2局限于子宮的內(nèi)膜癌手術(shù)選擇爭(zhēng)議：局限于子宮，宮頸累及？廣泛子宮切除術(shù)？DiseaselimitedtouterusMedicallyinoperable

operableTumordirectedRTTotalhysterectomyandbilateralsalpingo-oophorectomyLymphonodesdissectionpelvic+paraaorticThecurrentNCCN

ClinicalPracticeGuidelinerecommendspracticingradicalhysterectomyonlywhencervicalinfiltrationissuspectedonMRIorwhenconfirmedbycervicalbiopsy.2009NCCNGanToKagakuRyoho.1995Aug;22(9):1163-8.

Totalhysterectomyisdoneforcasesofstage0,modifiedradicalhysterectomyforstageI,radicalhysterectomyforstageII,andradicalhysterectomycombinedwithresectionofthemetastaticlesionsforstageIIIandIVZhonghuaFuChanKeZaZhi.2002Feb;37(2):90-3.

SurgicalmethodisnotthemainfactorinfluencedthesurviveofstageIendometrialcarcinoma.ZhonghuaFuChanKeZaZhi.2004Mar;39(3):156-8.ThepatientswithstageIendometrialcarcinomawhoweretreatedwithsimplehysterectomyandsalpingo-oophorectomydidalmostaswellasthosewhounderwentradicalhysterectomy.

Mauro

Signorelli,etal.GynecologicOncology2009ModifiedRadicalHysterectomyVersusExtrafascialHysterectomyintheTreatmentofStageIEndometrialCancer

Piver-Rutledge:5類LANCET2008：DenisQuerleu,etal:ClassificationofradicalhysterectomyExtrafacialhysterectomyModifiedhysterectomyRadicalhysterectomyLaterallyextendedresectionExtenteration方法：

Thepositionoftheuretersisdeterminedbypalpationwithoutfreeingtheuretersfromtheirbeds.Theparametriumistransectedmedialtotheureter,butlateraltothecervix,keepingtheparacervicalringintact.Theuterosacralandvesicouterineligamentsaretransectedclosetotheuterus.Thereisnoremovalofparacolposandaminimalpartofvaginaisresectedatfornixlevel.1011FIGO2009外陰癌FIGO2009年腫瘤分期改變OLDNEW16分期改變帶來的新問題分段診刮或?qū)m腔鏡檢查宮頸管陰性宮頸上皮浸潤(rùn)I型子宮切除術(shù)MR局限于頸管內(nèi)膜侵犯宮頸間質(zhì)II或III型子宮切除術(shù)宮頸間質(zhì)浸潤(rùn)Depthofmyometrialinvasionandpelvicorparaaorticlymphnodepositivityweresignificantlycorrelatedwithparamatrialinvolvement.

Ofthe19patientswithpelviclymphnodemetastasis,8patients(42.1%)hadconcomitantPMI.Conversely,ofthe10patientswithPMI,8(80.0%)hadlymphnodemetastasis.THISISANAREAOFCONTINUEDDEBATE

23JKoreanMedSci2010;25:552-6原因：Currentpre-operativeevaluationmethodisnotsensitiveenoughtodetectcervicalinvasionMedicalstatuscervicalstromalinvasionshouldbefollowedbyadjuvantradiotherapyandthus,theprognosiswouldnotbechangedbyperforminga‘highmorbidityproducingsurgery’consideringthelowincidenceofPMI原因：4.Metastasischaracteristics:

differentfromcervicalcancerPMI:lowincidence6%PMI(+):LN(+)80%LN(+):PMI(+)<45%Metastasispatterns:

directinvasionofcancercellstotheparametrialconnectivetissues

parametriallymp