Publications by authors named "Luis Chiva"

51 Publications

ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors.

Int J Gynecol Cancer 2021 Jul 10;31(7):961-982. Epub 2021 Jun 10.

Gynaecologic Oncology, Hammersmith Hospital, Imperial College, London, UK.

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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http://dx.doi.org/10.1136/ijgc-2021-002565DOI Listing
July 2021

Intra-operative radiation therapy after a total lateral extended infralevator exenteration for recurrent cervical cancer.

Int J Gynecol Cancer 2021 May 24. Epub 2021 May 24.

Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2021-002592DOI Listing
May 2021

Ovarian yolk sac tumor.

Int J Gynecol Cancer 2021 May;31(5):797-798

Servicio de Anatomía Patológica, Clínica Universidad de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2021-002538DOI Listing
May 2021

Thoracic anatomical landmarks and uniportal VATS cardiophrenic lymph node resection in advanced ovarian cancer.

Int J Gynecol Cancer 2021 May 1;31(5):793-794. Epub 2021 Apr 1.

Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2021-002425DOI Listing
May 2021

Giant port-site recurrence after laparoscopic-staging for endometrial cancer.

Int J Gynecol Cancer 2021 Apr;31(4):641

Medical Oncology, Clinica Universidad de Navarra, Madrid, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2020-002379DOI Listing
April 2021

Is Conization a Protective Surgical Maneuver in Early Cervical Cancer?

Ann Surg Oncol 2021 Jul 17;28(7):3463-3464. Epub 2021 Mar 17.

Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1245/s10434-021-09705-5DOI Listing
July 2021

Role of cardiophrenic lymph node removal in advanced ovarian cancer.

Int J Gynecol Cancer 2021 Feb 3;31(2):307. Epub 2020 Dec 3.

Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2020-002207DOI Listing
February 2021

Double identification of sentinel lymph node with indocyanine green and 99m-technetium in vulvar cancer and V-Y flap for vulvar reconstruction.

Int J Gynecol Cancer 2021 Feb 23;31(2):300-301. Epub 2020 Nov 23.

Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2020-002066DOI Listing
February 2021

Perspectives, fears and expectations of patients with gynaecological cancers during the COVID-19 pandemic: A Pan-European study of the European Network of Gynaecological Cancer Advocacy Groups (ENGAGe).

Cancer Med 2021 01 18;10(1):208-219. Epub 2020 Nov 18.

Department of Surgery, Institute Gustave Roussy, Villejuif, France.

Background: The impact of the COVID-19 pandemic on European gynaecological cancer patients under active treatment or follow-up has not been documented. We sought to capture the patient perceptions of the COVID-19 implications and the worldwide imposed treatment modifications.

Methods: A patient survey was conducted in 16 European countries, using a new COVID-19-related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations.

Findings: We collected 1388 forms; 592 online and 796 hard-copy (May, 2020). We excluded 137 due to missing data. Median patients' age was 55 years (range: 18-89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID-19, only 17.5% were more afraid of COVID-19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow-up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID-19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3-12) and 8.1 (range: 3.8-13.4), respectively. Multivariate analysis identified high HADS-depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients' anxiety.

Interpretation: Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID-19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients' communication and education.
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http://dx.doi.org/10.1002/cam4.3605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753798PMC
January 2021

PleurX indwelling pleural catheter for the treatment of recurrent pleural effusion in advanced ovarian cancer.

Int J Gynecol Cancer 2021 Apr 4;31(4):635-636. Epub 2020 Nov 4.

Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, MADRID, Spain.

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http://dx.doi.org/10.1136/ijgc-2020-002024DOI Listing
April 2021

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer.

Int J Gynecol Cancer 2020 09 11;30(9):1269-1277. Epub 2020 Aug 11.

Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Background: Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse.

Methods: We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group.

Results: Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52).

Conclusions: Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.
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http://dx.doi.org/10.1136/ijgc-2020-001506DOI Listing
September 2020

Patterns of recurrence after laparoscopic versus open abdominal radical hysterectomy in patients with cervical cancer: a propensity-matched analysis.

