Margherita Fischetti

Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: Analysis and management of complications in upper abdominal surgery

OBJECTIVE To evaluate the complication rate and its impact in patients who have undergone upper abdominal surgery for treatment of advanced ovarian cancer. METHODS Patients who have undergone upper abdominal surgery including diaphragm surgery, splenectomy, distal pancreatectomy, gastric resection, liver resection and biliary surgery were considered for the study. Perioperative complications were evaluated and graded according to Clavien-Dindo. RESULTS One hundred and twenty one patients were included. Two hundred and twelve surgical procedures were performed. Thirty-six patients reported at least one complication, but 61.1% of these the complication was mild. Median hospital stay for patients with and without complication was 7 vs. 13days respectively (p<0.001). There was a significant correlation between post-operative hospital stay and the total number of surgical procedures (R=0.445, p<0.001). At multivariate analysis, diaphragmatic resection and pancreatic resection were associated with a significant increase of postoperative hospital stay, furthermore diaphragmatic resection (p=0.004), hepatic resection (p=0.004), pancreatectomy (p=0.011) and biliary surgery (p=0.049) were independent predictors of severe (G3-G4) complication. CONCLUSIONS Rate of complications of patients submitted to upper abdominal surgery for ovarian cancer is acceptable. Prediction of severe complications is the goal for its optimal management. Extensive procedures should be avoided with those patients in which optimal residual tumor could not be reached.

Fertility-sparing surgery in early-stage cervical cancer patients: Oncologic and reproductive outcomes

Objective The aim of this study was to evaluate the safety, feasibility, and effectiveness of conservative management of early-stage cervical cancer (eCC) in young women willing to preserve their childbearing potential. Methods Data of 22 consecutive young women (aged <40 years) undergoing conservative management of eCC were prospectively collected. Conservative management consists of cervical conization plus laparoscopic pelvic lymphadenectomy. Results Median age was 32.5 years (range, 27–40 years). Twenty-one women (95%) were nulliparous. Histology included adenocarcinoma, squamous cell carcinoma, and adenosquamous carcinoma in 11 (50%), 10 (45%), and 1 (5%) patients, respectively. Six (27%) and 16 patients (73%) were affected by stage IA2 and IB1, respectively. The mean number of pelvic lymph node removed was 26 (SD, 8.6). After primary treatment, 3 patients required radical surgery due to the presence of metastatic nodes detected at the time of diagnostic lymphadenectomy. In addition, 1 patient (5%), after the successful execution of conservative treatment, asked for hysterectomy. After a mean follow-up of 48.8 (SD, 32.8) months, no recurrence was diagnosed among patients undergoing ultraconservative treatment, whereas 2 out of 3 patients with positive pelvic nodes who had radical hysterectomy developed recurrent disease. Considering the whole cohort, 5-year disease-free and overall survival rates were 85.9% and 93.7%, respectively. Looking at reproductive outcomes, 15 of 18 patients (4 patients had hysterectomy) attempted to conceive, and 8 (53%) women had spontaneous pregnancies Conclusions Conservative management for eCC seems to be associated with long-term oncologic effectiveness, preserving reproductive function. Further large prospective studies are warranted to improve patients’ care.

An update of laparoscopy in cervical cancer staging: is it a useful procedure?

Objective: It was the aim of this study to report on the role of laparoscopic staging in a large series of locally advanced cervical cancer (LACC) patients and its impact on prognosis. Methods: Consecutive patients with LACC were considered for surgical staging: gynecological examination, cystoscopy and laparoscopy with peritoneal biopsies and peritoneal fluid cytology. Results: Between February 2000 and September 2010, a total of 167 women were evaluated. In 5 patients, laparoscopy could not be performed. One hundred and sixty-two patients had correct laparoscopic staging: 49 International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA (>4 cm), 67 IIB, 39 III, and 7 IVA. Abdominal spread was found in 33 cases (20%). There was a minor laparoscopy complication rate of 1%. We found a significant difference in the distribution of peritoneal spread for tumor grade and FIGO stage (p = 0.01 and p < 0.0001, respectively), whereas no statistically significant difference for the histological type was found [p = not significant (NS)]. The median follow-up was 80 months (range 4-144). The median overall survival was 65 months. The patients without abdominal spread did not benefit from a significantly longer survival (median overall survival of 59 vs. 70 months; p = NS). Conclusions: Laparoscopic staging in cervical cancer is a safe and feasible technique but it does not modify the prognosis of LACC patients.

Dose-Dense Neoadjuvant Chemotherapy plus Radical Surgery in Locally Advanced Cervical Cancer: A Phase II Study

Objective: To assess the efficacy and toxicity profile of dose-dense cisplatin-based neoadjuvant chemotherapy (NACT) followed by radical surgery in patients affected by locally advanced cervical cancer. Methods: Patients affected by carcinoma of the uterine cervix FIGO (International Federation of Obstetrics and Gynecology) stage IB2-IIIB were enrolled into the study. The treatment schedule consisted of 5 cycles of intravenous paclitaxel 60 mg/m2 plus cisplatin 60 mg/m2 every 10 days; patients were then submitted to radical hysterectomy and pelvic lymphadenectomy. Results: From January 2011 to March 2013, 22 patients were enrolled. Median age was 47 (26-83) years. FIGO stages included 1 IIA, 15 IIB, 1 IIIA, and 5 IIIB. Ninety-one percent of patients completed all the 5 planned cycles of NACT. Three patients experienced allergic reactions to paclitaxel. Grade 3-4 hematological toxicity was observed in 18% of cases. In 3 cases, grade 3-4 extra-hematological adverse and life-threatening events were reported (1 ototoxicity, 1 transient ischemic attack, and 1 myocardial infarction). No treatment-related death occurred. The operability rate was 86.4%. The overall response rate was 52.6%: 5 patients (26.3%) experienced clinical complete response, and 5 (26.3%) showed a clinical partial response. Stable disease was observed in 47.4% of patients, with no progressive disease recorded. Pathological response was observed in 57.9% of cases. Six out of 19 (31.6%) patients were submitted to adjuvant treatment. Conclusion: Dose-dense cisplatin-based NACT showed a response rate in approximately half of patients. However, in consideration of the reported extra-hematological toxicity, further studies on and new strategies with dose-dense platinum-based NACT are required to improve outcome in cervical cancer patients.

Benign schwannoma in supraclavicular region: a false‑positive lymph node recurrence of breast cancer suspected by PET scan

IntroductionPositron emission tomography (PET) is the most accurate imaging modalities to detect malignancies. And it helps to take decisions regarding diagnosis, staging, recurrence, and therapeutical management.Case presentationWe report a case of a suspected supraclavicular lymph node relapse, diagnosed by PET-CT in a breast cancer patient. The lymph node was surgically removed in outpatient with local anesthesia. Histological findings diagnosed a benign Schwannoma. In this patient PET-CT failed to distinguish benign tumors from metastatic supraclavicular lymph nodes. ConclusionThis case confirms the need to investigate histologically suspected supraclavicular lesions, during breast cancer follow up.