Laterally extended parametrectomy

被引:4
|
作者
Capilna, Mihai Emil [1 ]
Ungar, Laszlo [2 ]
Cozlea, Alexandra Lavinia [1 ]
Gheorghe, Mihai [1 ]
Stanca, Mihai [1 ]
Lintner, Balazs [3 ]
Moldovan, Andreea Anamaria [4 ]
机构
[1] GE Palade Univ Med Pharm Sci & Technol, Obstet & Gynecol Clin 1, Targu Mure, Romania
[2] Duna Med Ctr, Dept Gynecol, Budapest, Hungary
[3] Semmelweis Univ, Dept Gynecol, Budapest, Hungary
[4] Cty Hosp, Dept Infect Dis & Epidemiol, Brasov, Romania
关键词
Parametrectomy; Cervical cancer; Recurrences; Excision margins;
D O I
10.5468/ogs.21103
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure. Methods LEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvic sidewall. Its initial indications were for lymph node positive Stage Ib (current International Federation of Gynecology and Obstetrics 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitive radiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated for removing tumors involving the soft structures of the pelvic sidewall during a pelvic exenteration, aiming to obtain lateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliac vessels, but also to the true limits of the pelvic sidewall. Results During LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of the pelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on the pelvic sidewall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internal iliac artery and vein) and the variable anatomic distribution of pelvic sidewall veins. Conclusion LEP is a feasible technique for removing pelvic sidewall recurrences, aiming to obtain surgical free margins.
引用
收藏
页码:470 / 472
页数:3
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