ABSTRACT
Endometrial cancer is a tumor associated with a good prognosis as it is often diagnosed at an early stage. Up to 20 % of patients with stage I disease have a nodal involvement. Knowledge of nodal status provides important prognostic information. As preoperative assessment yields a poor value, prognostic lymphadenectomy appears to be indicated. However, therapeutic benefit of pelvic and para-aortic lymphadenectomy remains controversial. Recent randomized trials did not find any impact on survival for patients with low risk of nodal involvement. Thus, lymphadenectomy should no more be systematically performed in this low risk group. Nevertheless, pelvic and para-aortic lymphadenectomy seems to have a benefit in the high risk group, as isolated involved para-aortic nodes have been described.
Subject(s)
Carcinoma, Endometrioid/mortality , Carcinoma, Endometrioid/surgery , Endometrial Neoplasms/mortality , Endometrial Neoplasms/surgery , Lymph Node Excision , Female , Humans , Prognosis , Randomized Controlled Trials as TopicABSTRACT
The development of gynaecologic laparoscopic surgery has also spread into some areas of the pelvic cancer surgery. Nevertheless, in France, less than 5% of interventions for endometrial cancer are currently performed by laparoscopy. As compared with laparotomy, laparoscopy, which is equally effective, provides per- and postoperative benefits, with comparable recurrence and survival rates. Operators' training seems to be the most significant limitation to the development of laparoscopy in the surgical treatment of early endometrial cancer.
Subject(s)
Endometrial Neoplasms/pathology , Endometrial Neoplasms/surgery , Laparoscopy , Female , Humans , Neoplasm Recurrence, Local , Quality of LifeABSTRACT
OBJECTIVE: To assess the satisfaction and recovery of women undergoing sterilization with a permanent birth control device (Essure micro-insert). PATIENTS AND METHODS: French multicenter survey carried out in 12 public and private hospitals. One thousand and thirty-two patients undergoing permanent hysteroscopic sterilization (Essure micro-insert) between 2002 and 2006 were enrolled. An anonymous satisfaction questionnaire was sent to all patients. Demographic data as well as the level of tolerance and acceptability of the procedure were analyzed. Seven hundred and two (68%) patients responded to the questionnaire. RESULTS: Forty-five percent of all procedures were done without anaesthesia, and 55% under local or general anaesthesia or neuroleptanalgesia. Mean age was 42 years. Sterilization was a personal decision in 62% of cases. Only one out of three women (33%) was informed of the law of sterilization's legalization. Patients came to know about this procedure by their gynecologist (74%), or by media (14%). Eighty-four percent of patients considered the level of tolerance during the procedure from no pain to moderate pain. The method without anesthaesia is described painless in 24% of cases when the surgeon has done more than 50 procedures versus 11% when he has done less than 50 (P = 0.012). Seventy-seven percent of patients were appreciative of following the procedure on the monitor screen. Patients returned to everyday life within 24 h in 90% of cases, whereas 24 h return to work was attained in 75%. The procedure without general anesthesia offered a quicker return to work (80% within 24 h) than the procedure carried out with general anesthesia (59%, P < 0.05). The memory of the procedure was described as "very good" to "acceptable" in 96% of cases. Most of the patients (98%) would recommend this procedure to their friends. DISCUSSION AND CONCLUSION: The results of this national survey confirm that hysteroscopic sterilization is associated with good overall satisfaction, because it is a fast, easy and safe method of permanent sterilization with good levels of tolerance and immediate recovery. The technique without anaesthesia is now recommended. Its tolerance is improved with surgeon's experience.