Int J Gynecol Cancer 2020 07 23;30(7):987-992. Epub 2020 May 23.

Gynecologic Oncology, Isituto Tumori Milano, Milan, Italy.

Objective: Recent evidence has suggested that laparoscopic radical hysterectomy is associated with an increased risk of recurrence in comparison with open abdominal radical hysterectomy. The aim of our study was to identify patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer.

Methods: This a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery performed between January 1990 and December 2018. Inclusion criteria were: age ≥18 years old, radical hysterectomy (type B or type C), no recurrent disease, and clinical follow-up >30 days. The primary endpoint was to evaluate patterns of first recurrence following laparoscopic and open abdominal radical hysterectomy. The secondary endpoint was to estimate the effect of the primary surgical approach (laparoscopy and open surgery) in post-recurrence survival outcomes (event-free survival and overall survival). In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Survival outcomes were estimated using the Kaplan-Meier model.

Results: A total of 1058 patients were included in the analysis (823 underwent open abdominal radical hysterectomy and 235 patients underwent laparoscopic radical hysterectomy). The study included 117 (14.2%) and 35 (14.9%) patients who developed recurrent cervical cancer after open or laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2), we reduced the population to 105 patients (35 vs 70 patients with recurrence after laparoscopic and open radical hysterectomy). Median follow-up time was 39.1 (range 4-221) months and 32.3 (range 4-124) months for patients undergoing open and laparoscopic surgery, respectively. Patients undergoing laparoscopic radical hysterectomy had shorter progression-free survival than patients undergoing open abdominal surgery (HR 1.98, 95% CI 1.32 to 2.97; p=0.005). Patients undergoing laparoscopic radical hysterectomy were more likely to develop intrapelvic recurrences (74% vs 34%; p<0.001) and peritoneal carcinomatosis (17% vs 1%; p=0.005) than patients undergoing open surgery.

Conclusions: Patients undergoing laparoscopic radical hysterectomy are at higher risk of developing intrapelvic recurrences and peritoneal carcinomatosis. Further evidence is needed in order to corroborate our findings.
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http://dx.doi.org/10.1136/ijgc-2020-001381DOI Listing
July 2020

COVID-19 Global Pandemic: Options for Management of Gynecologic Cancers.

Int J Gynecol Cancer 2020 05 27;30(5):561-563. Epub 2020 Mar 27.

Gynecologic Oncology, Clinica ASTORGA, Medellin, Colombia.

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http://dx.doi.org/10.1136/ijgc-2020-001419DOI Listing
May 2020

Multidisciplinary approach in the pelvic relapse of a previously irradiated cervical tumor.

Int J Gynecol Cancer 2020 05 2;30(5):714. Epub 2020 Mar 2.

Obstetrics and Gynecology, Clinica Universitaria de Navarra, Madrid, Spain.

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http://dx.doi.org/10.1136/ijgc-2020-001207DOI Listing
May 2020

Magnetic resonance imaging and ultrasound for assessing parametrial infiltration in cervical cancer. A systematic review and meta-analysis.

Med Ultrason 2020 03;22(1):85-91

Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain.

Aims: To provide information on the current evidence regarding the diagnostic performance of ultrasound and MRI for assessing parametrial involvement in cervical cancer using the histological report as the reference standard.

Material And Methods: Meta-analysis. An extensive search of papers comparing ultrasound and MRI in assessing parametrial infiltration in cervical cancer using pathologic analysis as a reference standard was performed in Medline (Pubmed) and Web of Science from January 1990 to September 2019. Quality was assessed using the QUADAS-2 tool.

Results: Our extended search identified 205 citations but after exclusions we finally included 9 articles in the meta-analysis. The risk of bias for most studies was low for four domains were assessed in QUADAS-2. Overall, for ultrasound pooled estimated sensitivity and specificity for diagnosing parametrial infiltration was 78% (95% confidence interval [CI]:48%-93%) and 96% (95% CI=89%-99%), respectively. For MRI these figures were 68% (95% CI=54%-80%) and 91% (95% CI=84%-95%), respectively. No statistical differences were found when comparing both methods (p=0.548). Heterogeneity was low/moderate for MRI and high for ultrasound.

