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The Journal of Obstetrics and... Nov 2023Ovarian cancer is an intractable disease that is mostly diagnosed at an advanced stage and has a high recurrence rate. The early development of characteristic peritoneal...
Ovarian cancer is an intractable disease that is mostly diagnosed at an advanced stage and has a high recurrence rate. The early development of characteristic peritoneal dissemination via ascites contributes to a poor prognosis. Based on the "seed and soil" theory, ovarian cancer is considered to form a disseminated tumor that interacts with the peritoneum; superficial mesothelial cells are structurally important. Thus far, we have reported that peritoneal mesothelial cells, which originally are ecological defenses, transform into ovarian cancer-associated mesothelial cells, which are allies of cancer. They are found to be actively involved in the formation of a friendly "soil" that promotes the survival of "seeds" of ovarian cancer cells. We also demonstrated that the progression of ovarian cancer and the induction of its refractory nature are partially mediated through competition and cooperation between ovarian cancer and mesothelial cells. We believe that it is necessary to shift the aim of treatment strategies from solely targeting cancer cells to focusing on the crosstalk between the surrounding environment and ovarian cancer, an approach that ultimately aims to achieve "coexistence" with cancer through disease control.
Topics: Humans; Female; Ovarian Neoplasms; Peritoneum; Abdominal Cavity; Ascites; Cell Line, Tumor; Tumor Microenvironment
PubMed: 37533323
DOI: 10.1111/jog.15756 -
Journal of Robotic Surgery Aug 2023An omentectomy is a standard component care of gynecological cancers, particularly for surgical staging and treatment for malignant ovarian neoplasms, borderline tumors,... (Review)
Review
An omentectomy is a standard component care of gynecological cancers, particularly for surgical staging and treatment for malignant ovarian neoplasms, borderline tumors, fallopian tube cancers, primary peritoneal cancers as well as certain histological subtypes of endometrial cancer. Traditionally, an omentectomy is performed by an open laparotomy approach, however, use of a robotic approach has gained popularity and has been proven to be both safe and effective. In spite of the advantages of robotic surgery compared to laparotomy, the inherent technical challenges of a robotic omentectomy may limit its uptake. In this article, we review (1) the physiology and surgical anatomy of the omentum, (2) the role of the omentum in immune regulation and oncogenesis, (3) indications for an omentectomy in the setting of gynecological malignancy, and (4) describe a step-by-step 3-arm technique for performing both a infracolic and gastrocolic omentectomy procedure using a robotic approach.
Topics: Female; Humans; Genital Neoplasms, Female; Robotic Surgical Procedures; Ovarian Neoplasms; Robotics; Omentum; Neoplasm Staging
PubMed: 36648633
DOI: 10.1007/s11701-022-01519-1 -
FASEB Journal : Official Publication of... Sep 2023During peritoneal dialysis (PD), the peritoneum is exposed to a bioincompatible dialysate, deteriorating the tissue and limiting the long-term effectiveness of PD....
During peritoneal dialysis (PD), the peritoneum is exposed to a bioincompatible dialysate, deteriorating the tissue and limiting the long-term effectiveness of PD. Peritoneal fibrosis is triggered by chronic inflammation induced by a variety of stimuli, including peritonitis. Exposure to PD fluid alters peritoneal macrophages phenotype. Inflammasome activation triggers chronic inflammation. First, it was determined whether inflammasome activation causes peritoneal deterioration. In the in vivo experiments, the increased expression of the inflammasome components, caspase-1 activity, and concomitant overproduction of IL-1β and IL-18 were observed in a mouse model of peritoneal fibrosis. ASC-positive and F4/80-positive cells colocalized in the subperitoneal mesothelial cell layer. These macrophages expressed high CD44 levels indicating that the CD44-positive macrophages contribute to developing peritoneal deterioration. Furthermore, intravital imaging of the peritoneal microvasculature demonstrated that the circulating CD44-positive leukocytes may contribute to peritoneal fibrosis. Bone marrow transplantation in ASC-deficient mice suppressed inflammasome activation, thereby attenuating peritoneal fibrosis in a high glucose-based PD solution-injected mouse model. Our results suggest inflammasome activation in CD44-positive macrophages may be involved in developing peritoneal fibrosis. The inflammasome-derived pro-inflammatory cytokines might therefore serve as new biomarkers for developing encapsulating peritoneal sclerosis.
