Kenneth D Hatch
- Professor, Obstetrics and Gynecology
Dr Hatch was born and raised in rural western Nebraska. He graduated from the University of Nebraska College of Medicine in 1971 and performed his internship there. He spent 2 years in the Air Force and then moved to Birmingham Alabama to finish residency in OB GYN and a fellowship in gynecologic oncology. During his 16 years ar Alabama he became the division director of the fellowship and a full professor. He moved to Arizona to be the vice-chairman of the department and to start the gyncologic oncology division in the cancer center. His clinical interest is centered around surgical techniques. His innovations in the reconstruction of the pelvis after radical surgery for gynecologic cancer have been published and adopted world wide. When minimally invasive surgery was introduced into gynecologic oncology he wrote the first IRB approved protocols for endometrial cancer. The University of Arizona became a training center for laparoscopic surgery and over 350 individuals from 7 different countries participated. He has lectured in 51 countries and performed surgery in 17 demonstrating the reconstructive and laparoscopic surgery. In his first visit to China in 2004, 6 of the hospitals he operated in did not have laparoscopic equipment. He taught in China 6 times perfoming 63 operations in nearly every province. Many China hospitals sent professors to Tucson for periods of training and returned to establish programs in their hospitals. His book on laparoscopic surgery was translated into chinese and is an eBook on the Chinese Higher Education Press. Currently he is concentrating on reconstructive procedures for vaginal and bladder prolapse and incontinence. He has never used the polyproplyne graft for prolapse and has championed the use of the patients own tissue to correct the prolapse. After more than 500 patients the results are excellent with 3% requiring more surgery.
Dr Hatch has been president of The Society of Gynecologic Oncologists, The Society of Pelvic Surgeons, The American Society of Colposcopy and Cervical Pathology and the Charles Flowers Society. He has authored over 200 papers, 4 books and contributed chapters to 22 other books. He is a former Chairman of the Department of Obstetrics and Gyncology and during his chairmanship the department was ranked in the top 25 departments in the nation. He is currently full time in the department as Professor and Director of gynecologic surgery.
- M.D. Medical Education
- University of Nebraska School of Medicine, Omaha, Nebraska, United States
- B.S. Premedical Education
- University of Nebraska, Lincoln, Nebraska, United States
- Professor, Department of OB/GYN, University of Arizona School of Medicine (1995 - Ongoing)
- Chairman, Department of OB/GYN, University of Arizona School of Medicine (1995 - 2004)
- Top Doctors, annually since 2004
- Spring 2017
Licensure & Certification
- Board Certified Obstetrics & Gynecology, American Board of Obstetrics & Gynecology (1980)
- Certificate of Special Competence in Gynecologic Oncology, American Board of Obstetrics & Gynecology (1980)
- Certification, National Board of Medical Examiners (1972)
- Recertification, American Board of Obstetrics and Gynecology (1993)
Surgical techniques and skills
Laparoscopic imaging to detect ovarian cancer precursors.Outcomes of pelvic reconstructive surgery.
No activities entered.
- Hatch, K. D., & Jonathan, B. S. (2018). Operative Techniquest in Gynecologic Surgery - Gynecologic Oncology. Wolters Kluwer.
- Cardenas-Trowers, O. O., Malekzadeh, P., Nix, D. E., & Hatch, K. D. (2017). Vaginal Mesh Removal Outcomes: Eight Years of Experience at an Academic Hospital. Female pelvic medicine & reconstructive surgery.More infoThe purpose of this study is to describe the clinical history leading up to and the outcomes after vaginal mesh removal surgery at an academic hospital.
- Cardenas-Trowers, O., Heusinkveld, J., & Hatch, K. (2017). Simple and effective: transvaginal vesico-vaginal fistula repair with a modified Latzko technique. International urogynecology journal.More infoThe incidence of vesico-vaginal fistulas after hysterectomies for benign indications in developed countries is less than one percent. The objective of this video is to demonstrate an easy-to-follow, step-by-step approach to repairing a small, uncomplicated vesico-vaginal fistula transvaginally using a modified Latzko technique.
- Carbonell, L., Addis, I. B., & Hatch, K. D. (2016). Demographic and outcome data of women undergoing bilateral sacrospinous ligament fixation. American Journal of Clinical and Experimental Obstetrics and Gynecology.
- Hatch, K. D., Steinmetz, I., Whitehair, J., & Hallum, A. (2016). Influence of resident training on length and outcome of laparoscopically assisted radical vaginal hysterectomy for treatment of early cervical cancer. American Journal of Clinical and Experimental Obstetrics and Gynecology, 3(1), 16-21.
- Risi, M. D., Rouse, A. R., Chambers, S. K., Hatch, K. D., Zheng, W., & Gmitro, A. F. (2016). Pilot Clinical Evaluation of a Confocal Microlaparoscope for Ovarian Cancer Detection. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 26(2), 248-54.More infoThe aim of this study is to evaluate the performance of a confocal fluorescence microlaparoscope for in vivo detection of ovarian cancer.
- Tate, T. H., Baggett, B., Rice, P. F., Koevary, J. W., Orsinger, G. V., Nymeyer, A. C., Welge, W. A., Saboda, K., Roe, D. J., Hatch, K. D., Chambers, S. K., Utzinger, U., & Barton, J. K. (2016). Multispectral fluorescence imaging of human ovarian and fallopian tube tissue for early-stage cancer detection. Journal of biomedical optics, 21(5), 56005.
- Wang, X., Li, L., Cragun, J. M., Chambers, S. K., Hatch, K. D., & Zheng, W. (2016). Assessment of the Role of Intraoperative Frozen Section in Guiding Surgical Staging for Endometrial Cancer. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 26(5), 918-23.More infoThe aim of this study was to assess the role of intraoperative frozen section (FS) in guiding decision making for surgical staging of endometrioid endometrial cancer (EC).
- Abu Shahin, N., Hatch, K. D., & Zheng, W. (2015). Primary endometrial endometrioid carcinoma with signet ring cells: an unexpected morphology of a common tumor. American Journal of Clinical and Experimental Obstetrics and Gynecology, 2(4), 180-184.
