Lymphadenectomy in patients with uterine and ovarian malignancies

Kada je riječ o zloćudnim bolestima maternice i jajnika, optimalan način za utvrđivanje proširenosti bolesti je upravo kirurški zahvat. Etablirani FIGO klasifikacijski sustav u direktnoj je korelaciji s prognozom, kao najvažnijom interesnom varijablom. Kliničkim metodama utvrđivanja proširenosti bolesti nedostaje osjetljivosti i stoga ostavljaju mogućnost nedetektiranih mikroskopskih metastaza koje naposljetku dovode do neuspješnog liječenja. Najvažniji nezavisni prognostički faktor upravo je zahvaćenost limfnih čvorova i to čini kirurško odstranjivanje istih bitnim dijelom procjene proširenosti bolesti. Također, limfadenektomija je pokazala i terapeutski značaj u smislu citoredukcije tumora, poglavito kada je riječ o tumorima jajnika. Kroz povijest se limfadenektomija izvodila većinom laparotomijskim pristupom, što je bilo povezano s velikim rezovima, intra i peri operacijskim komplikacijama i sličnim problemima, a zbog čega razvoj minimalno invazivne kirurgije nosi veliki značaj. Cilj ovog rada bio je usporediti laparotomijski i laparoskopski pristup radikalnom kirurškom liječenju, koje uključuje limfadenektomiju, u bolesnica sa zloćudnim bolestima maternice i jajnika. U analizu je uključeno 237 ispitanica, koje su operirane u Klinici za ženske bolesti i porode Kliničkog bolničkog centra Zagreb, u razdoblju od 1.1.2016. godine do 31.12.2017. godine. Isključni parametar bio je učinjena sampling limfadenektomija. Ispitanice su podijeljene u grupe ovisno o kirurškom pristupu kojim su operirane. Rezultati statističke analize pokazali su statistički neznačajnu razliku između dobi i BMI-a ispitanica u laparoskopskoj i laparotomijskoj grupi. Također, statistički značajna razlika nije pronađena ni po pitanju parametara broja izvađenih zdjeličnih limfnih čvorova ukupno, s desne strane i paraaortalnih limfnih čvorova. Statistički značajna razlika pronađena je u slučaju broja izvađenih lijevostranih zdjeličnih limfnih čvorova i to u korist laparoskopije, a također je pronađena i u trajanju poslijeoperacijske hospitalizacije koja je dvostruko kraća u laparoskopskoj grupi. Rezultati su u skladu sa sličnim istraživanjima koja su se bavila ovom tematikom te na temelju njih i literature korištene u ovom radu možemo izvesti zaključak kako je laparoskopija jednako vrijedna kirurška tehnika laparotomiji, a po određenim parametrima i superiornija te je preporučljivo savladati njenu krivulju učenja i dalje ju unaprijediti.When it comes to gynecological malignancies, surgical staging is the optimal way to asses the extent of disease. The established FIGO classification system is in direct correlation to prognosis which is our most important variable of interest. Clinical staging methods lack sensitivity, and therefore leave a potential for undetected microscopic metastases which ultimately lead to treatment failure. Affection of lymph nodes is the most important independent prognostic factor, thus the surgical removal of lymph nodes presents an important part of proper staging process. It has also been shown that lymphadenectomy carries a therapeutic value in terms of tumor cytoreduction. Throughout the history lymphadenectomy was primarily performed via laparotomy, and there have been problems associated with large incisions, and intra- and perioperative complications. For these reasons, development of minimaly invasive surgery is potentially of great value. The aim of this retrospective research was to compare open and laparoscopic approaches to radical surgical treatment that includes lymphadenectomy, in patients with malignant diseases of uterus and ovaries. In this analysis, 237 participants were enrolled. They were all operated in the Department of Gynecology and Obstetrics, the University Hospital Center Zagreb, in the period of time between January 1, 2016 and December 31, 2017. Those participants who had only sampling lymphadenectomy done were excluded from the research. The participants were divided into separate groups, depending on the surgical approach used to operate each individual. The results of statistical data analysis showed no statistically significant difference between the groups in age and BMI. Statistically significant difference was not found either in observing parameters related to the number of pelvic lymph nodes that were dissected in total, on the right side and paraaortic lymph nodes in total. Significant difference, however, was found in the matter of the number of lymph nodes dissected on the left side, in favor of laparoscopy, and in the matter of the duration of postoperative hospitalization, which was twice shorter in the laparoscopy group. Our results are in accordance with similar research dealing with the same subject and based on our results, we can conclude that laparoscopy is equally valuable surgical technique as laparotomy, and in certain parameters even superior to it, so it is recommendable to take on this demanding learning curve in order to be able to master and further improve the technique