Lokal İleri Evre Serviks Kanserinde Mini-Laparoskopik Cerrahi Evreleme

Öz

Amaç: Lokal ileri evre serviks kanseri olan hastalarda kemoradyoterapi öncesinde, eş zamanlı over transpozisyonu yapılarak veya yapılmaksızın gerçekleştirilen mini-laparoskopik para-aortik lenf nodu (PALN) diseksiyonunun uygulanabilirliğini, güvenilirliğini ve cerrahi sonuçlarını değerlendirmek. Yöntem: Bu retrospektif çalışma, üçüncü basamak bir üniversite hastanesinde 5 mm'lik optik transumbilikal trokar ve 3,5 mm/5 mm'li yan trokarlar kullanılarak mini-laparoskopik PALN değerlendirmesi yapılan FIGO 2009 evre IB2–IVA serviks kanserli dokuz hastayı değerlendirmiştir. Premenopozal hastalara eş zamanlı bilateral salpenjektomi ve over transpozisyonu uygulanmıştır. Demografik özellikler, ameliyat süreleri, intraoperatif/postoperatif komplikasyonlar, çıkarılan lenf nodu sayıları, hastanede kalış süresi ve kemoradyoterapiye başlama süreleri kaydedilmiş ve analiz edilmiştir. Bulgular: Hastaların ortalama yaşı 41.25±9.50, ortalama beden kitle indeksi (BKİ) ise 24.5±3.24 kg/m2 idi. Beş premenopozal hastaya over transpozisyonu ile kombine mini-laparoskopik PALN diseksiyonu başarıyla uygulandı. Ortalama ameliyat süresi 205±51.4 dakika, çıkarılan ortalama para-aortik lenf nodu sayısı ise 15.89±7.61 olarak kaydedildi. Ameliyat sırasında bir hastada primer sütür ile başarıyla onarılan eksternal iliyak ven yaralanması gerçekleşti ve ameliyat sonrasında şilöz asit gelişerek tedavi edildi. Ortalama hastanede kalış süresi 5±3.02 gündü. Dokuz hastanın tamamı cerrahiden sonraki 20 gün içinde kemoradyoterapiye başarıyla başladı. Sonuç: Mini-laparoskopik PALN diseksiyonu, lokal ileri evre serviks kanserinin evrelenmesinde teknik olarak uygulanabilir ve güvenli bir yöntemdir. Yeterli lenf nodu sayısı sunmasının yanı sıra primer kemoradyoterapiyi geciktirmeden hızlı bir ameliyat sonrası iyileşme potansiyeli sağlar. Bu bulguları doğrulamak ve uzun vadeli klinik sonuçları belirlemek için daha geniş kapsamlı prospektif kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• para-aortik lenfadenektomi
• serviks kanseri
• evreleme
• radyoterapi
• mini-laparoskopi

Mini-laparoscopic Surgical Staging in Locally Advanced Cervical Cancer

Öz

Background: To evaluate the feasibility, safety, and surgical outcomes of mini-laparoscopic para-aortic lymph node (PALN) dissection—with or without simultaneous ovarian transposition—in patients with locally advanced cervical cancer prior to chemoradiotherapy. Methods: This retrospective study evaluated nine patients with FIGO 2009 stage IB2–IVA cervical cancer who underwent mini-laparoscopic PALN assessment using a 5-mm optical transumbilical trocar and 3.5-mm/5-mm ancillary trocars at a tertiary university hospital. Premenopausal patients underwent concurrent bilateral salpingectomy and lateral ovarian transposition. Demographic characteristics, operative times, intraoperative/postoperative complications, node yields, length of hospital stay, and time to chemoradiotherapy were recorded and analyzed. Results: The mean patient age was 41.25±9.50 years, and the mean body mass index (BMI) was 24.5±3.24〖" kg/m" 〗^2. Five premenopausal patients successfully underwent mini-laparoscopic PALN dissection combined with ovarian transposition. The mean operative time was 205±51.4 minutes, and the mean number of removed para-aortic lymph nodes was 15.89±7.61. One intraoperative external iliac vein injury occurred, which was successfully repaired intraoperatively with primary suture, followed by postoperatively managed chylous ascites. The mean hospital stay was 5±3.02 days. All nine patients successfully initiated definitive chemoradiotherapy within 20 days of surgery. Conclusion: Mini-laparoscopic PALN dissection is a technically feasible and safe procedure for staging locally advanced cervical cancer, offering adequate node yield and potential for rapid postoperative recovery without delaying primary chemoradiotherapy. Larger prospective controlled studies are warranted to confirm these findings and establish long-term clinical outcomes.

Anahtar Kelimeler

• cervical cancer
• staging
• radiotherapy
• mini-laparoscopy
• para-aortic lymphadenectomy

Kaynakça

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