- Fleisch, M. C., Newton, J., Steinmetz, I., Whitehair, J., Hallum, A., & Hatch, K. D. (2015). Learning and teaching advanced laparoscopic procedures: do alternating trainees impair a laparoscopic surgeon's learning curve?. Journal of minimally invasive gynecology, 14(3), 293-9.More infoIn this study we investigated whether teaching advanced laparoscopic procedures like laparoscopic-assisted surgical staging (LASS) for endometrial cancer negatively affects the learning curve of the attending surgeon.
- George, R., Chandrasekaran, A., Brewer, M. A., Hatch, K. D., & Utzinger, U. (2015). Clinical research device for ovarian cancer detection by optical spectroscopy in the ultraviolet C-visible. Journal of biomedical optics, 15(5), 057009.More infoEarly detection of ovarian cancer could greatly increase the likelihood of successful treatment. However, present detection techniques are not very effective, and symptoms are more commonly seen in later stage disease. Amino acids, structural proteins, and enzymatic cofactors have endogenous optical properties influenced by precancerous changes and tumor growth. We present the technical details of an optical spectroscopy system used to quantify these properties. A fiber optic probe excites the surface epithelium (origin of 90% of cases) over 270 to 580 nm and collects fluorescence and reflectance at 300 to 800 nm with four or greater orders of magnitude instrument to background suppression. Up to four sites per ovary are investigated on patients giving consent to oophorectomy and the system's in vivo optical evaluation. Data acquisition is completed within 20 s per site. We illustrate design, selection, and development of the components used in the system. Concerns relating to clinical use, performance, calibration, and quality control are addressed. In the future, spectroscopic data will be compared with histological biopsies from the corresponding tissue sites. If proven effective, this technique can be useful in screening women at high risk of developing ovarian cancer to determine whether oophorectomy is necessary.
- Hatch, K. D., Nunes, C., & Carbonell, L. (2015). Chronic groin and vulvar abscess following removal of eroded trans-obturator tape segment. American Journal of Clinical and Experimental Obstetrics and Gynecology, 2(3), 136-139.
- Shen, Y., Wang, Y., Wang, Y., Geffre, C. P., & Hatch, K. D. (2015). Mid-urethral sling approach for female stress urinary incontinence: benefits versus risks. American Journal of Clinical and Experimental Obstetrics & Gynecology, 2(4), 151-165.
- Tanbakuchi, A. A., Rouse, A. R., Udovich, J. A., Hatch, K. D., & Gmitro, A. F. (2015). Clinical confocal microlaparoscope for real-time in vivo optical biopsies. Journal of biomedical optics, 14(4), 044030.More infoSuccessful treatment of cancer is highly dependent on the stage at which it is diagnosed. Early diagnosis, when the disease is still localized at its origin, results in very high cure rates-even for cancers that typically have poor prognosis. Biopsies are often used for diagnosis of disease. However, because biopsies are destructive, only a limited number can be taken. This leads to reduced sensitivity for detection due to sampling error. A real-time fluorescence confocal microlaparoscope has been developed that provides instant in vivo cellular images, comparable to those provided by histology, through a nondestructive procedure. The device includes an integrated contrast agent delivery mechanism and a computerized depth scan system. The instrument uses a fiber bundle to relay the image plane of a slit-scan confocal microlaparoscope into tissue. It has a 3-mum lateral resolution and a 25-mum axial resolution. Initial in vivo clinical testing using the device to image human ovaries has been done in 21 patients. Results indicate that the device can successfully image organs in vivo without complications. Results with excised tissue demonstrate that the instrument can resolve sufficient cellular detail to visualize the cellular changes associated with the onset of cancer.
- Orsinger, G. V., Watson, J. M., Gordon, M., Nymeyer, A. C., de Leon, E. E., Brownlee, J. W., Hatch, K. D., Chambers, S. K., Barton, J. K., Kostuk, R. K., & Romanowski, M. (2014). Simultaneous multiplane imaging of human ovarian cancer by volume holographic imaging. Journal of biomedical optics, 19(3), 36020.More infoOvarian cancer is the most deadly gynecologic cancer, a fact which is attributable to poor early detection and survival once the disease has reached advanced stages. Intraoperative laparoscopic volume holographic imaging has the potential to provide simultaneous visualization of surface and subsurface structures in ovarian tissues for improved assessment of developing ovarian cancer. In this ex vivo ovarian tissue study, we assembled a benchtop volume holographic imaging system (VHIS) to characterize the microarchitecture of 78 normal and 40 abnormal tissue specimens derived from ovarian, fallopian tube, uterine, and peritoneal tissues, collected from 26 patients aged 22 to 73 undergoing bilateral salpingo-oophorectomy, hysterectomy with bilateral salpingo-oophorectomy, or abdominal cytoreductive surgery. All tissues were successfully imaged with the VHIS in both reflectance- and fluorescence-modes revealing morphological features which can be used to distinguish between normal, benign abnormalities, and cancerous tissues. We present the development and successful application of VHIS for imaging human ovarian tissue. Comparison of VHIS images with corresponding histopathology allowed for qualitatively distinguishing microstructural features unique to the studied tissue type and disease state. These results motivate the development of a laparoscopic VHIS for evaluating the surface and subsurface morphological alterations in ovarian cancer pathogenesis.
- Wang, Y., Li, L., Wang, Y., Yuan, Z., Zhang, W., Hatch, K. D., & Zheng, W. (2014). IMP3 as a cytoplasmic biomarker for early serous tubal carcinogenesis. Journal of experimental & clinical cancer research : CR, 33, 60.More infoSerous tubal intraepithelial carcinoma (STIC) and the p53 signature in tubal mucosa have been supported to be precursor lesions in high-grade serous carcinoma (HGSC) of the fallopian tube, ovary, and peritoneum. It remains critical to find biomarkers for precursor lesions in order to detect HGSCs efficiently. IMP3 is an oncoprotein that has been explored in human malignancies. No studies have specifically addressed the expression of IMP3 in precursor or early lesions of HGSC. The main purposes of this study are to evaluate if IMP3 plays any role in the process of pelvic serous carcinogenesis by examining its expression in HGSC precursor lesions, to examine the relationship between IMP3 and p53 in those precursor lesions, and to check if IMP3 can be used as a biomarker for early diagnosis.
