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Oncologic and Reproductive Results in Conservative Surgery for Ovarian Low Malignant Potential Tumours
S172
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177
hysterectomy. It has been usually performed with open surgery or multi-port laparoscopic operation. In this presentation, we present our experience with single-port surgical staging operation including pelvic lymph node dissection and paraaortic lymph node sampling (up to the infrarenal area) in endometrial cancer. Patients: A 59-year-old woman, G 3, P 3, visited our department with endometrial cancer. Single-port total laparoscopic hysterectomy with bilateral adnexectomy, and pelvic lymph node dissection with paraaortic lymph node sampling were performed. We performed para-aortic lymph node sampling up to the level of infrarenal area and there were no enlarged or suspicious nodes. A transumbilical drainage tube (Kim’s Transumbilical Drainage System) was inserted into the pelvic cavity. After surgery, the tumor was confirmed to be well-differentiated, endometrioid type, stage Ia endometrial cancer. The number of obtained pelvic lymph nodes in this operation was 31, and the number of obtained paraaortic lymph nodes was 5, with no lymph node invasion. The total operation time was 185 min, and the pre- and post-operative hemoglobin change was 3.1 g/dl. We removed the transumbilical drainage tube 5 days after surgery. She was discharged the same day and there were no postoperative complications. Intervention: We performed surgical staging operation with singleport access. After performing a 1.5 to 2.0 cm umbilical incision, we inserted one laparoscope and three other instruments into four cannulas of the port created by a wound retractor and a surgical glove. The operation was executed with conventional rigid straight laparoscopic instruments. Conclusion: Our case suggests that single-port laparoscopic comprehensive surgical staging operation including pelvic lymph node dissection and paraaortic lymph node sampling (up to the infrarenal area) in gynecologic cancer is possible and a feasible alternative to conventional laparoscopic surgery. 586 Repeat Laparoscopic Para-Aortic Lymphadenectomy of an Isolated Lymph Node Recurrence in Patient with Stage IB2 Cervical Cancer Koh AR, Choi JS, Lee JH, Son CE, Jeon SW, Hong JH, Bae JW. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Korea Study Objective: To report a case of repeat laparoscopic para-aortic lymphadenectomy after surgery and concurrent chemoradiation of cervical cancer, FIGO stage IB2. Design: A case report. Setting: University teaching hospital. Patients: One patuient with isolated recurrent para-aortic lymph node. Intervention: Repeat Laparoscopic Para-aortic Lymphadenectomy. Measurements and Main Results: A 49-year-old woman had an isolated para-aortic lymph node recurrence 12 months after the initial treatment, F-18 fluoro-deoxyglucose-positron emission tomography-computed tomography showed left para-aortic lymph nodes with increased uptake of F-18 fluorodeoxyglucose. This was successfully removed in a repeat LPAL. She received three cycles of combination chemotherapy and showed a complete clinical response. Conclusion: Repeat LPAL is thus a feasible and effective procedure to remove and confirm of an isolated para-aortic lymph node recurrence after previous surgery and chemoradiation for treating cervical cancer.
