Abstract:
BACKGROUND:Laparoscopy has acquired an increasing role in the management of ovarian cancer. Laparoscopic cytoreduction could represent a new frontier for selected patients after neoadjuvant chemotherapy (NACT). OBJECTIVE:We sought to assess feasibility and early complication rate of minimally invasive (MI) interval debulking surgery (IDS) in stage III-IV epithelial ovarian cancer (EOC) patients after NACT. STUDY DESIGN:This is a phase II multicentric study in advanced EOC cases with clinical complete response after NACT, according to Gynecologic Cancer Intergroup and Response Evaluation Criteria In Solid Tumors criteria. Institutional review board approval was obtained and all patients signed written informed consent to be included in the protocol. The study was registered in clinicaltrials.gov (NCT02324595) and was named "MISSION" trial. For patients meeting inclusion criteria, surgical procedures started with diagnostic laparoscopy to confirm preoperative findings and assess surgical complexity. MI-IDS included hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, peritonectomy, and bowel resection. Pelvic and/or aortic lymphadenectomy was not considered as standard procedure in these cases. Intraoperative and postoperative outcomes, time to restart chemotherapy, survival rate, and quality of life data were registered. RESULTS:From December 2013 through February 2015, of 184 advanced EOC patients considered eligible for IDS, 52 (28.2%) met inclusion criteria and were enrolled in the study. For 22 (12%) of them, standard laparotomic approach was preferred because of intraoperative surgeon evaluation. Thirty (16.3%) patients received the planned treatment of MI-IDS. Median age was 61 (range 39-81) years and median body mass index was 24 (range 20-31) kg/m(2). Median numbers of NACT cycles was 4 (range 3-7). Median operative time was 285 (range 124-418) minutes and median estimated blood loss was 100 (range 50-200) mL. Surgical procedures included 28 (93.3%) hysterectomy and bilateral salpingo-oophorectomy, 29 (96.6%) omentectomy, 2 (6.6%) appendectomy, 11 (36.6%) regional peritonectomy, and 1 (3.4%) bowel resection. A residual tumor of 0 cm was reached in 29 (96.6%) patients and 0.5 cm in only 1 (3.4%) case. The vast majority of patients were discharged on postoperative day 2 (range 2-3). No early postoperative complications were registered. Median time to restart chemotherapy was 20 (10-30) days and all patients successfully completed the cycles. Histological findings showed 3 (10%) complete response, 9 (30%) microscopic residual disease, and 18 (60%) evidence of macroscopic residual disease. With a median follow-up of 10.5 month, 5 peritoneal and 2 lymph nodal recurrences were observed. Psychometric test revealed moderate discomfort in the vast majority of patients (66.7%). All patients are still alive. CONCLUSION:Invasive-IDS in patients with clinically complete response to NACT seems to be feasible and safe in terms of perioperative outcomes, psycho-oncological impact, and survival rate. The equivalence between MI surgery and laparotomy needs to be confirmed with a longer follow-up and a larger number of patients.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Gueli Alletti S,Bottoni C,Fanfani F,Gallotta V,Chiantera V,Costantini B,Cosentino F,Ercoli A,Scambia G,Fagotti Adoi
10.1016/j.ajog.2015.10.922subject
Has Abstractpub_date
2016-04-01 00:00:00pages
503.e1-503.e6issue
4eissn
0002-9378issn
1097-6868pii
S0002-9378(15)02227-9journal_volume
214pub_type
杂志文章,多中心研究abstract:OBJECTIVE:Hemolytic disease of the fetus and newborn infant (HDFN) can be associated with bilirubin encephalopathy, which is usually averted through neonatal exchange transfusions (EXT). However, EXT can be associated with significant procedure-related morbidity. We hypothesized that maternal oral administration of phe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.08.016
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVES:Extraperitoneal approaches to removal of lymph nodes for staging in cervical cancer patients are numerous, and each has disadvantages. We developed a supraumbilical transverse incision to initiate irradiation within days of cervical cancer staging. STUDY DESIGN:Twenty patients with advanced stage IIB or III...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90080-3