- Wu, T., Rouse, A. R., Chambers, S. K., Hatch, K. D., & Gmitro, A. F. (2014). Confocal microlaparoscope for imaging the fallopian tube. Journal of biomedical optics, 19(11), 116010.More infoRecent evidence suggests that ovarian cancer can originate in the fallopian tube. Unlike many other cancers, poor access to the ovary and fallopian tubes has limited the ability to study the progression of this deadly disease and to diagnosis it during the early stage when it is most amenable to therapy. A rigid confocal microlaparoscope system designed to image the epithelial surface of the ovary in vivo was previously reported. A new confocal microlaparoscope with an articulating distal tip has been developed to enable in vivo access to human fallopian tubes. The new microlaparoscope is compatible with 5-mm trocars and includes a 2.2-mm-diameter articulating distal tip consisting of a bare fiber bundle and an automated dye delivery system for fluorescence confocal imaging. This small articulating device should enable the confocal microlaparoscope to image early stage ovarian cancer arising inside the fallopian tube. Ex vivo images of animal tissue and human fallopian tube using the new articulating device are presented along with in vivo imaging results using the rigid confocal microlaparoscope system.
- Tanbakuchi, A. A., Udovich, J. A., Rouse, A. R., Hatch, K. D., & Gmitro, A. F. (2010). In vivo imaging of ovarian tissue using a novel confocal microlaparoscope. American journal of obstetrics and gynecology, 202(1), 90.e1-9.More infoThe objective of the study was to develop a clinical confocal microlaparoscope for imaging ovary epithelium in vivo with the long-term objective of diagnosing cancer in vivo.
- Hatch, K. D., & Davis, J. R. (2008). Complete resolution of Paget disease of the vulva with imiquimod cream. Journal of lower genital tract disease, 12(2), 90-4.More infoExtra mammary Paget disease (EMPD) is a neoplastic disease of apocrine gland bearing skin. Surgical excision is the standard of care for EMPD; however, it is accompanied by recurrence in more than 60% of the patients. Recently, imiquimod cream has been reported to induce complete responses in primary or recurrent EMPD. We report on 2 women with vulva EMPD who achieved biopsy-confirmed resolution of their disease after topical application of imiquimod 5% cream.
- Garcia, F. A., Ranger-Moore, J., Barker, B., Davis, J., Brewer, M., Lozevski, J., Vinyak, S., Liu, Y., Yemane, J., Hatch, K. D., Alberts, D. S., Bartels, H. G., & Bartels, P. H. (2004). Karyometric image analysis for intraepithelial and invasive cervical lesions. Analytical and quantitative cytology and histology, 26(3), 141-50.More infoTo derive an objective, numeric measure for the progression of intraepithelial and invasive squamous cell cervical lesions.
- Hatch, K. D., Sheets, E., Kennedy, A., Ferris, D. G., Darragh, T., & Twiggs, L. (2004). Multicenter direct to vial evaluation of a liquid-based pap test. Journal of lower genital tract disease, 8(4), 308-12.More infoTo estimate the efficacy of a fluid-based, thin-layer preparation (TP) compared with the conventional Pap (CP) test to detect biopsy confirmed precancerous cervical lesions.
- Hatch, K. D. (2003). Laparoscopic lymphadenectomy and laparoscopic-assisted vaginal hysterectomy. Gynecologic oncology, 90(3), 503-4.
- Babin, E. A., Davis, J. R., Hatch, K. D., & Hallum, A. V. (2000). Wilms' tumor of the cervix: a case report and review of the literature. Gynecologic oncology, 76(1), 107-11.More infoExtrarenal Wilms' tumors are rare, with only 55 well-documented cases in the literature and only 4 confined to the uterus. A fifth case along with review of the current literature is presented.
- Hatch, K. D. (1998). The role of operative laparoscopy to evaluate candidates for pelvic exenteration. Gynecologic oncology, 69(2), 93.
- Monk, B. J., Alberts, D. S., Burger, R. A., Fanta, P. T., Hallum, A. V., Hatch, K. D., & Salmon, S. E. (1998). In vitro phase II comparison of the cytotoxicity of a novel platinum analog, nedaplatin (254-S), with that of cisplatin and carboplatin against fresh, human cervical cancers. Gynecologic oncology, 71(2), 308-12.More infoTo compare the in vitro cytotoxicity of nedaplatin, an investigational platinum analog, with that of cisplatin and carboplatin against fresh cervical cancers from untreated patients.
- Hatch, K. D. (1997). Electrosurgical Excision Procedures: LLETZ and LEEP-A Critical Analysis. Journal of lower genital tract disease, 1(2), 107-10.
- Hatch, K. D. (1997). Response 2. Journal of lower genital tract disease, 1(4), 277-8.
- Hatch, K. D. (1997). What works. Telemedicine links specialists with rural Iowans. Health management technology, 18(10), 32.
- Childers, J. M., Lang, J., Surwit, E. A., & Hatch, K. D. (1995). Laparoscopic surgical staging of ovarian cancer. Gynecologic oncology, 59(1), 25-33.More infoThe feasibility of laparoscopic staging in patients with ovarian cancer was undertaken prospectively to determine the ability to adequately evaluate both the intraperitoneal cavity and the retroperitoneal lymph nodes. Two groups of ovarian cancer patients were evaluated: those with optimally debulked advanced disease undergoing second-look procedures and those with presumed stage I disease undergoing surgical staging. Twenty-four of the 44 laparoscopic second-look procedures (56%) were positive for persistent disease. Five of these patients had microscopic disease only, in the omentum, washings, pelvic peritoneum, and in para-aortic lymph nodes (2 patients). In the group of 14 patients undergoing staging for presumed early ovarian carcinoma, metastatic disease was discovered in 8 (57%) patients. Two patients had peritoneal washings positive for adenocarcinoma; 3 had pelvic disease, 1 confined to a fallopian tube and 2 to the pelvic peritoneum; and 3 patients had para-aortic lymph nodes positive for metastatic adenocarcinoma. There were no serious complications in this category. The average hospital stay was 1.6 days. Laparoscopic staging appears to be an accurate staging technique, and further investigation into the validity of this approach is warranted.