Design: Observational cohort prospective study. Setting: A tertiary referral centre. Patients: 26 ovarian LMP tumours in patients younger than 40 years old (mean age 26; range 17-39 years). The histologic types are summarized in table 1. Table 1 Histologic Types
n
%
Serous Mucinous Endometrioid Clear-Cell tumour
16 7 2 1
61.5 26.9 7.7 3.8
Intervention: All of them were treated by laparoscopy without surgical complications We performed fertility-preserving surgery, ranging from unilateral cystectomy to ipsilateral salpingo-oophorectomy with contralateral cystectomy. The uterus was preserved in all cases. In 11 patients the diagnosis was obtained by intraoperative biopsy, and therefore, a staging surgery was performed, including omentectomy and peritoneal washings and biopsies in all cases, and in 5 of the cases a pelvic lymphadenectomy. In the rest of the patients, the diagnosis was obtained in a further study of the tissue, 3 of those cases underwent a laparoscopic restaging surgery. The mean follow-up period was 47 months (range 4- 274). Measurements and Main Results: Reproductive outcomes: 21 patients were assessed for reproductive outcome, although only 9 patients had immediate pregnancy desire. Eight patients obtained pregnancies: 5 patients had normal term deliveries after spontaneous pregnancies; 3 patients obtained pregnancies after in-vitro fertilization (IVF), two of them had normal pregnancies and deliveries and one had recurrent miscarriages. The remaining patient is nowadays in the waiting list for IVF. The oncologic follow-up is summarized in table 2. Table 2 Follow-up \6 months No information Evaluable patients Recurrences unilateral cystectomy unilateral adnexectomy salpingo-oophorectomy with contralateral cystectomy
n
%
2 1 23 6 1/4 2/15 3/4
26.1 25.0 13.3 75.0
All patients who relapsed are currently free of disease and one of them became pregnant after conservative treatment of relapse. Conclusion: Conservative fertility-sparing laparoscopic management for ovarian low malignant potential tumours has good reproductive outcome and oncologic results could be considered to be safe.
588
587 Oncologic and Reproductive Results in Conservative Surgery for Ovarian Low Malignant Potential Tumours Martinez-Serrano MJ, Siso C, Gonzalez-Foruria I, Fuste P, MartinezRoman S, del Pino M, Alonso I, Torne A, Pahisa J. Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clinic-University of Barcelona, Barcelona, Spain Study Objective: To describe the oncologic and reproductive results in young patients who underwent laparoscopic surgery for ovarian low malignant potential (LMP) tumours.
Laparoscopic Surgery Versus Laparotomy in the Management of Early Endometrial Cancer: Long-Term Follow-Up Outcomes Park S-M, Park J-Y, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H. Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea Study Objective: To compare the operative and survival outcomes between laparoscopic surgery and laparotomy in early endometrial cancer. Design: In this retrospective study, we reviewed medical records for patients admitted from Jan 1997 to Dec 2009. Median follow-up time was 52 months. Setting: Department of Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea.
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177
hysterectomy. It has been usually performed with open surgery or multi-port laparoscopic operation. In this presentation, we present our experience with single-port surgical staging operation including pelvic lymph node dissection and paraaortic lymph node sampling (up to the infrarenal area) in endometrial cancer. Patients: A 59-year-old woman, G 3, P 3, visited our department with endometrial cancer. Single-port total laparoscopic hysterectomy with bilateral adnexectomy, and pelvic lymph node dissection with paraaortic lymph node sampling were performed. We performed para-aortic lymph node sampling up to the level of infrarenal area and there were no enlarged or suspicious nodes. A transumbilical drainage tube (Kim’s Transumbilical Drainage System) was inserted into the pelvic cavity. After surgery, the tumor was confirmed to be well-differentiated, endometrioid type, stage Ia endometrial cancer. The number of obtained pelvic lymph nodes in this operation was 31, and the number of obtained paraaortic lymph nodes was 5, with no lymph node invasion. The total operation time was 185 min, and the pre- and post-operative hemoglobin change was 3.1 g/dl. We removed the transumbilical drainage tube 5 days after surgery. She was discharged the same day and there were no postoperative complications. Intervention: We performed surgical staging operation with singleport access. After performing a 1.5 to 2.0 cm umbilical incision, we inserted one laparoscope and three other instruments into four cannulas of the port created by a wound retractor and a surgical glove. The operation was executed with conventional rigid straight laparoscopic instruments. Conclusion: Our case suggests that single-port laparoscopic comprehensive surgical staging operation including pelvic lymph node dissection and paraaortic lymph node sampling (up to the infrarenal area) in gynecologic cancer is possible and a feasible alternative to conventional laparoscopic surgery. 586 Repeat Laparoscopic Para-Aortic Lymphadenectomy of an Isolated Lymph Node Recurrence in Patient with Stage IB2 Cervical Cancer Koh AR, Choi JS, Lee JH, Son CE, Jeon SW, Hong JH, Bae JW. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Korea Study Objective: To report a case of repeat laparoscopic para-aortic lymphadenectomy after surgery and concurrent chemoradiation of cervical cancer, FIGO stage IB2. Design: A case report. Setting: University teaching hospital. Patients: One patuient with isolated recurrent para-aortic lymph node. Intervention: Repeat Laparoscopic Para-aortic Lymphadenectomy. Measurements and Main Results: A 49-year-old woman had an isolated para-aortic lymph node recurrence 12 months after the initial treatment, F-18 fluoro-deoxyglucose-positron emission tomography-computed tomography showed left para-aortic lymph nodes with increased uptake of F-18 fluorodeoxyglucose. This was successfully removed in a repeat LPAL. She received three cycles of combination chemotherapy and showed a complete clinical response. Conclusion: Repeat LPAL is thus a feasible and effective procedure to remove and confirm of an isolated para-aortic lymph node recurrence after previous surgery and chemoradiation for treating cervical cancer.
