Lisa N. Abaid

A Retrospective Review of the GelPort System in Single-Port Access Pelvic Surgery

STUDY OBJECTIVEnSince the advent of single-port access surgery, novel instruments have been developed to facilitate this laparoscopic approach. The GelPort system is an innovative sealing device that permits abdominal access and frequent instrument exchange during surgery while preserving the pneumoperitoneum. The GelPort system has been previously reported in gastric, colorectal, and urologic single-port access procedures but has yet to be described during pelvic surgery.nnnDESIGNnA retrospective pilot study reviewing 19 single-port access pelvic surgeries that involved the GelPort system was undertaken. Patient and operative statistics, including diagnosis, surgery and anesthesia times, complications and length of hospital stay were evaluated (Canadian Task Force Classification II-2).nnnRESULTSnOperative time exhibited a direct association with anesthesia time (p=.001). Additionally, patient blood loss (p=.043) and anesthesia time (p=.003) were significant prognostic indicators for length of hospital stay. There were no significant patient complications or subsequent port site hernias.nnnCONCLUSIONSnThe GelPort system appears to contribute favorably to single-port access surgery because the device permits circumferential access and retraction during instrumentation. Furthermore, the specialized design augments a surgeons versatility and access to complicated anatomic regions without compromising the peritoneum.

Perivascular Epithelioid Cell Neoplasms: A Systematic Review of Prognostic Factors

Perivascular epithelioid cell tumors (PEComas) are rare, soft tissue tumors characterized by epithelioid cells with clear or eosinophilic cytoplasm and a perivascular disbursement. We compiled the treatment and follow-up results from an extensive collection of reported gynecologic PEComa cases and statistically analyzed their respective therapy modalities and corresponding patient outcomes. In the group of patients with PEComa who received surgical management alone, there was a tendency for them to exhibit a lower disease recurrence rate. Conversely, patients with PEComa who initially received surgery and chemotherapy or radiation therapy were associated with a higher disease recurrence rate (P =.024). Metastatic involvement was related to higher patient mortality rates (P =.0001), although this finding was unrelated to treatment type. Surgical management alone may suffice for nonaggressive lesions, but chemotherapy and radiotherapy appear necessary for patients who present with high-risk histologic condition or metastatic disease. Because PEComas exhibit varying biologic behavior and an ill-defined presentation, the treatment for these lesions necessitates further evaluation.

Improved overall survival with 12 cycles of single-agent paclitaxel maintenance therapy following a complete response to induction chemotherapy in advanced ovarian carcinoma.

Objectives: Previously reported studies have suggested that maintenance therapy in the treatment of ovarian cancer may provide progression-free survival (PFS) benefits, although they have not discerned a similar impact on patient overall survival (OS). Methods: We examined the long-term PFS and OS of a previous study population consecutively treated with either 3 cycles (group A; n = 13 patients) or 12 cycles (group B; n = 13) of paclitaxel (135 mg/m2; Q21 days) maintenance therapy. Eligible patients received maintenance chemotherapy following a complete response to 6 cycles of primary induction chemotherapy, comprising 6 cycles of carboplatin (AUC = 5), paclitaxel (175 mg/m2), and gemcitabine (800 mg/m2) per protocol. Results: There were statistically significant PFS differences between group A (12 months) and group B (24 months) (p = 0.016). Moreover, the OS in group A was 38 months and 80 months for group B (p = 0.012). Current follow-up for this patient population exceeds 58 months. Conclusions: In the present investigation, 12 cycles of single agent paclitaxel maintenance therapy were associated with improved patient PFS and OS benefits. Despite contradictory reports, paclitaxel-based maintenance therapy may favorably impact both PFS and OS in advanced ovarian cancer patients who obtain a complete response to primary induction chemotherapy.

Chemotherapy and patient co-morbidity in ventral site hernia development

OBJECTIVEnThe risk factors associated with early ventral site hernia development following cancer surgery are ill defined and associated with an undetermined incidence.nnnMETHODSnWe analyzed 1,391 gynecologic cancer patient charts to identify the number of post-operative ventral site hernias over a nearly 6 year period. The following study variables were noted for evaluation: patient demographics, disease co-morbidity (hypertension, cardiovascular disease, diabetes), body mass index (BMI), treatment (e.g., chemotherapy regimen), intra-operative (e.g., bleeding) and postoperative (e.g., infection) complications, time to hernia development and length of hospital stay.nnnRESULTSnTwenty-six gynecologic cancer patients who developed a post-operative ventral hernia and subsequently underwent herniorrhaphy by our gynecologic oncology service were identified. The patient groups overall time to initial hernia development was 11.23 months. Following a multiple regression analysis, we found that treatment (e.g., bevacizumab, liposomal doxorubicin or radiotherapy associated with compromised wound healing [p=0.0186] and disease co-morbidity [0.0432]) were significant prognostic indicators for an accelerated time to hernia development. Moreover, five patients underwent treatment associated with compromised wound healing and also had disease co-morbidity. In this sub-group, post-operative hernia development occurred more rapidly (3.8 months) than the overall group of patients. BMI and age did not impact time to hernia development (p>0.05).nnnCONCLUSIONnIn the present gynecologic cancer patient series, a tendency for early post-operative hernia development appeared to coincide with treatment associated with compromised wound healing and disease co-morbidity. Gynecologic cancer surgeons should anticipate this potential complication and consider employing prophylactic intra-operative mesh to potentially prevent this condition.

