No abstract available.
Female ; Ovarian Hyperstimulation Syndrome*

Uterine carcinosarcomas are rare and highly aggressive tumors with a poor prognosis. Due to early metastasis and disease progression, it is known to be far more aggressive than matched grade 3 endometroid endometrial carcinomas. Five-year survival for stage IV is reported to be 10% and overall survival for stage IVB is expected to be very poor. The authors report one case after experiencing long-term survival (over 5 years) for stage IVB carcinosarcoma of uterus. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed to 56 year old patient for uterine myoma. On pathology report, uterine carcinosarcoma was diagnosed and image studies were performed. With the impression of stage IVB uterine carcinosarcoma, 6 cycles of chemotherapy (ifosfamide and cisplatin) was conducted as adjuvant. Up to recently (over 5 years), she maintains good performance scale without evidence of tumor recurrence or disease progression.
Carcinosarcoma ; Disease Progression ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Myoma ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Uterus

No abstract available.
Biometry* ; Rheology* ; Umbilical Arteries*

Minimally invasive surgery is widely used in benign gynecologic diseases and may be used in malignancies. We performed a single-port access laparoscopy staging - bilateral salpingo-oophorectomy, laparoscopy-assisted vaginal hysterectomy, bilateral pelvic lymphadenectomy, infracolic omentectomy, and washing cytology - in a borderline ovarian tumor. The number of harvested pelvic lymph nodes were twenty-three and there were no intraoperative or postoperative complications. Single-port access laparoscopic staging may be performed in selected patients. The efficacy, safety, and potential benefits of this technique should be evaluated in further trials.
Female ; Genital Diseases, Female ; Humans ; Hysterectomy, Vaginal ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications

The recent development of laparoscopic cholecysteetomy has introduced the technique of laparoscopy to the general surgical operation. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation in order to visualize better the abdominal viscera may causes some problems-hypercarbia, hypertension, pneumomediastinum, subcutaneous emphysema and cardiovascular impairment, We studied the changes of cardiovascular system and pulmonary gas exchanges clinically during general anesthesia for laparoscopic eholecystectomy in the 16 patients of Seoul National University Hospital. After induction of anesthsia, ventilation was controlled with tidal volume 10 ml/kg and respiration rate 10-15/min to maintain PaCO2 35 mmHg before insufflation of carbon dioxide. After measuring of control value of mean arterial pressure(MAP), heart rate(HR) and arterial blood gas analysis before insufflation of CO2, ventilation setting was not changed throughout the operation. MAP, HR, arterial blood gas analysis were measured at 30 min interval until the end of operation. The changes of MAP, HR and PaO2, throughout the operation are not statistically significant in comparison to control(preinsufflation) values. The PaCO2 was increased significantly by 8-10 mmHg in comparison to control values(p-value<0.01). In conclusion, minute ventilation should be corrected during general anesthesia for laparoscapic cholecysteetomy with CO2 insufflation according to continuous monitoring of end tidal CO2 and arterial carbon dioxide tension.
Anesthesia, General* ; Blood Gas Analysis ; Carbon ; Carbon Dioxide ; Cardiovascular System ; Cholecystectomy, Laparoscopic* ; Heart ; Humans ; Hypertension ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Pneumoperitoneum ; Respiratory Rate ; Seoul ; Subcutaneous Emphysema ; Tidal Volume ; Ventilation ; Viscera

