The Experts below are selected from a list of 19458 Experts worldwide ranked by ideXlab platform
Robert E. Bristow - One of the best experts on this subject based on the ideXlab platform.
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Cytoreductive Surgery for advanced and recurrent endometrial cancer: a review of the literature.
Women's health (London England), 2009Co-Authors: Joyce N. Barlin, Stefanie Ueda, Robert E. BristowAbstract:There is no standard approach to managing women with advanced or recurrent endometrial cancer; however, there is increasing evidence to support a role for Cytoreductive Surgery in these women to improve survival outcome. The existing literature is limited by the inherent biases of retrospective studies, as well as small numbers of patients in individual studies; however, the association between optimal or complete Cytoreductive Surgery in patients with advanced and recurrent endometrial cancer and improved overall survival has been consistent. Furthermore, there is also a strong association between the size of postoperative residual disease and survival; as such, maximal cytoreduction should be the goal in carefully selected patients with advanced or recurrent endometrial cancer who are candidates for surgical management. Additional prospective research is needed in order to further define the role of Cytoreductive Surgery in advanced and recurrent endometrial cancer, and to develop effective adjuvant the...
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Cytoreductive Surgery for recurrent ovarian cancer: A meta-analysis
Gynecologic oncology, 2008Co-Authors: Robert E. Bristow, Isha Puri, Dennis S. ChiAbstract:Abstract Objective To determine the relative effect of multiple prognostic variables on overall post-recurrence survival time among cohorts of patients with recurrent ovarian cancer undergoing Cytoreductive Surgery. Methods Forty cohorts of patients with recurrent ovarian cancer (2019 patients) meeting study inclusion criteria were identified from the MEDLINE database (1983–2007). Simple and multiple linear regression analyses, with weighted correlation calculations, were used to assess the effect on median post-recurrence survival time of the following variables: year of publication, age, disease-free interval, localized disease, tumor grade and histology, the proportion of patients undergoing complete Cytoreductive Surgery, requirement for bowel resection, and the sequence of Cytoreductive Surgery and salvage chemotherapy. Results The mean weighted median disease-free interval prior to Cytoreductive Surgery was 20.2 months, and the mean weighted median overall post-recurrence survival time was 30.3 months. The weighted mean proportion of patients in each cohort undergoing complete Cytoreductive Surgery was 52.2%. Median survival improved with increasing year of publication ( p =0.009); however, the only statistically significant clinical variable independently associated with post-recurrence survival time was the proportion of patients undergoing complete Cytoreductive Surgery ( p =0.019). After controlling for all other factors, each 10% increase in the proportion of patients undergoing complete Cytoreductive Surgery was associated with a 3.0 month increase in median cohort survival time. Conclusions Among patients undergoing operative intervention for recurrent ovarian cancer, the proportion of patients undergoing complete Cytoreductive Surgery is independently associated with overall post-recurrence survival time. For this select group of patients, the surgical objective should be resection of all macroscopic disease.
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Salvage Cytoreductive Surgery for recurrent endometrial cancer
Gynecologic oncology, 2006Co-Authors: Robert E. Bristow, Antonio Santillan, Marianna Zahurak, Ginger J. Gardner, Robert L. Giuntoli, Deborah K. ArmstrongAbstract:Abstract Objective To determine the survival impact of salvage Cytoreductive Surgery, and other prognostic variables, among patients with recurrent endometrial cancer. Methods All patients diagnosed with endometrial cancer recurrence between 7/1/97 and 6/30/05 were retrospectively identified from the tumor registry database. Demographic, pathological, and clinical data were abstracted from the medical record. Survival estimates were calculated using the Kaplan and Meier method. Univariate and multivariate regression analyses were used to identify characteristics associated with overall survival from time of recurrence. Results Sixty-one patients were identified with endometrial cancer recurrence a median of 18.5 months after initial diagnosis. Median age at recurrence was 63 years, and the median post-recurrence follow-up time was 22.0 months. Thirty-five patients underwent salvage Cytoreductive Surgery and had a median survival time of 28.0 months, compared to 13.0 months for patients treated non-surgically ( P P = 0.0005). On multivariate analysis, salvage Surgery and residual disease status were significant and independent predictors of post-recurrence survival. Conclusions Complete salvage Cytoreductive Surgery for recurrent endometrial cancer is associated with prolonged post-recurrence survival compared to patients left with any gross residual disease. Additional studies are warranted to define appropriate surgical indications and selection criteria.
Mitchel S. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Cytoreductive Surgery for patients with recurrent epithelial ovarian carcinoma
Gynecologic oncology, 2007Co-Authors: Stephen J. Tebes, Robyn Sayer, J Palmer, Christine C. Tebes, Martin A. Martino, Mitchel S. HoffmanAbstract:Abstract Objective. This study aims to identify favorable preoperative characteristics and examine the impact of secondary Cytoreductive Surgery on survival for patients with recurrent epithelial ovarian carcinoma. Methods. Patients who underwent Cytoreductive Surgery for recurrent epithelial ovarian cancer were identified in our surgical database for the period 1988–2004. Patient charts were reviewed and data collected regarding patient demographics, surgical management, preoperative evaluation, perioperative complications, and oncologic outcome. Results. Eighty-five patients met eligibility criteria. Preoperative factors that correlated with improved survival were disease-free interval of greater than 12 months ( p p p Conclusion. When selecting patients for secondary cytoreduction, the most significant preoperative factors are disease-free interval and success of a prior Cytoreductive effort. Once secondary Cytoreductive Surgery is attempted, the most important factor for improved survival is optimal cytoreduction. Of equal importance is counseling regarding the significant risk for bowel Surgery, colostomy, and complications.
