Thumuluru Kavitha Madhuri

The prognostic significance of specific HOX gene expression patterns in ovarian cancer

HOX genes are vital for all aspects of mammalian growth and differentiation, and their dysregulated expression is related to ovarian carcinogenesis. The aim of the current study was to establish the prognostic value of HOX dysregulation as well as its role in platinum resistance. The potential to target HOX proteins through the HOX/PBX interaction was also explored in the context of platinum resistance. HOX gene expression was determined in ovarian cancer cell lines and primary EOCs by QPCR, and compared to expression in normal ovarian epithelium and fallopian tube tissue samples. Statistical analysis included one‐way ANOVA and t‐tests, using statistical software R and GraphPad. The analysis identified 36 of the 39 HOX genes as being overexpressed in high grade serous EOC compared to normal tissue. We detected a molecular HOX gene‐signature that predicted poor outcome. Overexpression of HOXB4 and HOXB9 was identified in high grade serous cell lines after platinum resistance developed. Targeting the HOX/PBX dimer with the HXR9 peptide enhanced the cytotoxicity of cisplatin in platinum‐resistant ovarian cancer. In conclusion, this study has shown the HOX genes are highly dysregulated in ovarian cancer with high expression of HOXA13, B6, C13, D1 and D13 being predictive of poor clinical outcome. Targeting the HOX/PBX dimer in platinum–resistant cancer represents a potentially new therapeutic option that should be further developed and tested in clinical trials.

First clinical experience of argon neutral plasma energy in gynaecological surgery in the UK

We describe the first in vivo use of neutral argon plasma energy in gynaecological surgery in the UK and the largest series worldwide. The use of PlasmaJet® (PJ) in different applications in 118 selected cases in a tertiary referral centre for gynaecological oncology and minimal access surgery was assessed. The effectiveness, ease of use, ergonomics and safety of PJ in gynaecological surgery is evaluated prospectively. Following this experience, we have devised a table of recommended power settings for different applications.

Robot assisted surgery in gynaecologic oncology – starting a program and initial learning curve from a UK tertiary referral centre: the Guildford perspective

The paper discusses the setup and evaluation of early data following the establishment of a robotic surgery programme in a UK gynaecological oncology cancer centre.

Early experience of laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta) versus abdominal radical hysterectomy for early stage cervical cancer

The objective of this study was to compare outcomes of laparoscopically assisted radical vaginal hysterectomy (LARVH) vs. abdominal radical hysterectomy (RH) for early-stage cervical cancer. This is a retrospective study of all LARVH and RH procedures between January 2003 and June 2006 in our tertiary referral centre. Demographic, intraoperative and postoperative parameters in both groups were compared. Fourteen women (stage IA2–IB) underwent LARVH, and 12 women (stage IA2 to IB) had RH. All had clear excision margins. None of the laparoscopic procedures were converted into laparotomy. There have not been any recurrences in either group during the follow-up period. We conclude that LARVH and RH are equally efficacious surgical methods. The LARVH group had shorter hospital stay, reduced blood loss, shorter bladder recovery time, less postoperative complications but higher intraoperative injury rate in comparison to RH. This may reflect the learning curve of this new procedure.

Interval debulking surgery following neo-adjuvant chemotherapy for stage IVB ovarian cancer using neutral argon plasma (PlasmaJet™).

OBJECTIVE We present a novel surgical approach to ovarian cancer debulking using neutral argon plasma (PlasmaJet™). CASE HISTORY A 48 year-old woman diagnosed with FIGO stage IVB grade 3 serous epithelial ovarian carcinoma received three cycles of neoadjuvant chemotherapy with carboplatin and paclitaxel. OPERATIVE TECHNIQUE Dissection and radical debulking surgery were performed using PlasmaJet™ as previously described [1,2]. This included diaphragmatic and abdominal peritoneal stripping, supra-colic omentectomy, tumour ablation on the small and large intestines and mesentery, pelvic and para-aortic lymphadenectomy. RESULTS The only post-operative complication was a superficial wound breakdown, which healed by secondary intention. She remains well two years after surgery, with no sign of recurrence. CONCLUSION In this case, PlasmaJet™ facilitated diaphragmatic peritoneal stripping as well as dissection of tissue close to bowel and major vessels. Further study is required to assess whether this device can reduce the need for bowel resection while achieving complete cytoreduction.

Synchronous uterine artery embolization and laparoscopic myomectomy for massive uterine leiomyomas.

This report relates that preoperative uterine artery embolization and laparoscopic morcellation may be appropriate treatment for even the largest of leiomyomas. Size need not be a limiting factor for laparoscopic myomectomies.

Use of neutral plasma coagulation in groin node dissection for vulvar malignancy: a novel technique

Vulvar cancer is an uncommon disease with approximately 1000 cases reported annually in the UK. Lymph node involvement is an important prognostic indicator. Vulvectomy and bilateral groin node dissection are the preferred surgical treatments for early disease and increase survival. However, significant morbidity with lymphocyst formation and wound breakdown has been reported in more than 50% of cases. We report the first case following use of the PlasmaJet® neutral argon coagulation system to reduce postoperative lymphocyst formation.

Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy—a randomised phase II trial: perioperative outcomes and surgicopathological measurements

1 Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG 2010;117:1485–92. 2 Andrews V, Thakar R, Sultan AH, Jones PW. Are mediolateral episiotomies actually mediolateral? BJOG 2005;112:1156–8. 3 Eogan M, Daly L, O’Connell PR, O’Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG 2005;113:190–4. 4 DeLancey JOL. Episiotomy: what’s the angle? Int J Obstet Gynecol 2008;103:3–4.

Laparoscopic interval surgery for stage 4 primary fallopian tube carcinoma—a case report

Primary fallopian tube carcinoma (PFTC) is an uncommon malignancy of the female genital tract. Rationale for treatment of PFTC is similar to epithelial ovarian cancer (EOC) due to pathological similarities and pattern of disease spread. Surgical cytoreduction of advanced stage or large volume disease has been by laparotomy and debulking. We present the first case of laparoscopic interval surgery (IS) for stage IVb PFTC minimising peri-operative morbidity with no delay in resuming chemotherapy. This case demonstrates that there exists a role for laparoscopic surgery in selected patients which should be explored.

Isolated Uethral Metastasis From a Primary Ovarian Malignancy

BACKGROUND Epithelial ovarian cancer (EOC) is the deadliest of gynaecological cancers, often manifesting itself at a later stage (stage 3 and 4). Metastases and recurrences tend to be limited to the abdominopelvic cavity, and cutaneous metastases are rare. CASE SUMMARY We report an interesting case of a 51-year-old who presented 2 years after her initial treatment with surgery and adjuvant chemotherapy for a stage IIB with an isolated recurrence in the external urethral meatus. CONCLUSION This case highlights the need for clinicians and patients to remain vigilant during follow-up visits to rule out recurrences despite nonspecific symptoms reported by patients.