Grzegorz Panek

The evaluation of intra‐ and postoperative complications related to debulking surgery with bowel resection in patients with FIGO stage III–IV ovarian cancer

The surgical treatment of advanced ovarian cancer is based on the maximal debulking with widening the operation range to the infiltrated organs. The aims are as follows: (1) the assessment of the quantity and quality of intra- and postoperative complications in patients with advanced ovarian cancer in which partial bowel resection was performed and (2) the evaluation of intra- and postoperative complications related to surgery with bowel resection and anastomosis, compared to Hartmanns procedure. The analysis of debulking procedures with intestinal resection and postoperative period in 39 ovarian cancer patients, FIGO stage III–IV, was performed. During 39 operations, the most frequent type of resection was the sigmoidectomy or proctosigmoidectomy (29 patients). In the remaining patients, left- and right-side hemicolectomy or partial enterectomy was done. Twenty-four anastomosis and 15 Hartmanns procedures were performed. There were no differences between surgery with anastomosis and Hartmanns procedure in aspect of quantity of complications, blood loss, and the time of surgery. There were no statistically significant differences in overall survival and progression-free survival in both groups. We conclude that the percentage of complications related to debulking surgery with intestinal resection in advanced ovarian cancer patients might be accepted. The quantity of complications related to surgery with anastomosis and to Hartmanns procedure is similar. If possible, the surgery with anastomosis should be performed.

Results of chemotherapy for pulmonary metastases of carcinoma of the cervix in patients after primary surgical and radiotherapeutic management.

The purpose of this study was to evaluate the results of chemotherapy of pulmonary metastases from invasive carcinoma of the cervix, which were detected after a disease-free period after initial treatment with surgery or radiotherapy. Fifty patients with radiologically proven pulmonary metastases were treated with chemotherapy. All patients received a platinum-5-fluorouracil (PF) program: cisplatin 75 mg/m2 and 5-fluorouracil 800 mg/m2 every 4 weeks. The overall 1- and 3-year survival after PF chemotherapy was 62% and 17.6%, respectively. The progression-free survival at 1 and 3 years was 36.7% and 14.3%, respectively. There were 6 (12%) complete responses and 17 (34%) partial responses. Hematologic tolerance was acceptable. Third degree and fourth degree leukopenia was diagnosed in four (8%) and six (12%) patients, respectively. Three individuals had third degree thrombocytopenia. In the multivariate analysis, the following prognostic factors were associated with poor survival: time to recurrence after primary treatment (P= 0.002), number of lung metastases (P= 0.016), and progression during chemotherapy (P= 0.001). We conclude that PF regimen is a safe and reasonably effective chemotherapy in the management of patients with pulmonary metastases after primary treatment for invasive carcinoma of the cervix who do not qualify for surgical metastasectomy.

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

OBJECTIVES The aim of this study is to assess the effectiveness of pipelle in sampling diagnostic material from the uterine cavity and determining clinical factors, which may affect its effectiveness. MATERIAL AND METHODS The retrospective analysis included 312 patients who underwent pipelle biopsy because of various indications. Evaluated factors which may affect the effectiveness of this method were: types of indications for the procedure, age, BMI, anteflexion or retroflexion of the uterus, presence of uterine fibroids, miscarriages, natural deliveries, deliveries in general. RESULTS In 259 (83.01%) cases sampled material allowed for a histopathological diagnosis. In 53 (16.99%) of the women we failed to sample tissue material from the uterine cavity. Indications for the procedure, BMI, age and menopausal status were factors of potential impact on the diagnostic effectiveness (p < 0.05). The diagnostic value of pipelle was found to be the lowest in women with overweight and obesity (BMI > 28), post-menopausal women, women over 55 years of age and where biopsy was performed for indications other than abnormal uterine bleeding. On the other hand, pipelle shows clearly the highest effectiveness in sampling diagnostic material from the uterine cavity in young women (< 45 years of age), menstruating women, women with normal body weight or underweight (BMI < 23) and abnormal uterine bleeding. CONCLUSIONS Choosing a pipelle as an endometrial biopsy method should consider the indications, BMI, age and menopausal status. Omission of these factors can increase non-diagnostic outcomes resulting in necessity of repeated biopsies, the risk of complications and increases the costs of health care system.

Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer

OBJECTIVES The aim of the study was to assess the concordance between the preoperative endometrial sampling and microscopic examination of the hysterectomy specimens in patients surgically treated for atypical endometrial hyperplasia and endometrial carcinoma. MATERIAL AND METHODS We analysed a group of 204 patients, of whom 160 (78.43%) underwent surgical treatment for cancer of the corpus uteri and 44 (21.57%) for atypical endometrial hyperplasia. The preoperative diagnosis was based on the histological examination of endocervical and endometrial samples obtained by fractional curettage and it was compared to the histological findings at hysterectomy. The comparison was made for the basic diagnosis, the histological type of the cancer and the grade of tumour differentiation. RESULTS When the histological types of cancer diagnosed in endometrial curettage and hysterectomy specimens were com-pared, the concordance was observed in 134/160 patients (83.75%). The highest concordance was found for endometrioid carcinoma (127/148 patients, 85.81%). The grade of tumour differentiation was accurate in 69.31% of patients. The highest concordance was for moderately differentiated carcinomas. Of 44 patients who underwent surgical treatment for atypical endometrial hyperplasia, the preoperative diagnosis was confirmed by the postoperative histopathological examination in 21 patients (47.73%). In 15 patients (34.09%) endometrial cancer was diagnosed at hysterectomy. CONCLUSIONS In endometrial cancer our findings demonstrate a high level of concordance between the histological diagnosis on endometrial curettage and at hysterectomy. Own observations have confirmed that over 30% of patients undergoing surgical treatment for atypical endometrial hyperplasia have concurrent endometrial cancer which is determined by surgery.

Is routine performance of the uterine cervix canal curettage prior to the curettage of the uterine cavity justified

OBJECTIVES Endocervical curettage (ECC) together with the dilatation and curettage of the uterine cavity (D & C) is routinely performed in everyday clinical practice. The aim of this study is to assess the rationale of the performance of ECC prior to D & C in indications other than abnormal uterine bleeding (AUB). MATERIAL AND METHODS Case histories of 736 patients after ECC performed in the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, were analyzed retrospectively, the indications for the procedure - age, menopausal status, parity, procedure operators experience - as well as the result of the histopathology examination were taken into account. Three groups of patients were distinguished based on the indications for the procedure. RESULTS In 645 (87.6%) of cases normal histopathology results were obtained. 40 (5.4%) cases were abnormal. 31 cases of uterine cervix dysplasia were disclosed (CIN 1-20; CIN 2-5; CIN 3-6), 8 cases of endometrial cancer and 1 case of cancer of the uterine cervix were disclosed. In 51 (7%) of cases tissue material for histopathology examination was not obtained. In patients where ECC and D & C were performed due to indications other than abnormal bleeding from uterine cavity, no abnormal results were revealed. In addition, in this group the highest number of non-diagnostic ECCs was reported (11.59%; p < 0.05). CONCLUSIONS In the case of endometrial biopsy for indications other than AUB routine ECC prior to D & C need not be performed.

Critical analysis of cases of endometrial carcinoma of the uterine corpus incidentally diagnosed after incomplete surgery for other indications. Three case reports and a review of the literature

Incidental diagnosis of endometrial carcinoma after the operation for presumed benign disease is rare. At present, there are no recognized guidelines on optimal management of uterine malignancy diagnosed after incomplete surgery for other indications and the reported experience is limited. Although the risk of histological diagnosis of endometrial carcinoma in the uterus removed for pre-operatively diagnosed benign disease is very low, one should always bear in mind that it may indeed occur. Omission of certain diagnostic procedures prior to hysterectomy may result in incidental finding of a malignancy at or after surgery, even when preoperative imaging studies reveal benign disease. Many centres develop their own strategies, although in most cases the adnexa and cervix are removed and thorough exploration of the abdominal cavity is performed. Also, in view of the technical difficulties involved in removing the uterus and adnexa via the vagina and a potential high risk of cancer either developing in the cervical stump or disseminated from inadvertently morcellated uterine fragments, one should carefully consider the potential benefits and risks of supracervical hysterectomy. We present three patients with endometrial carcinoma diagnosed after hysterectomy, who subsequently underwent completion surgery. A review of the literature follows, which presents opinions from international centres.

Incidence of proapoptotic proteins p53 and p21 in epithelial ovarian tumors

OBJECTIVE The aim of the study was to evaluate the expression of proapoptotic proteins p53 and p21 in cystadenomas, borderline tumors and ovarian cancers. The correlation between proapoptotic proteins and selected parameters of ovarian tumors was also assessed. MATERIAL AND METHODS The study group consisted of 66 patients operated on because of epithelial ovarian tumor The study group was further divided into three subgroups: cystadenomas, borderline tumors and ovarian cancers. RESULTS The average value of p53 was the highest in the ovarian cancer group (50.12 +/- 39.52), whereas average value for p21 was the highest in patients with borderline tumors (24.41 +/- 24.43). There was a negative correlation between tumor stage and parameters of p21(+++), p21(++), p271 (+) but no correlation was found between the expression of p53, p21 and histological type of ovarian cancer. CONCLUSION The assessment of p53 and p21 can be expensive, but it proves to be a useful tool in difficult cases. Positive reaction to p53 can be noted in both, benign and malignant ovarian tumors, but in case of cancer its intensity is notably stronger.