ABSTRACT
La cirugía mínimamente invasiva (CMI) en el manejo de las neoplasias ginecológicas se ha incrementado considerablemente en la última década. La posibilidad de realizar los procedimientos quirúrgicos necesarios para tratar el cáncer ginecológico ha mejorado el cuidado y la calidad de vida de las pacientes. En el presente artículo se revisa las innovaciones en CMI y se discute las aplicaciones así como la experiencia del Instituto Nacional de Enfermedades Neoplásicas de Perú en el manejo del cáncer de cérvix, endometrio y ovario.
Minimally invasive surgery in the management of gynecologic malignancies has increased considerably in the last decade. The ability to perform minimally surgical procedures has revolutionized care and quality of life outcomes for patients. In this article, we review innovations in minimally invasive surgery and its applications are discussed as well as the experience at National Institute of Neoplasic Diseases of Peru in the treatment of cervical, endometrial and ovarian cancer.
ABSTRACT
OBJECTIVE: The treatment of intraepithelial neoplasia and microinvasive cervical cancer ranges from local destruvtive methods to total hysterectomy. The conservative treatment has increased as more lesions are being detected in young women. METHODS: This study was designed to compare the 112 microinvasive cervical cancer treatment reliability, efficacy, and safety of cold knife conization (23), electric conizer (31), and largr loop (58). RESULTS: The mean age for cold cone, conizer, and LEEP were 41.1, 41.4, and 42.2 years old. The parity for cold cone, conizer and LEEP were 3.1, 2.1, and 2.7 siblings. Resection margine involved pathologic finding were 47.8%, 54.8%, and 74.1% (P<0.05). After hysterectomy, residual disease for cold cone, conizer and LEEP were 1, 24, and 30 cases CONCLUSION: The results suggest that LEEP is quicker, safer, and lower cost than cold knife conization for the management of cervical intraepithelial neoplasia and micro invasive cancer.
Subject(s)
Female , Humans , Uterine Cervical Dysplasia , Conization , Hysterectomy , Parity , Siblings , Uterine Cervical NeoplasmsABSTRACT
331 patients of stage IIb uterine cervix cancer treated by radiation alone at Kosin Medical Center between June 1980 and Dec. 1985 were analysed to determine parameters of radiotherapy associated to disease states. Survival rate was highest among the reported (82.8% for crude and 82.4% for disease free survival). Pelvic control rate in 6 weeks after the end of radiotherapy was 93.6% in the patients treated with ICR following total pelvic radiation and 71.6% with small field additional external irradiation. 5 year survival rate in those who achieved pelvic control was 98. 9% and 12.9% in those who had pelvic failure and/or metastasis after radiation. The survival rate figured maximal 88.5% with dosage of 7500~8500 cgy to point A with acceptable incidence of complications (4.9%) but without increasing survival above it and minimal 74.1% with dosage of less than 6500 cgy. The treatment failure was counted 18.7% (62 of 331 patients): Local failure 72. 6% ( 45 of 62 patients), locoregional failure 3.2% (2 of 62 patients) and distant failure 24% (15 of 62 patients). Late complications were found In 50 patients (15.1%) and 42% of them was rectal bleeding and stenosis. The dose of 8500 cgy to point A was found to be critical for complication and 70% of complications occurred above it and was more serious one such as fistula. Rectal complications were developed above rectal dose 6500 cgy and bladder complication above bladder dose 7500 cgy. Major cause of death was cachexia due to locoregional failure (73.7% of death), next was due to metastasis to lung, liver and bone, and only 3 patients died of complication of intestinal perforations and obstruction. In conclusion higher external radiation dose for a bulky uterine cervix and barrel shaped uterus was essential for local control.