Professional Documents
Culture Documents
Honduras 2011
Pedro T. Ramirez, M.D.
Professor
Director of Minimally Invasive Research & Education
Department of Gynecologic Oncology
Cervix
Case Presentation
28 year old G0 with irregular bleeding and CIN-III
Medical: Negative
Surgical History: Negative
OBGYN: Menses normal. Paps-History CINII
Pelvic exam:
No gross cervical lesion
Adnexa normal
Cone: Adenocarcinoma 3mm invasion + margins
Points of Discussion
Standard of care
Options for fertility preservation
Surgical approach
Intraoperative decisions
Surgery
Exploratory laparotomy
Radical trachelectomy
Lymphatic mapping
Bilateral pelvic lymphadenectomy
Surgical Specimen
Points of Discussion
DFS
OS
Conclusion:
Radical trachelectomy has similar oncologic
outcome to radical hysterectomy
Case Presentation
34 year old G0 with history of stage IIB
cervical cancer s/p chemotherapy and
radiation
Presentation: Cough
Medical: Negative
Surgical History: Negative
Pelvic exam:
Normal s/p radiation changes
Adnexa and rectal normal
Imaging Studies
Points of Discussion
Discussion of prognosis
Role of supportive care
Options for treatment
GOG-179
GOG-204
Ongoing trials
GOG-240
Uterine
Case Presentation
46 year old G3P2 obese female with
irregular bleeding
Medical: Diabetes & Hypertension
Surgical History: Cholecystectomy
Pelvic exam:
No gross cervical lesion
Adnexa normal
Difficult due to body habitus
Surgery
Robotic hysterectomy
Bilateral salpingo-oophorectomy
Frozen:
G1 endometrioid adenocarcinoma
No invasion
FINAL:
Points of Discussion
Preoperative evaluation
Discussion according to patient age
Surgical approach
Intraoperative options
Postoperative hormone replacement
Case Presentation
38 year old G4P2 female with pelvic
pain and bladder pressure
Medical: Negative
Surgical History: Myomectomy-Fibroid
Pelvic exam:
26 cm irregular uterus
Adnexa non-palpable
Cervix normal
Imaging Studies
Surgery
Exploratory laparotomy
Total abdominal hysterectomy
Bilateral salpingo-oophorectomy
Frozen:
FINAL:
Uterine leiomyosarcoma
Tumor size: 24 cms
R ovary-leiomyosarcoma
Points of Discussion
Preoperative evaluation
Surgical approach
Role of intraoperative frozen section
Indications for lymphadenectomy
Postoperative therapy
Ovary
Case Presentation
30 year old G0 with dyspareunia.
Medical and Surgical History: Negative
OBGYN: Menses normal. No STDs.
Paps Normal
Pelvic exam:
Bilateral adnexal
masses
Cervix normal
Surgery
May 23, 2011
Exploratory laparotomy
R salpingo-oophorectomy
L cystectomy
Points of Discussion
Differential diagnosis
Options for follow up vs. surgery
Surgical approach
Intraoperative options
Postoperative counseling
Case Presentation
68 year old G0 with abdominal bloating and
worsening shortness of breath.
Medical: Congestive heart failure and
emphysema
Surgical History: Bilateral salpingo-oophorectomy
Exam:
Decreased breath sounds L
Abdomen distended and firm
Pelvis: Firm nodularity in cul-de-sac
Pathology
CT-Guided biopsy:
Interval Cytoreductive
Surgery
Chemotherapy followed by surgery
3 cycles---Surgery---3 cycles
Patients who are NOT good surgical
candidates
-Multiple liver or lung metastases
-Suprarenal lymph nodes
-Mesenteric adenopathy
Recent European study shows
NO difference in survival
Points of Discussion
Case Presentation
32 year old G0 with R pelvic pain.
Medical: History of breast cancer at age 30.
Surgical History: Appendectomy
Exam: Abdominal tenderness in R to deep
palpation
Pelvis: Mobile palpable
mass in pelvis ~12 cms
Social: Patient due to be married in 6 weeks
Surgery
Exploratory laparotomy
R salpingo-oophorectomy
Pelvic and para-aortic lymphadenectomy
Omental biopsy
Peritoneal biopsies
Frozen:
Points of Discussion
Case Presentation
60 year old G3P2 with new onset bloating &
pain
Medical: Hypertension
Surgical History: Cholecystectomy
Hystectomy-Fibroids
Exam: Chest-Normal
Abdomen distended & soft
Firm/Irregular pelvic mass
Surgery
Exploratory laparotomy
Bilateral salpingo-oophorectomy
Omentectomy
Splenectomy
Partial liver resection
Para-aortic radical lymphadenectomy
Diaphragmatic stripping
Recto-sigmoid resection with re-anastomosis
Frozen: HG serous neoplasm
SPLEEN
Points of Discussion
Post-operative Course
POD # 4