Abstract:
OBJECTIVE:To compare the incidence of postoperative complications and opioid pain medication usage in gynecologic oncology patients who did and did not receive an epidural prior to undergoing exploratory laparotomy. METHODS:Retrospective cohort study of all patients undergoing exploratory laparotomy with the gynecologic oncology division at Washington University in St Louis between January 2012 and October 2015. Data on demographics, pathology, postoperative pain and opioid use, and incidence of postoperative complications were collected. RESULTS:Five hundred and sixty-one patients underwent laparotomy, 305 with an epidural and 256 without. Patients with an epidural used significantly less hydromorphone in the post-anesthesia care unit (PACU) (p = 0.003) and on postoperative day (POD)#1 (p = 0.05), less total opioids on POD#0 (p < 0.01), and more non-opioid pain medication on POD#1-3 (p < 0.01). Patients with an epidural had lower pain scores in the PACU (p = 0.01), on POD#0 (p < 0.01), POD#1 (p < 0.01), and POD#3 (p = 0.03). Patients with epidurals had shorter hospital length of stay (p < 0.01), no difference in hospital readmission or incidence of venous thromboembolism up to 90 days postoperatively, longer duration of Foley catheter (20.4 vs 10.3 h, p = 0.02) with no difference in postoperative urinary tract infection, higher incidence of postoperative hypotension (63% vs 36.3%, p < 0.01), and lower incidence of wound complications (5% vs 14.1%, p < 0.01). CONCLUSIONS:Perioperative epidurals used in patients undergoing major abdominal surgery correlate with decreased postoperative opioid use, increased use of non-opioid pain medications, and improved pain relief postoperatively with acceptable postoperative risks and should be standard of care for these patients.
journal_name
Gynecol Oncoljournal_title
Gynecologic oncologyauthors
Huepenbecker SP,Cusworth SE,Kuroki LM,Lu P,Samen CDK,Woolfolk C,Deterding R,Wan L,Helsten DL,Bottros M,Mutch DG,Powell MA,Massad LS,Thaker PHdoi
10.1016/j.ygyno.2019.02.017subject
Has Abstractpub_date
2019-05-01 00:00:00pages
356-361issue
2eissn
0090-8258issn
1095-6859pii
S0090-8258(19)30127-1journal_volume
153pub_type
杂志文章abstract::Over a 7-year period from 1987 to 1994, 120 patients consecutive patients with FIGO stage IB invasive cervical cancer who underwent type 3 radical abdominal hysterectomy and bilateral pelvic lymphadenectomy had either Jackson-Pratt closed-suction drainage (Group 1, patients 1-60) or no drainage (Group 2, patients 61-1...
journal_title:Gynecologic oncology
pub_type: 临床试验,杂志文章
doi:10.1006/gyno.1995.1131
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:The goal of this study was to determine if three-dimensional power Doppler ultrasound improves the specificity for ovarian cancer detection as compared with two-dimensional ultrasound. METHODS:Seventy-one women with a known complex pelvic mass were referred for a preoperative ultrasound evaluation with both ...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.2001.6253
更新日期:2001-07-01 00:00:00
abstract::Stage IIB-IV squamous cell carcinoma of the cervix when treated by irradiation has a significant failure rate. Causes of pelvic and distant failure are discussed. New techniques employed to improve local control and decrease distant metastasis are presented. Data on morbidity, mortality, and survival will be reviewed ...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/0090-8258(86)90135-6
更新日期:1986-03-01 00:00:00
abstract::Background. Reports of supradiaphragmatic involvement of lymph nodes by serous borderline ovarian tumors are rare. Case. We describe the finding of metastatic tumor involving an internal mammary lymph node in a 74-year-old patient with serous borderline ovarian tumor. The positive lymph node was found incidentally dur...