Borderline ovarian tumors and extended patient follow-up: an individual institution's experience.

Borderline tumors of the ovary (BOT) comprise nearly 20% of all ovarian malignancies and are associated with a favorable prognosis. However, since these lesions can present with malignant features and recur, a further evaluation of appropriate patient management and long‐term follow‐up is warranted.

The Utility of Routine Follow-Up Procedures in the Surveillance of Uterine Cancer: A 20-Year Institutional Review

Objectives: The purpose of this study was to assess the value of routine follow-up procedures during uterine cancer surveillance and the corresponding cost throughout a 20-year period at a single medical institution. Methods: We sought to determine which surveillance method (CA-125, imaging, physical examination or vaginal cytology) detected the highest number of patient recurrences and the corresponding cost vis-à-vis the number of identified progressive disease cases. Results: Serial imaging detected the highest number of progressive disease cases but the cost was rather high (USD 17,174 per patient recurrence), whereas CA-125 testing was the least expensive (USD 6,810 per patient recurrence). We also found that those with a variant histology [for example, adenosquamous and uterine papillary serous carcinoma (p < 0.001) and advanced (III/IV) disease stage (p = 0.001)] were associated with an unfavorable progression-free interval. Conclusions: In the present investigation, serial imaging detected the highest number of progressive disease cases, although no single surveillance method was associated with a sensitive recurrent disease detection rate. Nevertheless, the CA-125 assay appeared to be the most cost-effective method in following patients with epithelial uterine malignancies. Thus, in the context of high-risk disease, a combination of procedures may still be necessary for optimal uterine cancer patient follow-up.

Delayed Staple Erosion into the Bladder After Removal of a Benign Ovarian Mass

We describe the case of a 54-year-old woman who presented with an ovarian mass in September 2000. The patient remained asymptomatic for 4 years until she developed a persistent urinary tract infection and hematuria. After a computed tomographic scan of the pelvis revealed urolithiasis, the secondary finding of potential staple erosion via cystoscopy was realized. Delayed staple erosion rarely occurs and can result in detrimental patient outcome. The diagnosis and management of this unusual complication are documented.

Leiomyosarcoma with Synchronous Clear Cell Ovarian Carcinoma

Background: Uterine leiomyomas are typically considered benign lesions. Despite aggressive management, they can be unpredictable and eventually exhibit disease recurrence several years following initial treatment. Case Report: We report a case involving a 55-year-old woman who was treated for a uterine leiomyoma at an outside medical institution 20 years ago. In November 2009, she presented to our gynecologic oncology service with a complex mass. Following surgery, the patient was diagnosed with a 16 cm ovarian mass and a synchronous leiomyosarcoma; the latter neoplasm appeared to originate from a previously resected uterine leiomyoma. Conclusions: The coexistence of these two lesions is exceedingly rare. We suspect that the leiomyosarcoma developed from either the patient’s original uterine leiomyoma or leiomyomatosis peritonealis disseminata.

Clear cell carcinoma of the pelvic side wall arising from endometriosis.

Endometriosis is a condition wherein an ectopic layer of endometrial tissue arises in an extra-uterine location, often effecting significant pelvic pain and infertility. While very uncommon, there have been reported cases of endometriosis undergoing malignant transformation, frequently involving the ovaries and seldom in extra-gonadal regions. We recount a case depicting a 63u202fyear-old woman who presented with an apparent inguinal hernia in 2017; she was ultimately diagnosed with a pelvic side wall clear cell carcinoma and attendant metastatic disease to the medial groin, which emanated from endometriosis. Malignant transformation of endometriosis identified in the pelvic side wall is a very rare finding. Nevertheless, oncologists should maintain a high index of suspicion in patients with a history of endometriosis or pelvic surgery.

The safety and feasibility of minimally invasive sentinel lymph node staging using indocyanine green in the management of endometrial cancer

OBJECTIVESnThe purpose of this study was to report on the feasibility of laparoscopic sentinel lymph node (SLN) staging using indocyanine green (ICG) in the management of endometrial cancer.nnnSTUDY DESIGNnWe retrospectively evaluated the charts of presumed, clinical stage I endometrial cancer patients who underwent robotic-assisted surgery that incorporated mapping with ICG and SLN dissection from January 2016 until February 2017. Patient demographics, operative characteristics (e.g., complications, lymph node counts) and pathology data were evaluated.nnnRESULTSnThere were 87 patients who were included in the study. A total of 370 lymph nodes were removed, of which 245 were SLNs; unilateral and bilateral mapping of the SLNs was achieved in 84 (96.5%) and 71 (81.6%) of subjects, respectively. There were 10 (11.5%) patients who had metastatic disease identified within 22 (5.9%) of the total (nu202f=u202f370) lymph nodes extracted, 19 (7.7%) of which were sentinel lymph nodes. We did not observe any intraoperative complications.nnnCONCLUSIONnThe results from our study suggest that minimally invasive SLN staging using ICG is a feasible procedure that is potentially effective at detecting metastases, which may ultimately attenuate the incidence of surgical morbidity.