Prof Dr Ahmet G

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ROBOTIK LAPAROSKOPIK LENFADENEKTOMI
TJOD 15-19 Mayis 2013

• Prof Dr Ahmet Göçmen
• Istanbul Medeniyet Üniversitesi
• Göztepe Ümraniye Egitim Arastirma Hastanesi

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The Most Frequent Cancers in Women Incidence and
Mortality
Turkey (Globocan 2008)
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lenfadenektomI

• Endometrial kanser
• Servikal kanser
• Ovarian kanser
• Fallopian tubal kanser
• Vulvar kanser

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Lenfadenektomi

• Pelvik lenfadenektomi
• Lewis Stallworthy 1970Pelvik ve
  Paraaortik lenfadenektomi Gynecologic
  Oncology Group - 1976

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• LNMinin varligini tesbit etmede
• - ultrasound, CT / MRI
• - inspeksiyon / palpasyon
• -süpheli veya büyümüs LN örnekleme
• - invazyon derinligi ve grade
• yeterli degil

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• 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 lt 1 cm in
size (endometrial cancer) Girardi 1993,
Benedetti 1998
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EndomETRIUM Ca LenfadenektomI

• Metastatik LNnin 37si 2mm
• LN metastazi olmayan olgularda survival daha
  iyidir
• Stage Iden stage IIIC geçis 31.5
• Sampling ile
• PLN metastazlarinin 62i,
• PALN metastazlarinin 17i atlanir
• Girardi F, Gynecol Oncol, 1993
  Ayhan A, EJGO, 2005 Ben-Shachar I,
• ObstetGynecol, 2005
  ACOG Practice Bulletin, 2005

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Endometriyum Kanserinde Nodal Yayilim Hastaliksiz
Yasam Iliskisi (5-year recurrence-free interval)
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- Nod 92
pelvik / - aortik 58
50
aortik 41
n 748 tümör tekrarlamasi 13
n 63 tümör tekrarlamasi 28
n 48 tümör tekrarlamasi 58
12 24 36 48
60 ay
Morrow ve ark, Gynecol oncol 1991
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Yeterli Lenfadenektomi

• Pelvik gt 20 lenf nodu
• Paraaortik gt 10 lenf nodu

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• Cx Ca
• PLND (IMA PALND)
• Evre Ia1 LVSI
• Evre Ia2-Ib-IIa
• Evre IIb-IV PALND
• Over-Tuba Ca PPALND
• Renal ven seviyesi

• Endometrium Ca PPALND gerekli
• Tümor çapi gt2 cm
• Grade 3 histoloji
• MI gt50 ( Evre I b)
• Nonendometrioid histoloji
• Renal ven seviyesi

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• Endometrium kanserinde LND siniri
• Pelvik
• IMA
• Renal ven

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• LND complications ()
• Vessel damage 3,9
• Lymphocysts 13,5
• DVT 5,0
• PE 2,8
• Paresthesia 2,7

Di Re and Baiocchi. IJGC 2000
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Üst PA LN
Alt PA LN
Pelvik LD
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Retroperitoneal
space

• Paravesical space
• Umblikal artere göre
• medial and lateral

Pararectak space Uretere göre Medial
(Okabayashi) Lateral (Latzko)
Corona mortis Obt nerve
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PelvIk LenfadenektomI
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The paraaortic lymph nodes are part of the
lumbar lymph node group. There are three
subgroups preaortic, retroaortic, and lateral
aortic (right and left). The preaortic group
drains the abdominal part of the gastrointestinal
tract down to the mid-rectum, whereas the
retroaortic group has no special area of
drainage. The lateral group receives the
lymphatic drainage from the iliac lymph nodes,
ovaries, and other pelvic viscera (apart from the
alimentary tract), and therefore it is this group
of nodes that is sampled in the surgical staging
of gynecologic malignancies.
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The lateral aortic group receives the lymphatic
drainage from the iliac lymph nodes, ovaries, and
other pelvic viscera (apart from the alimentary
tract), and therefore it is this group of nodes
that is sampled in the surgical staging of
gynecologic malignancies.