Conclusion: Ultrasound and MRI have similar diagnostic performance for detecting parametrial infiltration in women with cervical cancer. This might have relevance from the clinical point of view, since ultrasound is cheaper than MRI.
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http://dx.doi.org/10.11152/mu-2361DOI Listing
March 2020

Hyperthermic intraperitoneal chemotherapy does not improve survival in advanced ovarian cancer.

Cancer 2019 Dec;125 Suppl 24:4594-4597

Department of Gynecologic Oncology, MD Anderson Cancer Center, Madrid, Spain.

Despite its widespread use, until recently, there was no randomized evidence for hyperthermic intraperitoneal chemotherapy (HIPEC) versus surgery without HIPEC for ovarian cancer. Recently, a Dutch study (OVHIPEC) reported benefits in both progression-free survival (PFS) and overall survival (OS) gained from the use of HIPEC at the time of interval debulking surgery (IDS) for stage III ovarian carcinoma, whereas a Korean randomized trial failed to show a benefit of HIPEC for patients with ovarian cancer undergoing primary debulking surgery or IDS. In colorectal cancer, 2 randomized trials failed to show an improvement in survival with HIPEC. In addition to these contradictory results, there are a number of aspects of the Dutch OVHIPEC trial in ovarian cancer that can be criticized. Some criticisms include a reduction of the number of patients needed to be randomized because of too slow accrual; much lower PFS and OS in both arms than expected according to the statistical plan; the small size of the study, with imbalances between the 2 arms (eg, more low-grade tumors in the HIPEC arm); the timing of randomization before the start of IDS; the lack of clear inclusion criteria for neoadjuvant chemotherapy; and the heterogeneity of the results, with the largest effect shown at the smaller centers. Furthermore, it is questionable whether the adverse events were reported completely. In conclusion, data about HIPEC for ovarian cancer in general are not convincing, and they do not change the standard of care, which remains for ovarian cancer surgery and intravenous chemotherapy.
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http://dx.doi.org/10.1002/cncr.32496DOI Listing
December 2019

Diffusion-weighted magnetic resonance imaging in peritoneal carcinomatosis from suspected ovarian cancer: Diagnostic performance in correlation with surgical findings.

Eur J Radiol 2019 Dec 29;121:108696. Epub 2019 Sep 29.

Department of Gynecology, Clínica Universitaria de Navarra, C/Marquesado de Sta. Marta, 1, 28027, Madrid, Spain; University of Navarre, Medicine School, Department of Gynecology -Director, C/ Irunlarrea 1, 31008, Pamplona, Navarra, Spain. Electronic address:

Purpose: Ovarian cancer (OC) is the commonest cause of death by gynaecological cancer in developed countries. Peritoneal carcinomatosis (PC) complete debulking without residual disease of >1 cm is the best prognostic predictor in advanced OC. PC is assessed with Computed tomography (CT). CT accuracy and cytoreduction success predictive ability are limited. PET/CT is not an imaging standard for PC. PC shows high signal foci in Diffusion-weighted magnetic resonance imaging (DWI MRI). We assessed the diagnostic performance (DP) and tumour burden correlation of Whole body DWI with background suppression MRI (WB-DWIBS/MRI) in PC of suspected OC using the Peritoneal Cancer Index (PCI), referring to cytoreduction surgery as the standard reference.

Method: Fifty patients with suspicion of disseminated OC underwent cytoreduction and WB-DWIBS/MRI. The PCI scores tumour burden (0-3) in 13 anatomical regions (global range of 0-39). Two radiologists (Rad1/Rad2) assessed the PCI preoperatively and with surgical findings. We evaluated regional and global DP, the interobserver agreement (Cohen´s kappa coefficient), statistical differences (McNemar test) and tumour burden (Pearson's test).

