Laparoscopic pelvic lymphadenectomy: experience of a Gynaecological Cancer Centre in the UK.

INTRODUCTION: The role of laparoscopic lymphadenectomy in the management of gynaecological cancers has been established over the last two decades, having been first described in Dargent and Selvat (L'envahissement ganglionnaire pelvin. Medsi-Mcgraw Hill, Paris, 1989). It has been shown that laparoscopic lymphadenectomy can be performed in the majority of patients and is associated with a low complication rate. However, the technique continues to be undertaken in only a relatively small number of Gynaecological Cancer Centres in the UK owing to the long learning curve and wide variations in training. MATERIALS AND METHODS: At the Royal Wolverhampton NHS Trust Gynaecological Cancer Centre in the Greater Midlands Cancer Network laparoscopic lymphadenectomy has been performed since 1999 in the management of early cervical and high grade endometrial cancers. We have undertaken a retrospective audit (1999-2009) of these 42 cases to assess the feasibility of the procedure as well as to assess the complication rate. CONCLUSION: We are presenting the first reported series of exclusive laparoscopic transperitoneal lymphadenectomies from a Gynaecological Cancer Centre in the UK.

The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis.

This article discusses the history surrounding the debate on the etiopathology of endometriosis, specifically deep infiltrating endometriosis, and traces the controversies in its management that are as pertinent today as they were when the disease was first described in the late 19th and early 20th centuries.

Endometriomas as a marker of disease severity.

STUDY OBJECTIVE: Although superficial endometriosis can be treated effectively and safely by most gynecologic surgeons, deep infiltrating disease (DIE) needs to be treated in specialist endometriosis centers. For women to be treated in the most appropriate setting, it is necessary to identify if they have DIE. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Dedicated pelvic pain clinic attracting both secondary and tertiary referrals. PATIENTS: A total of 295 women with histologically confirmed endometriosis. INTERVENTIONS: Prospective intraoperative data were collected to investigate the role of endometriomas as a marker for DIE, and in particular, rectosigmoid disease. MEASUREMENTS AND MAIN RESULTS: In all, 61 (21%) women had an endometrioma. A significantly greater proportion of women with an endometrioma had accompanying endometriotic disease affecting the bowel compared with women without an endometrioma (77% vs 21%; p<.001). A strong relationship existed between presence of endometrioma and posterior cul-de-sac obliteration, rectosigmoid disease, and involvement of the seromuscular layer of the bowel. The presence of an endometrioma significantly increased the probability of having rectosigmoid disease, with a positive likelihood ratio of 6.96 (95% CI; 4.04-12.00). However, the absence of an endometrioma did not preclude having rectosigmoid disease, with a negative likelihood ratio of 0.55 (95% CI; 0.45-0.67). CONCLUSION: Although endometriomas provide a useful marker for DIE, the absence of an endometrioma does not preclude the presence of DIE, although a significantly lower proportion of women without an endometrioma will have DIE when compared with women with an endometrioma.

Ablative or excisional laparoscopic surgery for endometriotic cysts: resolving the issue.

A logistic regression analysis was carried out to compare laparoscopic excision with ablation for endometriotic cysts. Four comparative studies were identified. Cyst recurrence (%, +/- SE) was twice as likely after the ablation treatment (26.6% +/- 0.032) than after the excision treatment (13.2% +/- 0.019), (p <.001, relative risk 1.9). Two comparative studies were identified where postprocedure pregnancy rates were an outcome measure. Postoperative pregnancy rates were not significantly different for the ablation treatment (41.6% +/- 0.138) than for the excision treatment (56.9% +/- 0.23). There was only one comparative study to investigate symptom relief, therefore logistic regression analysis to compare studies was not possible. Three studies compared excisional surgery and perioperative medication with excisional surgery only. Cyst recurrence rates were not significantly different for the group that received medication (10.3% +/- 0.033) than for the group that did not (4.0% +/- 0.02).