- Hallum, A. V., Alberts, D. S., Lippman, S. M., Inclan, L., Shamdas, G. J., Childers, J. M., Surwit, E. A., Modiano, M., & Hatch, K. D. (1995). Phase II study of 13-cis-retinoic acid plus interferon-alpha 2a in heavily pretreated squamous carcinoma of the cervix. Gynecologic oncology, 56(3), 382-6.More infoThe combination of 13-cis-retinoic acid (13-cRA) and interferon (IFN)-alpha 2a has been reported to be highly active in previously untreated squamous carcinoma of the cervix. In this phase II study, 13-cRA was given at a dose of 1 mg/kg/day and IFN-alpha 2a was given subcutaneously at a dose of 3 million units/m2/day. Thirteen of 14 patients enrolled in this study are evaluable for response and toxicity. There were no complete or partial responses. Ten patients had progressive disease and the remaining three had stable disease. Principle toxicities were fatigue, nausea, and vomiting. This regimen appears cross-resistant with radiotherapy and/or platinum-based cytotoxic therapy in heavily pretreated patients with squamous carcinoma of the cervix.
- Hatch, K. D. (1995). Clinical appearance and treatment strategies for human papillomavirus: a gynecologic perspective. American journal of obstetrics and gynecology, 172(4 Pt 2), 1340-4.
- Hatch, K. D. (1995). Cryotherapy. Bailliere's clinical obstetrics and gynaecology, 9(1), 133-43.More infoCryotherapy is as effective as any other therapy for CIN 1 and CIN 2. It can be performed with a minimum of side-effects and long-term sequelae. It is more cost-efficient than other methods since the equipment is inexpensive and it requires little technical training.
- Childers, J. M., Aqua, K. A., Surwit, E. A., Hallum, A. V., & Hatch, K. D. (1994). Abdominal-wall tumor implantation after laparoscopy for malignant conditions. Obstetrics and gynecology, 84(5), 765-9.More infoTo determine the incidence of abdominal-wall tumor implantation after laparoscopic procedures in patients with known malignancies.
- Childers, J. M., Brzechffa, P. R., Hatch, K. D., & Surwit, E. A. (1993). Laparoscopically assisted surgical staging (LASS) of endometrial cancer. Gynecologic oncology, 51(1), 33-8.More infoWe report 59 patients who were considered candidates for laparoscopically assisted surgical staging (LASS) to manage their clinical stage I adenocarcinoma of the endometrium. Their ages ranged from 40 to 85 years, with a mean of 69; their weights ranged from 102 to 267 pounds, with a mean of 153 pounds. Patients with intraperitoneal disease were taken off study. Laparoscopic pelvic and para-aortic lymphadenectomies were performed based on the grade of the tumor and the depth of myometrial invasion. Six patients were discovered to have intraperitoneal disease. Of the remaining 53 patients, 29 underwent lymphadenectomy, 1 of whom had positive para-aortic nodes. Of the 24 patients who did not have laparoscopic lymphadenectomy, 2 should have, according to the study criteria; however, obesity precluded this from being performed. Eight patients had grade 3 lesions; of these, 4 lesions had metastasized. The remaining 3 patients with metastatic disease had grade 2 lesions. Complications were related to the laparoscopically assisted vaginal hysterectomy and resulted in two laparotomies: one for a transected ureter and the other for a cystotomy. Estimated blood loss was < 200 cc and the average hospital stay was 2.9 days. We feel that LASS is an attractive alternative to the traditional surgical approach in patients with stage I endometrial carcinoma.
- Childers, J. M., Hatch, K. D., Tran, A. N., & Surwit, E. A. (1993). Laparoscopic para-aortic lymphadenectomy in gynecologic malignancies. Obstetrics and gynecology, 82(5), 741-7.More infoTo determine the feasibility, safety, limiting factors, and advantages of laparoscopic para-aortic lymphadenectomy in a series of patients with gynecologic malignancies.
- Helm, C. W., Hatch, K. D., Partridge, E. E., & Shingleton, H. M. (1993). The rhomboid transposition flap for repair of the perineal defect after radical vulvar surgery. Gynecologic oncology, 50(2), 164-7.More infoA detailed account is given of experience at a single institution with the rhomboid transposition flap used to repair the perineal defect after surgery for carcinoma of the vulva. In 13 of 15 assessable cases, the flaps healed completely or had insignificant separation of a segment of the flap. In 2 cases, more major breakdown occurred in association with infection, but in both cases, satisfactory healing occurred without further surgery. In 14 cases, passage of a speculum and inspection of the vagina was possible at follow-up and only 1 patient experienced introital stenosis.
- Malfetano, J., Beecham, J. B., Bundy, B. N., & Hatch, K. D. (1993). A phase II trial of medroxyprogesterone acetate in epithelial ovarian cancers. A Gynecologic Oncology Group study. American journal of clinical oncology, 16(2), 149-51.More infoTwenty-four evaluable patients with advanced or recurrent epithelial ovarian carcinoma who progressed on platinum-containing combination chemotherapy were treated with medroxyprogesterone acetate (C.T. Provera) 50 mg orally three times a day until progression of disease. One patient had a partial response (4.2%), 9 patients had stable disease (37.5%), and 14 (58.3%) had increasing disease. The 95% upper confidence limit for response is less than or equal to 18.3%. There was no toxicity associated with its use. C.T. Provera has limited activity in patients with epithelial ovarian cancer who have failed combination chemotherapy.
- Butterworth, C. E., Hatch, K. D., Soong, S. J., Cole, P., Tamura, T., Sauberlich, H. E., Borst, M., Macaluso, M., & Baker, V. (1992). Oral folic acid supplementation for cervical dysplasia: a clinical intervention trial. American journal of obstetrics and gynecology, 166(3), 803-9.More infoWe attempted to evaluate the effect of oral folic acid supplementation on the course of cervical dysplasia.
- Childers, J. M., Hatch, K. D., & Surwit, E. A. (1992). Office laparoscopy and biopsy for evaluation of patients with intraperitoneal carcinomatosis using a new optical catheter. Gynecologic oncology, 47(3), 337-42.More infoWe report seven patients who underwent diagnostic laparoscopy and biopsy under local anesthesia using a new optical catheter. Six of these procedures were performed in the office. Four patients had previous malignancies (lung, breast, and fallopian tube), and intraperitoneal recurrences or new primaries were suspected. In two of these patients, laparoscopically directed biopsies confirmed adenocarcinoma similar to their prior malignancies, and in one a new primary was diagnosed. The fourth patient had no evidence of intraperitoneal disease. In the three patients with new intraperitoneal malignancies, biopsies obtained laparoscopically confirmed adenocarcinomas of the ovary in two patients and of the gastrointestinal tract in one patient. We feel that this procedure is a safe, simple, effective, and economical way to evaluate the intraperitoneal cavity and to obtain histologic or cytologic specimens for evaluation in patients with intraperitoneal malignancies. This is an ideal, minimally invasive method for detecting small-volume intraperitoneal disease. In addition, it allows some patients to be spared major operative procedures.