Design: Observational cohort prospective study. Setting: A tertiary referral centre. Patients: 26 ovarian LMP tumours in patients younger than 40 years old (mean age 26; range 17-39 years). The histologic types are summarized in table 1. Table 1 Histologic Types
n
%
Serous Mucinous Endometrioid Clear-Cell tumour
16 7 2 1
61.5 26.9 7.7 3.8
Intervention: All of them were treated by laparoscopy without surgical complications We performed fertility-preserving surgery, ranging from unilateral cystectomy to ipsilateral salpingo-oophorectomy with contralateral cystectomy. The uterus was preserved in all cases. In 11 patients the diagnosis was obtained by intraoperative biopsy, and therefore, a staging surgery was performed, including omentectomy and peritoneal washings and biopsies in all cases, and in 5 of the cases a pelvic lymphadenectomy. In the rest of the patients, the diagnosis was obtained in a further study of the tissue, 3 of those cases underwent a laparoscopic restaging surgery. The mean follow-up period was 47 months (range 4- 274). Measurements and Main Results: Reproductive outcomes: 21 patients were assessed for reproductive outcome, although only 9 patients had immediate pregnancy desire. Eight patients obtained pregnancies: 5 patients had normal term deliveries after spontaneous pregnancies; 3 patients obtained pregnancies after in-vitro fertilization (IVF), two of them had normal pregnancies and deliveries and one had recurrent miscarriages. The remaining patient is nowadays in the waiting list for IVF. The oncologic follow-up is summarized in table 2. Table 2 Follow-up \6 months No information Evaluable patients Recurrences unilateral cystectomy unilateral adnexectomy salpingo-oophorectomy with contralateral cystectomy
n
%
2 1 23 6 1/4 2/15 3/4
26.1 25.0 13.3 75.0
All patients who relapsed are currently free of disease and one of them became pregnant after conservative treatment of relapse. Conclusion: Conservative fertility-sparing laparoscopic management for ovarian low malignant potential tumours has good reproductive outcome and oncologic results could be considered to be safe.
588
587 Oncologic and Reproductive Results in Conservative Surgery for Ovarian Low Malignant Potential Tumours Martinez-Serrano MJ, Siso C, Gonzalez-Foruria I, Fuste P, MartinezRoman S, del Pino M, Alonso I, Torne A, Pahisa J. Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clinic-University of Barcelona, Barcelona, Spain Study Objective: To describe the oncologic and reproductive results in young patients who underwent laparoscopic surgery for ovarian low malignant potential (LMP) tumours.
Laparoscopic Surgery Versus Laparotomy in the Management of Early Endometrial Cancer: Long-Term Follow-Up Outcomes Park S-M, Park J-Y, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H. Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea Study Objective: To compare the operative and survival outcomes between laparoscopic surgery and laparotomy in early endometrial cancer. Design: In this retrospective study, we reviewed medical records for patients admitted from Jan 1997 to Dec 2009. Median follow-up time was 52 months. Setting: Department of Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea.