Evaluation of serum levels of soluble (s)L- and (s)P-selectins in endometrial cancer.

OBJECTIVES: A number of reports on the role of selectin in the process of carcinogenesis, at the stage of proliferation and metastasis, have been available. The aim of the study was to analyze (s)P- and (s)L-selectin serum concentrations in women with EC and to compare these concentrations to clinical/pathological parameters and disease progression using surgical-pathological staging data. MATERIAL AND METHODS: A total of 46 patients with EC and 50 healthy controls were included in the study. Serum concentrations of sL- and sP-selectins were measured in all participants. The oncologic protocol was implemented in all women from the study group. RESULTS: Significantly higher serum concentrations were found in EC women as compared to controls. No statistically significant differences were found between the concentrations of the soluble forms of selectins and the following parameters: histologic type of EC, histologic tumor differentiation, depth of myometrial infiltration, cervical involvement, distant metastases, vascular space invasion, and disease advancement. Slightly higher (s)P-selectin concentrations were observed in serous carcinoma, in women with cervical involvement, in the sera of women with vascular space invasion and with advanced stages of the disease. Slightly higher mean (s)P-selectin concentrations correlated with lower differentiation of the tumor. Slightly higher mean (s)P-selectin concentration was detected in the sera of women with lymph node metastases and with the serosal and/or adnexal involvement. The results were statistically insignificant, but they almost reached statistical significance. CONCLUSIONS: L- and P-selectins play a role in the biology of EC. The absence of an unambiguous relationship between differences in (s)L- and (s)P-selectin levels and disease advancement suggests that they do not play a vital role in tumor progression in endometrial cancer.

[Rectovaginal endometriosis--analysis of 160 cases]. / Endometrioza przestrzeni odbytniczo-pochwowej--analiza 160 przypadków.

OBJECTIVES: The aim of the study was a retrospective analysis of the medical records of patients who underwent surgery due to deep infiltrating rectovaginal endometriosis (mainly with the use of the 'shaving' technique). MATERIAL AND METHODS: We analysed 160 cases of patients who underwent surgery due to the deep infiltrating rectovaginal endometriosis in our ward between 2003-2014. Depending on lesion localization, disease severity and clinical characteristics, three possible ways of operation were proposed: laparoscopic, vaginal or a combined vagino-laparoscopic approach. RESULTS: A total of 120 patients underwent laparoscopic removal of the endometrial lesions, whereas 17 were operated vaginally and 23 with the use of the combined approach. Nodule resection was successfully performed in all cases. The combined vagino-laparoscopic operations were characterized by the longest operating time. The rate of perioperative complications was low in the group of patients who underwent laparoscopic or combined operations. The necessity of bowel wall suturing occurred in 15 cases. This procedure was performed in order to strengthen the bowel wall (in cases when no perforation occurred) or due to bowel resection during surgery. Unexpected bowel perforation occurred in only 5 cases. Conclusions: Vaginal, laparoscopic and the combined vagino-laparoscopic surgeries can be safely performed in cases of deep rectovaginal endometriosis.

[Evaluation of safety and effectiveness of pelvic organ prolapse treatment with the use of polypropylene mesh depending on mesh and application technique]. / Ocena bezpieczenstwa i wczesnych wyników leczenia zaburzen statyki narzadów plciowych (ZSNP) w zaleznosci od rodzaju zastosowanej siatki i techniki jej zakladania.

OBJECTIVES: Evaluation of safety and effectiveness of POP (pelvic organ prolapse) treatment with the use of polypropylene mesh depending on type of mesh and application technique. MATERIALS AND METHODS: We carried out a retrospective study and compared the frequency of perioperative complications and treatment results three months after the surgical procedure in two groups of patients, divided according to POP type. The first group comprise of patients with anterior compartment disorders who had Prolift Anterior (n = 100) or Pelvimesh Anterior (n = 98) placed. The second group included patients with posterior and central compartment who had Prolifit Posterior (n = 72) and Pelvimesh Posterior (n = 89) fitted. Early peri- and postoperative complications criteria were: profuse intraoperative bleeding (hemoglobin decrease of 3g%), intraoperative damage of urinary bladder and bowel, presence of hematoma in paravesical and perirectal space, urine retention after miction on the second day after the operation (> 100 ml), uroschesis after catheter removal, early operative failure (during 3 months after the operation), mesh erosion. RESULTS: No statistically significant differences in peri- and postoperative complications were reported between the studied groups (Pelvimesh vs. Prolift). No damage of urinary bladder or bowel was found in any of the studied groups. Other complications in Prolift Ant. Vs. Pelvimesh Ant groups were: postoperative anemia (4.00% vs. 4.09%); presence of hematoma (1.00% vs. 1.03%); postoperative urine retention (7.00% vs. 5.11%); uroschesis (1.00% vs. 1.03%); mesh erosion (2.00% vs. 1.03%); early operative failure (1.00% vs. 3.07%). Early postoperative results did not statistically differ between the Pelvimesh and the Prolift group. Results in the Prolift Post. vs. Pelvimesh Post. Groups were: postoperative anemia (2.78% vs. 5.62%); mesh erosion (1.38% vs. 0%), early operative failure (1.38% vs. 5.62%). Damage to bowel and hematoma was not observed in these groups. CONCLUSIONS: Our research failed to observe an advantage of any of the ready POP treatment kits. Despite application of different systems for mesh placement and pulling the arms through ligaments (either obturator foramen or sacrospinous ligament), no statistically significant differences were demonstrated with regard to the occurrence of early peri- and postoperative complications or efficiency in POP treatment in Prolift Anterior vs. Pelvimesh Anterior and Prolift Posterior vs. Prolift Pelvimesh groups.

Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers.

OBJECTIVES: The study was conducted to evaluate the efficacy feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer MATERIAL AND METHODS: The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity duration of the surgery blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay uterine volume, grade, stage of endometrial cancer (FIGO), and intra/ postoperative complications. RESULTS: Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p = 0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p = 0,032). There were no significant differences between both group in the history of previous laparotomies (p = 0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p = 0.003). Laparotomy was associated with greater blood loss during surgery Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values.: Hb-1.1 7 g/dl, Hct-3.49% for the TLH technique and Hb-7.8 g/dl Hct-5.47% for laparotomy; p = 0.011-Hb; p = 0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy--4 and 9 days, respectively (p = 0,0001). The influence of the operational technique on the number of pelvic lymph nodes taken for histopathological examination was evaluated. No statistically significant correlation between the number of lymph nodes taken for histopathological examination during the surgery and the operational technique was noted (p = 0.083). Mean number of nodes taken for examination was 15 during the TLH surgery and 19 during laparotomy Postoperative complications were observed in 2 patients from the TLH and in 12 patients from the laparotomy groups (p = 0.038). The most statistically significantly frequent complication in the laparotomy group was postoperative wound infection: 8 (19.05%) patients. CONCLUSIONS: Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.

[Total laparoscopic hysterectomy--indications and complications of 158 patients]. / Calkowite laparoskopowe wyciecie macicy--wskazania i powiklania u 158 pacjentek.

INTRODUCTION: Hysterectomy is one of the most common gynecological procedures. Development of modern laparoscopic techniques made it a crucial tool in contemporary gynecology both in diagnosis and treatment. Increasing experience and improved laparoscopic instruments enabled gynecologists to extend indications for laparoscopic procedures as well as the range of the operation itself. AIMS: 1) to present data (particularly perioperative) of patients who underwent laparoscopic hysterectomy 2) to analyze various information including: indication for the procedure, surgery duration, evaluation of different parameters like: volume of the excised uterus, postoperative HB and HCT drop, length of hospital stay as well as short- and long-term complications. MATERIAL AND METHODS: The analysis included peri- and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Indication for hysterectomy and duration of operation were analyzed. Uterine volume, postoperative HB and HCT drop, time of hospital stay and complications were evaluated. In the study a description of the method of laparoscopic hysterectomy was presented. RESULTS: Mean time of procedure was 68 min. (58-135 min.). Basing on operational protocols, the time of operation was measured from the moment laparoscopy started until the patient was fully awake after anesthesia. No adjustments were made for longer anesthetic recovery period. Estimated blood loss was 166.6 ml. Mean HB drop was 1.29 g/dl (0, 1-3 g/dl). Mean volume of the excised uterus was 108.24 cm3 (25.27-440.86 cm3). In 44 patients (27.84%) bilateral salpingo-oophorectomy was performed. In 4 cases (2.53%) there was an indication for postoperative antibiotics. None of the patients required blood transfusion or conversion to open surgery or the need to re-operate. Mean hospital stay after the surgery was 2.9 days. Overall, only 2 patients suffered long-term complications (1.26%): three weeks after the surgery urethro-vaginal fistulas occurred due to thermal injury to the ureter. That complication was noted during the first year of using this technique. Between 2008 and 2011 that type of adverse effect was not reported. CONCLUSIONS: The analysis included perioperative and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Data suggest that patients benefit from this procedure which is safe, associated with short postoperative recovery time, minimal blood loss and low complication rate, as well as good plastic result. We recommend laparoscopic hysterectomy as an alternative to open hysterectomy in cases when it can be safely performed.