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Prof Dr Ahmet Göçmen İstanbul Medeniyet Üniversitesi

ROBOTİK & LAPAROSKOPİK LENFADENEKTOMİ. TJOD 15-19 Mayıs 2013. Prof Dr Ahmet Göçmen İstanbul Medeniyet Üniversitesi Göztepe & Ümraniye Eğitim Araştırma Hastanesi. The Most Frequent Cancers in Women: Incidence and Mortality. Turkey (Globocan 2008*). Endometrial k an s er

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Prof Dr Ahmet Göçmen İstanbul Medeniyet Üniversitesi

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  1. ROBOTİK & LAPAROSKOPİK LENFADENEKTOMİ TJOD 15-19 Mayıs 2013 Prof Dr Ahmet Göçmen İstanbul Medeniyet Üniversitesi Göztepe & Ümraniye Eğitim Araştırma Hastanesi

  2. The Most Frequent Cancers in Women: Incidence and Mortality Turkey (Globocan 2008*)

  3. Endometrial kanser Servikal kanser Ovarian kanser Fallopian tubal kanser Vulvar kanser lenfadenektomİ

  4. Lenfadenektomi • Pelvik lenfadenektomi Lewis & Stallworthy – 1970Pelvik ve Paraaortik lenfadenektomi Gynecologic Oncology Group - 1976

  5. LNM’ının varlığını tesbit etmede - ultrasound, CT / MRI - inspeksiyon / palpasyon -şüpheliveya büyümüş LN örnekleme - invazyonderinliği ve grade yeterli değil

  6. * The size and shape of LNs do not correlate with the presence of LNMs - only 10 % of the metastatic LNs are enlarged Wu et al. 1984, Petru et al. 1994 * More the 50 % of the pelvic nodes are < 1 cm in size (endometrial cancer) Girardi 1993, Benedetti 1998

  7. Metastatik LN’nın %37’si ≤ 2mm LN metastazı olmayan olgularda survival daha iyidir Stage I’den stage IIIC geçiş %31.5 Sampling ile; PLN metastazlarının %62’i, PALN metastazlarının %17’i atlanır Girardi F, Gynecol Oncol, 1993; Ayhan A, EJGO, 2005; Ben-Shachar I, Obstet&Gynecol, 2005; ACOG Practice Bulletin, 2005 EndomETRİUMCaLenfadenektomİ

  8. Endometriyum Kanserinde Nodal Yayılım Hastalıksız Yaşam İlişkisi (5-year recurrence-free interval) l - Nod %92 + pelvik / - aortik %58 50 + aortik %41 n: 748 tümör tekrarlaması %13 n: 63 tümör tekrarlaması %28 n: 48 tümör tekrarlaması %58 12 24 36 48 60 ay Morrow ve ark, Gynecol oncol 1991

  9. Yeterli Lenfadenektomi • Pelvik > 20 lenf nodu • Paraaortik > 10 lenf nodu

  10. Cx Ca • PLND; (İMA PALND) • Evre Ia1; LVSI • Evre Ia2-Ib-IIa • Evre IIb-IV ; PALND • Over-Tuba Ca; PPALND • Renal ven seviyesi EndometriumCaPPALND gerekli; • Tümor çapı>2 cm • Grade 3 histoloji • MI >%50 ( Evre I b) • Nonendometrioid histoloji • Renalven seviyesi

  11. Endometrium kanserinde LND sınırı Pelvik IMA Renal ven

  12. * LND complications (%) Vessel damage 3,9 Lymphocysts 13,5 DVT 5,0 PE 2,8 Paresthesia 2,7 Di Re and Baiocchi. IJGC 2000

  13. Üst PA LN Alt PA LN Pelvik LD

  14. Paravesicalspace; Umblikal artere göre; medialandlateral Retroperitonealspace Pararectak space Uretere göre: Medial (Okabayashi) Lateral (Latzko) Corona mortis Obt nerve

  15. PelvİkLenfadenektomİ

  16. The paraaortic lymphnodes are part of the lumbar lymph node group. There arethree subgroups: preaortic, retroaortic, and lateral aortic(right and left). The preaortic group drains the abdominalpart of the gastrointestinal tract down to the mid-rectum,whereas the retroaortic group has no special area ofdrainage. The lateral group receives the lymphatic drainagefrom the iliac lymph nodes, ovaries, and other pelvic viscera(apart from the alimentary tract),and therefore it is thisgroup of nodes that is sampled in the surgical staging of gynecologic malignancies.

  17. The lateral aortic group receives the lymphatic drainagefrom the iliaclymph nodes, ovaries, and other pelvic viscera(apart from the alimentary tract),and therefore it is thisgroup of nodes that is sampled in the surgical staging of gynecologic malignancies.

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