journal_title:Gynecologic oncology
pub_type: 杂志文章,评审
doi:10.1006/gyno.2001.6234
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:Members of the glutathione S-transferase (GST) family have been shown to have functional polymorphisms that may affect drug metabolism and influence the effects of chemotherapy and survival from cancer. GSTM1, GSTT1, and GSTP1 genotypes were evaluated for their role in ovarian cancer treatment and survival. ...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2005.08.035
更新日期:2006-02-01 00:00:00
abstract::Cyclin D1 is a critical gene controlling the G1 phase progression through the cell cycle. Alterations of cyclin D1 have been demonstrated in a variety of cancer types. We recently reported that increased cyclin D1 expression is associated with malignancy also in ovarian tumors. Three human ovarian cancer cell lines (S...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1998.5062
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVES:To refine models to predict surgical morbidity and 90-day mortality after primary debulking surgery (PDS) for advanced epithelial ovarian cancer (EOC). METHODS:Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraope...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2015.10.025
更新日期:2016-01-01 00:00:00
abstract::Despite high initial response rates to platinum-based chemotherapy, most patients with advanced ovarian carcinoma die of drug-resistant disease. Drug resistance can be overcome in the hematologic malignancies and lymphomas with high-dose therapy and bone marrow transplantation (BMT) when used early, suggesting that th...
journal_title:Gynecologic oncology
pub_type: 临床试验,杂志文章
doi:10.1006/gyno.1995.1143
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:Implicit prejudice and stereotyping may exist in health care providers automatically without their awareness. These biases can correlate with outcomes that are consequential for the patient. This study examined gynecologic oncology care providers' implicit prejudice and stereotyping toward cervical cancer. M...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2019.01.013
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:Approximately 20% of patients receiving platinum-based chemotherapy for epithelial ovarian cancer (EOC) are refractory or develop early recurrence. Identifying these patients early could reduce treatment-associated morbidity and allow quicker transfer to more effective therapies. Much attention has focused on...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2012.05.006
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVE:Expression of the immunoreactive protein of matrix metalloproteinase 2 (MMP-2) was studied in cervical tumors representing various stages of cell atypia and differentiation. In this study, we evaluated whether the expression of MMP-2 is an early or late event in the process of dedifferentiation and cancer pro...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1998.5157
更新日期:1999-03-01 00:00:00
abstract::Verrucous carcinoma is a rare variant of epidermoid carcinoma with distinct clinical and histopathologic features. To date, 31 cases have been reported in the cervix. They are typically slow-growing, locally invasive tumors with low potential for lymphatic metastasis and appear to be radioresistant. We report a case w...
journal_title:Gynecologic oncology
pub_type: 杂志文章,评审
doi:10.1016/0090-8258(90)90185-n
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to investigate the feasibility of the sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging in the early stage invasive cervical cancer in patients undergoing radical hysterectomy and pelvic lymphadenectomy. METHODS:Between March 2007 and June 2009, a pro...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2010.12.336
更新日期:2011-03-01 00:00:00
abstract::Gastrointestinal stromal tumors (GISTs) are c-kit-positive tumors that may arise anywhere in the tubular gastrointestinal tract. Around 5% of the cases arise elsewhere in the abdominal cavity. Tumors originating in the omentum and mesentery have been reported.A 31-year-old woman presented with pelvic pain, a palpable ...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2003.08.025
更新日期:2003-12-01 00:00:00
abstract::The purpose of this study was to determine the influence of tumor grade, distribution, and extent of carcinomatosis in minimal residual epithelial ovarian cancer after primary optimal cytoreductive surgery. Between 1978 and 1990, 112 patients with stage III epithelial ovarian cancer underwent primary cytoreductive sur...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1994.1257
更新日期:1994-10-01 00:00:00
abstract::Between August 1990 and January 1992, 184 patients with squamous cell carcinoma of the cervix, FIGO stage IIB-IVA, were randomized to receive either two cycles of bleomycin, ifosfamide-mesna, and cis-platinum (BIP) chemotherapy (CT) followed by radiotherapy (RT) ("CT-RT group," n = 94) or RT alone (RT group, n = 90). ...
