Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience

Background: One aim of this study was to assess the efficacy and safety of laparoscopic paraaortic lymphadenectomy for paraaortic lymph node staging in locally advanced cervical carcinoma. The second aim was to identify prognostic factors in the evolution of this disease and to evaluate how the results of the surgery modify the oncological treatment of patients. Materials and methods: We analyzed 59 patients diagnosed with locally advanced cervical cancer International Federation of Gynecology and Obstetrics stage IB2-IVA who underwent laparoscopic paraaortic lymphadenectomy at our hospital between 2009 and 2015. Depending on the results of the paraaortic lymphadenectomy, treatment consisted of pelvic- or extended-field chemoradiotherapy. Results: The mean age at diagnosis was 52.3 years. The median operative time was 180 min. The mean hospital stay was 1.7 days. The mean number of paraaortic lymph nodes excised was 16.4. Eight patients (13.5%) had positive paraaortic lymph nodes. Thirteen patients (22%) underwent surgery via the transperitoneal route, and 46 (78%) underwent surgery via the retroperitoneal route. The sensitivity and specificity of computerized axial tomography (CT) scanning for detecting paraaortic lymph node involvement was 75 and 86%, respectively. The statistically significant prognostic factors that affected survival were surgical paraaortic lymph node involvement, radiological pelvic lymph node involvement, and radiological tumor size as assessed with nuclear magnetic resonance. The rate of serious complications was 1.7%. Conclusions: Pretherapeutic laparoscopic paraaortic lymphadenectomy for locally advanced cervical carcinoma allows the adaption of radiotherapy fields to avoid false-positive and false-negative imaging results

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Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience.

BACKGROUND: One aim of this study was to assess the efficacy and safety of laparoscopic paraaortic lymphadenectomy for paraaortic lymph node staging in locally advanced cervical carcinoma. The second aim was to identify prognostic factors in the evolution of this disease and to evaluate how the results of the surgery modify the oncological treatment of patients. MATERIALS AND METHODS: We analyzed 59 patients diagnosed with locally advanced cervical cancer International Federation of Gynecology and Obstetrics stage IB2-IVA who underwent laparoscopic paraaortic lymphadenectomy at our hospital between 2009 and 2015. Depending on the results of the paraaortic lymphadenectomy, treatment consisted of pelvic- or extended-field chemoradiotherapy. RESULTS: The mean age at diagnosis was 52.3 years. The median operative time was 180 min. The mean hospital stay was 1.7 days. The mean number of paraaortic lymph nodes excised was 16.4. Eight patients (13.5%) had positive paraaortic lymph nodes. Thirteen patients (22%) underwent surgery via the transperitoneal route, and 46 (78%) underwent surgery via the retroperitoneal route. The sensitivity and specificity of computerized axial tomography (CT) scanning for detecting paraaortic lymph node involvement was 75 and 86%, respectively. The statistically significant prognostic factors that affected survival were surgical paraaortic lymph node involvement, radiological pelvic lymph node involvement, and radiological tumor size as assessed with nuclear magnetic resonance. The rate of serious complications was 1.7%. CONCLUSIONS: Pretherapeutic laparoscopic paraaortic lymphadenectomy for locally advanced cervical carcinoma allows the adaption of radiotherapy fields to avoid false-positive and false-negative imaging results.

Menopausia y enfermedad cardiovascular / Menopause and cardiovascular disease

Varios estudios epidemiológicos han demostrado que las mujeres premenopáusicas están protegidas frente a las enfermedades cardiovasculares si las comparamos con los hombres de edad similar. Después de la menopausia el riesgo cardiovascular aumenta progresivamente. El tratamiento de reposición hormonal en las mujeres postmenopáusicas reduce de modo acusado la morbilidad y la mortalidad cardiovascular. Los efectos ateroprotectores de los estrógenos se han atribuido al efecto hormonal sobre el espectro lipídico. No obstante, el análisis de regresión múltiple sugiere que sólo el 25 por ciento de la reducción de los accidentes cardiovasculares es atribuible al efecto hipolipidemiante del tratamiento de reposición de estrógenos. Disponemos de numerosos datos que indican que la acción de los estrógenos sobre los vasos sanguíneos contribuye a los efectos protectores sobre el sistema cardiovascular. Los estrógenos inducen un mecanismo de vasodilatación e inhiben la respuesta de los vasos sanguíneos al insulto y del desarrollo de las lesiones aterosclerósicas. Los estrógenos no sólo alteran las concentraciones de los lípidos séricos, sino que modulan el sistema fibrinolítico y antioxidante e induce la producción de otras moléculas vasoactivas, como el NO o las prostaglandinas. Los efectos rápidos de los estrógenos sobre los vasos sanguíneos se producen por la activación de la sintetasa del óxido nítrico sin transcripción génica, mientras que los efectos a largo plazo implican cambios en la expresión génica (AU)