Author/Editor		Rakar, Stelio; Meglič, Leon; Cvjetičanin, Branko; Kobal, Borut
Title		Kirurško zdravljenje endometrijskega karcinoma
Translated title		Surgical treatment of endometrial cancer
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 2
Publication year		2003
Volume		str. II-39-42
Language		slo
Abstract		Background. Nowadays, endometrial cancer is the most frequent gynecologic malignancy with a relatively good prognosis. The prognosis and the quality of life of these patients can be improved considering the prognostic factors and more rational treatment. Methods. This retrograde analysis comprised 499 patients with endometrial cancer operated at the Department of Obstetrics and Gynecology and then irradiated at the Institute of Oncology in Ljubljana in the period 1995-1999. Results. Most patients had stage I disease (81.4%), good prognostic histological type (endometroid and adenoacanthoma in 81.3%), well- and moderately differentiated tumors (86%) and early myometrial invasion (72.4%). In the observed period we performed radical hysterectomy "old" Wertheim (Piver II) in only 8.4% of cases, in all other cases simple vaginal or abdominal hysterectomy (in 46.9% with pelvic lymphadenectomy) was done. Adjuvant irradiation was administered to 70% of patients. The analysis of 3- and 5- year survival comprises only 466 patients. The overall 5-year survival was 85.8%, in stage I cases 88.1%. There were no significant differences in survival in stage I cases regarding the type of surgery. In stage I the most important adverse prognostic factors were poor differentiation, deep myometrial invasion and serous-papillary histologic type, whereas lymph node involvement was very rare (less than 1%). Conclusions. For the choice of appropriate surgical treatment of patients with endometrial cancer it is necessary to consider the prognostic factors. In this analysis a more radical surgical procedure did not improve the survival significantly. The usefulness of limphadenectomy in stage I remains open.
Summary		Izhodišča. Endometrijski karcinom je danes najpogostejši ginekološki malignom s sorazmerno dobro prognozo. Z upoštevanjem napovednih dejavnikov in racionalnejšim zdravljenjem lahko še izboljšamo izid in kakovost življenja teh bolnic. Metode. Analiza je retrogradna in zajema 499 bolnic z endometrijskim karcinomom, operiranih na Ginekološki kliniki in dodatno obsevanih na Onkološkem inštitutu v Ljubljani v obdobju 1995-1999. Rezultati. Največ bolnic je bilo v I. stadiju bolezni (81,4%), največ je bilo napovedno ugodnih histoloških tipov (endometroidni in adenoakantom v 81,3%) ter dobro in srednje diferenciranih (86%) in z začetnim prodorom v miometrij (72,4%). V tem obdobju smo radikalno histerektomijo po načinu "stari Wertheim" izvedli le še pri 8,4% bolnic, pri ostalih pa smo naredili navadno vaginalno ali abdominalno histerektomijo, večinoma obenem s pelvično limfadenektomijo (46,9%), navadno histerektomijo pa v 44,7%. Dodatno obsevanih je bilo 70% vseh bolnic. Analiza 3- do 5- letnega preživetja je zajela le 466 bolnic. Celokupno 5-letno preživetje je bilo 85,8%, pri bolnicah v I. stadiju pa 88,1%. Ni statistično značilne razlike v preživetju bolnic v I. stadiju glede na vrsto operacije. V I. stadiju so najpomembnejši neugodni napovedni dejavniki slaba diferenciranost in globok prodor v miometrij ter serozni papilarni histološki tip, prizadetost bezgavk je izredno nizka (pod 1%). Zaključki. Vrednotenje napovednih dejavnikov je nujno za ustrezen izbor kirurškega zdravljenja. Tudi v tej analizi radikalnejši operativni poseg ni značilno izboljšal preživetja bolnic. Koristnost limfadenektomije v I. stadiju je še vprašljiva.
Descriptors		ENDOMETRIAL NEOPLASMS HYSTERECTOMY HYSTERECTOMY, VAGINAL LYMPH NODE EXCISION NEOPLASM STAGING SURVIVAL ANALYSIS