Robotic or laparoscopic pelvic exenteration for gynecological malignancies: feasible options to open surgery

Laura Dudus,Corina Minciuna,Stefan Tudor,Monica Lacatus,Bogdan Stefan Vasile,Catalin Vasilescu 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2

Objective: To acknowledge that minimally invasive pelvic exenteration is a feasible alternativeto open surger y and potentially identif y prediction factors for patient outcome. Methods: The study was designed as a retrospective single team analysis of 12 consecutivecases, set between Januar y 2008 and Januar y 2022. Results: Six anterior and 6 total pelvic exenterations were performed. A 75% of caseswere treated using a robotic approach. In 4 cases, an ileal conduit was used for urinar yreconstruction. Mean operative time was 360±30.7 minutes. for anterior pelvic exenterationsand 440±40.7 minutes. for total pelvic exenterations and mean blood loss was 350±35 mL. AnR0 resection was performed in 9 cases (75%) and peri-operative morbidity was 16.6%, withno deaths recorded. Median disease-free sur vival was 12 months (10–14) and overall sur vival(OS) was 20 months (1–127). In terms of OS, 50% of patients were still alive 24 monthsafter surger y. Taking into consideration the follow up period,16.6% of females under 50 orabove 70 years old did not reach the cut off and 4 out of 6 patients that failed to reach it werediagnosed with distant metastases or local recurrence (p=0.169). Conclusion: Our experience is ver y much consistent with literature in regard to primar y siteof cancer, post-operative complications, R0 resection and sur vival rates. On the other hand,minimally invasive approach and urinar y reconstruction type were in contrast with citedpublications. Minimally invasive pelvic exenteration is indeed a safe and feasible procedure,providing patients selection is appropriately performed.

Feasibility of laparoscopic Visceral- Peritoneal Debulking (L-VPD) in patients with stage III–IV ovarian cancer: the ULTRA-LAP trial pilot study

Roberto Tozzi,Marco Noventa,Carlo Saccardi,Giulia Spagnol,Orazio De Tommasi,Davide Coldebella,Matteo Marchetti 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2

Objective: A non-randomized prospective clinical trial (ULTRA-LAP) was registered to testsafety, side effects and efficacy of laparoscopic Visceral-Peritoneal Debulking (L-VPD) inpatients with stage III–IV ovarian cancer (OC). A pilot study was designed to identif y whichOC patients are suitable to undergo L-VPD. Methods: Between March 2016 and October 2021, all consecutive patients with OCunder went explorator y laparoscopy (EXL). All patients whose disease was deemed amenablefor a complete resection (CR) at imaging review and EXL, under went VPD. In all patients aconsistent attempt was made at completing L-VPD. Results: Two hundred and eight OC had EXL in the study period: 121 under went inter valVPD and 87 up-front VPD. Overall, 158 patients had VPD by laparotomy (75.9%) and 50(24.1%) had L-VPD, of which 34 patients as inter val (iL-VPD) and 16 as up-front (uL-VPD). Intra- and post-operative morbidity was ver y low in the L-VPD group. CR rate was 98% inL-VPD group and 94% in VPD. Most common reason for conversion was diaphragmaticdisease extending dorsally. Conclusion: In the pilot study of ULTRA-LAP, L-VPD was completed in 24,1% of OC. Initialanalysis supports the feasibility of L-VPD in 2 groups of OC: those with no gross disease atinter val surger y and those with gross visible disease at upfront or inter val surger y, but limitedto: pelvis (including recto-sigmoid), gastro colic omentum, peritoneum and diaphragm, thelatter not requiring dorsal liver mobilization. Both groups had 100% feasibility and have beenthus forth recruited to ULTRA-LAP. Trial Registration: ClinicalTrials.gov Identifier: NCT05862740

Treatment of Adult Gliomas: A Current Update

이주호,Wee Chan Woo 대한뇌신경재활학회 2022 뇌신경재활 Vol.15 No.3

Gliomas are the most common type of primar y brain tumor in adults. Glioma treatment requires a multidisciplinar y approach involving surger y, radiotherapy, and chemotherapy. Multiple trials have been conducted to establish the appropriate choice of treatment to achieve long-term sur vival and better quality of life. This review provides up-to-date evidence regarding treatment strategies for gliomas.

