Laterally extended parametrectomy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
ObjectiveTo describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of theprocedure. MethodsLEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvicsidewall. Its initial indications were for lymph node positive Stage Ib (current International Federation of Gynecologyand Obstetrics 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitiveradiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated forremoving tumors involving the soft structures of the pelvic sidewall during a pelvic exenteration, aiming to obtainlateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliacvessels, but also to the true limits of the pelvic sidewall. ResultsDuring LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of thepelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on thepelvic sidewall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internaliliac artery and vein) and the variable anatomic distribution of pelvic sidewall veins. ConclusionLEP is a feasible technique for removing pelvic sidewall recurrences, aiming to obtain surgical free margins.
Abstract
ObjectiveTo describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of theprocedure. MethodsLEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvicsidewall. Its initial indications were for lymph node positive Stage Ib (current International Federation of Gynecologyand Obstetrics 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitiveradiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated forremoving tumors involving the soft structures of the pelvic sidewall during a pelvic exenteration, aiming to obtainlateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliacvessels, but also to the true limits of the pelvic sidewall. ResultsDuring LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of thepelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on thepelvic sidewall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internaliliac artery and vein) and the variable anatomic distribution of pelvic sidewall veins. ConclusionLEP is a feasible technique for removing pelvic sidewall recurrences, aiming to obtain surgical free margins.
참고문헌 (6)
- Ungár L, "Surgical treatment of lymph node metastases in stage IB cervical cancer : the laterally extended parametrectomy(LEP)procedure", Int J Gynecol Cancer, 13, pp.647~651 (2003)
- Pálfalvi L, "Laterally extended parametrectomy (LEP), the technique for radical pelvic side wall dissection:feasibility, technique and results", Int J Gynecol Cancer, 13, pp.914~917 (2003)
- Cibula D, "Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement : ABRAX international retrospective cohort study", Eur J Cancer, 143, pp.88~100 (2021)
- Stanca M, "Prognostic factors associated with 5-year overall survival in cervical cancer patients treated with radical hysterectomy followed by adjuvant concurrent chemoradiation therapy at a tertiary care center in Eastern Europe", Diagnostics(Basel), 11, pp.570~ (2021)
- Căpîlna ME, "Pelvic exenteration--our initial experience in 15 cases", Eur J Gynaecol Oncol, 36, pp.142~145 (2015)
- Căpîlna ME, "Anatomical variations of the obturator veins and their surgical implications", Eur J Gynaecol Oncol, 38, pp.263~265 (2017)