子宫内膜癌治疗相关问题-妇产科课件.pptVIP

子宫内膜癌新分期 子宫内膜癌淋巴结切除必要性 子宫内膜癌子宫切除的范围 一定要切除腹主动脉旁淋巴结吗？ Eur J Gynaecol Oncol. 2007;28(2):98-102. Prince of Wales Hospital, Shatin, Hong Kong Is aortic lymphadenectomy necessary in the management of endometrial carcinoma? 75 (46.0%) pelvic lymphadenectomy alone 88 (54.0%) had both pelvic and aortic lymphadenectomy 35 (21.5%) nodal metastases positive pelvic 26 (16.0%) positive aortic 24 (27.3%) Isolated aortic metastases 17 cases (19.3%) 35 patients with nodal metastases recurrence developed in 15 (42.9%) and all except one died within five to 50 months The recurrence rate was higher (63.6%) among patients with upper aortic lymph node metastases all those who recurred died of disease within seven to 28 months. CONCLUSIONS aortic lymphadenectomy provides both diagnostic and therapeutic value in the management of endometrial carcinoma with high metastatic risk. Todo Y et al.Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010 Apr 3;375(9721):1165-72  671 patients with endometrial carcinoma systematic pelvic lymphadenectomy (n=325) pelvic and para-aortic lymphadenectomy (n=346) INTERPRETATION: Combined pelvic and para-aortic lymphadenectomy is recommended as treatment for patients with endometrial carcinoma of intermediate or high risk of recurrence. II期子宫内膜癌RH 手术的必要性 II期子宫内膜癌RH 手术的必要性 Depth of myometrial invasion and pelvic or paraaortic lymph node positivity were significantly correlated with paramatrial involvement. Of the 19 patients with pelvic lymph node metastasis, 8 patients (42.1%) had concomitant PMI. Conversely, of the 10 patients with PMI, 8(80.0%) had lymph node metastasis. Ⅰ期子宫内膜癌子宫切除范围 * I期子宫内膜癌 子宫切除范围： 全子宫切除术？筋膜外子宫切除术？二者异同？ 次广泛子宫切除术？ FIGO 2009 子宫内膜癌分期改变 影响子宫内膜癌子宫切除范围的选择吗？ 局限于子宫的内膜癌手术选择 争议：局限于子宫，宫颈累及？广泛子宫切除术？ 子宫切除范围值得探讨 内膜癌病变局限于子宫--手术方式 Disease limited to uterus Medically inoperable operable Tumor directed RT Total hysterectomy and bilateral salpingo