| 1. |
- Salehi, Sahar, et al.
(författare)
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Cardiophrenic lymph node resection in advanced ovarian cancer : surgical outcomes, pre- and postoperative imaging
- 2018
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Ingår i: Acta Oncologica. - 0284-186X. ; 57:6, s. 820-824
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the accuracy of preoperative imaging in the diagnosis of cardiophrenic lymph node (CPLN) metastases and to report perioperative outcomes after resection of CPLN at the time of cytoreductive surgery for advanced epithelial ovarian cancer (EOC). Furthermore, to assess clearance of CPLN by postoperative imaging. Methods: All women with stage IIIC/IV EOC subjected to surgery at our institution from January 2014 to October 2016 were retrospectively identified from a database. Among these, women subjected to CPLN resection during surgery were identified. Pre- and postoperative computed tomography (CT) scans, pathology reports, surgical approach and outcomes were reviewed. Results: One hundred and eighty women with stage IIIC/IV EOC subjected to surgery with curative intent were identified. Twenty-four (13%) of these women underwent CPLN resection. All had CT imaging suggestive of CPLN metastases. 20/24 (83%) had confirmed metastases upon final pathology. CPLN resection was associated with longer operation time, more often advanced upper abdominal surgery and more postoperative complications but there was no difference in days from surgery to initiation of chemotherapy. Postoperative CT was still indicative of CPLN metastases in 13/22 (59%) women despite resection with confirmative pathology. Conclusions: Resection of CPLN metastases is highly feasible without considerable added morbidity. Concern regarding surgical clearance is raised since postoperative imaging was indicative of metastases in the majority of women. The prognostic significance of stage IV disease based exclusively on CPLN metastases is unclear and any survival benefit from the procedure is yet to be determined.
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| 2. |
- Salehi, Sahar, et al.
(författare)
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Long-term quality of life after comprehensive surgical staging of high-risk endometrial cancer - results from the RASHEC trial
- 2018
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Ingår i: Acta Oncologica. - : TAYLOR & FRANCIS LTD. - 0284-186X .- 1651-226X. ; 57:12, s. 1671-1676
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The health-related quality of life (HRQoL) outcomes after comprehensive surgical staging including infrarenal paraaortic lymphadenectomy in women with high-risk endometrial cancer (EC) are unknown. Our aim was to investigate the long-term HRQoL between robot-assisted laparoscopic surgery (RALS) and laparotomy (LT). Patients and Methods: A total of 120 women with high-risk stage I-II EC were randomised to RALS or LT for hysterectomy, bilateral salpingoophorectomy, pelvic and infrarenal paraaortic lymphadenectomy in the previously reported Robot-Assisted Surgery for High-Risk Endometrial Cancer trial. The HRQoL was measured with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-30) and its supplementary questionnaire module for endometrial cancer (QLQ-EN24) questionnaire. Women were assessed before and 12 months after surgery. In addition, the EuroQol Eq5D non-disease specific questionnaire was used for descriptive analysis. Results: There was no difference in the functional scales (including global health status) in the intention to treat analysis, though LT conferred a small clinically important difference (CID) over RALS in cognitive functioning albeit not statistically significant -6 (95% CI-14 to 0, p = .06). LT conferred a significantly better outcome for the nausea and vomiting item though it did not reach a CID, 4 (95% CI 1 to 7, p = .01). In the EORTC-QLQ/QLQ-EN24, no significant differences were observed. Eq5D-3L questionnaire demonstrated a higher proportion of women reporting any extent of mobility impairment 12 months after surgery in the LT arm (p = .03). Conclusion: Overall, laparotomy and robot-assisted surgery conferred similar HRQoL 12 months after comprehensive staging for high-risk EC.
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| 3. |
- Salehi, Sahar
(författare)
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Robot-assisted laparoscopy and sentinel node biopsy in high risk endometrial cancer
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgery is standard treatment for early stage endometrial cancer (EC), the most common gynaecological malignancy in developed countries. Traditionally, surgery has been performed by laparotomy (LT). Comprehensive surgical staging, including pelvic (PLND) and paraaortic (PALND) lymph node dissection, is associated with morbidity and possible reduction in quality of life. Minimally invasive surgery (MIS) is associated with less morbidity, albeit newer MIS techniques, i.e. robot-assisted laparoscopic surgery (RALS), has not been compared with LT in a randomised setting. The sentinel lymph node technique is well established in other malignancies, however, the experience in EC is limited. The aim of this thesis was to evaluate if RALS for PLND and infrarenal PALND (IRPALND) in women with high risk EC is noninferior to LT in harvesting lymph nodes, to investigate short- and long-term morbidity as well as quality of life. We also wanted to evaluate the sentinel lymph node biopsy concept as a diagnostic tool for detecting lymph node metastases (LNM). In the RASHEC trial, we randomised 120 women with stage I-II EC with high-risk tumour features to hysterectomy, bilateral salpingo-oophorectomy, PLND and IRPALND by either RALS or LT between 2013 and 2016. Primary endpoint was paraaortic lymph node count. Patient-reported outcome (EORTC QLQ-C30 and the endometrial cancer module EN-24, EQ- 5D for generic health status) was assessed before surgery and 12 months after surgery. Computed tomography (CT) was performed at baseline, 3 and 12 months after surgery. Patient characteristics were evenly distributed between the two groups. In the per protocol analysis of 96 patients, difference of means with a 95% confidence interval was within the noninferiority margin for infrarenal paraaortic lymph node count (-1.6, 95% CI -5.78 - 2.57). No difference in perioperative complications (Clavien-Dindo classification) or readmissions to hospital within 30 days after surgery was found. RALS was associated with longer operation time (p<0.001) but less total blood loss (p<0.001), shorter hospital stay (p<0.001) and lower health care cost (p<0.05) compared to LT. We found no difference in self-reported lower limb lymphoedema, occurrence of lymphocysts, serious adverse events or admission to hospital for any reason between the two groups 12 months after surgery. Moreover, there was no difference in health-related quality of life. The Sentinel node in High Risk Endometrial Cancer (SHREC- study) is a prospective nonrandomised trial recruiting consecutive patients from two tertiary referral centres in Sweden (Lund and Stockholm) between 2014 and 2018 where each woman served as her own control. In total 261 patients underwent pelvic sentinel node biopsy followed by completion lymphadenectomy of which 257 were analysed. The sentinel lymph node biopsy algorithm applied in the SHREC-trial demonstrated a sensitivity for detection of LNM of 100% (95% CI 92-100) and a negative predictive value of 100% (95% CI 98-100). This thesis demonstrates that RALS is non-inferior to LT in harvesting infrarenal paraaortic lymph nodes. RALS was associated with shorter hospital stay and lower health care cost and there were no evident differences in morbidity or quality of life. Consequently, we find RALS to be a valid option for comprehensive surgical staging including IRPALND in high risk endometrial cancer. The choice of surgical modality should be made based on surgeons’ and patient preference. The sentinel lymph node biopsy algorithm has a satisfactory bilateral mapping rate and complete detection of LNM, corroborating previous reports. Gold standard diagnostic lymphadenectomy in women EC should therefore be replaced by the less invasive sentinel lymph node biopsy.
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