Abordaje laparoscópico mediante puerto único versus técnica convencional en el tratamiento quirúrgico del cáncer de endometrio / Single port laparoscopic approach versus conventional technique in the surgical treatment of endometrial cancer

Objetivo: El objetivo de este estudio es comparar el abordaje laparoscópico convencional con el acceso por puerto único en el tratamiento quirúrgico del cáncer de endometrio. Materiales y métodos: Estudio retrospectivo sobre 36 pacientes, 18 operadas con técnica convencional y 18 con acceso por puerto único mediante una única incisión en la piel y 3 en la fascia, para la inserción de un trócar de 10mm y 2 de 5mm. Resultados: Se obtiene menor dolor postoperatorio (22,3% vs. 83,3%, p<0,001) y un mejor resultado estético (10 vs. 8, p=0,001) en el grupo de pacientes intervenidas por puerto único. El tiempo quirúrgico fue mayor en el grupo con técnica convencional (120 vs. 180min; p=0,027). En cuanto a estancia hospitalaria (2,5 vs. 2,5 días, p=0,69), pérdida sanguínea (1,15 vs. 1,25g/dl, p=1), número de ganglios extirpados (16,5 vs. 18; p=0,78) y complicaciones intra (0% vs. 5%, p=0,19) y posquirúrgicas (16,6% vs. 11,1%, p=0,63) no hubo diferencias significativas. Conclusión: El abordaje por puerto único es una técnica factible, segura y efectiva en el tratamiento del cáncer ginecológico, presentando una menor tasa de dolor postoperatorio y un mejor resultado estético.(AU)

Objective: The objective of this study is to compare conventional laparoscopy with transumbilical single-port access for the surgical treatment of endometrial cancer. Materials and methods: A retrospective study was performed with 36 patients, of whom 18 were operated using conventional laparoscopy, and 18 using a transumbilical single-port access (laparoendoscopic single-site surgery, or LESS) by making a single incision in the umbilical skin of 2-3cm, and 3 incisions in the fascia. One 10-mm trocar and two 5-mm trocars were inserted next to each other to access the abdominal cavity. Results: There were no statistical differences between groups in postoperative changes in haemoglobin concentration (1.15 vs. 1.25g/dL, P=1), hospital stay (2.5 vs. 2.5 days, P=.69), intraoperative complication rate (0% vs. 5%, P=.19), postoperative complications (16.6% vs. 11.1%, P=.63), number of pelvic lymph nodes (16.5 vs. 18, P=.78), and number of para-aortic lymph nodes (9 vs. 10, P=.64). Patients in the LESS group experienced less postoperative pain (22.3% vs. 83.3%, P<.001), and had a higher rate of satisfaction with the cosmetic results (10 vs. 8, P=.001). The median operating time was lower in the LESS group (120-180min, P=.027). Conclusion: Laparoendoscopic single-site surgery is a feasible, safety and effective technique for the treatment of endometrial cancer, with less postoperative pain and better cosmetic results.(AU)

Tumoraciones mesenquimales de músculo liso de potencial maligno incierto (STUMP): revisión de un caso clínico / No disponible

Las tumoraciones mesenquimales de músculo liso uterino de potencial de malignidad incierta son hallazgos poco frecuentes en la clínica habitual. La Organización Mundial de la Salud los definió como aquellos tumores uterinos de músculo liso que no podían ser histológicamente clasificados como benignos o malignos. Presentamos un caso clínico de una mujer de 41años, que consultó por aumento del perímetro abdominal y dolor en la región abdominal. Se solicitaron pruebas de imagen, que pusieron de manifiesto la presencia de una gran masa abdominal (20cm). Ante tales hallazgos, se realizó exéresis quirúrgica de la tumoración y posterior histerectomía. El estudio anatomopatológico reveló el diagnóstico de tumoración muscular lisa de bajo grado de malignidad de potencial maligno incierto. Actualmente, la paciente se encuentra asintomática. Conclusión Las tumoraciones mesenquimales de músculo liso uterino de potencial de malignidad incierta son poco frecuentes. Su diagnóstico anatomopatológico es complicado y por ello varios estudios exponen técnicas de inmunohistoquímica que ayudan a esclarecer el diagnóstico definitivo. Algunos autores los clasifican según sus características histológicas, basándose en éstas para establecer el comportamiento y pronóstico de estos tumores. El tratamiento quirúrgico de elección no está definido y el seguimiento ha de ser estrecho por el riesgo de recurrencia existente (AU)