OBJECTIVE: To compare laparoscopic surgery with conventional abdominal surgery in patients with early stage endometrial cancer. METHODS: A retrospective review of 63 patients with early stage endometrial cancer managed between March 2003 and May 2005. Two groups were defined whether they had been treated by laparoscopy (case group: n=26) or by laparotomy (control group: n=37). We compared age, body mass index (BMI), hemoglobin change, operation time, number of pelvic lymph nodes, hospital stay, case with adjuvant treatment and recurrence between two groups. RESULTS: There was no statistical difference in characteristics (age, BMI, nulliparity, previous abdominal surgery, FIGO stage, histologic grade). between case and control group. In addition, there was no statistical difference in operation data and outcomes between two groups. Hemoglobin changes were 1.1 g/dL (case group) vs 1.7 g/dL (control group) (p=0.072). Operation time was 131 min vs. 115 min. The numbers of lymph nodes obtained were 8.7 vs 7.7 (right) 9.2 vs. 7.6 (left). Hospital stays were 8.4 vs. 9.2 days. Adjuvant treatment cases were 7 vs. 15. Recurrent case was one in each group. Two patients initially evaluated by laparoscopy were converted to laparotomy due to bleeding and adhesion. CONCLUSION: Laparoscopic surgery for treatment of early endometrial cancer is a safe and effective alternative to laparotomy . However, long-term survival and risk of recurrence have yet to be determined.
Body Mass Index ; Endometrial Neoplasms* ; Female ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Parity ; Recurrence ; Retrospective Studies

OBJECTIVE: To identify current practice patterns for unresolved issues in the surgical and adjuvant management of endometrial cancer in Korea. METHODS: We designed and conducted a survey of all 218 active members of the Korean Gynecologic Oncology Group to try to identify how they would manage various case scenarios for endometrial cancer. Data were collected using an Internet survey database. RESULTS: A total of 108 members (49.5%) responded to the survey. Laparoscopy (81.6%) was the most commonly used mode of surgery in early-stage endometrial cancer. Of all the respondents, 19.8% stated that lymphadenectomy could be omitted and 21.7% recommended selective lymphadenectomy based on sentinel biopsy or frozen results for patients with presumed stage IA/grade 1 disease. On the other hand, 71.9% of respondents recommended para-aortic lymphadenectomy for patients with presumed stage IB/grade 1 disease and 86.4% recommended this treatment for presumed stage IB/grade 3 disease. The majority of respondents performed adjuvant therapy for stage IB/grade 2 (91.7%), IB/grade 3 (99.0%), and stage II (89.6%). Whole pelvic radiotherapy and vaginal brachytherapy were the most frequently used options among these patients. All respondents administered adjuvant therapy when node metastasis was found, and concurrent chemoradiotherapy (53.2%) was the most preferred option for stage IIIC1 disease. CONCLUSION: There is broad variation in both the surgical and adjuvant treatment of endometrial cancer among Korean gynecologic oncologists.
Adult ; Combined Modality Therapy ; Endometrial Neoplasms/pathology/*therapy ; Female ; *Gynecology ; Humans ; Incidental Findings ; Lymph Node Excision/methods ; Lymphatic Metastasis ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neoadjuvant Therapy ; Personal Satisfaction ; Practice Patterns, Physicians' ; Republic of Korea ; Robotic Surgical Procedures

Purpose: This study aimed to identify the prognostic value of early metabolic response assessed using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiation therapy (RT) for cervical cancer. Materials and Methods: We identified 116 patients treated with definitive RT, including FDG-PET/CT–guided intracavitary brachytherapy, between 2009 and 2018. We calculated parameters including maximum (SUVmax) and mean standardized uptake values (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for baseline FDG-PET/CT (PETbase) and image-guided brachytherapy planning FDG-PET/CT (PETIGBT). Multivariable analyses of disease-free survival (DFS) and overall survival (OS) were performed. Results: We observed a time-dependent decrease in PET parameters between PETbase and PETIGBT; ΔSUVmax, ΔSUVmean, ΔMTV, and ΔTLG were 65%, 61%, 78%, and 93%, respectively. With a median follow-up of 59.5 months, the 5-year DFS and OS rates were 66% and 79%, respectively. Multivariable analysis demonstrated that ΔSUVmax ≥ 50% was associated with favorable DFS (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.14 to 5.77) and OS (HR, 5.14; 95% CI, 1.55 to 17.01). Patients with ΔSUVmax ≥ 50% (n=87) showed better DFS and OS than those with ΔSUVmax < 50% (n=29) (DFS, 76% vs. 35%, p < 0.001; OS, 90% vs. 41%, p < 0.001, respectively). Adenocarcinoma was frequently observed in ΔSUVmax < 50% compared to ΔSUVmax ≥ 50% (27.6% vs. 10.3%, p=0.003). In addition, models incorporating metabolic parameters showed improved accuracy for predicting DFS (p=0.012) and OS (p=0.004) than models with clinicopathologic factors. Conclusion Changes in metabolic parameters, especially those in SUVmax by > 50%, can help improve survival outcome predictions for patients with cervical cancer treated with definitive RT.

