Operative Therapie des Endometriumkarzinoms

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• 作者：Prof. Dr. med. Ingo B. Runnebaum
• 关键词：SchlüsselwörterGynäkologischer Tumor ; Minimalinvasive Chirurgie ; Hysterektomie ; Organerhalt ; Lymphonodektomie pelvin und paraaortal
• 刊名：Der Onkologe
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：23
• 期：1
• 页码：15-22
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Oncology;
• 出版者：Springer Medizin
• ISSN：1433-0415
• 卷排序：23

文摘

The review article presents the current state of the art of surgical treatment for endometrial cancer based on a selective literature search in PubMed until July 2016. Relevant controversies are included. Preoperative clinical diagnostics include assessment of functional fitness of the patient with respect to the treatment approach as well as transvaginal sonography and computed tomography (CT) scans of the chest and abdomen, which provide preoperative indications of the stage. Elevated serum CA125 can be associated with lymph node metastasis or higher stages. Standard therapy of type I endometroid endometrial cancer (pT1a G1/G2) is minimally invasive total hysterectomy (TH) with bilateral salpingo-oophorectomy (BSO). In premenopausal women ovary-conserving therapy is possible except in BRCA and Lynch syndromes. In intermediate risk endometrial cancer (pT1a G3 L0/L1 or pT1b) systematic pelvic and infrarenal para-aortic lymphadenectomy is additionally recommended. Sentinel node biopsy alone is still examined in clinical trials. In high-risk type I FIGO stage II (cervical stroma involvement but no parametrial infiltration), TH plus BSO with surgical staging and systematic pelvic and para-aortic lymphadenectomy is sufficient. In type II FIGO stage I (non-endometroid endometrial cancer), the same surgery is necessary but in addition omentectomy in cases of serous involvement. In FIGO stages III and IV, parametrial resection is necessary if compete resection (R0) is to be achieved and additionally surgical staging and macroscopic complete resection plus systematic pelvic and para-aortic lymphadenectomy.