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*)
LENFADENEKTOMİ
Endometrial kanser
Servikal kanser
Ovarian kanser
Fallopian tubal kanser
Vulvar kanser
Lenfadenektomi

Pelvik lenfadenektomi
Lewis & Stallworthy – 1970
Pelvik ve Paraaortik lenfadenektomi
Gynecologic Oncology Group - 1976
LNM’ının varlığını tesbit etmede
- ultrasound, CT / MRI
- inspeksiyon / palpasyon
-şüpheli veya büyümüş LN örnekleme
- invazyon derinliği ve grade
yeterli değil
*
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
ENDOMETRİUM CA LENFADENEKTOMİ
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
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
Yeterli Lenfadenektomi

Pelvik
> 20 lenf nodu

Paraaortik
> 10 lenf nodu





Cx Ca
PLND; (İMA PALND)
Evre Ia1; LVSI
Evre Ia2-Ib-IIa
Evre IIb-IV ; PALND
Endometrium Ca PPALND
gerekli;






Over-Tuba Ca; PPALND
Renal ven seviyesi

Tümor çapı >2 cm
Grade 3 histoloji
MI >%50 ( Evre I b)
Nonendometrioid histoloji
Renal ven seviyesi
Endometrium kanserinde LND sınırı
Pelvik
IMA
Renal ven
*
LND complications (%)
Vessel damage
Lymphocysts
DVT
PE
Paresthesia
3,9
13,5
5,0
2,8
2,7
Di Re and Baiocchi. IJGC 2000
Üst PA LN
Alt PA LN
Pelvik LD
RETROPERITONEAL SPACE



Paravesical space;
Umblikal artere göre;
medial and lateral
Pararectak space
Uretere göre:
Medial (Okabayashi)
Lateral (Latzko)
Corona mortis
Obt nerve
PELVİK LENFADENEKTOMİ
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 midrectum, 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.
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.
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Ahmet Göçmen