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare findings in routine clinical practice. STUMP are defined by The World Health Organization astumors that cannot be histologically diagnosed as benign or malignant. We present the case of a 41-year-old woman who consulted for abdominal distension and pain. Imaging tests showed the presence of a large abdominal mass (20 cm). The mass was surgically excised followed by hysterectomy. The histopathological diagnosis was uterine STUMP of low grade malignancy. The patient is currently asymptomatic. Conclusion: STUMP are rare. Pathological diagnosis is difficult and several studies describe immunohistochemical techniques that could help to confirm the final diagnosis. Some authors classify these tumors by their histological features, which are then used to establish their behavior and prognosis. The surgical treatment of choice has not been defined and close follow-up must be performed due to the risk of recurrence (AU)

Tumor filodes de la mama. A propósito de dos casos / Phyllodes tumor of the breast: apropos of two cases

El tumor filodes de mama constituye una neoplasia de tipo fibroepitelial de mama poco frecuente, pueden ser benignas, borderline y malignas, representando un 0,3 a 0,9% de todas las tumoraciones mamarias. El diagnóstico definitivo es anatomopatológico y la resección amplia, completa y con márgenes libres de la lesión, constituye el pilar fundamental del tratamiento de estas lesiones. Presentamos dos casos de dos pacientes de 33 y 38 años, respectivamente, diagnosticadas de tumor filodes de la mama y tratadas en nuestro servicio. Hemos estudiado los métodos diagnósticos y técnicas quirúrgicas utilizadas en su tratamiento así como su posterior evolución y lo hemos comparado con lo descrito en la bibliografía (AU)

Phyllodes tumour of the breast is a highly uncommon fibro epithelial tumour, representing 0.3 to 0.9% of all breast tumours. The definitive diagnosis is histological and the goal of treatment is wide and complete surgical excision of the tumour with disease-free margins. We report two patients, aged 33 and 38 years old, with phyllodes tumour of the breast diagnosed and treated in our center. We discuss the diagnostic techniques, surgical approaches, and follow-up in these patients and compare our experience with reports in the literature (AU)

Cáncer de mama en mujeres posmenopáusicas / No disponible

Objetivo Revisar nuestra experiencia en el manejo de pacientes posmenopáusicas diagnosticadas y tratadas de cáncer de mama. Material y métodos Se ha realizado estudio descriptivo retrospectivo de 903 pacientes con cáncer de mama entre 1992 y 2008. Se seleccionó a las pacientes posmenopáusicas: 568 (62,90%). Se analizaron factores como edad, paridad, antecedentes familiares y personales, tipo de cáncer, tipo de cirugía, resultados a.p., estadio, tratamientos complementarios y seguimiento. Se ha realizado estudio estadístico mediante SPSS 15.0.ResultadosLa edad media fue 65,26±0,46 (40–95) años. Solo en 117 (20,59%) pacientes existían antecedentes familiares de cáncer de mama. En 312 casos (54,92%) existían factores de riesgo epidemiológico. Eran nuligestas 55 pacientes (9,68%). El motivo de consulta más frecuente fue la palpación de un nódulo 328 (57,7%). Se emplearon diferentes métodos diagnósticos por imagen, siendo la mamografía 420 (73,9%) el más utilizado. En 238 (41,90%) fue necesario estudio mediante biopsia intraoperatoria para confirmación histológica del diagnóstico. El tratamiento neoadyuvante fue empleado en 63 casos (11,09%). El tratamiento quirúrgico como tratamiento inicial fue realizado en 505 casos (88,90%). Pudo realizarse cirugía conservadora en 225 (39,61%) casos. El tipo histológico más frecuente fue el carcinoma ductal infiltrante en 380 (66,9%) pacientes. El número de ganglios fue 12,41±0,26(1–36). La hormonoterapia se pautó en 333 (58,62%), siendo el tamoxifeno el más empleado, en 230 (69,1%).Conclusiones El incremento de la edad conlleva un aumento de la patología oncológica mamaria. El diagnóstico en estas pacientes es mayoritariamente clínico. Los tratamientos en estas pacientes son menos conservadores debido al diagnóstico en estadios más avanzados (AU)

