RESUMO
During the period of 2010-2015 laparoscopic surgery was performed in 1263 patients: 1113 with endometrial cancer (588 hysterectomies, 509 hysterectomies with pelvic lymphadenectomy, among them 16 with sentinel lymph node (SLN) mapping with Indocyanine green (ICG)); 86 with cervical cancer (80 nerve-sparing radical hysterectomies (NSRH), among them 15 with SLN mapping, 6 radical vaginal trachelectomies with endovideoassisted lymphadenectomy); 64 with ovarian malignancies. The average operating time in the group of hysterectomies was 101 minutes, in the group of hysterectomies with pelvic lymphadenectomy - 184 minutes, in the group of NSRH - 230 minutes. Average blood loss was less than 50 ml. No intraoperative complications were registered. Asymptomatic lymph cysts were observed in 122 cases. Symptomatic lymph cysts requiring surgical treatment were registered in 9 cases. Inconsistencies of vaginal sutures after radical hysterectomy were in two cases, ureterovaginal fistulas - in two cases. During a 3-year follow-up period twelve recurrences were observed in endometrial cancer patients (12/443; 2,7%), four patients (0,9%) died from disease. After NSRH two local recurrences (2,5%) were registered in patients with cervical cancer, after radical trachelectomy -two local recurrences (33%). One patient became pregnant in the group of vaginal trachelectomies. Therefore laparoscopic approach in treatment of female genital malignacies allows performing an adequate volume of surgery with minimal risk of intra- and postoperative complications, favorable course of the rehabilitation period, and oncological safety.
Assuntos
Neoplasias do Endométrio/cirurgia , Laparoscopia , Neoplasias Ovarianas/cirurgia , Neoplasias do Colo do Útero/cirurgia , Cirurgia Vídeoassistida , Adulto , Idoso , Intervalo Livre de Doença , Neoplasias do Endométrio/mortalidade , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/mortalidadeRESUMO
Surgery is the main method in treatment for endometrial cancer. The complexity of treatment of endometrial cancer patients in elderly age is a result of a large number of comorbidities and, as a consequence, the potential possibility of a large number of intra--and postoperative complications. The article presents the international data and the analysis of own results of a use of laparoscopy in surgical treatment of these patients. A comparison with a group of operations performed by laparotomy is carried out as well as it is evaluated the main intra--and perioperative parameters and also complications, and immediate outcomes of patients treated at the Oncogynecology Department of the N.N.Petrov Research Institute of Oncology.
Assuntos
Neoplasias do Endométrio/cirurgia , Histerectomia/métodos , Laparoscopia , Adenocarcinoma de Células Claras/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/cirurgia , Comorbidade , Conversão para Cirurgia Aberta/estatística & dados numéricos , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Estadiamento de Neoplasias , Federação Russa , Resultado do TratamentoRESUMO
For the period from September 2010 to September 2014 there were operated 513 patients with endometrial cancer using laparoscopic installation the Karl Storz company. 304 patients (59.2%) underwent hysterectomy with appendages, 209 (40.8%)--hysterectomy with appendages and pelvic lymphadenectomy, including 11 patients (2.2%) with the addition of omentectomy in serous and serous-papillary forms of endometrial cancer. The average age of patients was 58.4 years (44-75 years). Body mass index over 25.0 was determined in 456 patients (88.9%), of whom 183 patients (35.6%) had an excess of body weight, in 159 (31.0%)--obesity of I degree, in 79 (15.5%)--obesity of II degree and in 35 patients (6.8%)--obesity of III degree. There were no reported complications during surgery. The postoperative period in the majority of patients was characterized by the minimal complications and absence of contraindications for adjuvant radiotherapy. During follow-up period there were registered 4 relapses: in 1 patient with serous--papillary form of endometrial cancer during the first year after surgery--in the form of dissemination of tumor in the abdomen and pelvis; in 3 patients--in the form of a cytological detection of glandular cancer cells in vaginal stump. As a result, regardless of age and comorbidities, laparoscopy allows performing to endometrial cancer patients the entire volume of planned radical surgery with minimum damage and with minimal risk of intra- and postoperative complications, favorable and accelerated rehabilitation period.
Assuntos
Carcinoma Papilar/cirurgia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia/métodos , Laparoscopia , Obesidade/complicações , Idoso , Índice de Massa Corporal , Carcinoma Papilar/complicações , Carcinoma Papilar/diagnóstico , Conversão para Cirurgia Aberta , Cistadenocarcinoma Seroso/complicações , Cistadenocarcinoma Seroso/diagnóstico , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/diagnóstico , Feminino , Humanos , Histerectomia/efeitos adversos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Excisão de Linfonodo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/induzido quimicamente , Estadiamento de Neoplasias , Omento/cirurgia , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Federação Russa , Resultado do TratamentoRESUMO
We analyzed the international and our own experience of using different dyes in the identification of sentinel lymph nodes in oncogynecological practice. We evaluated the possibility of using indocyanine green (ICG) in the detection of sentinel lymph nodes in patients with endometrial and cervical cancer. The first results of the use of ICG at the Oncogynecology Department of the N.N.Petrov Research Institute of Oncology are presented.