- Omura, G. A., Hubbard, J. L., Hatch, K. D., Schlaerth, J. B., & Blessing, J. A. (1992). Chemotherapy of cervix cancer with mitolactol (dibromodulcitol, NSC 104800) and cisplatin. A phase I study of the Gynecologic Oncology Group. American journal of clinical oncology, 15(3), 185-7.More infoIn this Phase I study, thirteen women with advanced cervix cancer were treated with mitolactol (dibromodulcitol) plus cisplatin to determine a maximum tolerable dose schedule. Response was not an objective of this study, but four partial responses were seen in nine patients with measurable lesions. In general, the therapy was well tolerated, but of the ten patients treated at the first dose level (cisplatin 50 mg/m2 intravenously on day 1 plus mitolactol 180 mg/m2 orally on days 2-6 every 3-4 weeks), 5 required de-escalations and 8 required delays because of toxicity. All three patients treated with cisplatin plus a higher dose of mitolactol (270 mg/m2 x 5) required dose reductions and delays for hematologic toxicity. The first dose level appears tolerable by patients with, and promising in treating, advanced cervix cancer.
- Sutton, G. P., Soper, J. T., Blessing, J. A., Hatch, K. D., & Barnhill, D. R. (1992). Ifosfamide alone and in combination in the treatment of refractory malignant gestational trophoblastic disease. American journal of obstetrics and gynecology, 167(2), 489-95.More infoWe attempted to evaluate the use of ifosfamide either alone or in combination in patients with refractory malignant gestational trophoblastic disease.
- Austin, H., Austin, J. M., Partridge, E. E., Hatch, K. D., & Shingleton, H. M. (1991). Endometrial cancer, obesity, and body fat distribution. Cancer research, 51(2), 568-72.More infoA case-control study was undertaken to evaluate the roles of obesity and body fat distribution in the etiology of endometrial cancer. The study also included an evaluation of the associations of serum estrone, estradiol, and androstenedione with obesity, body fat distribution, and endometrial cancer risk. The study included 168 cases and 334 control subjects identified at an optometry clinic. A strong, positive relationship between overall obesity and endometrial cancer was found. The relative rate of endometrial cancer for women in the upper 90th percentile of a body mass index compared to those below the median was estimated as 5.5 with 95% confidence limits of 3.2-9.6. There was no association between endometrial cancer and the waist to hip ratio, an index of upper versus lower body fat distribution. A statistical test of trend across the four quartiles of the waist to hip ratio yielded a P value of 0.45 after adjustment for confounding by the body mass index. On the other hand, there was a statistically significant, independent positive effect of a high subscapular to tricep skinfold ratio, a measure of central versus peripheral obesity, on endometrial cancer risk. The relative rates of endometrial cancer for the second, third, or fourth quartile compared to the first quartile of this index were 1.5, 1.9, and 2.7, respectively (P = 0.007), after adjustment for the body mass index. Serum estrone and estradiol, but not androstenedione, were statistically significantly correlated with the body mass index among control subjects (r = 0.37 and 0.40 for estrone and estradiol, respectively). On the other hand, each of the sex hormones was uncorrelated with the waist to hip ratio after adjustment for body mass. The correlations between each of the three hormones and the subscapular to tricep skinfold ratio among controls were weak and were not statistically significant (0.10, 0.10, and 0.14 for estrone, estradiol and androstenedione, respectively). Cases had statistically significantly higher mean serum estrogen and androstenedione levels than did controls and these elevations did not simply reflect a higher prevalence of obesity among them. The findings are equivocal with respect to fat patterns and endometrial cancer. We suggest that future epidemiological studies of cancer and body fat distribution more carefully distinguish among the various types of fat patterns.
- Barter, J. F., Soong, S. J., Hatch, K. D., Orr, J. W., & Shingleton, H. M. (1990). Diagnosis and treatment of pulmonary metastases from cervical carcinoma. Gynecologic oncology, 38(3), 347-51.More infoThe records of 2116 patients treated for cervical malignancy from 1969 to 1984 at the University of Alabama at Birmingham were reviewed and 88 (4.16%) had pulmonary lesions consistent with metastatic cervical cancer. The data were analyzed to characterize risk factors for developing lung metastases, to determine radiographic patterns, to assess methods of documentation, and to determine response to chemotherapy. Platinum-type chemotherapy has a 67.7% response rate on chest X ray, with one-third of the responses being complete. The prognosis is poor with a median survival of 0.69 year (8.3 months); only 2 of these 88 patients were long-term survivors. Although the survival is poor, a few statistically significant factors could be identified as prognostic. Our data do not support use of surveillance chest X rays, as there is no statistically significant survival difference in symptomatic versus asymptomatic patients. The development of more effective salvage therapy may alter this recommendation.
- Muss, H. B., Blessing, J. A., Hatch, K. D., Soper, J. T., Webster, K. D., & Kemp, G. M. (1990). Methotrexate in advanced endometrial carcinoma. A phase II trial of the Gynecologic Oncology Group. American journal of clinical oncology, 13(1), 61-3.More infoThirty-three patients with advanced or metastatic endometrial carcinoma were entered in a Phase II trial utilizing methotrexate, 40 mg/m2 intravenously on a weekly basis. Almost all patients had prior total abdominal hysterectomy and almost two-thirds prior pelvic irradiation. No patient had prior chemotherapy. There was one complete and one partial response, for a complete and partial response rate of 6% (95% confidence intervals for a response of 1.7 to 19.6%). Toxicity was mild, with major adverse effects being nausea and vomiting and myelosuppression. One death may have been drug related. Methotrexate displays minimal clinical activity in patients with advanced or recurrent endometrial carcinoma who have received no prior chemotherapy.