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology consensus statement

김주현,김대연,김준환,NOH JOSEPH JOONHO,황우연,백민현,최민철,주원덕,이용재,서동훈,김용범 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2

The Korean Society of Gynecologic Oncology (KSGO) had been making an effort tostandardize and enhance the quality of domestic uterine corpus cancer treatment bydeveloping updated clinical practice guidelines in 2021. The KSGO revised the guidelinesbased on a literature search using 4 key elements: Population, Inter vention, Comparison,and Outcome framework. These elements include the evaluation of the efficacy and safety ofimmune checkpoint inhibitor treatment in recurrent/advanced endometrial cancer patientswho have failed platinum-based chemotherapy, as well as the effect of combined treatmentwith trastuzumab in patients with HER2/neu-positive endometrial cancer. Additionally,the guideline assessed the efficacy and safety of omitting lymph node dissection in low-riskendometrial cancer patients, investigated the effect of sentinel lymph node mapping inearly-stage endometrial cancer surger y, addressed the outcome of chemoradiation therapy asa postoperative treatment in patients with advanced (stage III–IVA) endometrial cancer, andexplored the impact of initial treatment with immune checkpoint inhibitors on sur vival inpatients with advanced or recurrent endometrial cancer patients.

Clinical guidelines for ovarian cancer: the Korean Society of Gynecologic Oncology guidelines

이방현,장석준,권병수,손주혁,임명철,김윤환,이신화,최철훈 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.1

Since the latest practice guidelines for ovarian cancer were developed by the Korean Society ofGynecologic Oncology (KSGO) in 2021, many studies have examined the efficacy and safetyof various treatments for epithelial ovarian cancer (EOC). Therefore, the need to developrecommendations for EOC treatments has been raised. This study searched the literatureusing 4 key items and the Population, Inter vention, Comparison, and Outcome: the efficacyand safety of poly-ADP ribose polymerase inhibitors in newly diagnosed advanced EOC; theefficacy and safety of intraperitoneal plus intravenous chemotherapy in optimally debulkedadvanced EOC; the efficacy and safety of secondar y cytoreductive surger y in platinum-sensitive recurrent ovarian cancer; and the efficacy and safety of the addition of bevacizumabto platinum-based chemotherapy in first platinum-sensitive recurrent EOC patients whoreceived prior bevacizumab. The evidence for these recommendations, according to eachkey question, was evaluated using a systematic review and meta-analysis. The committee ofovarian cancer of the KSGO developed updated guidelines for treatments of EOC.

Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Ju-Eun Kim,Dae-Jung Choi,PARK EUGENE JAE JIN,Ho-Jin Lee,Jin-Ho Hwang,Moon-Chan Kim,Jong-Seok Oh 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin’s triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.

이차 종양감축술을 시행 받은 재발성 상피성 난소암 환자들의 예후 인자 분석

김희승,김태훈,정현훈,김재원,박노현,송용상,강순범 대한부인종양학회 2008 Journal of Gynecologic Oncology Vol.19 No.1

