Elaboration of guideline for primary treatment of operable vulvar cancer.Review, consensus between proposers and opponents.Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Prague.A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents.Guideline for the diagnosis remain the same as in the proposal from 1998. We elaborated practically new guideline for surgical treatment. Wide excision or simplex vulvectomy is adequate only for stage la without angioinvasion, free margins have to be 5 mm. Standard surgical procedure is radical vulvectomy with inquinofemoral lymphadenectomy in stage 1a with angioinvasion, 1b and 2. In laterally localised lesions it is possible to perform hemivulvectomy or radical excision with inquinofemoral lymphadenectomy. Free margins have to be more than 8 mm. An alternative procedure in internally high-risk patients is sentinel node detection with radical vulvectomy (hemivulvectomy). Sentinel node detection has to by performed by combined method of blue dye and radiocoloid Tc 99 simultaneously. Bilateral inquinofemoral lymphadenectomy is indicated in case of positive sentinel node. Primary radiotherapy is indicated in higher stages, in stage 3 we can perform an exenteration with the agreement of patient.Guideline for the treatment of vulva cancer should be directions for clinicians and others, who participate in the process of treatment of the vulva cancer. Guidelines include all parts of the process (from diagnosis to follow up). All topics of the guidelines were arise from a voting of the proposers and opponents.
The prognosis of endometrial cancer (EC) is generally favorable, while lymph node status remains the most important prognostic factor. Sentinel lymph node mapping (SLNM) could help to find women in whom adjuvant therapy could be omitted. This review analyzes different techniques of injection and histopathologic elaboration of SLNM in EC. Results of studies on SLNM in ECs seem to be promising, but only a small series have been published so far. The studies are subdivided into three groups by the technique of injection (hysteroscopic, subserosal and cervical). Range of detection rate for SLNM varies from 45 to 100%. Hysteroscopic injection is not easy to learn; moreover, exact peritumoral injection in large tumors is often impossible. Subserosal administration of tracer is difficult during laparoscopic or robotic surgery. Cervical injection is quite a controversial technique because distribution of SLNs in ECs is different from cervical cancer; moreover, there is no large study using cervical injection with systematic pelvic and para-aortic lymphadenectomy.
The aim of the study is to summarize current data on chemotherapy administered during pregnancy.Review article.Dept. of Obstetrics and Gynaecology of the Charles University in Prague, 2nd Medical Faculty, University Hospital.Pubmed database was searched between the years 1980 and 2009 with the combinations of key words concerning cytostatics, therapy and pregnancy. Cisplatin administration was identified in 38 cases. Eight cases of administration of carboplatin during pregnancy were found with normal neonatal outcome Twenty-one case reports were found on the use of taxanes during pregnancy: 14 on paclitaxel and 7 on docetaxel.Based on the literature the administration of cytostatics during pregnancy can be considered under a close supervision and long-term follow-up in dedicated teams.
In our video we would like to demonstrate the technique of identification of sentinel lymph nodes and afferent lymphatic channels in paracervix using the combination of Tc radiocolloid and Patent Blue in patients with early stage cervical cancer.
Methodology
The patients included in this study were diagnosed with early stage spinocellular or adenocarcinoma of uterine cervix stage IA and IB1 up to 2 cm maximal diameter with maximal depth of invasion of less than half of the stroma. We use an ultrashort protocol consisting of application of 2 ml Tc (20 MBq) and 2 ml of Patent Blue diluted in 2 ml of saline. Tc is applicated in surgical theatre at the beginning of anaesthesia using 4 quadrant technique followed by the application of 1 ml Patent Blue into each quadrant. The surgical extirpation was performed in interval of 12 to 15 minutes after the application.
Results
During the period 2009–2018 we included 123 women. In this group we detected positive sentinel lymph nodes in 6 cases. The detection rate (DR) of sentinel lymph nodes was 122/123–99,2%, specific side detection rate (SSDR) 232/244–95,1% Our aim was to detect 246 channels in 123 women. No channels were detected in 6 women (4.9%), unilateral channel was detected in 25 women (20,3%) and bilateral channels were detected in 93 cases (75,6%).
Conclusion
Our video illustrates the safe technique of identifying and extirpation of sentinel nodes and afferent channels in the paracervix. In early stages of cervical cancers this technique can achieve very good detection rate of sentinel nodes on both sides of the pelvis. Work was supported Charles University research program PROGRES Q 28 (Oncology).
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