Ginger J. Gardner - One of the best experts on this subject based on the ideXlab platform.
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Ovarian cancer Cytoreductive Surgery in the elderly.
Current Treatment Options in Oncology, 2009Co-Authors: Ginger J. GardnerAbstract:Patient selection for Cytoreductive Surgery is a critical clinical assessment that defines the early management of ovarian cancer, and standardized patient-selection criteria for debulking Surgery are lacking. The term “elderly” has been variably defined in the ovarian cancer debulking literature as being older than age 60, 70, or 80+ years of age. Multiple studies indicate the feasibility and acceptable complication rates for debulking Surgery among women ≥70 years of age. These studies demonstrate improved survival among optimally debulked patients. There are limited data specifically addressing the advanced elderly, age ≥80; however, selected patients appear to be appropriate candidates. Further dedicated study addressing the patient selection for debulking Surgery and treatment outcomes among elderly ovarian cancer patients is needed. In this article, outcome studies addressing the application of major gynecologic Surgery, including Cytoreductive Surgery, in the elderly population are reviewed, and current areas of clinical investigation are highlighted.
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Salvage Cytoreductive Surgery for recurrent endometrial cancer
Gynecologic oncology, 2006Co-Authors: Robert E. Bristow, Antonio Santillan, Marianna Zahurak, Ginger J. Gardner, Robert L. Giuntoli, Deborah K. ArmstrongAbstract:Abstract Objective To determine the survival impact of salvage Cytoreductive Surgery, and other prognostic variables, among patients with recurrent endometrial cancer. Methods All patients diagnosed with endometrial cancer recurrence between 7/1/97 and 6/30/05 were retrospectively identified from the tumor registry database. Demographic, pathological, and clinical data were abstracted from the medical record. Survival estimates were calculated using the Kaplan and Meier method. Univariate and multivariate regression analyses were used to identify characteristics associated with overall survival from time of recurrence. Results Sixty-one patients were identified with endometrial cancer recurrence a median of 18.5 months after initial diagnosis. Median age at recurrence was 63 years, and the median post-recurrence follow-up time was 22.0 months. Thirty-five patients underwent salvage Cytoreductive Surgery and had a median survival time of 28.0 months, compared to 13.0 months for patients treated non-surgically ( P P = 0.0005). On multivariate analysis, salvage Surgery and residual disease status were significant and independent predictors of post-recurrence survival. Conclusions Complete salvage Cytoreductive Surgery for recurrent endometrial cancer is associated with prolonged post-recurrence survival compared to patients left with any gross residual disease. Additional studies are warranted to define appropriate surgical indications and selection criteria.
Deborah K. Armstrong - One of the best experts on this subject based on the ideXlab platform.
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Salvage Cytoreductive Surgery for recurrent endometrial cancer
Gynecologic oncology, 2006Co-Authors: Robert E. Bristow, Antonio Santillan, Marianna Zahurak, Ginger J. Gardner, Robert L. Giuntoli, Deborah K. ArmstrongAbstract:Abstract Objective To determine the survival impact of salvage Cytoreductive Surgery, and other prognostic variables, among patients with recurrent endometrial cancer. Methods All patients diagnosed with endometrial cancer recurrence between 7/1/97 and 6/30/05 were retrospectively identified from the tumor registry database. Demographic, pathological, and clinical data were abstracted from the medical record. Survival estimates were calculated using the Kaplan and Meier method. Univariate and multivariate regression analyses were used to identify characteristics associated with overall survival from time of recurrence. Results Sixty-one patients were identified with endometrial cancer recurrence a median of 18.5 months after initial diagnosis. Median age at recurrence was 63 years, and the median post-recurrence follow-up time was 22.0 months. Thirty-five patients underwent salvage Cytoreductive Surgery and had a median survival time of 28.0 months, compared to 13.0 months for patients treated non-surgically ( P P = 0.0005). On multivariate analysis, salvage Surgery and residual disease status were significant and independent predictors of post-recurrence survival. Conclusions Complete salvage Cytoreductive Surgery for recurrent endometrial cancer is associated with prolonged post-recurrence survival compared to patients left with any gross residual disease. Additional studies are warranted to define appropriate surgical indications and selection criteria.
Allan Covens - One of the best experts on this subject based on the ideXlab platform.
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Cytoreductive Surgery for recurrent ovarian cancer
Current opinion in obstetrics & gynecology, 2007Co-Authors: J. Hauspy, Allan CovensAbstract:Purpose of review The issue facing clinicians managing ovarian cancer has evolved over the past three decades from treatment for cure and subsequently palliation, to prolongation of survival for most patients. The purpose of this paper is to review the data, rationale, and issues surrounding Cytoreductive Surgery in recurrent ovarian cancer and its potential role in this new paradigm shift. Recent findings Abundant retrospective series report prolongation of survival with secondary Cytoreductive Surgery in recurrent ovarian cancer. Selection bias, publication bias, and subsequent therapies, however, are confounding factors for survival. As management of ovarian cancer has recently evolved to a treatment of a ‘chronic disease’, Surgery (which has a definite role in primary therapy) should be considered. Summary No prospective randomized studies have been performed to date, and therefore adoption of this method of management has been limited. The absence of good data leaves clinicians without clear direction on how to best manage patients. Patients with favorable characteristics such as a long disease-free interval, good performance status, a single or few small intra-abdominal recurrences may benefit from secondary cytoreduction. A prospective randomized study is needed.
