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Abstract

THE PLACE OF PELVIC AND LOMBOAORTIC CURAGE IN ENDOMETRAL CANCER

Dr G. Benjallloun, Dr. M. Sefrioui, *Dr. M. Mourabbih, Dr. M. Charkaoui, Pr. M. Ennachit, Pr. M.Benahssou and Pr. M.EL Karroumi

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Abstract

Materials and Methods: This is a retrospective study spanning a period of 04 years, from January 01, 2017 to December 31, 2020. Carried out on 45 cases of endometrial tumor having benefited from a lymph node dissection, both pelvic and lumbo-aortic, collected from the register of the Onco-gynecology department (CM6) at the Ibn Rochd University Hospital in Casablanca, and from computerized medical records of patients who were hospitalized in the department. Results: In our study, the median age at diagnosis was 66.25 years (39-85 years). The delay median visit was 8.6 months (01-24 months). The main complaint presented by the patients were postmenopausal bleeding (90.7%). Biopsy curettage of the endometrium coupled with hysteroscopy was performed in all our patients and allowed us to ask the definitive diagnosis of endometrial cancer in 100% of cases. He objectified an ADK of type I in 36 patients (80%), ADK type II in 07 patients (15.56%), mixed ADK in one patient (2.22%) and large cell carcinoma in one patient (2.22%). The grade the most dominant histological was grade 2 (46.47%) followed by grade 1 (22.22%) and finally guard 3 (11.11%). The intraoperative FIGO staging is done by pelvic MRI, objectifying: stage I in 13 cases (28.89%), stage II in 07 cases (15.56%), stage III in 20 cases (44.44%) and stage IV in 05 cases (11.11%). She underestimated the FIGO stage in 15.56% of cases (n = 07) and overestimated the FIGO stage in 28.89% of cases (n = 13). There was a concordance in 55.56% of cases (n = 25). Lymph node involvement was present in 42.22% of cases (19 patients), with 63.2% sensitivity, 100% specificity, compared to histology data. On this, an ESMO prognostic classification was carried out: 08 patients (17.78%) had a risk of low, 04 patients (8.89%) had an intermediate risk and 33 patients (73.33%) had an high risk. Pathological analysis of the hysterectomy piece with Pelvic and / or lumbar-aortic lymphadenectomies showed that nine patients had a FIGO 2018 stage IA endometrial cancer (20%), eleven had stage IB cancer (24.44%), ten had stage II cancer (22.22%), two had stage IIIA cancer (4.44%), two had stage IIIB cancer (4.44%), six had stage IIIC1 cancer (13.33%), two had stage IIIC2 cancer (4.44%), one had stage IVA cancer (2.22%) and two had stage IVB cancer (4.44%). The most frequently found histological type was endometrioid adenocarcinoma in 37 patients (82.22%), followed by serous adenocarcinoma papillary in 05 patients (11.11%) and carcinosarcoma in 02 patients (4.44%), one case clear cell adenocarcinoma was diagnosed (2.22%). Grade 1, 2 and 3 represented respectively 17.78% (08 patients), 44.44% (20 patients) and 37.78% (17 patients). Myometrium infiltration was more than 50% in 31 patients (68.89%), less than 50% of myometrium in 14 patients (31.11%). Cervical invasion was found in 17 patients (37.78%). Vascular emboli were present in 57.78% of cases (26 patients). The study peritoneal cytology was performed in 16 patients in our series and returned positive in a patient. Omentectomy was performed in 07 patients and tumor returned in one patient. Invasion of the right ovary was present in two patients in our series (4.44%). Metastatic nodes are identified on pelvic and / or lumbo-aortic dissection. It was positive in 12 patients (26.67%): right pelvic lymph node invasion in 04 patients (33.33%), left pelvic lymph node invasion in 05 patients (41.67%), invasion lumbar-aortic lymph node in 02 patients (16.67%) and a lymph node invasion of the Primary iliac bifurcation in one patient (8.33%). In our experience, 27 patients (60%) were referred after surgery for additional treatment in the oncology department (P40): eight patients (17.78%) received treatment combining external radiotherapy, vaginal chemotherapy and brachytherapy. One patient (2.22%) received treatment combining external radiotherapy, chemotherapy and hormone therapy. Five patients (11.11%) were treated with external beam radiotherapy and vaginal brachytherapy. A patient (2.22%) was treated with external beam radiation therapy and chemotherapy. Exclusive radiotherapy has was performed in one patient (2.22%), exclusive vaginal brachytherapy in five patients (11.11%) and exclusive chemotherapy in six patients (13.33%). At the time of the analysis of our data, postoperative complications were found in seven patients (15.56%), deglobulization, wall suppuration, deep vein thrombosis of the lower limb, and a urinary complication of the left frank ureterohydronephrosis type. In our series, 31 patients (68.89%) had a recurrence-free survival. However, 14 patients had locoregional recurrences and distant metastases, ie 31.11% of cases. Overall survival was 95.55% (43 cases), two patients with metastatic relapse are deceased. Conclusion: The controversy over the indication and extension of lymphadenectomy and far from resolved, hence the need for randomized studies. Waiting, the balance is between the probability of lymph node involvement and the risks of lymphadenectomy, the latter will be performed whenever there is a risk of damage lymph node associated with a low operative risk.

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