Endometrial cancer is increasingly common in affluent Western countries, largely owing to the growing obesity of those populations. There are two recognized types of endometrial cancer: Type I is more common and is associated with obese postmenopausal women and comprises approximately 80% of all endometrial cancers; Type II describes a woman who is often younger and thinner with a more aggressive histologic type that is nonestrogen dependent, of either serous or clear cell histology, and consists of a more aggressive clinical course and results in poorer prognosis. As the majority of patients with endometrial cancer present with symptoms and have early disease, screening is unlikely to be cost effective or reduce the mortality rate. However, surveillance of high-risk populations is a different proposition. Patients who may benefit from routine surveillance include those with a family history of endometrial cancer, a history of hormone replacement therapy with less than 12-14 days of progestogens, long-term use of tamoxifen, hereditary nonpolyposis colorectal cancer family syndrome, Cowden's syndrome, Peutz-Jeghers syndrome, a history of breast cancer and obesity. Most patients with endometrial cancer are offered surgery as first-line therapy. The standard surgical procedure should be an extrafascial total hysterectomy with bilateral salpingo-oophorectomy. Adnexal removal is also recommended, even if the adnexa appear normal, as they may contain micrometastases. The safety of a laparoscopic approach in the surgical management of uterine cancer has not yet been demonstrated in prospective randomized trials, therefore, the field awaits the Gynaecologic Oncology Group's prospective Lap-2 study. While post-treatment follow-up guidelines vary between institutions and countries, in general, patients at high risk of recurrence are followed closely every 3-4 months for the first year or two, then every 6 months to complete 5 years of follow-up.

An overview of uterine cancer and its management.

Laparoscopy, a minimally invasive surgery, may benefit select patients more than traditional abdominal approaches. The benefits of this procedure include low morbidity, shorter length of hospital stay, less blood loss, no significant increase in complications, and a shorter postoperative recovery period; this allows patients to begin adjuvant therapy more quickly. Laparoscopy has been used in gynecologic oncology since the early 1990s and has continued to grow and develop. Complex gynecologic oncology procedures can be performed with a low rate of complication and a low rate of conversion to laparotomy. The literature supports the fact that laparoscopy can be performed with short-term benefit with no increase in morbidity. Although the data are limited and emerging, the risk of cancer recurrence does not appear to increase because of this minimal access approach. Currently, advanced laparoscopic techniques are used to evaluate and treat cervical, endometrial, and ovarian malignancies. Specifically, transperitoneal laparoscopic lymphadenectomy including pelvic and paraaortic nodes is a feasible and efficacious procedure in the management of certain gynecologic malignancies.

Transperitoneal laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic cancers.

Peritoneal carcinomatosis after laparoscopic radical hysterectomy for early-stage cervical adenocarcinoma.

The aim of this study was to evaluate the complication rate of pelvic and para-aortic lymphadenectomy in the management of endometrial cancer following the changes to the recommendations of INCa 2010. This is a retrospective study of 208 patients operated for endometrial cancer between July 2010 and March 2014 in two referral centers. Eighty lymphadenectomy were performed, 65 with hysterectomy and bilateral annexectomy and 18 lymphadenectomy were performed for restaging. Complications assessment is based on the Dindo Clavien classification. We report 17 severe complications (grade 3a and over) (P<0.001), including 14 among patients receiving lymphadenectomy. Morbidity increases with the number of lymphnodes removed and their positivity (P<0.001). The para-aortic lymphadenectomy is primarily responsible for complications (P <0.001). We describe 7 lower limbs lymphedema, 12 nerve injuries, 8 ileus, 5 venous or arterial thromboembolism, 17 blood transfusions, 13 lymphoceles including 9 infected. The rate of intraoperative complications on a first lymphadenectomy is 8% while it reached 22% for restaging. Restaging is significantly more at risk of serious complications (P=0.03) with two deaths. Twenty-four chronic disorders with impaired quality of life (2 without lymphadenectomy) are reported. They are present in 50% of restaging (P=0.033 compared to first lymphadenectomy). Lymphadenectomy is a source of severe morbidity (17.5%) with 2.5% mortality. The benefit of this surgery should probably be discussed again.

