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RISS 인기검색어
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- 저자 : Paul Buderath (검색결과 3 건)
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Paul Buderath,Peter Rusch,Pawel Mach,Rainer Kimmig 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1
Objective: Peritoneal mesometrial resection (PMMR) plus targeted compartmentallymphadenectomy (TCL) aims at removal of the locoregional cancer field in endometrialcancer (EC). Optimal locoregional control without adjuvant radiotherapy and acceptablesurgical morbidity should be achieved concomitantly sparing systematic lymphadenectomy(LNE) for most of the patients. Methods: We evaluated data from 132 patients treated for EC. Out of these, between January2017 and June 2020 we performed robotic PMMR and TCL on 51 women. We present the firstdata of feasibility and safety of the procedure as well as preliminary oncological results. Results: The 51 patients treated with robotic PMMR and TCL showed comparable morbidityto classic laparoscopic hysterectomy or PMMR without LNE. One intraoperative complicationoccurred. Postoperative complications grade 3 and higher occurred in 2 cases (3.9%). One ofthese (85 years old) experienced grade 5 following pulmonary embolism with lysis therapy. Fifteen patients (29.4%) could be spared complete LNE. The rate of adjuvant radiotherapywas 3.9% in our collective (n=2), compared to 39.2% of patients (n=20) eligible for irradiationaccording to international guidelines. In a mean follow-up time of 15 months (0–41), nolocoregional recurrences were observed, although three patients showed distant relapse. Conclusions: Our data suggest that robotic PMMR and pelvic TCL can be performedregardless of BMI and comorbidities without a relevant increase in surgical morbidity. Moreover, despite a relevant reduction of adjuvant radiotherapy, first follow-up data hint at afavorable locoregional recurrence rate in the reported cohort.
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Rainer Kimmig,Paul Buderath,Peter Rusch,Pawel Mach,Bahriye Aktas 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5
Objective: Para-aortic indocyanine-green (ICG)-guided targeted compartmental lymphadenectomy is feasible in early ovarian cancer [1]; systematic pelvic and para-aortic lymphadenectomy could potentially be avoided if thoroughly investigated sentinel nodes could predict whether residual nodes will be involved or free of disease. In contrast to advanced ovarian cancer, where the therapeutic potential of lymphadenectomy will soon be clarified by the results of the Arbeitsgemeinschaft Gynäkologische Onkologie lymphadenectomy in ovarian neoplasms (AGO LION) trial, systematic lymphadenectomy seems to be mandatory for diagnostic and also therapeutic purposes in early ovarian cancer [2-4]. Sentinel node biopsy or resection of the regional lymphatic network may reduce morbidity compared to systematic lymphadenectomy as shown already for other entities [5-7]. Apart from the ovarian mesonephric pathway [1], a second Müllerian uterine pathway exists for lymphatic drainage of the ovary [8]. Lymphatic valves apparently do not exist at this level of the utero-ovarian network since injection of radioactivity into the ovarian ligaments also labelled pelvic nodes [9]. Methods: We applied ICG using 4×0.5 mL of a 1.66 mg/mL ICG solution for transcervical injection into the fundal and midcorporal myometrium at each side [10] instead of injection into the infundibulopelvic ligament, since the utero-ovarian drainage was intact. Results: In this case a 1.8 cm cancer of the right ovary was removed in continuity with its draining lymphatic vessels and at least the first 2 sentinel nodes in each channel “en bloc” as shown in this video for the pelvic part, consistent with the loco-regional ontogenetic approach [11,12]. Conclusion: This could potentially avoid most of systematic lymphadenectomies in early ovarian cancer.
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Rainer Kimmig,Paul Buderath,Pawel Mach,Peter Rusch,Bahriye Aktas 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.3
Objective: Whether pelvic and para-aortic lymphadenectomy is of therapeutic benefit in advanced ovarian cancer will remain unclear until the publication of the Arbeitsgemeinschaft Gynäkologische Onkologie lymphadenectomy in ovarian neoplasms (AGO LION) trial. In early ovarian cancer, however, lymphadenectomy seems mandatory for diagnostic and also therapeutic reasons [1-3]. Methods: Complete systematic lymphadenectomy is accompanied by morbidity which may be reduced by sentinel node biopsy already established for several solid tumors [4-6]. In ovarian cancer there are 2 main pathways in lymphatic drainage: along the ovarian vessels to the para-aortic nodes and the uterine vessels to the iliac lymph compartments [7]. Following injection of radioactive dye into the ovarian ligaments this could be confirmed suggesting that there is bidirectional flow at this level of the ovarian and uterine lymphatic pathways [8]. Indocyanine-green-guided (ICG) injection to the uterine corpus seems to be equally effective in labelling the “uterine Müllerian” and the “ovarian mesonephric” lymphatic drainage of the ovary [9,10]. Results: This technique [9] was applied and will be outlined in the video showing the procedure with respect to the para-aortic lymphatic drainage. Isolated sentinel node biopsy and tumor excision will not resect the organ compartment together with its super-ordinated draining lymphatic system at risk. Conclusion: Thus, the authors suggest to remove the malignancy together with its draining lymphatic vessels and at least the first 2 sentinel nodes in each channel en bloc; we propose to analyze this procedure consistent with the ontogenetic approach [11, 12] with respect to diagnostic accuracy and loco-regional control. This could potentially avoid most of systematic lymphadenectomies in early ovarian cancer.
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