更新日期:1993-08-01 00:00:00
abstract::The significance of midline wavering in the central nervous system as a diagnostic sign in hydrocephalus was evaluated prospectively in 27 hydrocephalic fetuses. No normal fetuses in a control group exhibited a wavering midline at three different times in pregnancy. Wavering along the entire length of the midline was ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90254-0
更新日期:1984-07-15 00:00:00
abstract::Diabetic ketoacidosis may occur in women treated with intravenous beta-sympathomimetic agents for tocolysis. We describe diabetic ketoacidosis and transient severe insulin resistance in a woman with diabetes who was treated with subcutaneous terbutaline infusion. Subcutaneous terbutaline infusion may precipitate trans...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91185-f
更新日期:1990-08-01 00:00:00
abstract:OBJECTIVE:Our purpose was to investigate whether the sensitivity of myometrial cells to oxytocin is affected by prolonged exposure to oxytocin antagonists. STUDY DESIGN:Tissue slices or cultured myometrial cells were exposed to peptides in vitro. Myometrial activation was studied by measuring the formation of inositol...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(94)90414-6
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to quantitatively determine an immunoglobulin G receptor, placental alkaline phosphatase, and its ligand immunoglobulin G in maternal and fetal blood and to study the transport capacity of the receptor. STUDY DESIGN:Venous blood samples from 66 term pregnant women and cord sam...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(94)90479-0
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to test the hypothesis that standardization of cardiac output in pregnancy by correcting for body surface area, and thus obtaining cardiac index, is justified. STUDY DESIGN:Cardiac output was determined by thoracic electrical bioimpedance monitoring in 78 pregnant women; recordings ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90367-4
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to examine the relationship between bilateral oophorectomy (BSO) and risk of coronary heart disease (CHD). STUDY DESIGN:We searched PubMed, EMBASE, meeting abstracts, and reference lists for studies that compared women with BSO at the time of hysterectomy with: (1) women with h...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2008.08.045
更新日期:2009-02-01 00:00:00
abstract::Fifty-seven prenatal patients with no known exposure to the element mercury, or any of its compounds, were observed for change in whole blood total mercury concentration from the initial prenatal clinic examination through delivery and postpartum hospitalization. On hospital admission for labor and delivery, whole blo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90087-4
更新日期:1982-06-15 00:00:00
abstract::A descriptive study of 125 infants with abdominal wall defects was undertaken to determine the effect of mode of delivery on outcome. Fifty-six infants had gastroschisis and 69 had omphalocele. Overall, there were no differences between the omphalocele and the gastroschisis groups in either cesarean section rate (22% ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91079-r
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to explore the association between glycosylated hemoglobin concentrations during pregnancy and macrosomia. STUDY DESIGN:One hundred thirty-six pregnancies in 120 women with type 1 or type 2 diabetes were studied longitudinally between January 1, 1991, and December 31, 1996. Glycosyl...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70460-6
更新日期:1999-07-01 00:00:00
abstract:OBJECTIVE:A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN:This retrospective, case-control analysis included every neon...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2004.06.035
更新日期:2005-01-01 00:00:00
abstract::In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Maayan-Metzger A, Schushan-Eisen I, Todris L, et al. Maternal hypotension during elective cesarean section and s...
