Does the Type of Surgical Approach and the Use of Uterine Manipulators Influence the Disease-Free Survival and Recurrence Rates in Early-Stage Endometrial Cancer?

OBJECTIVE: The purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer. STUDY DESIGN: This was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves. RESULTS: After a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P < 0.001), but the procedure took longer than laparotomic hysterectomy (P < 0.001). The proportion of patients with intraoperative and long-term complications was not significantly different between both groups. The use of uterine manipulators did not have increased recurrence rate in patients treated with laparoscopic approach. CONCLUSIONS: The laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach.

Tumor del estroma gastrointestinal en el tabique rectovaginal, un desafío diagnóstico / Gastrointestinal stromal tumor of the rectovaginal septum: a diagnostic challenge

Los tumores del estroma gastrointestinal (GIST) del tabique rectovaginal son entidades muy poco frecuentes, que cuando aparecen plantean grandes dificultades por su escasa sospecha diagnóstica. En la mayoría de los casos, se suelen confundir con leiomiomas o leiomiosarcomas, por su consistencia y tamaño similar, por lo que desempeña un papel clave el análisis histológico e inmunohistoquímico a la hora de planificar el abordaje terapéutico de estas pacientes. Presentamos el caso de una paciente de 75 años con un tumor GIST en el tabique rectovaginal, a la que se realizó resección total de la lesión y posterior tratamiento con Glivec (R) (mesilato de imatinib) (AU)

Gastrointestinal stromal tumors (GIST) of the rectovaginal septum are highly infrequent entities that pose a challenge due to the lack of diagnostic suspicion. These tumors are often misdiagnosed as leiomyomas or leiomyosarcomas because of the similarity in their structure and size. Histological analysis and immunochemistry play a key role in the choice of therapeutic strategy in these patients. We report the case of a 75-year-old woman with a GIST tumor in the rectovaginal septum. Tumor enucleation was performed and subsequent treatment with imatinib mesylate (Gleevec(R)) was established (AU)

Tratamiento del cáncer de endometrio sin histerectomía / Treatment of endometrial cancer without hysterectomy

El cáncer de endometrio es el tumor ginecológico maligno más frecuente en la mujer.El tratamiento protocolizado consiste en la cirugía (histerectomía total y doble anexectomía; en algunos casos debe añadirse linfadenectomía pélvica y paraaórtica, dependiendo de los factores de riesgo de afectación linfática); pero en mujeres jóvenes con cáncer de endometrio bien diferenciado, que debidamente informadas aceptan los riesgos y desean preservar su fertilidad, se puede realizar un tratamiento conservador con resección histeroscópica (RH), hormonoterapia y un seguimiento estricto.Presentamos un caso de una paciente de 29 años, nuligesta, en la que se realizó tratamiento conservador del cáncer de endometrio con resección histeroscópica y hormonoterapia con resultado satisfactorio en el primer año (AU)

Endometrial cancer is the most common gynecological malignancy diagnosed in women.AbstractThe standard therapy for endometrial cancer consists of a staging surgery (total hysterectomy and bilateral salpingo-oophorectomy; in some cases pelvic and paraaortica lymphadenectomy should be added depending on the risk factors for lymphatic involvement); but in young women with well-differentiated endometrial cancer, that properly informed accept the risks and wish to preserve their fertility, it is possible to realize a conservative treatment with hysteroscopic resection, hormonal therapy and a strict follow-up.AbstractWe have reported the case of endometrial cancer in a 29 years old woman, who was treated with hysteroscopical resection and hormonal therapy with satisfactory results during the first year follow-up (AU)

Estudio de patología vulvar en pacientes menopáusicas / Study of vulvar pathology in menopausal women

Objetivo: Estudiar la patología vulvar de las pacientes en edad menopáusica remitidas a una unidad del tracto genital inferior (UCTI). Material y métodos: Estudio observacional y descriptivo de las pacientes menopáusicas con patología vulvar remitidas a la UTGI del Hospital General Universitario de Alicante entre enero de 2000 y diciembre de 2007. Se evaluaron las patologías más frecuentes, el tipo de lesión, la localización, el diagnóstico y el tratamiento. Resultados: Se estudió a 189 pacientes mayores de 55 años; 68 (36%) presentaban patología vulvar. El liquen escleroso fue la más frecuente (46%), con prurito como síntoma principal (64%) y localizado principalmente en los labios mayores. El tratamiento instaurado con más frecuencia fueron los corticoides de alta potencia (64%).Conclusiones: La patología vulvar más frecuente en las pacientes menopáusicas de nuestra UTGI es el liquen escleroso, que se presenta habitualmente como prurito. Los corticoides de alta potencia fueron el tratamiento más efectivo (AU)

Objective: Study the pathology of the vulva found in menopausal patients referred to a lower genital tract unit (LGTU).Materials and methods: An observational and descriptive study of menopausal patients with vulvar pathology from the LGTU of Hospital General Universitario de Alicante (Spain), between January 2000 and December 2007. We assessed the more common diseases, lesion type, location, diagnosis and treatment. Results: We evaluated 189 patients (that were older than 55 years). Of these, 68 had vulvar pathology (36%), and lichen sclerosus (46%) the most frequent disease. The treatment most often established was with high-powered steroids (64%),which was also the most effective. Conclusions: The most common vulvar pathology in postmenopausal patients of our LGTU is the lichen sclerosus. Pruritus was the main symptom. High-powered steroids were the most effective treatment (AU)