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RISS 인기검색어
- 검색키워드
- 저자 : Bristow Robert E. (검색결과 5 건)
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Role of aggressive surgical cytoreduction in advanced ovarian cancer
장석준,Robert E. Bristow,Dennis S. Chi,William A. Cliby 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4
Ovarian cancer is the eighth most frequent cancer in women and is the most lethal gynecologic malignancy worldwide. The majority of ovarian cancer patients are newly diagnosed presenting with advanced-stage disease. Primary cytoreductive surgery and adjuvant taxane- and platinum-based combination chemotherapy are the standard treatment for advanced ovarian cancer. A number of studies have consistently shown that successful cytoreductive surgery and the resultant minimal residual disease are significantly associated with survival in patients with this disease. Much has been written and even more debated regarding the competing perspectives of biology of ovarian cancer versus the value of aggressive surgical resection. This review will focus on the current evidences and outcomes supporting the positive impact of aggressive surgical effort on survival in the primary management of ovarian cancer.
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장석준,Robert E. Bristow,유희석 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.1
Objective: The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary. Methods: We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated. Results: Surgical staging yielded: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO)stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%)of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the paraaortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis. Conclusion: A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Paraaortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.
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Surgical technique of en bloc pelvic resection for advanced ovarian cancer
장석준,Robert E. Bristow 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.2
Objective: The aim of this paper was to describe the operative details for en bloc removal of the adnexal tumor, uterus,pelvic peritoneum, and rectosigmoid colon with colorectal anastomosis in advanced epithelial ovarian cancer patients withwidespread pelvic involvement. Methods: The patient presented with good performance status and huge pelvic tumor extensively infiltrating into adjacentpelvic organs and obliterating the cul-de-sac. The patient underwent en bloc pelvic resection as primary cytoreductive surgery. En bloc pelvic resection procedure is initiated by carrying a circumscribing peritoneal incision to include all pan-pelvic diseasewithin this incision. After retroperitoneal pelvic dissection, the round ligaments and infundibulopelvic ligaments are divided. The ureters are dissected and mobilized from the peritoneum. After dissecting off the anterior pelvic peritoneum overlying thebladder with its tumor nodules, the bladder is mobilized caudally and the vesicovaginal space is developed. The uterine vesselsare divided at the level of the ureters, and the paracervical tissues (or parametria) are divided. The proximal sigmoid colon isdivided above the most proximal extent of gross tumor using a ligating and dividing stapling device. The sigmoid mesenteryis ligated and divided including the superior rectal vessels. The pararectal and retrorectal spaces are further developed anddissected down to the level of the pelvic floor. The posterior dissection is progressed and moves to the right and then to theleft of the rectum. The rectal pillars including the middle rectal vessels are ligated and divided. Hysterectomy is completed in aretrograde fashion. The distal rectum is divided using a linear stapler. The specimen is removed en bloc with the uterus, adnexa,pelvic peritoneum, rectosigmoid colon, and tumor masses leaving a macroscopically tumor-free pelvis. Colorectal anastomosiswas completed using stapling device. Results: En bloc pelvic resection was performed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvicperitonectomy, and rectosigmoid colectomy with colorectal anastomosis using a stapling device. Complete clearance of pelvicdisease leaving no gross residual disease was possible using en bloc pelvic resection. Conclusion: En bloc pelvic resection is effective for achieving maximal cytoreduction with the elimination of the pelvic diseasein advanced primary ovarian cancer patients with extensive pelvic organ involvement.
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Lim, Myong Cheol,Won, Young-Joo,Lim, Jiwon,Seo, Sang-Soo,Kang, Sokbom,Yoo, Chong Woo,Kim, Joo-Young,Oh, Jae Hwan,Bristow, Robert E.,Park, Sang-Yoon Springer Berlin Heidelberg 2018 Journal of cancer research and clinical oncology Vol.144 No.5
<P><B>Purpose</B></P><P>To evaluate the incidence of colon cancer as a second primary cancer (CCSPC) and the survival outcomes of women with and without CCSPC after the diagnosis of endometrial cancer (EC).</P><P><B>Methods</B></P><P>The standardized incidence ratio (SIR) of CCSPC and survival outcomes of EC survivors with and without CCSPC were analyzed using data from January 1 1993 to December 31 2011, obtained from the Korea Central Cancer Registry.</P><P><B>Results</B></P><P>Of 14,797 EC survivors, 147 (0.99%) developed CCSPC after an average interval of 5.5 years. The SIR of CCSPC among EC survivors was 2.56, higher than that of colon cancer in the general population. The SIR of CCSPC was highest for the ascending (3.77), followed by the transverse (3.45), descending colon (2.06), and rectum (1.99). The risk of a proximal site of CCSPC was high, especially within 5 years after the diagnosis of EC in the ascending (SIR, 4.37) and transverse (4.91) colon, and in young survivors (< 60 years) in the ascending (5.19) and transverse (3.82) colon. The 5- and 10-year overall survival rates were 84.8 and 80.4% among survivors with EC only and 89.2 and 76.3% for survivors with CCSPC, respectively.</P><P><B>Conclusions</B></P><P>The risk of CCSPC among EC survivors increases especially in the proximal colon in young survivors. These results could be used for surveillance and counseling of EC survivors.</P>
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