- Barter, J. F., Soong, S. J., Hatch, K. D., Orr, J. W., Partridge, E. C., Austin, J. M., & Shingleton, H. M. (1989). Treatment of nonmetastatic gestational trophoblastic disease with sequential intramuscular and oral methotrexate. Gynecologic oncology, 33(1), 82-4.More infoThirty-seven patients with nonmetastatic gestational trophoblastic disease (NMGTD) were treated with one or more cycles of oral methotrexate following intramuscular methotrexate as part of induction chemotherapy. Remission was achieved in 31 patients (83.8%). All failures were readily cured with alternate regimens. Prospective studies using this safe, easily administered modality are needed to verify its apparent efficacy.
- Barter, J. F., Soong, S. J., Shingleton, H. M., Hatch, K. D., & Orr, J. W. (1989). Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer. Gynecologic oncology, 32(3), 292-6.More infoFifty patients with cervical cancer were treated with radical hysterectomy and lymphadenectomy followed by postoperative radiation therapy for high risk factors (nodal metastases, lymphvascular space invasion, close or involved margins) at the University of Alabama at Birmingham Medical Center from 1969 to 1984. Fifteen (30%) of the patients treated had serious complications, 8 (16%) requiring an operation, and 1 (2%) dying as a result of treatment-related problems. This combined modality approach is associated with significant complications.
- Shingleton, H. M., Soong, S. J., Gelder, M. S., Hatch, K. D., Baker, V. V., & Austin, J. M. (1989). Clinical and histopathologic factors predicting recurrence and survival after pelvic exenteration for cancer of the cervix. Obstetrics and gynecology, 73(6), 1027-34.More infoBetween September 1969 and January 1, 1986, 143 pelvic exenterations for recurrent cervical cancer were performed by the gynecologic oncologists at the University of Alabama at Birmingham. Of this group, 78 patients underwent total pelvic exenteration, 63 patients had anterior exenteration, and two had posterior exenteration. The overall operative mortality rate was 6.3%, mostly associated with total pelvic exenteration. The 5-year survival rates were 50% overall, 63% with anterior exenteration and 42% with total exenteration. Univariate and multivariate analyses were performed to identify clinical and histopathologic factors predictive of prolonged survival. Using three clinical factors (duration from initial radiation therapy to exenteration, size of the central mass, and presence of preoperative sidewall fixation), low-, intermediate-, and high-risk groups were constructed; the 5-year survival rates for these groups were 82, 46, and 0%, respectively. Inclusion of one histopathologic factor (margin status of the surgical specimen) added to the ability to predict 2- and 5-year survival rates. The best candidates for cure by pelvic exenteration were those with recurrent small (less than 3 cm), mobile central masses who were a year or longer from the time of their previous radiation therapy. Attempts to resect bulky pelvic recurrences that impinge on the pelvic sidewall, especially in the case of persistent or early recurrent disease (within 6 months), or continuation of exenterative procedures in women known to have nodal metastases or extrapelvic spread, are generally futile. For those women falling between the two extremes, sound clinical and operative judgment is imperative in regard to selecting the treatment offering the best quality of life.
- Barter, J. F., Mazur, M., Holloway, R. W., & Hatch, K. D. (1988). Melanosis of the cervix. Gynecologic oncology, 29(1), 101-4.More infoBenign and malignant melanotic cervical lesions are rare and require biopsy to rule out melanoma. Reported is a case of cervical melanosis, defined as benign epithelial pigmentation.
- Barter, J. F., Orr, J. W., Holloway, R. W., Hatch, K. D., & Shingelton, H. M. (1987). Psammoma bodies in a cervicovaginal smear associated with an intrauterine device. A case report. The Journal of reproductive medicine, 32(2), 147-8.More infoPsammoma bodies were found in a cervicovaginal smear, presumably related to the patient's use of an intrauterine device. Colposcopy, endocervical and uterine curettage, and laparoscopy with pelvic washings ruled out other conditions that may be associated with psammoma bodies.
- Barter, J. F., Soong, S. J., Hatch, K. D., Orr, J. W., Partridge, E. C., Austin, J. M., & Shingleton, H. M. (1987). Treatment of nonmetastatic gestational trophoblastic disease with oral methotrexate. American journal of obstetrics and gynecology, 157(5), 1166-8.More infoFifteen patients with nonmetastatic gestational trophoblastic disease were treated solely with methotrexate given orally rather than intramuscularly. Remission, defined as a beta-human chorionic gonadotropin titer of less than 5 mIU/ml for 3 consecutive weeks, was attained in 13 (87%) of the 15 patients. Level of toxicity was acceptable. Patient comfort, convenience, and less time off work and in the physician's office are significant advantages to this efficacious, well-tolerated method of therapy.
- Dollar, J. R., Orr, J. W., Shingleton, H. M., Hatch, K. D., Partridge, R. E., & Soong, S. J. (1987). Metastatic tumors mimicking gynecologic cancer. Obstetrics and gynecology, 69(6), 865-7.More infoReview of the admissions to the Gynecologic Oncology Service at the University of Alabama Medical Center over a 12-year period reveals that 1% of all referrals had nongynecologic malignancies. Duration of symptoms was short; of 40 patients with adequate follow-up, 31 (77%) were dead from their cancer, with a median survival of eight months. The value of diagnostic radiologic procedures was assessed and, while these procedures proved helpful, most patients required a surgical procedure (often a reoperation) to establish the diagnosis.
- Farquharson, D. I., Shingleton, H. M., Orr, J. W., Hatch, K. D., Hester, S., & Soong, S. J. (1987). The short-term effect of radical hysterectomy on urethral and bladder function. British journal of obstetrics and gynaecology, 94(4), 351-7.More infoTo investigate bladder neck and urethral function after radical hysterectomy, 21 patients were investigated before and 3 months after the operation. Each patient had an excretory urogram, CO2 cystoscopy, uroflowmetry, water cystometry and a urethral pressure profile, using a dual sensor microtransducer catheter, at rest and during stress. Postoperatively there was a significant reduction in urethral length and urethral closure pressure; however, pressure transmission ratios were maintained, indicating no loss of bladder neck support with stress. Of the six patients with pre-operative bladder neck weakness, two (33%) had stress urinary incontinence at the 3 months assessment. No patient with a normal pre-operative assessment developed this complication. Fifteen (71%) voided by abdominal straining and this manoeuvre emptied the bladder effectively. These data suggest that patients with pre-operative evidence of an incompetent bladder neck may be predisposed to develop stress urinary incontinence after radical hysterectomy because of a reduction in the urethral closure pressure.