journal_title:Gynecologic oncology
pub_type: 临床试验,杂志文章,随机对照试验,评审
doi:10.1006/gyno.1994.1215
更新日期:1994-09-01 00:00:00
abstract::The altered expression of histocompatibility leukocyte antigens (HLA) in the development to cervical carcinoma suggests that tumor progression may be related to impaired recognition by host immune defense mechanisms. To investigate whether this phenomenon plays a role in the process of metastasis of cervical cancer, w...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1995.1156
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:Wee1-like kinase (Wee1) is a tyrosine kinase which negatively regulates entry into mitosis at the G2 to M-phase transition and has a role in inhibition of unscheduled DNA replication in S-phase. The present study investigated the clinical role of Wee1 in advanced-stage (FIGO III-IV) ovarian serous carcinoma. ...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2014.07.102
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To examine the influence of diabetes and metformin therapy on overall survival (OS) and progression-free survival (PFS) in patients with endometrial cancer (EC) by using propensity score (PS) matching to account for confounding factors. METHODS:We retrospectively identified consecutive patients with stage I-...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2015.11.019
更新日期:2016-02-01 00:00:00
abstract::Thirty-two patients with Stage III or IV epithelial ovarian cancer and residual tumor volumes in excess of 2 cm in diameter after initial debulking were treated with platinum and cyclophosphamide chemotherapy. Twenty-seven patients (84%) received at least six courses of chemotherapy. Six patients developed grade 3 or ...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/0090-8258(87)90296-4
更新日期:1987-06-01 00:00:00
abstract::An epidemiologic study of multiple primary malignant neoplasms in endometrial cancer patients in Israel is presented. During the 7-year period of the study, 104 patients (10.3%) out of 1007 patients diagnosed as having endometrial cancer had another primary cancer. There was a significant difference in the incidence o...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/0090-8258(85)90005-8
更新日期:1985-09-01 00:00:00
abstract:OBJECTIVE:This article critically reviews the literature on the association between endometriosis and gynecological cancers and breast cancer, based on epidemiologic data. METHODS:Literature review of the English language literature based on searching in the MEDLINE (PubMed) database and additional collection of repor...
journal_title:Gynecologic oncology
pub_type: 杂志文章,评审
doi:10.1016/j.ygyno.2011.06.017
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the mRNA and protein expression of cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2) in ovarian tumors and normal ovaries of the hen, which is an excellent model for human ovarian cancer. Tissue concentrations of prostaglandin E(2) (PGE2) and PGE2 metabolites were also determi...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2006.05.012
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of orally administered medroxyprogesterone acetate upon angiogenesis in the myometrium of patients with complex endometrial hyperplasia. METHODS:Microvessel counts in the myometrium of consecutive patients with complex endometrial hyperplasia, treated with oral medroxyprogesterone acet...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1998.5106
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVES:We sought to determine a baseline and five-year follow up sexual function score in women undergoing hysterectomy for endometrial cancer. METHODS:A cross-section of endometrial cancer patients receiving care from 2006 to 2010 was identified. Patients were surveyed during academic year 2011 using the Pelvic O...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2018.10.025
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:The aim of this retrospective multicenter study was to assess whether the pre-chemotherapy hemoglobin levels have any impact on the clinical outcome of patients with advanced epithelial ovarian cancer who received a first-line taxane/platinum-based regimen. METHODS:The study was conducted on 315 patients who...
journal_title:Gynecologic oncology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ygyno.2005.04.012
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:We conducted a case-control study to analyze risk factors for ovarian cancer. METHODS:Cases included 440 women (age range 13-80 years, median 54) with a histologically confirmed diagnosis of epithelial ovarian cancer who were admitted to the Gynecological Oncological Department of Gynecologic Oncology at the...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.2000.5909
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVES:Endometriosis-associated ovarian carcinoma (EAOC) has recently received increasing attention due to its suggested biological behavior, distinctive from those of usual epithelial ovarian cancer. To elucidate some of the controversies on this intriguing entity, a series of patients with EAOC were compared to o...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.2001.6382
更新日期:2001-10-01 00:00:00
abstract::Monoclonal antibody rp-28 directed against the ras gene product p21 has been studied to evaluate ras p21 expression in malignant and benign ovarian tissues. Some ovarian carcinomas of serous and mucinous cystadenocarcinomas, undifferentiated adenocarcinomas, and clear cell carcinomas demonstrated intense staining of r...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/0090-8258(92)90194-n
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVE:Determine factors impacting the uptake of genetic counseling and results of genetic testing following universal tumor testing for Lynch syndrome in patients with endometrial cancer. METHODS:The study population consisted of two unselected cohorts of endometrial cancer patients, 408 identified retrospectively...
journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2014.06.009
更新日期:2014-08-01 00:00:00