LAPAROSCOPIC MANAGEMENT OF CARCINOMA ENDOMETRIUM  Dr. Pradeep  Garg Assistant Professor Obstetrics & Gynaecology, All Indi...
LAPAROSCOPIC HYSTERECTOMY AND LYMPHADENECTOMY FOR CARCINOMA ENDOMETRIUM VIDEO To see this video please logon to  www.youtu...
Endometrial carcinoma (EC) <ul><li>Symptoms  </li></ul><ul><ul><li>most often occur in 6 or 7 decade </li></ul></ul><ul><u...
Diagnosis <ul><li>Endometrial aspiration biopsy </li></ul><ul><li>Pap test is unreliable diagnostic test, only 30-50 % wil...
Classification <ul><li>Endomtroid adenocarcinoma - 80% </li></ul><ul><li>Mucinous carcinoma  - 5% </li></ul><ul><li>Papill...
Papillary serous carcinoma <ul><li>Behave more aggressively than endometroid carcinoma. </li></ul><ul><li>Propensity to sp...
Adverse prognostic factors <ul><li>Advancing patient age </li></ul><ul><li>Nonendometroid or grade 3 histology </li></ul><...
Surgery for EC <ul><li>The gold standard for staging and preliminary treatment of endometrial cancer  is surgical . </li><...
Peritoneal cytology <ul><li>+  cytology is associated with poor prognostic factors like deep myometrial invasion, cervical...
Omentectomy <ul><li>Papillary serous </li></ul><ul><li>Mixed mullerian tumor </li></ul><ul><li>* intra-abdominal spread an...
LH for obese women with EC <ul><li>Reduced   </li></ul><ul><li>  W ound complications </li></ul><ul><ul><ul><li>Pulmonary ...
LAPAROSCOPIC HYSTERECTOMY AND LYMPHADENECTOMY FOR CARCINOMA ENDOMETRIUM VIDEO To see this video please logon to  www.youtu...
LAPAROSCOPIC LYMPHADENECTOMY <ul><li>Minimal morbidity </li></ul><ul><li>Shorter hospitalization </li></ul><ul><li>Feasibl...
COMPARISON OF LAPAROSCOPY AND LAPAROTOMY FOR ENDOMETRIAL CANCER   Author Patients Mean operating time (min) Mean lymph nod...
Advantages <ul><li>Minimally invasive technique </li></ul><ul><ul><li>Decreased Postoperative pain </li></ul></ul><ul><ul>...
LIMITATIONS  <ul><li>Advanced technology and experienced surgeon needed </li></ul><ul><li>Long learning curve </li></ul><u...
<ul><li>Need for extensive dissection </li></ul><ul><li>Need for expert laparoscopic surgeon </li></ul>Special considerati...
Survival rate <ul><li>Survival rate same as laparotomy </li></ul><ul><li>Obermair etr al, Gynecol Oncol 2004 </li></ul>
CONCLUSIONS <ul><li>Advanced operative laparoscopy has become an important surgical approach in management of endomtrial c...
<ul><li>For  queries mail me at </li></ul><ul><li>pkgarg _ in2004@yahoo.com  </li></ul>
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laparoscopic hysterectomy Carcinoma Endometrium (uterine carcinoma) Female Pelvic Anatomy Mob: 7289915430, www.drpradeepgarg

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pradeep garg aiims new delhi Carcinoma Endometrium laparoscopic hysterectomy uterine carcinoma, Female Pelvic Anatomy Mob: 7289915430, www.drpradeepgarg

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laparoscopic hysterectomy Carcinoma Endometrium (uterine carcinoma) Female Pelvic Anatomy Mob: 7289915430, www.drpradeepgarg

  1. 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. 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. 3. Endometrial carcinoma (EC) <ul><li>Symptoms </li></ul><ul><ul><li>most often occur in 6 or 7 decade </li></ul></ul><ul><ul><li>75% cases occur in women older than 50 years old age </li></ul></ul><ul><ul><li>90% 0f women have vaginal bleeding or discharge </li></ul></ul>
  4. 4. Diagnosis <ul><li>Endometrial aspiration biopsy </li></ul><ul><li>Pap test is unreliable diagnostic test, only 30-50 % will have abnormal test </li></ul>
  5. 5. Classification <ul><li>Endomtroid adenocarcinoma - 80% </li></ul><ul><li>Mucinous carcinoma - 5% </li></ul><ul><li>Papillary serous carcinoma - 4% </li></ul><ul><li>Clear cell carcinoma - 4% </li></ul><ul><li>Squamous carcinoma </li></ul><ul><li>Undifferenciated carcinoma </li></ul><ul><li>Mixed carcinoma </li></ul>
  6. 6. Papillary serous carcinoma <ul><li>Behave more aggressively than endometroid carcinoma. </li></ul><ul><li>Propensity to spread intra-abdominally, simulating the behavior of ovarian carcinoma. </li></ul><ul><li>Stage 1 disease > 50% have deep myometrial invasion and 50% have extrauterine disease at the time of surgery. </li></ul>
  7. 7. Adverse prognostic factors <ul><li>Advancing patient age </li></ul><ul><li>Nonendometroid or grade 3 histology </li></ul><ul><li>Deep myometrial invasion </li></ul><ul><li>Lymph-vascular space invasion </li></ul><ul><li>Large tumor size </li></ul><ul><li>Cervix extension </li></ul><ul><li>Lymph node metastasis </li></ul><ul><li>Intra-peritoneal spread </li></ul>
  8. 8. Surgery for EC <ul><li>The gold standard for staging and preliminary treatment of endometrial cancer is surgical . </li></ul><ul><li>In recent years several studies have demonstrated that a laparoscopic approach to surgery for EC results in outcomes comparable to or better than laparotomy </li></ul><ul><li>Journal of Minimally Invasive Gynecology 2005 </li></ul><ul><li>International journal of gynecological cancer 2005, </li></ul><ul><li>Gynecologic oncology 2004 </li></ul><ul><li>European journal of gynaecological oncology 2002 </li></ul>
  9. 9. Peritoneal cytology <ul><li>+ cytology is associated with poor prognostic factors like deep myometrial invasion, cervical involvement, adnexal spread and lymph node metastasis. </li></ul><ul><li>+ cytology in the absence of extrauterine disease or poor prognostic factors probably has no significant effect on recurrence or survival. </li></ul>
  10. 10. Omentectomy <ul><li>Papillary serous </li></ul><ul><li>Mixed mullerian tumor </li></ul><ul><li>* intra-abdominal spread and upper </li></ul><ul><li>abdominal recurrence </li></ul>
  11. 11. LH for obese women with EC <ul><li>Reduced </li></ul><ul><li> W ound complications </li></ul><ul><ul><ul><li>Pulmonary morbidity </li></ul></ul></ul><ul><ul><ul><li>Blood loss </li></ul></ul></ul><ul><ul><ul><li> J Am Assoc of Gynaecological Laparosc 2002 </li></ul></ul></ul>
  12. 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. 13. LAPAROSCOPIC LYMPHADENECTOMY <ul><li>Minimal morbidity </li></ul><ul><li>Shorter hospitalization </li></ul><ul><li>Feasible and safe </li></ul><ul><li>Complication rate not increased </li></ul><ul><li>Average no. of lymph nodes removed not different from laparotomy </li></ul>
  14. 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. 15. Advantages <ul><li>Minimally invasive technique </li></ul><ul><ul><li>Decreased Postoperative pain </li></ul></ul><ul><ul><li>Faster recovery </li></ul></ul><ul><ul><li>Cosmetic, reduced wound complications </li></ul></ul><ul><li>Feasibility: Advancement in instruments & technology </li></ul><ul><li>Safety and benefits of laparoscopy in oncology proven by randomized studies . </li></ul><ul><li> Lambaudie E et al, Surg Endosc. 2008 </li></ul>
  16. 16. LIMITATIONS <ul><li>Advanced technology and experienced surgeon needed </li></ul><ul><li>Long learning curve </li></ul><ul><li>Limited visual field </li></ul><ul><li>Inability to palpate </li></ul><ul><li>Risk of spill in peritoneal cavity </li></ul><ul><li>Port site metastasis </li></ul>
  17. 17. <ul><li>Need for extensive dissection </li></ul><ul><li>Need for expert laparoscopic surgeon </li></ul>Special considerations
  18. 18. Survival rate <ul><li>Survival rate same as laparotomy </li></ul><ul><li>Obermair etr al, Gynecol Oncol 2004 </li></ul>
  19. 19. CONCLUSIONS <ul><li>Advanced operative laparoscopy has become an important surgical approach in management of endomtrial cancer. </li></ul><ul><li>The overall complication rate appears acceptable with no compromise in oncological outcome </li></ul>
  20. 20. <ul><li>For queries mail me at </li></ul><ul><li>pkgarg _ in2004@yahoo.com </li></ul>
  21. 21. Thank You

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