Objective To review our experience in the management and treatment of postmenopausal women with breast cancer. Material and methods A descriptive and retrospective study was performed in 903 women with breast cancer between 1992 and 2008. A total of 568 (62.90%) menopausal women were selected. The factors studied included age, parity, familial and personal history, type of cancer, type of surgery, pathological findings, stage, complementary treatments and follow-up. Statistical analysis was performed using the SPSS statistical package version 15.0.ResultsThe mean age was 65.26±0.46 (40–95) years. Familial breast cancer was found in only 117 patients (20.59%) patients. Epidemiological risk factors were found in 312 (54.92%). Nulliparity was found in only 55 patients (9.68%). The most frequent reason for consultation was palpation of a nodule in 328 (57.7%). Distinct imaging procedures were used, the most frequent being mammography in 420 (73.9%). Intraoperative biopsy was required for histological confirmation of the diagnosis in 238 (41.90%). Neoadjuvant treatment was indicated in 63 patients (11.09%). Surgical treatment was the first step in 505 women (88.90%). Conservative surgery was feasible in 225 (39.61%) patients. The most frequent histological type was infiltrating ductal carcinoma cancer in 380 (66.9%) patients. The mean number of nodes was 12.41±0.26 (1–36). Hormono therapy was used in 333 (58.62%), the most widely used being tamoxifen in 230 (69.1%).Conclusions Increased age is associated with a greater risk of breast cancer. Diagnosis in these patients is mainly clinical. Conservative treatment is infrequent in these patients as tumors are usually diagnosed in the more advanced stages (AU)

Abordaje quirúrgico del cáncer de endometrio en pacientes mayores / No disponible

Objetivo: Valorar los posibles abordajes quirúrgicos del cáncer de endometrio y su morbilidad en pacientes > 65 años. Material y método: Hemos realizado un estudio descriptivo retrospectivo desde 1996 a 2006 de 70 pacientes, con edad $ 65 años, diagnosticadas de cáncer de endometrio. Se han clasificado según la vía quirúrgica en 3 grupos (vaginal, laparoscópica y laparotómica). Los factores estudiados han sido: la edad, el índice de masa corporal, las cirugías previas, el tipo de cirugía, las complicaciones peroperatorias, la tasa de conversión, la estancia media, la tasa de transfusión, el estadio FIGO, el tipo histológico y la tasa de supervivencia. Se ha realizado estudio estadístico mediante análisis informático SPSS. Resultados: La edad media fue 72,37 ± 0,68 (65-88) años y el índice de masa corporal 32,96 (17,57-52), en kg/m2, sin diferencias significativas. En 14,28% (10 pacientes) existían antecedentes de cirugías abdominales, el 68,67% (48) presentaba factores considerados de riesgo de enfermedad endometrial. La vía quirúrgica empleada fue en el 8,5% (6) vaginal, en el 50% (35) laparoscópica y en el 41,4%(29) laparotómica. La linfadenectomía se realizó en un 69% de las laparotomías y en un 97,1% de laparoscopias (tasa de conversión, 5,7%). Hubo complicaciones intraoperatorias (8,6%) y postoperatorias (28,57%) sin diferencias significativas; la estancia media fue de 6,39 ± 0,53 (2-33) días: vaginal, 5 ± 1,29 (3-10); laparoscopia, 5,32 ± 0,47 (2-14) y laparotomía, 7,93 ± 1,07 (3-33), con una p < 0,01 para la vía vaginal y la laparoscopia. La tasa de transfusión fue del 12,9%. No hubo diferencias significativas respecto a la supervivencia entre los diferentes abordajes quirúrgicos. Conclusión: El abordaje laparoscópico es una técnica viable con una escasa tasa de complicaciones y con una supervivencia similar a las pacientes intervenidas por laparotomía (AU)

