ABSTRACT
OBJECTIVE: Several controversies remain on conservative management of cervical cancer. Our aim was to develop a consensus recommendation on important and novel topics of fertility-sparing treatment of cervical cancer. METHODS: The consensus was sponsored by the Brazilian Society of Surgical Oncology (BSSO) from March 2020 to September 2020 and included a multidisciplinary team of 55 specialists. A total of 21 questions were addressed and they were assigned to specialists' groups that reviewed the literature and drafted preliminary recommendations. Further, the coordinators evaluated the recommendations that were classified by the level of evidence, and finally, they were voted by all participants. RESULTS: The questions included controversial topics on tumor assessment, surgical treatment, and surveillance in conservative management of cervical cancer. The two topics with lower agreement rates were the role of minimally invasive approach in radical trachelectomy and parametrial preservation. Additionally, only three recommendations had <90% of agreement (fertility preservation in Stage Ib2, anti-stenosis device, and uterine transposition). CONCLUSIONS: As very few clinical trials have been developed in surgery for cervical cancer, most recommendations were supported by low levels of evidence. We addressed important and novel topics in conservative management of cervical cancer and our study may contribute to literature.
Subject(s)
Fertility Preservation , Surgical Oncology , Trachelectomy , Uterine Cervical Neoplasms , Brazil , Consensus , Female , Humans , Neoplasm Staging , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgeryABSTRACT
BACKGROUND: Approximately 70% of cancer-related deaths occur in low- and middle-income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. METHODS: The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSIONS: It is possible to provide adequate treatment for most EC patients in resource-limited areas, but the first option should be referral to specialized centers with more resources.
Subject(s)
Developing Countries , Endometrial Neoplasms/surgery , Health Services Accessibility , Brazil , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Continuity of Patient Care , Diagnostic Imaging , Endometrial Neoplasms/pathology , Female , Fertility Preservation , Humans , Hysterectomy , Lymph Node Excision , Neoplasm Recurrence, Local/therapy , Neoplasm Staging , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/therapy , Physical Examination , Referral and Consultation , Sentinel Lymph Node Biopsy , Societies, MedicalABSTRACT
Relato de caso de uma paciente de 54 anos, sem queixas e sem alterações ao exame físico, realizou ultra-sonografia pélvica rotineira que mostrou cisto complexo em ovário direito, confirmado àtomografia. A dosagem sérica de CA125 estava elevada, enquanto os outros marcadores tumorais-antígeno carcinoembriogênico,alfa-fetoproteína, e a fração beta da gonadotropina coriônica estavam normais. A abordagem diagnóstica e terapêutica foi feita por meio de videolaparoscopia, com observação de lesões vegetantes em ambos os ovários, sem outras alterações. As massas tumorais foram biopsiadas e analisadas por técnica de congelação intraoperatória, sendo constatada neoplasia serosa de baixo potencial de malignidade - borderline. A seguir, foi realizado estadiamento para carcinoma ovariano, segundo norma preconizada pela Federação Internacional de Ginecologistas e Obstetras: salpingo oforectomia bilateral, histerectomia total, linfadenectomia pélvica bilateral e paraaórtica. Para completar o estadiamento, foi realizada a omentectomia por meio de corte transversal de 4 cm no epigástrio, dilatado com um afastador especial - Protractor®, a incisão também possibilitou a remoção das peças cirúrgicas. A paciente teve alta hospitalar no dia seguinte à cirurgia, evoluindo sem complicações. A análise histológica confirmou o tumor tipo borderline e não encontrou células malignas nas outras peças cirúrgicas removidas. A videolaparoscopia, uma minilaparotomia, e a utilização de um afastador especial permitiram o adequado diagnóstico, estadiamento e remoção de tumor ovariano localizado.