- Farquharson, D. I., Shingleton, H. M., Soong, S. J., Sanford, S. P., Levy, D. S., & Hatch, K. D. (1987). The adverse effects of cervical cancer treatment on bladder function. Gynecologic oncology, 27(1), 15-23.More infoBladder dysfunction is a recognized complication following radical hysterectomy, however, the effect of radiation alone or in combination with surgery on bladder function has received little attention. Thirty patients who underwent radical hysterectomy with postoperative whole pelvis radiation (RH + RT) were matched for age, stage of disease, and time interval since therapy, with 30 patients who had radical hysterectomy alone (RH) and 30 patients who were treated with pelvic radiotherapy (RT). Bladder function was assessed by symptoms and urodynamic evaluation. Altered bladder sensation and voiding problems were associated with surgery, and were more frequent after RH or RH + RT than RT (P = 0.002). fifty percent of RH patients voided by abdominal straining compared to 10% who had only RT. No greater problem was seen after RH + RT compared to RH. Urinary incontinence was present in 15% of patients prior to therapy. After treatment, incontinence requiring protection developed in 23% of RT patients, 26% of RH patients, and 63% of RH + RT patients. The severity of the incontinence was greater after RH + RT. Bladder neck and urethral function was similar in all groups, however, bladder compliance was reduced in RT patients and significantly (P = 0.0001) reduced after RH + RT compared to RH alone. This reduction was related to the bladder dose of external radiation and was a factor in the etiology of the urinary incontinence seen in RH + RT patients.
- Barter, J. F., Hatch, K. D., Orr, J. W., & Shingleton, H. M. (1986). Isolated abdominal wound recurrence of an endometrial adenocarcinoma confined to a polyp. Gynecologic oncology, 25(3), 372-5.More infoAn unusual case of Stage IB moderately well-differentiated endometrial adenocarcinoma that was confined to a polyp and recurred only in the abdominal wound is presented. Eighteen months following complete excision, local electron beam therapy, and the institution of hormonal therapy, the patient is alive and without other evidence of recurrence. The mechanisms of metastasis in this case are discussed.
- Barter, J. F., Orr, J. W., Hatch, K. D., & Shingleton, H. M. (1986). Diethylstilbestrol in pregnancy: an update. Southern medical journal, 79(12), 1531-4.More infoSeveral decades ago, diethylstilbestrol (DES) was considered efficacious in improving pregnancy outcome. Later data did not support this, and the exposed mothers and offspring have suffered from a variety of problems attributed to the drug. Knowledge of these problems is essential in dealing with these patients.
- Orr, J. W., Ball, G. C., Soong, S. J., Hatch, K. D., Partridge, E. E., & Austin, J. M. (1986). Surgical treatment of women found to have invasive cervix cancer at the time of total hysterectomy. Obstetrics and gynecology, 68(3), 353-6.More infoTwenty-three patients were referred after the unexpected finding of invasive cervix cancer at the time of total hysterectomy. Each was deemed a candidate for additional therapy and was treated surgically with a radical reoperation consisting of a lymphadenectomy, radical parametrectomy, and upper vaginectomy. When compared with patients undergoing radical hysterectomy at this institution, this reoperation was not technically more difficult as judged by the objective measures of operative time and blood loss. The risk of perioperative morbidity was not greater than radical hysterectomy. The surgical findings obviated the need for additional radiation therapy in more than 73% of patients. While therapy for all patients must be individualized, a radical reoperation should be considered a safe and efficacious alternative to pelvic radiation for patients who are deemed to require additional therapy in this clinical situation.
- To, A. C., Gore, H., Shingleton, H. M., Wilkerson, J. A., Soong, S. J., & Hatch, K. D. (1986). Lymph node metastasis in cancer of the cervix: a preliminary report. American journal of obstetrics and gynecology, 155(2), 388-9.More infoAccurate assessment of lymph node metastasis in cervical cancer is imperative to treatment plan. A histologic sampling method is suggested in which surgically excised lymph nodes are dissected at multiple levels before paraffin embedding. This approach proves to be a more sensitive procedure than the current bisection method in detecting metastasis.
- To, A. C., Soong, S. J., Shingleton, H. M., Gore, H., Wilkerson, J. A., Hatch, K. D., Phillips, D., & Dollar, J. R. (1986). Immunohistochemistry of the blood group A,B,H isoantigens and Oxford Ca antigen as prognostic markers for stage IB squamous cell carcinoma of the cervix. Cancer, 58(11), 2435-9.More infoCurrently, there is lack of a histologic classification of squamous cell carcinoma of the cervix that correlates significantly with patient survival. This study investigated the survival predictive value of two immunohistochemical markers, the blood group A,B,H isoantigens and the Oxford Ca antigen, on conventional histologic sections of tumor tissues from 85 surgically treated patients with Stage IB squamous cell cervical cancer. The results indicated that the two antigens are two distinct markers, neither of which correlates with tumor grade. The expression of the A,B,H isoantigens is significantly related to patient survival after adjustment for the depth of stromal invasion of the tumor, whereas the Oxford Ca antigen has no survival predictive value.
- Muss, H. B., Sutton, G. P., Bundy, B., & Hatch, K. D. (1985). Mitoxantrone (NSC 301739) in patients with advanced cervical carcinoma. A phase II study of the Gynecologic Oncology Group. American journal of clinical oncology, 8(4), 312-5.More infoTwenty-six evaluable patients with advanced or recurrent squamous cell carcinoma of the uterine cervix were treated with mitoxantrone at a dosage of 12 mg/m2 every 3 weeks. Twenty-five of 26 patients had had prior irradiation and 24 prior chemotherapy. There were two partial responses, one in a patient with pelvic recurrence and another in a patient with a right upper quadrant mass. Progression-free intervals for these two patients were 5.1 and 4.6 months, respectively. Toxicity was moderate and consisted mainly of leukopenia. No septic or bleeding complications were observed. Mitoxantrone is minimally active in patients with advanced cervical cancer who have been previously treated.
- Delgado, G., Goldson, A. L., Ashayeri, E., Hill, L. T., Petrilli, E. S., & Hatch, K. D. (1984). Intraoperative radiation in the treatment of advanced cervical cancer. Obstetrics and gynecology, 63(2), 246-52.More infoNineteen patients with invasive cervical cancer were treated with intraoperative radiation and most of the patients subsequently received conventional external radiation therapy and intracavitary applications. The technique, resulting complications, and survival of the patients are discussed.
- Shingleton, H. M., Gore, H., Soong, S. J., Orr, J. W., Hatch, K. D., Austin, J. M., & Partridge, E. E. (1983). Tumor recurrence and survival in stage IB cancer of the cervix. American journal of clinical oncology, 6(3), 265-72.More infoClinical records of 371 women with carcinoma of the cervix, Stage IB, treated in the decade 1969-1979 were reviewed. Cancer recurred in 67 women (18.1%). A group of 171 patients treated by radiation, including 25 who were surgically staged prior to treatment, was compared to 200 patients treated by radical abdominal hysterectomy and pelvic node dissection, including 35 who had postoperative whole pelvis radiation. A multifactorial analysis included time to recurrence, site of recurrence, treatment for recurrence, and survival after recurrence. Pathology review and clinicopathological correlation included tumor configuration, histologic type, size of tumor in greatest dimension, and rate of node metastases in patients undergoing either radical hysterectomy or surgical staging procedures. Lesion size was found to be the most accurate predictor of disease-free survival; this was true whether the patient was treated by surgery or radiation and was not significantly affected by the tumor histology. Nodal metastases were associated with increasing size of lesions and predicted high recurrence rates. Node metastasis rates were not affected by the histology of the tumor.
- Butterworth, C. E., Hatch, K. D., Gore, H., Mueller, H., & Krumdieck, C. L. (1982). Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. The American journal of clinical nutrition, 35(1), 73-82.More infoForty-seven young women with mild or moderate dysplasia of the uterine cervix (cervical intraepithelial neoplasia) diagnosed by cervical smears, received oral supplements of folic acid, 10 mg, or a placebo (ascorbic acid, 10 mg) daily for 3 months under double-blind conditions. All had used a combination-type oral contraceptive agent for at least 6 months and continued it while returning monthly for follow-up examinations. All smears and a biopsy obtained at the end of the trial period were classified by a single observer without knowledge of treatment status using an arbitrary scoring system (1 normal, 2 mild, 3 moderate, 4 severe, 5 carcinoma in situe). Mean biopsy scores from folate supplemented subjects were significantly better than in folate-unsupplemented subjects (2.28 versus 2.92, respectively; p less than 0.05). Final versus initial cytology scores were also significantly better in supplemented subjects (1.95 versus 2.32, respectively; p less than 0.05), unchanged in patients receiving the placebo (2.27 versus 2.30, respectively). Before treatment the mean red cell folate concentration was lower among oral contraceptive agent users than nonusers (189 versus 269 ng/ml, respectively; p less than 0.01) and even lower among users with dysplasia (161 versus 269 ng/ml, respectively; p less than 0.001). Morphological features of megaloblastosis were associated with dysplasia and also improved in folate supplemented subjects. These studies indicate that either a reversible, localized derangement in folate metabolism may sometimes be misdiagnosed as cervical dysplasia, or else such a derangement is an integral component of the dysplastic process that may be arrested or in some cases reversed by oral folic acid supplementation.
- Partridge, E. E., Murad, T., Shingleton, H. M., Austin, J. M., & Hatch, K. D. (1980). Verrucous lesions of the female genitalia. I. Giant condylomata. American journal of obstetrics and gynecology, 137(4), 412-8.More infoSmall condylomata acuminata are easily diagnosed clinically and are not often difficult to treat. Giant condylomata, however, can pose real problems in diagnosis and treatment. They must be distinguished from verrucous carcinomas or giant condylomata with squamous malignant change. Large biopsy specimens that include the stroma are necessary in order to make the correct diagnosis, since these entities have somewhat similar histologic features. Treatment should be surgical because radiation and podopyhyllum have both proved to be of little benefit. Surgical removal also allows excellent pathologic study to determine the presence of squamous malignant change or verrucous carcinoma.
- Partridge, E. E., Murad, T., Shingleton, H. M., Austin, J. M., & Hatch, K. D. (1980). Verrucous lesions of the female genitalia. II. Verrucous carcinoma. American journal of obstetrics and gynecology, 137(4), 419-24.More infoVerrucous carcinoma is a variant of squamous cell carcinoma that often presents as a large cauliflower-like lesion with locally destructive growth. A high index of suspicion on the part of the clinician and pathologist is needed for an accurate diagnosis since the pathologic findings may be benign on an individual cell basis or may even resemble those of a condyloma. Deep biopsy that includes the base of the lesion is needed for accurate histologic diagnosis, and the pathologist should be aware of the aggressive nature of the lesion. The treatment of choice is surgical, with wide local excision being sufficient in most cases. Radiotherapy often fails to eradicate the lesion and may even cause it to become more anaplastic.
- Partridge, E. E., Beasley, W. E., Holcomb, C., Hatch, K. D., Shingleton, H. M., & Austin, J. M. (1979). The Swan-Ganz catheter and management of patients undergoing pelvic exenteration. Obstetrics and gynecology, 53(2), 253-5.More infoA Swan-Ganz catheter has been used in 10 consecutive patients undergoing pelvic exenteration and has made the intraoperative and postoperative management of these patients a much easier task. Use of this catheter eliminates the guesswork involved in managing fluid and volume status by providing an accurate assessment of left ventricular end diastolic pressure. The complication rate is reported as 5% and consists mostly of ruptured balloons, infection, coiling of the catheter, and cardiac irritability. There have been no complications in the 10 patients in whom we have used the catheter. We believe that the use of the Swan-Ganz catheter in these difficult-to-manage patients is justified because of its low complication rate, easy use, and the accurate valuable information obtained.
- Cardenas-Trowers, O., Malekzadeh, P., Nix, D. E., & Hatch, K. D. (2017, May). Vaginal Mesh Removal Outcomes: Eight years of experience at an academic hospital. American Urological Association Education and Research Conference. Boston, MA: American Urological Association.