gynecologic cancer intergroup cervix cancer research network cantu surgery.pdf18 (50%) 5...
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![Page 1: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/1.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Role of Surgery in Cervical Cancer
David Cantú MD PhD
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 2: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/2.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Is it still an Issue to
be explored?
?
![Page 3: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/3.jpg)
![Page 4: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/4.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Continues to be the cornerstone of
treatment in early stages
![Page 5: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/5.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 6: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/6.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Tumor Size
• Desire for fertility preservation
• Neoadjuvant chemotherapy
• Sentinel lymph node
![Page 7: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/7.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 8: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/8.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Minimally Invasive Procedures
![Page 9: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/9.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 10: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/10.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Facilities
• Training
• Preferences
• COSTS!!!!
![Page 11: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/11.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Locally Advanced Disease
![Page 12: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/12.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 13: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/13.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 14: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/14.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 15: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/15.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
![Page 16: Gynecologic Cancer InterGroup Cervix Cancer Research Network Cantu SURGERY.pdf18 (50%) 5 pielonefritis 14 fistulas 1 (2%) Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic infections 48 (44.8%)](https://reader033.vdocuments.us/reader033/viewer/2022053116/6093f9b24a0f8a417d108277/html5/thumbnails/16.jpg)
Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Recurrent Disease
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Objetivo :
Definir selección de px para EP en CaCu recurrente , El grado óptimo de la cirugía en términos de morbilidad y mortalidad.
European Journal of Surgical Oncology (2015), doi: 10.1016/j.ejso.2015.03.235.
Material y Metodos:
•Revisión de la literatura,
•Artículos publicados en los últimos 25 años:
•Exenteración pélvica,
•Cáncer cervical recurrente,
•Tratamiento del cáncer cervical,
•Radioterapia y cáncer de cuello uterino.
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European Journal of Surgical Oncology (2015), doi: 10.1016/j.ejso.2015.03.235.
• .
Descartar la presencia de mets.
• Resección completa del tumor con márgenes quirúrgicos no involucrados y es un fuerte factor pronóstico de supervivencia postoperatoria.
La cirugía curativa requiere
• 40% de EP fueron abortados IOp debido a una enfermedad no resecable.
1989
CaCU recurrente a Distancia:
Para-aórtica 81%
Supraclavicular 7%
Ganglios linfáticos pulmonares 21%
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• Difícil comparar los resultados, – Heterogeneidad respecto al tipo de procedimiento y
el tipo de cáncer que se está investigando (cervical, endometrial, de ovario o vulvar).
• Rara vez se centran únicamente en CaCU y aún más raramente en la recidiva.
• No explican cómo o por qué se eligió un procedimiento dado.
• Márgenes quirúrgicos negativos es un importante factor pronóstico, potencialmente modificable.
European Journal of Surgical Oncology (2015), doi: 10.1016/j.ejso.2015.03.235.
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AutorR Complicacione
s tempranas
Tipo Complicacione
s tardías
tipo Muertes
Berek NR NR NR 17 fitula gatrointetinal 3 (4%)
Goldberg NR NR NR NR 1 (0.9%)
Maggioni 48 (44.8%) NR 52 (48,5%) NR 0
Benn 27 (50%) 10 cardioresp, 6 ileo, 1
obstruction ureteral
33 (61%) 15 ileo, 11 ureteral, 15
hernias
0
McLean NR 15 infections, 8 abscesses, 6
sepsis
NR NR 1 (2%)
Vergote 21 (58%) 2 pelvic abscesses, 14
leaking stomas and
sepsis
18 (50%) 5 pielonefritis
14 fistulas
1 (2%)
Baiocch 57 ( 53.3%) 13 fistulas, 17 pelvic
infections
48 (44.8%) 8 fistulas, 9 occlusions, 16
Obstruction urinaria
13 (12%)
Yoo 10 (16 %) 4 skin infections, 1 ileus
5 fistulas, 3 wound
dehiscences
22 (36%) 10 fistulas (7
enterocutaneea,
2 rectovaginal, 1
Ureteroenteric)
0
Schmidt 143 (51%) 42 rectovaginal fistulas, 20
pelvic
abscesses, 10 pulmonary
emboli
NR NR 14 (5%)
Tanaka 10 ( 83%) 5 ileus, 3 leaking
gastrointenstinal
anastomoses
NR NR 0
Chiantera 48 8 21.3%) 23 sepsis, 15
cardiorespiratory, 39 wound
dehiscences, 22 urinary, 29
gastrointenstinal
NR NR 7 (3%)
European Journal of Surgical Oncology (2015), doi: 10.1016/j.ejso.2015.03.235.
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
• Palliative Procedures
– Ileal Conduit
– Colostomy
– Other diversions
– Other Procedures
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Is it still an Issue to
be explored?
?