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Focus On Gynecological Cancers and Endometriotic Nodules

Epublication, Mar 2017;17(03). URL: http://websurg.com/doi/fc01en21
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Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
A Wattiez, R Nasir, I Argay
Surgical intervention
1 year ago
4653 views
310 likes
0 comments
42:42
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
Role of laparoscopy in treating ovarian cancer
Borderline ovarian tumors (BOTs) represent about 10 to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. The standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at an earlier stage, in younger women and have a better prognosis and a higher survival rate than IOCs, fertility-sparing surgery is one of the options to preserve a childbearing capacity. However, conservative surgery is still controversial.
So far, postoperative chemotherapy, radiotherapy, and hormone therapy are not recommended. BOTs are characteristically difficult to diagnose using preoperative radiological methods, exhibit inconsistencies in expression of tumor markers, and are often inaccurately identified using frozen sections. In these slides, Dr. Marco Puga will discuss the controversial issues of BOTs and will present the management of BOTs.
M Puga
Lecture
1 year ago
2449 views
167 likes
0 comments
31:15
Role of laparoscopy in treating ovarian cancer
Borderline ovarian tumors (BOTs) represent about 10 to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. The standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at an earlier stage, in younger women and have a better prognosis and a higher survival rate than IOCs, fertility-sparing surgery is one of the options to preserve a childbearing capacity. However, conservative surgery is still controversial.
So far, postoperative chemotherapy, radiotherapy, and hormone therapy are not recommended. BOTs are characteristically difficult to diagnose using preoperative radiological methods, exhibit inconsistencies in expression of tumor markers, and are often inaccurately identified using frozen sections. In these slides, Dr. Marco Puga will discuss the controversial issues of BOTs and will present the management of BOTs.
Sentinel node technique in uterine cancers (update of April 2012 lecture)
Endometrial cancer is the most common gynecologic malignancy. In the majority of patients, the disease will present at an early stage, without metastasis, and with an excellent prognosis.
Total hysterectomy and bilateral salpingo-oophorectomy with or without a lymph node dissection is the standard method in the management of endometrial cancer. Although the rate of metastasis in patients with early stage endometrial cancer is low, the standard of treatment still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging, resulting in detrimental side-effects, including lower extremity lymphedema. SLN mapping is based on the concept that lymph node metastasis is the result of an orderly process, that is, the lymph drains in a specific pattern away from the tumor, and therefore if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. Among gynecological cancers, a variety of methods have been described to detect a sentinel node in situ including colored dyes and radioisotopes, the latter requiring a specialized gamma detection probe. In this key presentation, Dr. Querleu will talk about the SNL technique in uterine cancers.
D Querleu
Lecture
1 year ago
1250 views
128 likes
0 comments
34:36
Sentinel node technique in uterine cancers (update of April 2012 lecture)
Endometrial cancer is the most common gynecologic malignancy. In the majority of patients, the disease will present at an early stage, without metastasis, and with an excellent prognosis.
Total hysterectomy and bilateral salpingo-oophorectomy with or without a lymph node dissection is the standard method in the management of endometrial cancer. Although the rate of metastasis in patients with early stage endometrial cancer is low, the standard of treatment still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging, resulting in detrimental side-effects, including lower extremity lymphedema. SLN mapping is based on the concept that lymph node metastasis is the result of an orderly process, that is, the lymph drains in a specific pattern away from the tumor, and therefore if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. Among gynecological cancers, a variety of methods have been described to detect a sentinel node in situ including colored dyes and radioisotopes, the latter requiring a specialized gamma detection probe. In this key presentation, Dr. Querleu will talk about the SNL technique in uterine cancers.
Role of para-aortic staging lymphadenectomy in advanced cervical cancer (update of September 2014 lecture)
Pelvic and para-aortic lymph node evaluation is a major component of the surgical staging procedure for several gynecologic malignancies. Cervical cancer is clinically staged, but assessment of pelvic and para-aortic lymph nodes is performed with lymphadenectomy and/or imaging. The surgical and oncologic goals of lymph node dissection are to define the extent of disease, and thereby, to guide further treatment. Lymphadenectomy may also have a therapeutic goal in conditions in which removing nodes harboring metastatic disease improves survival. The role of para-aortic lymph node dissection for women diagnosed with LACC had been described in these slides.
F Kridelka
Lecture
1 year ago
1243 views
122 likes
1 comment
27:54
Role of para-aortic staging lymphadenectomy in advanced cervical cancer (update of September 2014 lecture)
Pelvic and para-aortic lymph node evaluation is a major component of the surgical staging procedure for several gynecologic malignancies. Cervical cancer is clinically staged, but assessment of pelvic and para-aortic lymph nodes is performed with lymphadenectomy and/or imaging. The surgical and oncologic goals of lymph node dissection are to define the extent of disease, and thereby, to guide further treatment. Lymphadenectomy may also have a therapeutic goal in conditions in which removing nodes harboring metastatic disease improves survival. The role of para-aortic lymph node dissection for women diagnosed with LACC had been described in these slides.
Endometrial cancer surgical indications
The surgical management of endometrial cancer has been markedly changed by minimally invasive techniques. After three decades of laparoscopy, robotic surgery has built upon and expanded the population of patients able to benefit from minimally invasive techniques. Updates in the field of laparoscopy continue, including single site surgery. The emergence and rapid uptake of robotics continues to produce favorable outcomes while simultaneously expanding minimal access surgery to the obese and elderly populations. Sentinel lymph node detection and single port surgery are expanding areas which will continue to push the role of minimally invasive surgery (MIS) in endometrial cancer. In this key lecture, Dr. Querleu will discuss the role of MIS in the management of endometrial cancer.
D Querleu
Lecture
1 year ago
1261 views
101 likes
0 comments
29:34
Endometrial cancer surgical indications
The surgical management of endometrial cancer has been markedly changed by minimally invasive techniques. After three decades of laparoscopy, robotic surgery has built upon and expanded the population of patients able to benefit from minimally invasive techniques. Updates in the field of laparoscopy continue, including single site surgery. The emergence and rapid uptake of robotics continues to produce favorable outcomes while simultaneously expanding minimal access surgery to the obese and elderly populations. Sentinel lymph node detection and single port surgery are expanding areas which will continue to push the role of minimally invasive surgery (MIS) in endometrial cancer. In this key lecture, Dr. Querleu will discuss the role of MIS in the management of endometrial cancer.