Cirugía y Cirujanos

Segundo Consenso Mexicano de Cáncer de Endometrio

Endometrial cancer is the fourth gynecologic cancer with the highest incidence and mortality worldwide. In Mexico it holds the second place with 5,500 new cases and 1,100 deaths and constitutes an important public health issue. To develop recommendations for the diagnosis and management of endometrial cancer from an interinstitutional perspective of the Mexican health system. The consensus was performed through a modified Delphi panel. A committee of oncologists defined 10 specific subjects to be discussed by the work groups of experts with professional experience in the management of endometrial cancer. The consensus was performed in-person by voting to decide if a recommendation was adequate for inclusion in the present report, with an agreement cut-off point of 80%. Consensus was obtained in 33 recommendations based on the identified evidence evaluated by the experts who reached a formal consensus on the final draft of all clinical recommendations. The present guideline provides clinical recommendations for the diagnosis and management of endometrial cancer, contributing to the quality of care in patients with endometrial cancer in Mexico.

Lipoma vulvar gigante

Comparación de las características citogenéticas y moleculares observadas en los cánceres de endometrio: clínica conocida y dificultades en el tratamiento

Understanding the relationship between genetic structure and the molecular changes involved in endometrial cancer (EC) provides an opportunity to personalize treatments and incorporate targeted therapies. We compared cytogenetic and molecular features observed in tumoral and adjacent healthy tissue endometrium samples in EC patients. Non-clonal chromosome aberrations (NCCAs) frequently in patients with EC, especially in 10,15,17,22, X chromosomes and were monitored in 73.7%, clonal chromosomal alterations were observed in 26.3% of the patients. Down POLE gene expression in 42.1%, up p53gene expression in 57.9%, PTEN down-regulation in 47.3%, down ARID1A gene expression in 42.1%, PIK3CA up-regulation was observed in 68% of patients. The up-regulation of tumor suppressor genes in our study shows that not only these genes are involved but also different pathways and factors play a role in tumorigenesis. Furthermore, an increased number of NCCAs shows an essential role in the development of ECs.

Índice de carcinomatosis peritoneal y supervivencia global en pacientes llevados a cirugía citorreductora más quimioterapia intraperitoneal hipertérmica

The peritoneal carcinomatosis (PC) secondary to gastrointestinal or gynecological cancer has increased its incidence. It has a worse prognosis compared to other sites of metastasis. The peritoneal carcinomatosis index (PCI) establishes overall survival in patients with gastrointestinal or gynecological tumors and carcinomatosis. To evaluate the relationship of PCI to overall survival (OS) and recurrence-free survival (RFS) in patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). A descriptive, retrolective study of 80 charts of patients with CP was conducted. We included patients with colon, ovarian, appendicular, pseudomyxoma and gastric tumors with CP treated with CRS plus HIPEC. The OS and RFS were determined according to the type of adenocarcinoma and the degree of differentiation. The OS and RFS were determined in months in patients with PCI > 15 PCI as well as in patients with PCI 70 months, compared to patients with gastric tumors (4 months). The PCI and histology are predictors of OS. Patients with ovarian tumors and PCI < 15 have higher OS, similar to pseudomyxomas. RFS was also higher in patients with PCI < 15.

Utilidad de la linfadenectomía pélvica en la etapificación del disgerminoma de ovario

To determine the usefulness of pelvic lymphadenectomy in the staging of ovarian dysgerminoma. Patients with a histopathological diagnosis of ovarian dysgerminoma who were staged between January 1995 and December 2013 were retrospectively studied. We found 39 cases, the mean age was 23.5 years. Histologically, 34 were pure dysgerminomas and 5 were mixed associated with endodermal sinus tumors. According to FIGO, we found stage IA in 15 patients, stage IB in 1 patient, stage IC in 8 patients, stage IIB in 1 patient, stage IIIA in 1 patient, and stage IIIC in 13 patients. Pelvic nodes with metastases were not documented in any of the patients studied. The lymphatic spread pattern in ovarian dysgerminomas is always towards the retroperitoneal nodes, both paracaval and paraaortic, but there is no spread towards the pelvic lymph nodes. Therefore, we recommend not performing pelvic lymphadenectomy in surgical staging in these patients.

Investigación del efecto de los grupos sanguíneos ABO en el pronóstico del cáncer de endometrio de tipo endometrioide

The aim of this study was to examine how the ABO blood type affects endometrioid-type, EC prognosis. A total of 522 patients diagnosed with EC between February 2010 and December 2021 were assessed, retrospectively. ABO blood types were used to divide the patients into four groups as A, B, O, and AB. Demographic data, menopause, prognostic variables, FIGO stage, and survival were evaluated. A in 217 patients, B in 84 patients, O in 181 patients, and AB blood type in 40 patients were analyzed. Age, gravida, parity, body mass index, menopause, comorbidity, prognostic variables, FIGO stage, and survival according to the groups were similar (p > 0.012). Group A differed from other groups statistically in peritoneal fluid cytology (p = 0.004). B blood type had the best chance of cumulative overall survival, followed by AB, A, and O blood types, in that order (p = 0.170). In light of blood types sensitivity to endometrioid-type EC, O blood type has been identified as blood type with the highest risk of endometrioid EC.