Surgical management of squamous cell vulvar cancer without clitoris, urethra or anus involvement

Vulvar cancers, which constitute 5% of all gynecologic cancers, are the fourth most common female genital cancers, preceded by uterine, ovarian and cervical cancers. The treatment methods employed for vulvar cancers have changed over the years, with previously applied radical surgical approaches, such as en bloc resection, being gradually suspended in favor of treatment approaches that require dissection of less tissue. While the removal of less tissue, which today's approaches have focused on, prevents morbidity, this method seems to result in higher risks of recurrence. It is therefore important that the balance between preventing the recurrence of the disease and forefending against postoperative complications and vulvar deformity be properly understood. As a working assumption, if patients with vulvar cancer are diagnosed at an early stage, properly evaluated and administered appropriate treatment, the most positive results can be obtained. This paper aims to highlight this assumption and demonstrate, through the provision of actual data, how to plan the treatment approach for patients who are diagnosed early. Statements extracted from the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2016 Sub-Committees on vulvar squamous cell carcinoma and articles by the European Society of Gynaecological Oncology (ESGO) regarding Vulvar Cancer Recommendations were used to obtain updated information

Histerektomide robotik veya laparoskopik yaklaşım: Operatif sonuçlar ve maliyet karşılaştırılması

Purpose: The present study aimed to compare surgical outcomes and cost analysis of robotic-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) hysterectomy procedures. Materials and Methods: The patients who underwent total robotic hysterectomy or total conventional laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy due to benign gynecological disorders such as uterine fibroid, abnormal uterine bleeding, endometrial hyperplasia, adenomyosis, persistent ovarian cysts, chronic pelvic pain were retrospectively evaluated. Results: A total of 80 women underwent RAS or CLS hysterectomy during the study period. The mean total operative time was 187 +/- 10 min. in RAS and 133 +/- 24 min. in CLS groups, respectively. The mean total cost of the RAS hysterectomy group was 17.710 TL, and CLS hysterectomy group was 7000 TL. Conclusion: Both CLS and RAS hysterectomies for benign gynecological indications are safe surgical procedures with negligible complication rates. RAS is a more expensive procedure compared to CLS.Amaç: Bu çalışma, robotik yardımlı cerrahi (RAC) ve geleneksel laparoskopik cerrahi (GLC) histerektomi prosedürlerinin cerrahi sonuçlarını ve maliyet analizini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: Uterin fibroid, anormal uterin kanama, endometrial hiperplazi, adenomiyozis, persiste eden over kistleri, kronik pelvik ağrı gibi benign jinekolojik bozukluklar nedeniyle bilateral salpingo-ooferektomi ile birlikte veya salpingo-ooferektomi olmaksızın total robotik histerektomi veya total konvansiyonel laparoskopik histerektomi uygulanan hastalar geriye dönük olarak değerlendirildi. Bulgular: Çalışma dönemi sırasında toplam 80 kadına RAC veya GLC histerektomi yapıldı. Ortalama toplam ameliyat süresi RAC ve GLC gruplarında sırasıyla 187 ± 10 dk. ve 133 ± 24 dk. idi . RAC histerektomi grubunun ortalama toplam maliyeti 17.710 TL ve GLC histerektomi grubunun 7000 TL idi. Sonuç: İyi huylu jinekolojik endikasyonlar için hem GLC hem de RAC histerektomiler ihmal edilebilir komplikasyon oranları ile güvenli cerrahi prosedürlerdir. Maliyetlerle ilgili olarak, RAC, GLC 'ye göre daha pahalı bir prosedürdür

The effect of omentectomy on the blood levels of adipokines in obese patients with endometrial cancer

Objective: To investigate the blood levels of adipokines in obese patients with endometrial cancer who have and have not undergone omentectomy. Methods: Between September 2017 and September 2019, the study recruited 54 patients with endometrial cancer. Measurements were taken of blood levels of human leptin, perilipin-1, adiponectin, adipolin, resistin, visfatin, and estrone preoperatively and postoperatively before adjuvant therapy or at the end of one month. The serum samples were separated by centrifugation for 10 mins at 3,000 revolutions/min, then stored at −80 °C until assay. Results: In this prospective study, a total of 54 endometrial cancer patients were analyzed in two separate groups according to the omentectomy status. Comprehensive staging surgery with omentectomy and without omentectomy was performed in 26 patients and 28 patients, respectively. The age, body mass index, body fat index, waist circumference, and skin thickness values of the patients with and without omentectomy were found to be similar. No statistically significant difference was determined between the patients with and without omentectomy in respect of the blood level of the adipokines measured preoperatively. A strong statistically significant correlation was determined between the pre and postoperative levels of Human Leptin (p = 0.002), perilipin-1(p = 0.001), adipolin (p < 0.001), adiponectin (p < 0.001), resistin (p = 0.001), visfatin (p < 0.001), and estrone (p = 0.004) (r = −0.43, −0.47, 0.75, 0.84, −0.47, - 0.58, −0.41, respectively) Conclusions: Omentectomy affected the postoperative blood levels of adipokines in obese patients with endometrial cancer. As omentectomy may have some positive effects on metabolism in these patients, it may be considered during endometrial cancer surgery due to the possible positive metabolic effects