were found in recurrence and survival rate.Conclusions
In our experience, laparoscopic and abdominal surgery can achieve similar results in the treatment of endometrial cancer. In our series, even with the BMI and the number of lymphadenectomies being higher in the laparoscopic group, the rates of complications were similar in the two groups. 相似文献20.
Roberto Angioli Francesco Plotti Ester Valentina Cafà Nella Dugo Stella Capriglione Corrado Terranova Roberto Montera Federica Guzzo Pierluigi Benedetti Panici 《European journal of obstetrics, gynecology, and reproductive biology》2013