journal_title:American journal of obstetrics and gynecology
pub_type: 评论,杂志文章
doi:10.1016/j.ajog.2009.11.012
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to measure fetal renal volume by means of three-dimensional ultrasonography and to use those data to establish the accurate constant and formula for fetal renal volume assessment with two-dimensional ultrasonography. STUDY DESIGN:Singleton fetuses between 15 and 40 weeks' gestation ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(00)70227-4
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to compare the efficacy and outcomes of 2 vs 1 stitch at the time of cervical cerclage placement for preterm birth prevention. STUDY DESIGN:This was a retrospective cohort study of women with singleton gestation undergoing history- or ultrasound-indicated transvaginal cervical ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.11.039
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:We hypothesized that glycodelin stimulates vascular endothelial growth factor (VEGF) expression in response to oxidative stress. STUDY DESIGN:EM42 (human endometrial epithelial cell line) and primary endometrial epithelial cells were subjected to oxidative stress with minimally oxidized low density lipoprote...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.07.025
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:This study aimed to investigate the effect of maternal cigarette smoking on endothelial nitric oxide synthase (eNOS) activity and concentration in the fetal umbilical vein, and subsequently, to relate the findings to the size of the newborn. STUDY DESIGN:Forty-four nonsmoking and 30 smoking women were includ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2003.12.040
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:We investigated in a pregnant rabbit model the effects of intravaginal inoculation of type la group B streptococci and antibiotic intervention. STUDY DESIGN:We inoculated 10(4) to 10(6) cfu of type la group B streptococci into the upper vagina hysteroscopically at day 21 to 27 of a 31-day gestation. Initiall...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70153-9
更新日期:1996-08-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the threshold of metabolic acidosis at delivery associated with newborn complications. STUDY DESIGN:This study was a matched case-control study of 174 term newborn infants. Three groups defined by umbilical artery base deficit at birth were 4 to 8 mmol/L, 8 to 12 mmol/L, and 12 t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70080-2
更新日期:1997-12-01 00:00:00
abstract:OBJECTIVES:Our goals were to determine the mortality risk for infants weighing 501 to 1500 gm according to gestational age, birth weight, and gender and to document birth weight-related changes in mortality and morbidity over a 5-year time period. STUDY DESIGN:In this observational study perinatal data were prospectiv...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/0002-9378(95)90628-2
更新日期:1995-11-01 00:00:00
abstract::Despite current recommendations against its use, activity restriction remains a common intervention used to prevent preterm birth in multiple clinical settings. Hypertensive disorders of pregnancy, preterm premature rupture of membranes, multiple gestations, vaginal bleeding, short cervical length, placenta previa, an...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1016/j.ajog.2020.04.031
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:The risk of perinatal death associated with labor after previous cesarean section appears higher than with a repeated cesarean section. On the other hand, repeated cesarean sections are associated with increased maternal morbidity and mortality from placental pathologic conditions (previa or accreta) on subse...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/s0002-9378(03)00833-0
更新日期:2003-09-01 00:00:00
abstract::To assess uterine activity before labor in patients delivering preterm, at term, and postterm, the maximum spontaneous contraction frequency per 10-minute window during the initial portion of antepartum fetal heart rate monitoring was analyzed. Patients with multiple gestation, third trimester bleeding, polyhydramnios...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90353-5
更新日期:1988-06-01 00:00:00
abstract::Preeclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage and is an important cause of maternal and perinatal morbidity and mortality, particularly when of early onset. Although a significant amount of research has been dedicated in identifyin...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2020.08.045
更新日期:2020-08-21 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine whether the epidemiology of low-grade ovarian serous cancers is distinct from that of high-grade ovarian serous cancers. STUDY DESIGN:The National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program reports incidence, and survival, data from...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.01.035
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:We evaluated the use of the harmonic scalpel in reducing the occurrence of symptomatic lymphoceles and its related complications in paraaortic laparoscopic lymphadenectomies (PALLs). STUDY DESIGN:All PALL that were performed at the Institut Claudius Regaud between January 2003 and June 2007 were included. Si...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2009.05.026
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:Cerebral palsy (CP) is characterized by motor deficits. There is increasing evidence that CP may result from inflammatory and infection-mediated white matter damage. Our objective was to develop an inflammatory model for CP based on chronic lipopolysaccharide (LPS) exposure with a recognizable phenotype in of...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.05.072
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:Our objective was to determine the localization of immunoreactive endothelin in human cyclic endometrium and in umbilical cord during normal delivery and after cesarean section. STUDY DESIGN:Fixed dated endometrial tissue (n = 41) and umbilical cord (n = 6) were subjected to immunohistochemistry with an anti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)91652-4
更新日期:1992-07-01 00:00:00
abstract:BACKGROUND:Fibroid tumors are the most common benign tumors in women of reproductive age. Treatment is usually indicated for those who are symptomatic, with different techniques being used. OBJECTIVE:The purpose of this study was to compare the long-term outcome of laparoscopic myomectomy with magnetic resonance-guide...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.09.002
更新日期:2018-10-01 00:00:00
abstract::We describe a patient who had abnormal sonographic findings of the liver 24 hours before signs and symptoms of severe preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). The abnormal sonographic appearance of the liver prompted further investigation and was instrumental in the ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80047-8
更新日期:1985-07-15 00:00:00