D.S. McMeekin

Effectiveness of cyanoacrylate microbial sealant in the reduction of surgical site infection in gynecologic oncology procedures: A phase III single institution prospective randomized trial

OBJECTIVES Surgery is a cornerstone for patients with gynecologic malignancies. Surgical site infections (SSI) remain a source of post-operative morbidity. Consequences range from escalated costs, delay in adjuvant therapy, and increased morbidity. Our primary objective was to evaluate the effectiveness of a cyanoacrylate microbial sealant (CMS) to reduce post-operative SSI following laparotomy for suspected gynecologic malignancy. METHODS Patients were randomized using a 1:1 allocation to receive either standard skin preparation or standard preparation with CMS and stratified by BMI. Patients were followed for 6weeks for SSI. Demographic data was collected through the EMR. Associations between SSI, use of CMS, and clinicopathologic factors were explored using descriptive statistics, chi-square and multivariate analysis. RESULTS 300 patients underwent randomization. Median age of the cohort was 58. Arms were matched and there was no difference in rate of medical comorbidities. Mean BMI was 38.8kg/m2 in patients randomized to BMI≥30 and 26.3kg/m2 randomized to BMI<30. Surgical characteristics for the entire cohort: 66% malignancy, 91% clean-contaminated, 21% bowel surgery, 25% transfusion. Seventy-six (25%) patients developed a SSI: 43 patients (28%) treated with CMS, compared to 33 (21%) patients treated without CMS (p=0.18). Multivariate model demonstrated that BMI≥30 (p<0.005), surgery for malignancy (p=0.010), transfusion in the OR (p<0.001), and closure with staples (p=0.0005) were associated with post-operative SSI. CONCLUSIONS Patients presenting to a gynecologic oncologist for surgery frequently present with multiple risk factors for SSI and laparotomy is complicated by surgical-site complications in up to 30% of cases. The addition of CMS alone does not appear to reduce risk of overall SSI. Additional risk-reducing strategies including use of antimicrobial agents and optimization of modifiable risk factors prior to surgery should be explored as pathways for reducing this significant post-operative morbidity.

The use of biologic agents and clinical trials may prolong survival for women with primary platinum resistant ovarian carcinoma

Hispanic (8%), Asian (4%), and other races (3%). 29% were from the South, 26% from the Midwest, 25% Northeast, and 21% were from the West. 23% of hospitals were higher volume (N20 cases/year) vs. lower volume hospitals. 1647 (25%) underwent robotic surgery (RS), 820 (12%) laparoscopic (LS), vs. 4093 (62%) had open surgery (OS). The older (N 62 years, median) were more likely to have RS compared to younger (26% vs. 24%, p = 0.02). 29% of Whites had RS compared to only 20% Native Americans, 15% Hispanics, 12% Blacks, and 11% of Asians (p b 0.01). Patients from Midwest, Northeast, South and West had RS in 26%, 26%, 25%, and 23% of cases. Higher volume hospital performed 72% of all surgeries and 84% of all RS. Moreover, these higher volume hospitals were more likely to use RS compared to lower volume institutions (29% vs. 14%, p b 0.01). Those with low(b

1A randomized phase III trial of pelvic radiation therapy (PXRT) versus vaginal cuff brachytherapy followed by paclitaxel/carboplatin chemotherapy (VCB/C) in patients with high risk (HR), early stage endometrial cancer (EC): A Gynecologic Oncology Group trial

40,999),middle (

Uterine Serous Carcinoma: Increased Familial Risk for Lynch-Associated Malignancies

41,000–

A first-in-human phase I study of the oral Notch inhibitor, LY900009, in patients with advanced cancer

50,999), upper middle (

Biomarkers associated with metabolic syndrome, endometrioid adenocarcinoma (EC) of the uterus, and disease prognosis

51,000–

Positive vulvar sentinel lymph node biopsy: A single-institution retrospective review

66,999), and high (N

Stage IIIC Endometrial Cancer Should be Further Stratified

67,000) socioeconomic had RS in 21%, 25%, 28%, and 27% of cases (p b 0.01). Those with Medicare orprivate insurance were more likelyto receive RS at 27% and 26% vs. 14% of Medicaid patients (p b 0.01). Conclusions: In this nationwide analysis of endometrial cancer patients, older, Whites, higher socioeconomic class, receiving care from higher volume hospitals were associated with likelihood of receiving robotic surgery. Further studies are warranted to better understand the barriers of receiving robotic surgery.