Objective: To evaluate the feasibility of distinct approaches for the treatment of endometrial cancer and associated morbidity in patients over 65 years old. Material and methods: We performed a retrospective descriptive study of 70 consecutive patients diagnosed with endometrial cancer from 1996 to 2006. All the patients were 65 years old or older. The surgical approach was classified in three groups: vaginal, laparoscopy and laparotomy. The following factors were analyzed: age, body mass index, previous surgery, type of surgery, perioperative complications, laparotomy rate, mean length of hospital stay, transfusion rate, FIGO stage, histological type, and recurrence and survival rates. Statistical analysis was performed using SPPS computer analysis. Results: The mean age was 72.37 ± 0.68 years (65-88) and the mean body mass index was 32.96 (17.57-52), with no statistically significant differences. Ten patients (14.28%) had previous abdominal surgery and 48 (68.67%) had endometrial risk factors. Surgical access was vaginal in six patients (8.5%), laparoscopic in 35 (50%) and laparotomic in 29 (41.4%). Lymphadenectomy was feasible in 69% of laparotomic interventions and in 97.1% of laparoscopic procedures (conversion rate: 5.7%). The intraoperative complications rate was 8.6% and the postoperative complications rate was 28.57%, with no statistically significant differences. The mean length of hospital stay was 6.39 ± 0.53 days (2-33), 5 ± 1.29 (3-10) with the vaginal route, 5.32 ± 0.47 (2-14) with laparoscopy, and 7.93 ± 1.07 (3-33) with laparotomy; differences between the vaginal and laparoscopic routes were statistically significant (P<.01). The transfusion rate was 12.9%. The survival rate was similar among the three surgical approaches. Conclusions: The laparoscopic approach is a feasible technique, with a low complications rate and a similar survival rate to that of other approaches (AU)

Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in stages I and II endometrial cancer. Operating data, follow up and survival.

OBJECTIVE: To assess the feasibility of laparoscopy in the treatment of early stage endometrial carcinoma and follow up outcomes compared to classic laparotomy. METHODS: A retrospective review of 90 consecutive patients with endometrial cancer managed between January 1997 and December 2003. Two groups were defined whether they had been treated by laparoscopy (N = 38; LPS group) or by laparotomy (N = 37; LPM group). Nine patients treated by vaginal hysterectomy and 6 cases with stages III-IV were excluded from the study. RESULTS: Both groups were comparable in mean age and mean BMI. Mean operating time was longer for LPS group, 164.91 +/- 5.60 (77-240) vs. 129.97 +/- 5.08 (60-180) min (P < 0.05). Intraoperative complications were seen in 7 patients (18.9%) from LPM and in 5 cases (13.2%) in the laparoscopic group. Two patients (5.2%) initially evaluated by laparoscopy were converted into laparotomy due to an increasing and uncontrollable hypercapnia. There were more post-operative complications in patients managed by laparotomy (14 cases; 38.8%), than by laparoscopy (7 cases; 18.4%) (P < 0.05). Blood transfusion was necessary in 4 patients (10.8%) in LPM group while none was required in LPS group (P < 0.01). Hospital readmission was only recorded in 3 patients treated by laparotomy (6.7%) (P < 0.05). Hospital stay was longer in LPM group 7.06 +/- 0.58 (4-21) vs. LPS 5.04 +/- 0.73 (2-17) days (P < 0.05). With a median follow up of 53.21 +/- 4.32 months for LPM (5-90) and 36.31 +/- 2.75 months for LPS (9-65) there was no significant difference in disease recurrence between the two groups. CONCLUSION: Laparoscopic staging combined with vaginal hysterectomy appears to be a feasible alternative to classical surgical approach in patients with early stage I or II endometrial carcinoma.