Topics: Animals; Mice; Peritoneum; Peritoneal Fibrosis; Inflammasomes; Peritonitis; Disease Models, Animal; Inflammation
PubMed: 37606578
DOI: 10.1096/fj.202201777RRR -
Pleura and Peritoneum Sep 2023The pleural and peritoneal cavity share many related features due to their common celomic origin. Normally these two spaces are completely separated with the development... (Review)
Review
The pleural and peritoneal cavity share many related features due to their common celomic origin. Normally these two spaces are completely separated with the development of the diaphragm. Defects in diaphragm morphogenesis may result in congenital diaphragmatic hernias, which is the most known form of communication between the pleural and peritoneal cavity. However, in several cases, findings of pleuroperitoneal communication (PPC) have been described in adults through an apparently intact diaphragm. In this comprehensive review we systematically evaluate clinical scenarios of this form of "unexpected" PPC as reported in the literature and focus on the possible mechanisms involved.
PubMed: 37662602
DOI: 10.1515/pp-2023-0013 -
Brachytherapy 2023In select cases of locally advanced cervical cancer, a hybrid brachytherapy (HBT) approach consisting of a combined intracavitary (IC)/insterstitial (IS) implant can... (Review)
Review
PURPOSE
In select cases of locally advanced cervical cancer, a hybrid brachytherapy (HBT) approach consisting of a combined intracavitary (IC)/insterstitial (IS) implant can yield improved target coverage and/or decreased organ at risk dose compared to IC techniques while limiting invasiveness compared to IS techniques.
METHODS AND MATERIALS
The technique involves placement of transvaginal and/or perineal needles in addition to the tandem and ring/ovoids using either a specialized applicator or free-hand placement. Following applicator and needle placement, brachytherapy may then be planned using principles similar to IC or IS techniques. During treatment planning, it can be helpful to obtain both MRI and CT imaging, as plastic MRI-compatible needles do not show up well on MRI.
RESULTS
In patients where acceptable target coverage cannot be achieved using IC alone or doses to nearby OAR are too high, HBT should be evaluated. HBT can improve both dose to target and OAR while sparing patients the morbidity of perineal template-based interstitial brachytherapy. Specific scenarios where HBT may be preferred include bulky residual primary tumor especially with poor response to EBRT, extension into the lateral parametrium, vaginal extension of tumor, and an asymmetric target. Use of HBT can typically permit extension of dose coverage by an additional 1-2 cm beyond what can be achieved with an IC alone technique.
CONCLUSION
HBT allows for improved therapeutic ratio by improving target volume coverage and/or lowering doses to OARs. Brachytherapists should be trained on the practical aspects of administering HBT to be able to offer a less invasive and impactful treatment option when appropriate.
Topics: Female; Humans; Uterine Cervical Neoplasms; Brachytherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Needles
PubMed: 37481370
DOI: 10.1016/j.brachy.2023.07.001 -
International Journal of Molecular... Aug 2023Gynaecological serous carcinomas (GSCs) constitute a distinctive entity among female tumours characterised by a very poor prognosis. In addition to late-stage diagnosis...
