laparoscopic hysterectomy Carcinoma Endometrium (uterine carcinoma)

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pradeep garg aiims new delhi Carcinoma Endometrium laparoscopic hysterectomy uterine carcinoma

pradeep garg aiims new delhi Carcinoma Endometrium laparoscopic hysterectomy uterine carcinoma

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  • 1. LAPAROSCOPIC MANAGEMENT OF CARCINOMA ENDOMETRIUM Dr. Pradeep Garg Assistant Professor Obstetrics & Gynaecology, All India Institute of Medical Sciences New Delhi-110029 Email:pkgarg_in2004@yahoo.com
  • 2. LAPAROSCOPIC HYSTERECTOMY AND LYMPHADENECTOMY FOR CARCINOMA ENDOMETRIUM VIDEO To see this video please logon to www.youtube.com and type pradeep garg endometrial carcinoma or http://www.youtube.com/watch?v=tB8mjaMjS8w
  • 3. Endometrial carcinoma (EC)
    • Symptoms
      • most often occur in 6 or 7 decade
      • 75% cases occur in women older than 50 years old age
      • 90% 0f women have vaginal bleeding or discharge
  • 4. Diagnosis
    • Endometrial aspiration biopsy
    • Pap test is unreliable diagnostic test, only 30-50 % will have abnormal test
  • 5. Classification
    • Endomtroid adenocarcinoma - 80%
    • Mucinous carcinoma - 5%
    • Papillary serous carcinoma - 4%
    • Clear cell carcinoma - 4%
    • Squamous carcinoma
    • Undifferenciated carcinoma
    • Mixed carcinoma
  • 6. Papillary serous carcinoma
    • Behave more aggressively than endometroid carcinoma.
    • Propensity to spread intra-abdominally, simulating the behavior of ovarian carcinoma.
    • Stage 1 disease > 50% have deep myometrial invasion and 50% have extrauterine disease at the time of surgery.
  • 7. Adverse prognostic factors
    • Advancing patient age
    • Nonendometroid or grade 3 histology
    • Deep myometrial invasion
    • Lymph-vascular space invasion
    • Large tumor size
    • Cervix extension
    • Lymph node metastasis
    • Intra-peritoneal spread
  • 8. Surgery for EC
    • The gold standard for staging and preliminary treatment of endometrial cancer is surgical .
    • In recent years several studies have demonstrated that a laparoscopic approach to surgery for EC results in outcomes comparable to or better than laparotomy
    • Journal of Minimally Invasive Gynecology 2005
    • International journal of gynecological cancer 2005,
    • Gynecologic oncology 2004
    • European journal of gynaecological oncology 2002
  • 9. Peritoneal cytology
    • + cytology is associated with poor prognostic factors like deep myometrial invasion, cervical involvement, adnexal spread and lymph node metastasis.
    • + cytology in the absence of extrauterine disease or poor prognostic factors probably has no significant effect on recurrence or survival.
  • 10. Omentectomy
    • Papillary serous
    • Mixed mullerian tumor
    • * intra-abdominal spread and upper
    • abdominal recurrence
  • 11. LH for obese women with EC
    • Reduced
    • W ound complications
        • Pulmonary morbidity
        • Blood loss
        • J Am Assoc of Gynaecological Laparosc 2002
  • 12. LAPAROSCOPIC HYSTERECTOMY AND LYMPHADENECTOMY FOR CARCINOMA ENDOMETRIUM VIDEO To see this video please logon to www.youtube.com and type pradeep garg endometrial carcinoma or http://www.youtube.com/watch?v=tB8mjaMjS8w
  • 13. LAPAROSCOPIC LYMPHADENECTOMY
    • Minimal morbidity
    • Shorter hospitalization
    • Feasible and safe
    • Complication rate not increased
    • Average no. of lymph nodes removed not different from laparotomy
  • 14. COMPARISON OF LAPAROSCOPY AND LAPAROTOMY FOR ENDOMETRIAL CANCER Author Patients Mean operating time (min) Mean lymph node (no.) Conversion to laparotomy / caused by complications (%) Laparoscopy         Rojke et al, 1994 33 217 18.9 5.3 Magrina et al, 1995 15 174 18.6 3.4 Gemignani et al, 1999 69 214 7 (0-14) 3.0 Total of mean 221 186 18.5 2.6 Laparotomy         Boike et al, 1994 37 194 18.7   Magrina et al, 1995 15 142 23.5   Gemignani et al, 1999 251 144 6 (0-30)   Total of mean 391 149 18  
  • 15. Advantages
    • Minimally invasive technique
      • Decreased Postoperative pain
      • Faster recovery
      • Cosmetic, reduced wound complications
    • Feasibility: Advancement in instruments & technology
    • Safety and benefits of laparoscopy in oncology proven by randomized studies .
    • Lambaudie E et al, Surg Endosc. 2008
  • 16. LIMITATIONS
    • Advanced technology and experienced surgeon needed
    • Long learning curve
    • Limited visual field
    • Inability to palpate
    • Risk of spill in peritoneal cavity
    • Port site metastasis
  • 17.
    • Need for extensive dissection
    • Need for expert laparoscopic surgeon
    Special considerations
  • 18. Survival rate
    • Survival rate same as laparotomy
    • Obermair etr al, Gynecol Oncol 2004
  • 19. CONCLUSIONS
    • Advanced operative laparoscopy has become an important surgical approach in management of endomtrial cancer.
    • The overall complication rate appears acceptable with no compromise in oncological outcome
  • 20.
    • For queries mail me at
    • pkgarg _ in2004@yahoo.com
  • 21. Thank You