[Morbidity of pelvic lymphadenectomy and para-aortic lymphadenectomy in endometrial cancer].

Resume Objectifs En combinant nos resultats avec ceux de la litterature, nous pouvons distinguer plusieurs situations, et evaluer l'interet de la stadification chirurgicale dans la prise en charge des tumeurs germinales malignes de l'ovaire. Patientes et methodes Il s'agit d'une serie retrospective de 36 patientes (21,5 ans [8–61]) traitees pour tumeur germinale maligne de l'ovaire entre janvier 1984 et decembre 2004. Trois groupes ont pu etre distingues : groupe 1 : dysgerminome pur ; groupe 2 : teratome immature pur ; groupe 3 : tumeur secretante. Toutes les patientes ont eu un suivi minimal de 18 mois apres traitement. Nous rapportons le type de chirurgie conservatrice ou non, la realisation ou non d'une stadification chirurgicale, le type de chimiotherapie eventuelle et la survie. Resultats Les stades FIGO etaient respectivement : groupe 1 : IA n  = 2, IC n  = 2, IIB n  = 1, IIIA n  = 2, IIIC n  = 3 ; groupe 2 : IA n  = 3 (G1, G2, G2), IC n  = 1 (G3) ; groupe 3 : IA n  = 8, IC n  = 4, IIA n  = 1, IIIA n  = 1, IIIB n  = 3, IIIC n  = 5. Trois patientes ont eu une chimiotherapie neoadjuvante. Toutes les patientes ont subi une chirurgie de reduction (conservatrice n  = 31) avec stadification dans 15 cas. Vingt-six patientes ont eu une chimiotherapie adjuvante. La survie globale a cinq ans etait de 92 %. Discussion et conclusion La chirurgie de la femme jeune avec une tumeur ovarienne germinale maligne doit etre conservatrice (annexectomie) afin de preserver la fertilite et devant le bon pronostic de cette maladie. En cas de stade IA avec composante non secretante certifie par une stadification chirurgicale, une surveillance stricte peut etre mise en place (clinique, imagerie, AFP, HCG). Pour les stades superieurs au stade IA, la chimiotherapie est indiquee apres chirurgie conservatrice et stadification chirurgicale.

Tumeurs germinales malignes de l'ovaire. À propos de 36 cas

Resume Objectif. – Evaluer les complications des lymphadenectomies pelviennes et lomboaortiques par voie cœlioscopique en oncologie gynecologique pour en valider la pratique courante. Patientes et methodes. – De decembre 1988 a mars 2004, 915 patientes ont fait l'objet d'une lymphadenectomie pelvienne et/ou aortique sous controle cœlioscopique. Les interventions — 771 au centre Oscar-Lambret, et 144 a l'institut Claudius-Regaud — ont ete realisees dans le cadre d'une (re)stadification pour 98 cancers debutants de l'ovaire, 237 cancers du col aux stades precoces et 216 cancers avances du col. Elles ont ete associees a un traitement chirurgical radical ou conservateur (trachelectomie), par cœlioscopie ou voie vaginale, dans 161 cas de cancer de l'endometre et 203 cancers du col uterin. Resultats. – Un total de 1102 lymphadenectomies pelviennes ou aortiques a ete pratique : 714 pelviennes (694 transperitoneales, 20 extraperitoneales) et 388 aortiques (154 transperitoneales, 234 extraperitoneales. Dix-sept laparotomies (1,85 %) ont ete necessaires pour impossibilite technique ou complications. Discussion et conclusions. – La technique peut etre consideree comme sure, avec un taux de complications non superieur a celui de la laparotomie, et une mortalite nulle jusqu'a aujourd'hui.

Complications des lymphadénectomies coelioscopiques en oncologie gynécologique : 1102 interventions chez 915 patientes

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Complications des lymphadénectomies coelioscopiques en oncologie gynécologique : 1102 interventions chez 915 patientes