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6.
Clinics ; 74: e1218, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019711

ABSTRACT

OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Vulvar Neoplasms/surgery , Wound Healing , Carcinoma, Squamous Cell/surgery , Surgical Wound/therapy , Pilot Projects , Reproducibility of Results , Risk Factors , Treatment Outcome , Wound Closure Techniques , Surgical Wound/pathology
8.
Clinics ; 73(supl.1): e522s, 2018. tab
Article in English | LILACS | ID: biblio-952829

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach. METHODS: In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS: The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery. CONCLUSIONS: Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.


Subject(s)
Humans , Female , Middle Aged , Aged , Endometrial Neoplasms/surgery , Laparoscopy/methods , Robotic Surgical Procedures/methods , Prospective Studies , Treatment Outcome , Laparoscopy/economics , Laparoscopy/adverse effects , Perioperative Period , Operative Time , Robotic Surgical Procedures/economics , Robotic Surgical Procedures/adverse effects , Length of Stay
9.
Clinics ; 72(1): 30-35, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-840034

ABSTRACT

OBJECTIVES: To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy. METHODS: A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis. RESULTS: Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%. CONCLUSION: Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.


Subject(s)
Humans , Female , Adult , Aged , CA-125 Antigen/blood , Endometrial Neoplasms/pathology , Lymphatic Metastasis/diagnosis , Endometrial Neoplasms/surgery , Lymph Node Excision , Lymphatic Metastasis/prevention & control , Neoplasm Invasiveness , Predictive Value of Tests , Retrospective Studies , Risk Factors
10.
Rev. bras. ginecol. obstet ; 39(1): 35-39, Jan. 2017. graf
Article in English | LILACS | ID: biblio-843902

ABSTRACT

ABSTRACT Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.


RESUMO A cirurgia robótica para carcinoma do colo do útero apresenta vantagens quando comparada com cirurgias laparotômicas ou laparoscópicas. A cirurgia robótica de portal único tem muitas vantagens quando comparada com cirurgias de múltiplos acessos, porém a segurança e a viabilidade deste procedimento ainda não estão estabelecidas para cirurgias oncológicas radicais. Apresentamos um caso de carcinoma de colo do útero, tratado por histerectomia radical, identificação e biópsia de linfonodo sentinela e linfadenectomia pélvica realizada totalmente por cirurgia robótica de acesso único. A paciente recuperou-se bem e recebeu alta no primeiro dia pós-operatório.


Subject(s)
Humans , Female , Adult , Hysterectomy/methods , Robotic Surgical Procedures , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , Sentinel Lymph Node Biopsy/methods
12.
Clinics ; 70(7): 470-474, 2015. tab
Article in English | LILACS | ID: lil-752400

ABSTRACT

OBJECTIVE : The aim of this study was to determine the lymph node status in a large cohort of women with endometrial cancer from the public health system who were referred to an oncology reference center in Brazil to identify candidates for the omission of lymphadenectomy based on clinicopathological parameters. METHODS : We retrospectively analyzed a cohort of 310 women with endometrial cancer (255 endometrioid, 40 serous, and 15 clear cell tumors) treated between 2009 and 2014. We evaluated the histological type, grade (low vs. high), tumor size (cm), depth of myometrial invasion (≤50%, >50%) and lymphovascular space invasion to determine which factors were correlated with the presence of lymph node metastasis. RESULTS : The factors related to lymph node involvement were tumor size (p=0.03), myometrial invasion (p<0.01), tumor grade (p<0.01), and lymphovascular space invasion (p<0.01). The histological type was not associated with the nodal status (p=0.52). Only twelve of 176 patients (6.8%) had low-grade endometrioid carcinoma, tumor size ≤2 cm and <50% myometrial infiltration. CONCLUSIONS : The omission of lymphadenectomy based on the histological type, grade, tumor size and depth of myometrial invasion is not likely to have a large impact on the surgical treatment of endometrial cancer in our population because most patients present with large and advanced tumors. New strategies are proposed that prioritize hysterectomy performed in a general hospital as soon as possible after diagnosis, followed by an evaluation of the need for lymph node dissection at a reference center. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Endometrial Neoplasms/surgery , Lymph Node Excision/methods , Brazil , Endometrial Neoplasms/pathology , Hysterectomy , Lymph Nodes/pathology , Retrospective Studies
13.
Clinics ; 67(5): 437-441, 2012. graf, tab
Article in English | LILACS | ID: lil-626338

