Linfadenectomia inguinal modificada no carcinoma do penis : avaliação prospectiva de 27 pacientes
Roberto Gonçalves de Lucena
DISSERTAÇÃO
Português
(Broch.)
T/UNICAMP L963L
Campinas, SP : [s.n.], 2001.
87f. : il.
Orientador: Carlos Arturo Levi D'Ancona
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Resumo: O acometimento dos linfonodos inguinais no carcinoma epidennóide do pênis é um dos fatores prognósticos mais importantes. A não identificação de metástases em linfonodos inguinais diminui a sobrevida, mesmo após o resgate cirúrgico. A avaliação clínica dos linfonodos inguinais traz índices...
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Resumo: O acometimento dos linfonodos inguinais no carcinoma epidennóide do pênis é um dos fatores prognósticos mais importantes. A não identificação de metástases em linfonodos inguinais diminui a sobrevida, mesmo após o resgate cirúrgico. A avaliação clínica dos linfonodos inguinais traz índices de falha variáveis, o que estimulou alguns autores a proporem diferentes procedimentos com o intuito de estadiar e tratar os linfonodos inguinais. Realizou-se um estudo clínico prospectivo no qual se comparou o estadiamento clínico e cirúrgico realizado através da linfadenectomia inguinal modificada com a preservação da veia safena magna , tendo como limite medial a musculatura adutora, limite lateral os vasos femurais e, superionnente, a arcada inguinal. O que foi realizado no mesmo ato da penectomia. Um total de 27 pacientes portadores de carcinoma espinocelular do pênis com estadiamento do tumor primário T2 e T3. O índice de falso-positivo e falso-negativo do estadiamento clínico em relação ao estadiamento cirúrgico foi de 12,96 e 5,55%, respectivamente. Após um seguimento médio de 24,70 meses, apenas um paciente apresentou recidiva em linfonodos inguinais. O índice de complicações nos pacientes submetidos à linfadenectomia modificada foi de 36,5%, significantemente inferior aos pacientes que realizaram a linfadenectomia radical(87 ,5%), sendo identificado o malor índice de complicações infecciosas quando comparados com a literatura. A liníadenectomia inguinal modificada é um método com menor morbidade operatória quando comparada com a liníadenectomia radical. Sendo discutível a sua realização no mesmo tempo operatório do tratamento do tumor primário
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Abstract: The involvement of inguinal lymph nodes in epidermoid carcinoma of the penis is one of the most important prognostic factors. Survival is reduced when lymph nodes metastasis is not identified, even after surgical intervention. Clinical evaluation of inguinal lymph nodes offers varied...
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Abstract: The involvement of inguinal lymph nodes in epidermoid carcinoma of the penis is one of the most important prognostic factors. Survival is reduced when lymph nodes metastasis is not identified, even after surgical intervention. Clinical evaluation of inguinal lymph nodes offers varied degrees of failure. This has stimulated some authors to propose different approaches in order to stage inguinal lymph nodes. We designed a prospective clinical study where we compared clinical and surgical staging by means of a modified inguinal lymphadenectomy with preservation of the saphena magna vein, which had as medial limit the adductor musculature, laterally the femoral vas and superiorly the inguinal arch. The procedure was done at the same time as penectomy. Twenty-seven patients suffering from epidermoid carcinoma of the penis, with primary tumor staged as T2 and T3, were studied. False-negative and false-positive clinical stages, when related to surgical staging, were 5.55 and 12.96%, respectively. After a mean follow-up of 24.7 months only one patient presented with tumor recurrence in the inguinal lymph nodes. The complication rate in patients that were submitted to modified lymphadenectomy was 35.5%, which was significantly inferior to patients that had had radical lymphadenectomy (87.5%). Infectious complications occurred in a high number when compared to the literature. Modified lymphadenectomy is a method that offers lower surgical morbidity when compared to radical lymphadenectomy. Whether this procedure should be performed at the same time as the surgery of the primary tumor is debatable. The involvement of inguinal lymph nodes in epidermoid carcinoma of the penis is one of the most important prognostic factors. Survival is reduced when lymph nodes metastasis is not identified, even after surgical intervention. Clinical evaluation of inguinal lymph nodes offers varied degrees of failure. This hás stimulated some authors to propose different approaches in order to stage inguinal lymph nodes. We designed a prospective clinical study where we compared clinical and surgical staging by means of a modified inguinal lymphadenectomy with preservation of the saphena magna vein, which had as medial limit the adductor musculature, laterally the femoral vas and superiorly the inguinal arch. The procedure was done at the same time as penectomy. Twenty-seven patients suffering from epidermoid carcinoma of the penis, with primary tumor staged as T2 and T3, were studied. False-negative and false-positive clinical stages, when related to surgical staging, were 5.55 and 12.96%, respectively. After a mean follow-up of 24.7 months only one patient presented with tumor recurrence in the inguinal lymph nodes. The complication rate in patients that were submitted to modified lymphadenectomy was 35.5%, which was significantly inferior to patients that had had radical lymphadenectomy (87.5%). Infectious complications occurred in a high number when compared to the literature. Modified lymphadenectomy is a method that offers lower surgical morbidity when compared to radical lymphadenectomy. Whether this procedure should be performed at the same time as the surgery of the primary tumor is debatable
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Linfadenectomia inguinal modificada no carcinoma do penis : avaliação prospectiva de 27 pacientes
Roberto Gonçalves de Lucena
Linfadenectomia inguinal modificada no carcinoma do penis : avaliação prospectiva de 27 pacientes
Roberto Gonçalves de Lucena
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