Gynaecological serous carcinomas (GSCs) constitute a distinctive entity among female tumours characterised by a very poor prognosis. In addition to late-stage diagnosis and a high rate of recurrent disease associated with massive peritoneal carcinomatosis, the systematic acquisition of resistance to first-line chemotherapy based on platinum determines the unfavourable outcome of GSC patients. To explore the molecular mechanisms associated with platinum resistance, we generated patient-derived organoids (PDOs) from liquid biopsies of GSC patients. PDOs are emerging as a relevant preclinical model system to assist in clinical decision making, mainly from tumoural tissue and particularly for personalised therapeutic options. To approach platinum resistance in a GSC context, proficient PDOs were generated from the ascitic fluid of ovarian, primary peritoneal and uterine serous carcinoma patients in platinum-sensitive and platinum-resistant clinical settings from the uterine aspirate of a uterine serous carcinoma patient, and we also induced platinum resistance in vitro in a representative platinum-sensitive PDO. Histological and immunofluorescent characterisation of these ascites-derived organoids showed resemblance to the corresponding original tumours, and assessment of platinum sensitivity in these preclinical models replicated the clinical setting of the corresponding GSC patients. Differential gene expression profiling of a panel of 770 genes representing major canonical cancer pathways, comparing platinum-sensitive and platinum-resistant PDOs, revealed cellular response to DNA damage stimulus as the principal biological process associated with the acquisition of resistance to the first-line therapy for GSC. Additionally, candidate genes involved in regulation of cell adhesion, cell cycles, and transcription emerged from this proof-of-concept study. In conclusion, we describe the generation of PDOs from liquid biopsies in the context of gynaecological serous carcinomas to explore the molecular determinants of platinum resistance.
Topics: Humans; Female; Ascites; Organoids; Peritoneum; Ascitic Fluid; Cystadenocarcinoma, Serous
PubMed: 37686015
DOI: 10.3390/ijms241713208 -
International Journal of Molecular... Apr 2024A spectrum of immune states resulting from tumor resident macrophages and T-lymphocytes in the solid tumor microenvironment correlates with patient outcomes. We...
A spectrum of immune states resulting from tumor resident macrophages and T-lymphocytes in the solid tumor microenvironment correlates with patient outcomes. We hypothesized that in gastric cancer (GC), macrophages in a polarized immunosuppressive transcriptional state would be prognostic of poor survival. We derived transcriptomic signatures for M2 (M2, ; ; ; ; ; ; ; ; ; ) and M1 (M1, ; ; ; ; ; ; ) macrophages, and cytolytic T-lymphocytes (CTL, ; ; ; ; ). Primary GC in a TCGA stomach cancer dataset was evaluated for signature expressions, and a log-rank test determined overall survival (OS) and the disease-free interval (DFI). In 341 TCGA GC entries, high M2 expression was associated with histological types and later stages. Low M2 expression was associated with significantly better 5-year OS and DFI. We validated M2 in prospectively collected peritoneal fluid of a GC patient cohort ( = 28). Single-cell RNA sequencing was used for signature expression in cells and the log-rank test compared OS. GC patients with high M2 in cells in their peritoneal fluid had significantly worse OS than those with low expression. Multivariate analyses confirmed M2 was significantly and independently associated with survival. As an independent predictor of poor survival, M2 may be prognostic in primary tumors and peritoneal fluid of GC patients.
Topics: Humans; Stomach Neoplasms; Peritoneum; Macrophages, Peritoneal; Biomarkers; Macrophages; Tumor Microenvironment; Fibrinogen
PubMed: 38612926
DOI: 10.3390/ijms25074117 -
Langenbeck's Archives of Surgery Aug 2023To assess the effect of high inferior mesenteric artery tie on defecatory, urinary, and sexual function after surgery for sigmoid colon cancer. Performing a... (Randomized Controlled Trial)
Randomized Controlled Trial
Impact on defecatory, urinary and sexual function after high-tie sigmoidectomy: a post-hoc analysis of a multicenter randomized controlled trial comparing extended versus standard complete mesocolon excision.
OBJECTIVE
To assess the effect of high inferior mesenteric artery tie on defecatory, urinary, and sexual function after surgery for sigmoid colon cancer. Performing a sigmoidectomy poses a notable risk of causing injury to the preaortic sympathetic nerves during the high ligation of the inferior mesenteric artery, as well as to the superior hypogastric plexus during dissection at the level of the sacral promontory. Postoperative defecatory and genitourinary dysfunction after sigmoid colon resection are often underestimated and underreported.
METHODS
This study is a secondary research of a multicenter, single-blind, randomized clinical trial. The trial involved patients with sigmoid cancer who underwent either extended complete mesocolic excision (e-CME) or standard CME (s-CME). Patients completed questionnaires to assess defecatory, urinary, and sexual function before, 1 month after surgery, and 1 year after surgery. Multivariate analysis was conducted to identify factors associated with functional dysfunction.