ABSTRACT

OBJECTIVE: Differentiation between benign and malignant ovarian neoplasms is essential for creating a system for patient referrals. Therefore, the contributions of the tumor markers CA125 and human epididymis protein 4 (HE4) as well as the risk ovarian malignancy algorithm (ROMA) and risk malignancy index (RMI) values were considered individually and in combination to evaluate their utility for establishing this type of patient referral system. METHODS: Patients who had been diagnosed with ovarian masses through imaging analyses (n = 128) were assessed for their expression of the tumor markers CA125 and HE4. The ROMA and RMI values were also determined. The sensitivity and specificity of each parameter were calculated using receiver operating characteristic curves according to the area under the curve (AUC) for each method. RESULTS: The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively. Among carcinomas, the sensitivities of CA125, HE4, ROMA (pre-and post-menopausal), and RMI were 93.5%, 87.1%, 80%, 95.2%, and 87.1%, respectively. The most accurate numerical values were obtained with RMI, although the four parameters were shown to be statistically equivalent. CONCLUSION: There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses. RMI had the lowest sensitivity but was the most numerically accurate method. HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis. All of the parameters demonstrated increased sensitivity when tumors with low malignancy potential were considered low-risk, which may be used as an acceptable assessment method for referring patients to reference centers.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Young Adult , Algorithms , /analysis , Ovarian Neoplasms/diagnosis , Proteins/analysis , Referral and Consultation/standards , Biomarkers, Tumor/analysis , Endometriosis/diagnosis , Prospective Studies , Risk Assessment , Sensitivity and Specificity
14.
Clinics ; 66(1): 73-76, 2011. ilus, tab
Article in English | LILACS | ID: lil-578599

ABSTRACT

INTRODUCTION: Serous carcinomas are the most frequent histologic type of ovarian and peritoneal cancers, and can also be detected in the endometrium and fallopian tubes. Serous carcinomas are usually high-grade neoplasms when diagnosed, yet the identification of an associated precursor lesion remains challenging. Pathological examination of specimens obtained from prophylactic bilateral salpingo-oophorectomies that were performed for patients harboring BRCA1/2 mutations suggests that high-grade serous carcinomas may arise in the fallopian tubes rather than in the ovaries. OBJECTIVE: To investigate the presence and extent of fallopian tube involvement in cases of serous pelvic carcinomas. METHODS: Thirty-four cases of serous pelvic carcinoma with clinical presentations suggesting an ovarian origin were analyzed retrospectively. Histologic samples of fallopian tube tissues were available for these cases and were analyzed. Probable primary site, type of tubal involvement, tissues involved in the neoplasia and vascular involvement were evaluated. RESULTS: Fallopian tube involvement was observed in 24/34 (70.6 percent) cases. In 4 (11.8 percent) of these cases, an intraepithelial neoplasia was present, and therefore these cases were hypothesized to be primary from fallopian tubes. For an additional 7/34 (20.6 percent) cases, a fallopian tube origin was considered a possible primary. CONCLUSIONS: Fallopian tubes can be the primary site for a subset of pelvic high-grade serous carcinomas.


Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Young Adult , Carcinoma/pathology , Fallopian Tube Neoplasms/etiology , Fallopian Tubes/pathology , Ovarian Neoplasms/pathology , Pelvic Neoplasms/pathology , Diagnosis, Differential , Fallopian Tube Neoplasms/pathology , Genes, BRCA1 , Retrospective Studies
16.
Rev. ginecol. obstet ; 15(4): 229-233, nov. 2004.
Article in Portuguese | LILACS | ID: lil-400623

ABSTRACT

O estado dos linfonodos é o mais importante fator prognóstico no câncer de mama. A retirada e o estudo dos linfonodos axilares são procedimentos consagrados no plano de tratamento da maioria dos tumores malignos da mama. Entretanto, a linfadenectomia sistemática acompanha-se de considerável morbidade funcional...


Subject(s)
Humans , Female , Lymph Node Excision , Breast Neoplasms/pathology , Sentinel Lymph Node Biopsy , Prognosis
17.
Rev. ginecol. obstet ; 15(4): 234-237, nov. 2004. tab
Article in Portuguese | LILACS | ID: lil-400624

ABSTRACT

Os autores discorrem sobre as limitações da ecografia transvaginal na diferenciação de tumores ovarianos benignos de malignos. O advento da técnica Doppler nas suas modalidades colorida, pulsátil e de amplitude têm melhorado esta situação, embora, seu valor preditivo dependa diretamente da seleção dos parâmetros do Doppler(valor do cutt-off para índice de resistência, escolha dos vasos, etc), da experiência do ecografista e da sensibilidade do equipamento utilizado...