Objective: To identify clinical prognostic factor improving survival of recurrent epithelial ovarian cancer (EOC) patients treated with secondary cytoreductive surgery (SCS). Methods: The indications of SCS were as follows; 1) complete response (CR) after primary cytoreductive surgery and adjuvant chemotherapy, 2) disease-free survival (DFS) (≥6 months). Clinical data of 17 patients including age, DFS, peritoneal seeding identified during SCS, the number of recurrent tumors (≥ 1 cm), serum CA-125 levels and maximal diameter of residual tumor after SCS were reviewed retrospectively between January 1990 and March 2007. Survival analyses were performed using Kaplan- Meier method with log-rank test and univariate Cox’s regression analysis. Results: Mean age of them was 51.7 years. No peritoneal seeding identified during SCS was a prognostic factor improving progression-free survival after SCS (PFS-SCS) (30 vs. 6 months, P<.01). DFS (≥12 months) (100 vs. 39 months), 2 or less than localized recurrent tumor (≥ 1 cm) (100 vs. 44 months), serum CA-125 level (≤37 U/mL) (100 vs. 39 months) and maximal diameter of residual tumor (≤1 cm) after SCS (100 vs. 39 months) were significant prognostic factors improving overall survival (OS) (P<.05). Conclusions: DFS (≥12 months), 2 or less than recurrent tumors (≥1 cm), serum CA-125 levels with normal value after SCS, optimal debulking surgery and no peritoneal seeding may be associated with the improvement of survival in recurrent epithelial ovarian cancer patients treated with SCS. 목 적: 이차 종양감축술을 시행 받은 재발성 상피성 난소암 환자들의 생존율을 향상시키는 임상적 예후 인자를 모색하였다. 연구 방법: 연구 대상으로 1990년 1월부터 2007년 3월까지 일차 종양감축술 및 보조적 항암화학요법 후 완전반 응을 보이고, 무병생존기간이 6개월 이상으로 이차 종양감축술을 시행 받은 17명의 재발성 상피성 난소암 환자 들을 선정하였고, 연령, 복막파종의 유무, 무병생존기간, 1 cm 이상의 재발 병변의 수, 이차 종양감축술 후 혈 중 CA-125 및 잔여 종양의 크기를 후향적으로 고찰하였다. 이차 종양감축술을 시행 받은 후 무진행생존기간과 전체생존기간을 Kaplan-Meier 생존 분석을 이용하여 통계적으로 비교하였고, 단일변수 Cox 회귀분석을 시행하 여 생존율과 관련된 유의한 예후 인자들에 대한 통계적인 검정을 시행하였다. 결 과: 평균 연령은 51.7세였고, 수술 중 확인된 복막 파종이 없는 경우 이차 종양감축술을 시행 받은 후 무진 행생존기간이 유의하게 길었다 (30 vs. 6 개월, P<.01). 무병생존기간이 12개월 이상인 경우 (100 vs. 39 개 월), 1 cm 이상의 재발 병변의 수가 2개 이하인 경우 (100 vs. 44 개월), 이차 종양감축술 후 혈중 CA-125가 37 U/mL 이하인 경우 (100 vs. 39 개월), 이차 종양감축술 후 잔여 종양의 크기가 1 cm 이하인 경우 (100 vs. 39 개월) 전체생존기간이 유의하게 길었다 (P<.05). 결 론: 재발성 상피성 난소암 환자들의 치료로 이차 종양감축술을 시행할 경우 12개월 이상의 무병생존기간, 2 개 이하의 1 cm 이상 재발 병변의 수, 이차 종양감축술 후 정상 범위의 혈중 CA-125 및 잔여 종양의 크기가 1 cm 이하인 경우, 수술 중 복막파종의 소견이 없을 경우 예후의 향상을 보이는 것으로 사료된다.

Short-course radiotherapy and chemotherapy for conversion surgery in patients with unresectable metastatic rectal cancer:a preliminary case series study

Youngbae Jeon,Kyoung-Won Han,이석호,Sun Jin Sym,최승준,하승연,백정흠 대한종양외과학회 2021 Korean Journal of Clinical Oncology Vol.17 No.2

Purpose: Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases. Methods: The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion. Results: Seven patients (five men and two women) underwent short-course RT (5×5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46–84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0–9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4–48.8 months and progression-free survival time of 14.7–41.1 months. Conclusion: Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.

Case Report : Autoamputation of a Giant Colonic Lipoma

( Hye Kyong Jeong ),( Sung Bum Cho ),( Tae Jin Seo ),( Kyoung Rok Lee ),( Wan Sik Lee ),( Hyun Soo Kim ),( Young Eun Joo ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Gut and Liver Vol.5 No.3

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously. (Gut Liver 2011;5:380-382)

하지정맥류 바로 알기: 과다한 하지정맥류 치료 청구에 대한 대한정맥학회의 윤리강령 선포를 환영하며

민승기 대한의사협회 2022 대한의사협회지 Vol.65 No.4

Background: Varicose veins (VV) is a common chronic venous disorder that is often left untreated due to its minor symptoms. However, recent developments in minimal invasive surgery has resulted in a rapid increase of VV treatment cases. Unfortunately, there have been some ethical issues regarding the high cost of intervention and non-professional treatment administered for VV at some private clinics. Current Concepts: Most endovenous therapies for VV are not reimbursed by the national health insurance but are only covered by personal health insurance plans in Korea. Rapid increase in the coverage costs for VV treatment has led to conflicts between the insurance companies and doctors in several cases. Recently, the Korean Society for Phlebology declared the Code of Ethics to support evidence-based treatment and warn against unethical practices related to interventions for VV. Discussion and Conclusion: The Korean Society for Vascular Surgery and Korean Society for Phlebology have just launched a campaign for the optimal treatment of VV on their YouTube channel, which shares accurate information regarding VV treatment to inform patients and doctors. To strengthen doctor-patient relationship and to avoid falling prey to unethical practitioners, it is critical to educate and update patients and healthcare service providers regarding the options available for VV treatment.