The aim of this study was to evaluate the outcomes of women with advanced apical prolapse who were treated with the obliterative LeFort partial colpocleisis (LFC) procedure. We reviewed the medical records of patients who underwent LFC for advanced apical prolapse. We collected data for baseline patient characteristics, co-morbidities, severity of prolapse, operating time, intraoperative injuries, and postoperative complications. Subjective postoperative outcomes and patient satisfaction levels were also assessed. Ninety-five patients underwent LFC during the study period. Median age of patients at operation was 76.0years. Mean operation time was 121.5 ± 31.9 min. Mean postoperative hospital stay was 3.5 ± 1.6 days. Postoperative complications, which were virtually all urinary symptoms, were present in 29.8% of patients, and 89.3% of patients have been in spontaneous remission. There was one case with perineal wound infection, one case of prolapse recurrence, and one case of de novo rectal prolapse after LFC. The objective success rate of the LFC procedure for all patients was 98.9% (94/95). Most (96%) patients were satisfied with the LFC results and pleased with the improvement in body image. The obliterative LFC procedure had a high success rate and was associated with minimal adverse events for the elderly patients with advanced apical prolapse. This procedure should be considered as a treatment option for the advanced apical prolapse in selected elderly women who do not want to conserve vaginal intercourse, as it offers improvement in quality of life and is associated with a low regret rate.
To evaluate the prognostic value of metabolic parameters derived from serial 18F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with advanced epithelial ovarian cancer (EOC). Thirteen patients with advanced EOC who received surgical staging and adjuvant platinum-based combination chemotherapy were prospectively enrolled. 18F-FDG PET/CT was performed before and after the surgical staging, and after third cycle of chemotherapy. Tumor glucose metabolism at baseline and its change after operation and third cycle of chemotherapy such as changes of maximum standardized uptake values (ΔSUVmax) via 18F-FDG PET/CT were measured, and assessed regarding their ability to predict recurrence. Median duration of progression-free survival (PFS) was 25 months (range, 13-34), and although optimal debulking was performed in 10 patients, 5 (38.5%) patients experienced recurrence. Univariate analyses showed significant associations between recurrence and low ΔSUVmax after surgical staging, and low SUVmax change after third cycle of chemotherapy. Multivariate analysis identified low ΔSUVmax after third cycle of chemotherapy as an independent risk factor for recurrence (P=.047, hazard ratio (HR) 16.375, 95% CI 1.041-257.536). Kaplan-Meier survival curves showed that PFS significantly differed in groups categorized based on ΔSUVmax after chemotherapy (P=.001, log-rank test). 18F-FDG PET/CT allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after chemotherapy. The metabolic response measured as ΔSUVmax after third cycle of chemotherapy appears to be promising predictor of recurrence in patients with advanced EOC.
1 January 2025 in Journal of Korean Medical Science