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Ovarian Neoplasms , Neovascularization, Pathologic , Ultrasonography, Doppler , Diagnosis, Differential , Sensitivity and Specificity
18.
Rev. bras. mastologia ; 14(3): 102-106, jul.-set. 2004. ilus, tab
Article in Portuguese | LILACS | ID: lil-410624

ABSTRACT

A cicatriz radiada (CR) é uma entidade de patogênese pouco clara, com apresentação morfológica comum a alguns papilomas e adenoses esclerosantes, o que nos motivou a verificar a real associação entre essas lesões e a sua possível relação com lesões precursoras do câncer mamário e carcinomas. Estudamos retrospectivamente 532 espécimes mamários. O diagnóstico de CR foi feito em 54 (10,1 por cento) casos, 27 (50 por cento) dos quais associados à lesão papilífera; 38 (70 por cento), à adenose esclerosante; e 43 (79,6 por cento), a pelo menos uma dessas lesões (p<0,001). O diagnóstico de hiperplasia atípica foi mas freqüente nos espécimes com CR (25,9 por cento x 8,8 por cento) (p=0,005). Embora os casos com CR apresentassem maior freqüência de associação com carcinoma in situ ou invasivo (35,2 por cento x 26,6 por cento), essa combinação não foi significante. A união da CR com as lesões papilíferas e esclerosantes sugere provável relação etiopatogênica e a possibilidade de que representem estádios evolutivos do mesmo processo. A maior probabilidade de achado de lesões proliferativas epiteliais intraductais atípicas em espécimes com CR reforça a necessidade de ampliação cirúrgica por ocasião desse diagnóstico em biópsias por agulha grossa, sugerindo que a CR possa, per se, representar lesão de risco, eventualmente relacionadas às já conhecidas


Subject(s)
Humans , Female , Adult , Middle Aged , Biopsy, Needle , Breast Neoplasms , Carcinoma , Cicatrix , Breast Diseases/pathology , Retrospective Studies , Sclerosis
19.
Rev. ginecol. obstet ; 15(2): 84-88, abr.-jun. 2004. ilus, graf
Article in Portuguese | LILACS | ID: lil-385140

ABSTRACT

Estudo retrospectivo conduzido em 40 pacientes com carcinoma escamoso do colo uterino tratadas com radioterapia exclusiva com o objetivo de avaliar a angiogênese como fator preditivo de recidiva. As pacientes foram tratadas em nosso serviço no período entre 1985 e 1991 e têm seguimento médio...


Subject(s)
Humans , Female , Adult , Middle Aged , Carcinoma, Squamous Cell/radiotherapy , Neoplasm Recurrence, Local , Neovascularization, Pathologic , Immunohistochemistry , Prognosis , Retrospective Studies , Uterine Cervical Neoplasms
20.
Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo ; 59(3): 128-130, June 2004. ilus
Article in English | LILACS | ID: lil-363371

ABSTRACT

Torção anexial pode ocorrer em crianças e adolescentes do sexo feminino. Frequentemente está associada com doenças ovarianas que resultam em crescimento da gônada. A torção anexial pode comprometer os ovários isoladamente, as tubas uterinas ou ambos e o sintoma principal é dor pélvica aguda. Descrevemos um caso de dor pélvica aguda em uma menina de 8 anos de idade, com diagnóstico prévio de puberdade precoce e que estava em tratamento com análogo de GnRH. O exame ultra-sonográfico demonstrava útero de tamanho normal com ovários aumentados bilateralmente e múltiplos cistos. Na laparotomia foi encontrado torção completa do anexo direito. O exame histológico demonstrou edema maciço de ovário associado com múltiplos cistos antrais e redução da reserva folicular.


Subject(s)
Child , Female , Humans , Adnexal Diseases/chemically induced , Fertility Agents, Female/adverse effects , Fibrous Dysplasia, Polyostotic/complications , Leuprolide/adverse effects , Puberty, Precocious/drug therapy , Adnexal Diseases/pathology , Adnexal Diseases/surgery , Fertility Agents, Female/therapeutic use , Fibrous Dysplasia, Polyostotic/diagnosis , Leuprolide/therapeutic use , Torsion Abnormality/chemically induced , Torsion Abnormality/pathology , Torsion Abnormality/surgery
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