Laparoscopy in the treatment of cancer of the corpus uteri in patients with metabolic syndrome. A case report

Today, the common term metabolic syndrome encompasses visceral (abdominal) obesity, glucose intolerance, type 2 diabetes mellitus (DM), hypertension, and dyslipidemia. In Europe, the rate of obesity mong the women ranges from 6 to 36 %. In the USA, 65 % of the adult population is overweight and 30 % is obese. High estrogen production in adipose tissue in patients with obesity has been established to increase the risk of cancer of the corpus uteri (CCU) by 4 times as compared to that in normal weight female patients. Furthermore, obese patients are at increased risk for DM that is also a risk factor for CCU. A rise in the number of obese patients leads to the population redistribution of gynecological cancer. The increasing number of patients with gynecological cancer is overweight. This patient group has an increased risk from surgery and anesthesia, a higher incidence of postoperative complications, and delayed recovery. Laparotomy increases the duration of hospital stay and the rate of wound complications. The frequency of urologic injuries in obese patients varies between 2 and 4 %. In this patient category, the rate of damage to the large vessels or bowels has also statistically significant differences. The literature highlights a number of complications specific to patients with obesity: trocar damage to anterior abdominal wall vessels, particularly to the inferior epigastric artery, urinary bladder, as well as trocar site hernia. The authors describe their experience in treating CCU patients with metabolic syndrome at the Department of Surgery for Female Reproductive System Tumors, N. N. Blokhin Russian Cancer Research Center. They demonstrate that laparoscopic extirpation of the uterus and its appendages can be performed in patients with third-degree obesity (weighing 174 kg) in Stage I CCU. It should be noted that this weight was previously regarded as an absolute contraindication to surgical treatment. Today, the active introduction of laparoscopic techniques into gynecological oncology and the improvement of anesthetic maintenance make it possible to virtually level off a contraindication to surgery, such as obesity, and to transfer it to a class of indications. An examination algorithm and the clinical features of the disease are given

Video-assisted surgery in the treatment of early corpus uteri cancer

The immediate and late results of surgical treatment were assessed in patients with early corpus uteri cancer (CUC), by applying endo- scopic procedures. The paper gives comparative data on 2 comparable groups of patients with Т1-2N0М0 CUC, who have undergone laparoscopic (n=47) or open-access (n=50) surgery. The comparative analysis has demonstrated the advantages of an endoscopic technique over a laparotomic access in its immediate results, the duration of surgical intervention, the volume of intraoperative blood loss, the pattern and incidence of complications, the reduction in the length of hospital stay, and its cosmetic effect. The patients were found to have better quality of life after laparoscopic extirpation of the uterus. Overall and relapse-free survival rates were comparable in the two groups and did not depend on the technique of surgical intervention

CO₂ laser in the diagnostics of resection margins in breast tumors

To diagnostics of the evaporation of tumor tissue by radiation of single-mode medical CO2 laser is proposed a laser Doppler diagnostic method based on autodyne detection (reception on a laser resonator) of backscattered radiation from the evaporation zone. Intraoperative diagnostics of laser tissue evaporation lets surgeon to determine in real time tumour margins and evaporate it without additional normal tissue traumatization. The sensitivity limits of the method were studied on samples of malignant and benign tumors of breast together with plots of healthy tissue in vitro. It was shown that areas of tumor tissue are well determined by the autodyne method in 80 % of cases

Laparoscopic surgery in treatment of patients with endometrial cancer and obesity

The paper evaluates the role and place of laparoscopic surgery in treatment of patients with endometrial cancer and obesity. It describes the types of similar operations: laparoscopic hysterectomy ± pelvic lymphadenectomy. Overall and disease-free survival is reported to be the same with both laparoscopy and open surgery

SENTINEL LYMPH NODES IN ENDOMETRIAL CANCER

Endometrial cancer (EC) typically is treated surgically. Because of the adjuvant treatment implications, complete surgical staging including lymphadenectomy is recommended for high-risk ECs. Sentinel lymph node mapping has the potential to provide information about lymph node metastasis while avoiding potential complications of extended lymph node dissection

LAPAROSCOPIC SURGERY ON UTERUS AND ITS APPENDAGES IN PATIENTS WITH BREAST CANCER

One of the components of pathogenetic treatment of patients with breast cancer is castration. The aim of research is to investigate the significance of video assisted laparoscopic surgery on female reproductive organs in the treatment of breast cancer patients. The study is based on analysis of treatment results of 320 breast cancer patients with noncompromised menstruation and presence of steroid hor- mone receptors in tumor tissue. In comparison to surgical techniques used earlier, video assisted endoscopic surgery allows to decrease the aggressiveness of operation, accelerate the rehabilitation of patients, and lower the length of hospital stay. Radiation castration is not always effective: menstruation recovered in some patients. Besides, radiotherapy can not be recommended for patients with patho- logically transformed ovaries. Chemical castration with Zoladex or other analogous drugs is inaccessible for most patients in Russia