Results: 72% (36/50) were epithelial OC and 78% (39/50) achieved complete cytoreduction. Global-PCI correlation was 0.762 (Rad1) with DP: Sensitivity 0.84, specificity 0.89, accuracy 0.89, and kappa 0.41. Average global-PCI was 7. The pelvis and right hypochondrium showed the highest positive rate and DP, while the intestinal regions presented the lowest. Previous studies reported higher sensitivity than CT or PET/CT, although only a few used the PCI.

Conclusions: WB-DWIBS/MRI is reliable to depict, quantify and to predict complete cytoreductive surgery in OC PC.
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http://dx.doi.org/10.1016/j.ejrad.2019.108696DOI Listing
December 2019

Is There a Role for Intraperitoneal Chemotherapy, Including HIPEC, in the Management of Ovarian Cancer?

J Clin Oncol 2019 09 12;37(27):2420-2423. Epub 2019 Aug 12.

Clinica Universidad de Navarra, Navarre, Spain.

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http://dx.doi.org/10.1200/JCO.19.00091DOI Listing
September 2019

Oncological outcome of surgical management in patients with recurrent uterine cancer-a multicenter retrospective cohort study-CEEGOG EX01 Trial.

Int J Gynecol Cancer 2019 05;29(4):711-720

Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.

Objectives: To assess the survival of patients who have received an operation for recurrent cervical and endometrial cancer and to determine prognostic variables for improved oncologic outcome.

Methods: A retrospective multicenter analysis of the medical records of 518 patients with cervical (N = 288) or endometrial cancer (N = 230) who underwent surgery for disease recurrence and who had completed at least 1 year of follow-up.

Results: The median survival reached 57 months for patients with cervical cancer and 113 months for patients with endometrial cancer after surgical treatment of recurrence (p = 0.036). Histological sub-type had a significant impact on overall survival, with the best outcome in endometrial endometrioid cancer (121 months), followed by cervical squamous cell carcinoma, cervical adenocarcinoma, or other types of endometrial cancer (81 vs 35 vs 35 months; p <0.001). The site of recurrence did not significantly influence survival in cervical or in endometrial cancer. Cancer stage at first diagnosis, tumor grade, lymph node status at recurrence, progression-free interval after first diagnosis, and free resection margins were associated with improved overall survival on univariate analysis. On multivariate analysis, the stage at first diagnosis and resection margins were significant independent predictive parameters of an improved oncologic outcome.

Conclusion: Long-term survival can be achieved via secondary cytoreductive surgery in selected patients with recurrent cervical and endometrial cancer. An excellent outcome is possible even if the recurrence site is located in the lymph nodes. The possibility of achieving complete resection should be the main criterion for patient selection.
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http://dx.doi.org/10.1136/ijgc-2019-000292DOI Listing
May 2019

Early-stage mucinous carcinoma (infiltrative type) of the ovary and fertility preservation.

Int J Gynecol Cancer 2019 05 16;29(4):835-839. Epub 2019 Apr 16.

Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain

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http://dx.doi.org/10.1136/ijgc-2019-000446DOI Listing
May 2019

Minimally Invasive or Abdominal Radical Hysterectomy for Cervical Cancer.

N Engl J Med 2019 Feb;380(8):793-4

Institut Bergonié Cancer Center, Bordeaux, France

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http://dx.doi.org/10.1056/NEJMc1816590DOI Listing
February 2019

The hook of the humanitarian medicine: an exciting adventure in Congo.

Authors:
Luis Chiva

Int J Gynecol Cancer 2019 01;29(1):221-222

Department of Gynecology, Universidad de Navarra, Madrid, Spain

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http://dx.doi.org/10.1136/ijgc-2018-000002DOI Listing
January 2019

Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography.

Int J Gynecol Cancer 2019 Feb 10;29(2):227-233. Epub 2019 Jan 10.

Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain.

Objective: To compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer.

Methods: An observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index.

Results: The tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT.

Conclusion: Detailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.
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http://dx.doi.org/10.1136/ijgc-2018-000066DOI Listing
February 2019

Is there a role for HIPEC in ovarian cancer?

Arch Gynecol Obstet 2018 11;298(5):859-860

Department of Gynecology, Charité Medical University of Berlin, Germany and North-Eastern German Society of Gynaecologic Oncology (NOGGO) Ovarian Cancer Study Group and AGO Study Group, Berlin, Germany.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is promoted by some as a standard treatment for peritoneal carcinomatosis of epithelial ovarian cancer (EOC) and other tumor entities, despite lack of robust data supporting this. Publicly available evidence addressing the value of HIPEC in EOC is rather inconclusive, revealing contradictory and inconsistent results while some studies even report harm to the patients from a higher morbidity. On this ground, we cannot recommend the implementation and use of HIPEC outside of a randomized clinical trial setting.
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http://dx.doi.org/10.1007/s00404-018-4908-0DOI Listing
November 2018

Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer.

N Engl J Med 2018 04;378(14):1362-3

Kliniken Essen-Mitte, Essen, Germany

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http://dx.doi.org/10.1056/NEJMc1802033DOI Listing
April 2018

Retroperitoneal Laparoscopic Para-Aortic Lymphadenectomy in Para-Aortic Staging of Locally Advanced Cervical Cancer.

J Minim Invasive Gynecol 2018 Nov - Dec;25(7):1142-1143. Epub 2018 Feb 7.

Clínica Universitaria de Navarra, Navarra, Spain.

Study Objective: To review/learn a surgical technique not very well-known by gynecologic oncologists.

Design: Level of evidence III.

Setting: A review of a surgical technique with emphasis on the para-aortic sentinel lymph nodes using indocyanine green.

Intervention: The film features the following steps to perform the procedure: 1. Creating a retroperitoneal window. 2. What to do if the peritoneum is torn. 3. Finding the psoas muscle, right ureter, and common iliac artery. Dissecting the right common iliac artery caudally to the bifurcation of the external iliac artery and internal iliac artery and cranially to the inferior mesenteric artery, the ovarian arteries, and the left renal vein. 4. A view of all of the nodes with fluorescence when indocyanine green is injected into the cervix. At present, the sentinel lymph nodes are not the standard of care for locally advanced cervical cancer. If the nodes are metastatic at this stage, all the para-aortic area will undergo radiation therapy. 5. Dissecting the inferior vena cava from the intersection with the right uterer to the right and left renal veins. 6. Performing the lateroaortic, preaortic, and precaval lymphadenectomy. 7. A final view with all of the elements (i.e., bifurcation of the common iliac artery, the left renal vein, and both ureters). 8. In the final part of the video, we open the peritoneal window to decrease the incidence of lymphoceles.

Conclusion: The real novelty of this video is how the para-aortic area nodes are seen when green indocyanine is injected into the cervix. This video shows a simplified technique of retroperitoneal para-aortic lymphadenectomy using an advanced bipolar sealant. Some tips and tricks to facilitate the procedure are emphasized, especially in cases of accidental peritoneal tears. To decrease the incidence of lymphoceles before completing the surgery, the peritoneal window should be opened. This surgical technique is especially useful in endometrial cancer for staging the para-aortic area in obese patients and in advanced cervical cancer to determine the field of radiotherapy.
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http://dx.doi.org/10.1016/j.jmig.2018.01.033DOI Listing
July 2019

European Society of Gynaecological Oncology (ESGO) Guidelines for Ovarian Cancer Surgery.

Int J Gynecol Cancer 2017 09;27(7):1534-1542

Clinica Universidad de Navarra, Pamplona, Spain.

Methods: The European Society of Gynaecological Oncology council nominated an international multidisciplinary development group made of practicing clinicians who have demonstrated leadership and interest in the care of ovarian cancer (20 experts across Europe). To ensure that the statements are evidence based, the current literature identified from a systematic search has been reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group (expert agreement). The guidelines are thus based on the best available evidence and expert agreement. Before publication, the guidelines were reviewed by 66 international reviewers independent from the development group including patients representatives.

Results: The guidelines cover preoperative workup, specialized multidisciplinary decision making, and surgical management of diagnosed epithelial ovarian, fallopian tube, and peritoneal cancers. The guidelines are also illustrated by algorithms.
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http://dx.doi.org/10.1097/IGC.0000000000001041DOI Listing
September 2017

European Surgical Education and Training in Gynecologic Oncology: The impact of an Accredited Fellowship.

Int J Gynecol Cancer 2017 05;27(4):819-825

*Department Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain; †University of Toulouse, Toulouse, France; ‡Department of Obstetrics and Gynecology, Charles University Hospital, Prague, Czech Republic; and §Department of Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany.

Objective: The aim of this study was to understand the current situation of surgical education and training in Europe among members of the European Society of Gynecological Oncology (ESGO) and its impact on the daily surgical practice of those that have completed an accredited fellowship in gynecologic oncology.

Methods: A questionnaire addressing topics of interest in surgical training was designed and sent to ESGO members with surgical experience in gynecologic oncology. The survey was completely confidentially and could be completed in less than 5 minutes. Responses from 349 members from 42 European countries were obtained, which was 38% of the potential target population. The respondents were divided into 2 groups depending on whether they had undergone an official accreditation process.

Results: Two thirds of respondents said they had received a good surgical education. However, accredited gynecologists felt that global surgical training was significantly better. Surgical self-confidence among accredited specialists was significantly higher regarding most surgical oncological procedures than it was among their peers without such accreditation. However, the rate of self-assurance in ultraradical operations, and bowel and urinary reconstruction was quite low in both groups. There was a general request for standardizing surgical education across the ESGO area. Respondents demanded further training in laparoscopy, ultraradical procedures, bowel and urinary reconstruction, and postoperative management of complications. Furthermore, they requested the creation of fellowship programs in places where they are not now accredited and the promotion of rotations and exchange in centers of excellence. Finally, respondents want supporting training in disadvantaged countries of the ESGO area.

Conclusions: Specialists in gynecologic oncology that have obtained a formal accreditation received a significantly better surgical education than those that have not. The ESGO responders recognize that their society should lead the standardization of surgical training and promote ways of improving members' surgical skills.
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http://dx.doi.org/10.1097/IGC.0000000000000942DOI Listing
May 2017

Brief Report About the Role of Hyperthermic Intraperitoneal Chemotherapy in a Prospective Randomized Phase 3 Study in Recurrent Ovarian Cancer From Spiliotis et al.

Int J Gynecol Cancer 2017 02;27(2):246-247

*Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte, Essen; †Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg; ‡Department of Gynecology, Charité, Berlin, Germany; and §Department of Gynecology Oncology, MD Anderson Cancer Center, Madrid, Spain.

A published so-called phase 3 study regarding HIPEC in ovarian cancer raised multiple questions. This commentary focusses on the weakness of the publication and discusses this in detail.
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http://dx.doi.org/10.1097/IGC.0000000000000864DOI Listing
February 2017

Value of Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer: A European Perspective.

J Clin Oncol 2017 02 9;35(6):587-590. Epub 2017 Jan 9.

Christina Fotopoulou, Imperial College London, London, United Kingdom; Jalid Sehouli, Charité Medical University of Berlin, Berlin, Germany; Giovanni Aletti, European Institute of Oncology, Milan, Italy; Philipp Harter, Kliniken Essen Mitte, Essen, Germany; Sven Mahner, Ludwig-Maximilians-University, Munich, Germany; Denis Querleu, Institut Bergonié, Bordeaux, France; Luis Chiva, Clínica Universidad de Navarra, Navarra, Spain; Hani Gabra, Imperial College London, London, United Kingdom; Nicoletta Colombo, European Institute of Oncology, Milan, Italy; and Andreas du Bois, Kliniken Essen Mitte, Essen, Germany.

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http://dx.doi.org/10.1200/JCO.2016.71.0723DOI Listing
February 2017