Purpose: This study aimed to identify the prognostic value of early metabolic response assessed using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiation therapy (RT) for cervical cancer. Materials and Methods: We identified 116 patients treated with definitive RT, including FDG-PET/CT–guided intracavitary brachytherapy, between 2009 and 2018. We calculated parameters including maximum (SUVmax) and mean standardized uptake values (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for baseline FDG-PET/CT (PETbase) and image-guided brachytherapy planning FDG-PET/CT (PETIGBT). Multivariable analyses of disease-free survival (DFS) and overall survival (OS) were performed. Results: We observed a time-dependent decrease in PET parameters between PETbase and PETIGBT; ΔSUVmax, ΔSUVmean, ΔMTV, and ΔTLG were 65%, 61%, 78%, and 93%, respectively. With a median follow-up of 59.5 months, the 5-year DFS and OS rates were 66% and 79%, respectively. Multivariable analysis demonstrated that ΔSUVmax ≥ 50% was associated with favorable DFS (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.14 to 5.77) and OS (HR, 5.14; 95% CI, 1.55 to 17.01). Patients with ΔSUVmax ≥ 50% (n=87) showed better DFS and OS than those with ΔSUVmax < 50% (n=29) (DFS, 76% vs. 35%, p < 0.001; OS, 90% vs. 41%, p < 0.001, respectively). Adenocarcinoma was frequently observed in ΔSUVmax < 50% compared to ΔSUVmax ≥ 50% (27.6% vs. 10.3%, p=0.003). In addition, models incorporating metabolic parameters showed improved accuracy for predicting DFS (p=0.012) and OS (p=0.004) than models with clinicopathologic factors. Conclusion Changes in metabolic parameters, especially those in SUVmax by > 50%, can help improve survival outcome predictions for patients with cervical cancer treated with definitive RT.

The plasminogen and plasmin system, which is mainly regulated by urokinase-type plasminogen activator (uPA), its receptor (uPAR) and its inhibitor (PAI-1), is generally believed to play a role in cancer invasion and metastasis. This study was conducted to investigate the role of uPA, uPAR and PAI-1 in the invasion and metastasis of gastric adenocarcinoma. The expression of mRNAs for uPA and PAI-1 was determined by Northern blot analysis in nine primary gastric cancer tissues, nine paired metastatic lymph nodes and normal gastric mucosa. The mRNA of uPA was not or faintly detected in normal mucosa, while the expression was increased in both primary gastric cancer tissues and metastatic lymph nodes to a similar degree. The mRNA expression for PAI-1 in the gastric cancer tissues was not different from that in the paired metastatic lymph nodes and normal mucosae. uPAR was determined by immunohistochemical staining, demonstrating that five (56%) and six (67%) out of nine primary gastric cancer tissues and nine paired metastatic lymph nodes were positive, respectively and the intensity was stronger in metastatic lymph nodes. The results support the concept that most gastric cancer cells may have an innately moderate level of uPA and uPAR, and that increase of uPAR expression can be considered to be closely associated with cancer invasion and metastasis.
Adenocarcinoma/*metabolism/pathology ; Gastric Mucosa/metabolism ; Gene Expression ; Human ; Immunoenzyme Techniques ; Lymph Nodes/metabolism/pathology ; Neoplasm Metastasis ; Plasminogen Activator Inhibitor 1/*biosynthesis/genetics ; Plasminogen Activators/*biosynthesis/genetics ; RNA, Messenger/biosynthesis ; Receptors, Cell Surface/*biosynthesis/genetics ; Stomach Neoplasms/*metabolism/pathology ; Support, Non-U.S. Gov't ; Urinary Plasminogen Activator/*biosynthesis/genetics