Carcinoma de mama bilateralsincrónico / Synchronous bilateral breast carcinoma

El carcinoma de mama bilateral sincrónico se define por la aparición de dos tumores de forma simultánea en ambas mamas. Según otros autores, es aquel que se diagnostica en los primeros 3, 6 o 12 meses tras el descubrimiento del primer tumor. De forma habitual, el cáncer de mama contralateral se diagnostica mediante mamografía, y suele encontrarse en un estadio más temprano que el primero. Presentamos el caso de una mujer de 35 años que, sin antecedentes personales de interés, fue diagnosticada de carcinoma de mama bilateral sincrónico (AU)

Comparison of cervical smears secured with different instruments.

BACKGROUND: In this presentation we have compared the results from cytologic samples obtained with the cervical brush and Ayre's wooden spatula, against samples obtained with Acellon Combi. METHODS: One thousand cervical smears were collected. This was a cross-sectional study, where it was decided randomly to use cervical brush for sampling of the endocervix and Ayre's wooden spatula for exocervix or Acellon Combi for both. RESULTS: The combination of the cervical brush and the wooden spatula yielded an acceptable quantity of columnar cells in 71.6% of the cases, during both endocervical and exocervical sampling, while the Acellon Combi yielded an acceptable quantity in 61.7% of the cases (p<0.01). The combination of brush/spatula yielded an acceptable quantity of squamous cells from samples of endocervix and exocervix in 87.5% cases, while with the Acellon device amounted to 77.4% (p<0.001). Highly significant differences in the state of cellular preservation of samples from endocervix obtained with cervical brush technique were found upon comparison to Acellon group. CONCLUSIONS: Henceforth, we believe that the use of the cervical brush and the Ayre wooden spatula increases the quantity and preservation of the cells retrieved during cervical smears compared to Acellon Combi.

Total and regional bone mineral content in women treated with GnRH agonists.

Changes in bone mineral content induced by GnRH agonists were investigated by measuring total body bone mineral content (TBBM) and regional bone mineral content (BMC) (arms, legs, trunk, pelvis) and densities with dual energy X-ray absorptiometry in 25 premenopausal women before and after a 6-month treatment with gonadotropin-releasing hormone (GnRH) agonists. Biological markers of bone remodeling, estrogens, luteinizing hormone, and follicle-stimulating hormone were also measured. Weight and body mass index increased significantly after treatment (P < 0.05), and TBBM, corrected for weight (TBBM/W), decreased (P < 0.001). The changes in BMC that we observed ranged from +2.5% to -6.9%. The greatest decrease in regional BMC occurred in the trunk (4.4%, P < 0.001), with TBBM decreasing by 2.1% (P < 0.001). No significant changes were observed in the limbs. Tartrate-resistant acid phosphatase (TRAP) increased significantly after treatment (P < 0.001) and a significant negative correlation between TRAP and TBBM (P < 0.001) and between TRAP and estradiol (P < 0.001) were observed before treatment. The lack of changes observed in the BMC of the limbs indicate that GnRH agonists cause a preferential loss of BMC in trunk osseous structures, a situation similar to that of the first years of menopause.

Total and regional bone mass values and biochemical markers of bone remodeling in endometriosis.

OBJECTIVE: TO measure peripheral, axial, and total bone mass and to assess markers of bone remodeling in women with endometriosis, with the aim of addressing previous reports of diminished peripheral bone mass in these patients. METHODS: Whole body bone densitometry, estradiol (E2) levels, and biochemical bone markers (calcium, phosphorus, total alkaline phosphatase, tartrate-resistant acid phosphatase, and total proteins) were determined in 28 patients with endometriosis and compared with findings in 33 controls. RESULTS: There were no significant differences between the groups in bone mass at different sites or in biochemical bone markers. We observed a significant negative correlation between tartrate-resistant acid phosphatase and E2 levels (P < .001) and with total (P < .001), head (P < .01), and axial (trunk) (P < .001) bone mass. Total alkaline phosphatase did not correlate with any of the indices studied. CONCLUSIONS: Bone mass was not lower in any of the areas studied in women with endometriosis. There was a significant negative correlation of tartrate-resistant acid phosphatase with E2 and with total, head, and trunk bone mass.