RESULTS
Seventy-nine patients completed functional assessments before and 1 year after surgery. One year after sigmoidectomy with a high tie of the inferior mesenteric artery, 15.2% of patients had minor low anterior resection syndrome (LARS) and 12.7% had major LARS; 22.2% of males and 29.4% of females had urinary dysfunction; and 43.8% of males and 27.3% of females had sexual dysfunction. After multivariate analysis, no significant associations were found between clinical and surgical factors and gastrointestinal or urinary dysfunction after 1 year of surgery. Age was identified as the only factor linked to sexual dysfunction in both sexes (women, β = - 0.54, p = 0.002; men β = - 0.38, p = 0.010). Regarding recovery outcomes, diabetes mellitus was identified as a contributing factor to suboptimal gastrointestinal recovery (p = 0.033) and urinary recovery in women (p = 0.039). Furthermore, the treatment arm was found to be significantly associated with the recovery of erectile function after 1 year of surgery (p = 0.046).
CONCLUSIONS
A high tie of the inferior mesenteric artery during sigmoidectomy is associated with a high incidence of defecatory and genitourinary dysfunction. Age was identified as a significant factor associated with sexual dysfunction 1 year after sigmoid colon resection in both sexes.
TRIAL REGISTRATION
Clinical trials NCT03083951 HIGHLIGHTS: • One year after high-tie sigmoidectomy, 27.9% of patients had LARS; 22.2% of the men and 29.4% of the women had urinary dysfunction; and 43.8% of the men and 27.3% of the women had sexual dysfunction. • e-CME is associated with a high rate of urinary dysfunction in men 1 year after surgery. However, after multivariate analysis, no association was found between e-CME and urinary dysfunction in men. • Age was correlated with the recovery of sexual function in both sexes 1 year after surgery. Furthermore, diabetes mellitus was identified as the factor associated with poorer recovery of urinary function in females.
Topics: Male; Humans; Female; Colon, Sigmoid; Mesocolon; Postoperative Complications; Rectal Neoplasms; Single-Blind Method; Laparoscopy; Colectomy
PubMed: 37526748
DOI: 10.1007/s00423-023-03026-9 -
BMJ Case Reports Dec 2023Intra-abdominal synovial sarcomas are a rare type of soft tissue sarcomas that arise in the soft tissues of the abdominal cavity. They account for less than 1% of all...
Intra-abdominal synovial sarcomas are a rare type of soft tissue sarcomas that arise in the soft tissues of the abdominal cavity. They account for less than 1% of all primary synovial sarcoma cases. We report a case of a male patient in his early 30s who presented to the hospital with abdominal pain of 2 weeks duration. On examination, a mass was felt in the left mid-abdomen. MRI revealed a 12.7 cm×8.2 cm×8.6 cm soft tissue mass on the mesentery of the jejunum. The patient underwent surgical resection of the tumour, and the final pathology was synovial sarcoma, pT2b, grade 3.
Topics: Humans; Male; Abdominal Cavity; Magnetic Resonance Imaging; Mesentery; Sarcoma; Sarcoma, Synovial; Adult
PubMed: 38123320
DOI: 10.1136/bcr-2023-255628 -
Journal of Surgical Oncology Nov 2023Cytoreductive surgery (CRS) has now been accepted as an integral component in the management of gastrointestinal and gynecological cancers with peritoneal metastases.... (Review)
Review
Cytoreductive surgery (CRS) has now been accepted as an integral component in the management of gastrointestinal and gynecological cancers with peritoneal metastases. Since the adoption of CRS is influenced by access to advanced medical facilities, trained multidisciplinary teams, and funding, there is wide variability in incorporation of CRS into routine clinical practice between high- versus low- and middle-income countries. This review highlights the global trends in the adoption of CRS for peritoneal malignancies with a specific focus on the establishment of CRS programs and barriers to incorporate CRS into routine clinical care in low- and middle-income countries.
Topics: Humans; Peritoneal Neoplasms; Cytoreduction Surgical Procedures; Peritoneum; Hyperthermia, Induced; Survival Rate; Combined Modality Therapy; Retrospective Studies; Colorectal Neoplasms; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37818906
DOI: 10.1002/jso.27448