Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer

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Abstract

Study Objective: To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). Design: A prospective cohort study (Canadian Task Force classification II-1). Setting: A university hospital. Patients: Fifty-one gynecologic cancer patients with isolated recurrent disease. Interventions: IOUS during secondary cytoreductive surgery (SCS) by MIS. Measurements and Main Results: From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77–280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6–19), all patients except 2 were still alive. Conclusions: About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction.

Original languageEnglish
Pages (from-to)848-854
Number of pages7
JournalJournal of Minimally Invasive Gynecology
Volume25
Issue number5
DOIs
Publication statusPublished - Jul 1 2018

Fingerprint

Minimally Invasive Surgical Procedures
Recurrence
Neoplasms
Therapeutics
Vaginal Neoplasms
Female Genital Diseases
Ovarian Diseases
Intraoperative Complications
Touch
Robotics
Advisory Committees
Operative Time
Pelvis
Sarcoma
Laparoscopy
Laparotomy
Ultrasonography
Emotions
Cohort Studies
Lymph Nodes

Keywords

  • Cancer
  • Gynecology
  • Minimally invasive surgery
  • Recurrence
  • Relapse
  • Ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{0c906e580786419ea0cc9e2ca8bc8b2d,
title = "Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer",
abstract = "Study Objective: To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). Design: A prospective cohort study (Canadian Task Force classification II-1). Setting: A university hospital. Patients: Fifty-one gynecologic cancer patients with isolated recurrent disease. Interventions: IOUS during secondary cytoreductive surgery (SCS) by MIS. Measurements and Main Results: From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5{\%}) needed IOUS. Type of disease was ovarian in 5 women (42{\%}), endometrial in 4 (33{\%}), cervical in 1 (8{\%}), vaginal cancer in 1 (8{\%}), and uterine sarcoma in 1 (8{\%}). Recurrence was localized deep in the pelvis in 7 cases (58{\%}), lymph nodes in 3 (25{\%}), and extraperitoneal in 2 cases (17{\%}). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83{\%} laparoscopy and 17{\%} robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77–280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92{\%}), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6–19), all patients except 2 were still alive. Conclusions: About 1 of 4 patients (25{\%}) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction.",
keywords = "Cancer, Gynecology, Minimally invasive surgery, Recurrence, Relapse, Ultrasound",
author = "Floriana Mascilini and Lorena Quagliozzi and Francesca Moro and Moruzzi, {Maria Cristina} and Valerio Gallotta and Alletti, {Salvatore Gueli} and Giovanni Scambia and Testa, {Antonia Carla} and Anna Fagotti",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.jmig.2017.12.023",
language = "English",
volume = "25",
pages = "848--854",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
publisher = "Elsevier",
number = "5",

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TY - JOUR

T1 - Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer

AU - Mascilini, Floriana

AU - Quagliozzi, Lorena

AU - Moro, Francesca

AU - Moruzzi, Maria Cristina

AU - Gallotta, Valerio

AU - Alletti, Salvatore Gueli

AU - Scambia, Giovanni

AU - Testa, Antonia Carla

AU - Fagotti, Anna

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Study Objective: To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). Design: A prospective cohort study (Canadian Task Force classification II-1). Setting: A university hospital. Patients: Fifty-one gynecologic cancer patients with isolated recurrent disease. Interventions: IOUS during secondary cytoreductive surgery (SCS) by MIS. Measurements and Main Results: From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77–280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6–19), all patients except 2 were still alive. Conclusions: About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction.

AB - Study Objective: To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). Design: A prospective cohort study (Canadian Task Force classification II-1). Setting: A university hospital. Patients: Fifty-one gynecologic cancer patients with isolated recurrent disease. Interventions: IOUS during secondary cytoreductive surgery (SCS) by MIS. Measurements and Main Results: From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77–280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6–19), all patients except 2 were still alive. Conclusions: About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction.

KW - Cancer

KW - Gynecology

KW - Minimally invasive surgery

KW - Recurrence

KW - Relapse

KW - Ultrasound

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