Explain：Endometrial cancer

Content: Extended ATH + BPLD

Clinical Information:

Th The patient had {{ abnormal vaginal bleeding, lowewr abdomen pain, abnormal Pap smear }}.

Patient underwent a fractional dilatation and curettage malignant endometrial cancer.

Clinical staging is stage {{IA, IB, IC, IIA, IIB, IIIA, IIIB, IIIC, IVA, IVB}}.

Pelvic and abdominal CT shows retroperitoneal lymph node {{enlarged, not enlarged}}.

The biochemical data are: CA-125:_______, CEA:________.

Oral pill {{ +, -}}

Menopause {{ +, -}}.

Hormone replacement therapy {{ +, -}}

DM {{ +, -}}

H/T {{ +, -}}

BW::_______ Kg, BH::_______cm

Operative Procedures:

Type of operation: Extended ATH + [[BSO, RSO, LSO, BS, BPLD, para-aortic lymph node sampling, omentectomy, appendectomy, enterolysis, cytology]].

The intestinal loop was placed up to the abdominal cavity and the uterus and adnexae were exposed. Bilateral round ligaments were severed and both anterior and posterior broad ligaments were incised over the ovarian ligament posteriorly and close to the bladder reflection at the isthmus level anteriorly. The infundibulo-pelvic ligaments or ovarian ligaments were clamped and double ligated depending on salpingo-oophorectomy or not. The posterior broad ligament were further incised downward until the upper ends of uterosacral ligaments was reached. Then the bladder base was mobilized downward carefully to expose the cervico-vesicle fascia and the lower margin of cervix. Bilateral ascending branches of uterine artery were clamped and dissected with double ligations. Then the upper cardinal ligaments were clamped, dissected, and ligated close to the lateral cervical edges after careful separation of bladder pillars laterally.

The infundibulopelvic ligament was clamped, cut and ligated with 1-0 silk catgut materials.. The ovarian ligament was clamped, cut and ligated with 1-0 silk catgut materials also. Mesosalpinx vessels were separated and clamped, cut separately, and ligated with 2-0 silk materials. The ovary was removed. The rough cut margin and serosa were sutured with 2-0 chromic catgut materials continually.

The bladder was further pushed downward until the lower cervical margin could be definitely palpated beneath the vaginal wall. A sharp incision through the upper vaginal wall at the cervico-vaginal junction was performed by knife. After opened the vaginal wall, the cervix was dissected from vaginal fornix by scissors. Attention was put to prevent injury to the rectum. The vaginal cuff was closed by continued 1-0 vicryl suture. After hemostasis, peritoneal defect was closed by approximate the bladder serosal edge to the peritoneum over posterior vaginal stump. Bilateral round ligaments were sutured together with the vaginal stump.

The abdominal wall was closed layer by layer. The peritoneum below the umbilicus was approximated by 1-0 chromic catgut, the abdominal fascia was closed by 1-0 vicryl continuous suture, the sub-cutaneous fat was approximated by 1-0 vicryl, and the skin was approximately by 3-0 vicryl subcutaneously. Scrupulous irrigation with normal saline before closure of abdominal wall and between layers of closure was done to wash away the possible floating tumor cells. The patient was sent to POR intensive care unit for recovery and respiratory support. The patient stood the procedure well and was in stable condition.

Operative Findings:

endometrium tumor size: _________CM.

Lymph node status: [[node not enlarged, R’t pelvic nodes enlarged, L’t node enlarged, paraaortic node not enlarged, Paraaortic node metastasis]]

Complication: [[massive bleeding, ureter injury, bladder injury, intestine injury, _______________]].

Pathology:

Pathologic stage: {{IA, IB, IC, IIA, IIB, IIIA, IIIB, IIIC, IVA, IVB}}

Cytology: {{negative, positive}} for malighancy

Cell type: {{ADENOCARCINOMA, ADENOACATHOMA, ADENOSQUAMOUS CELL CARCINOMA, PAPILLARY SEROUS CARCINOMA, CLEAR CELL CARCINOMA, SMALL CELL CARCINOMA, UNDIFFERENTIATED}}.

Grade: {{1, 2, 3}}

Depth: {{no myometrium invasion, <1/2, >1/2, serosa of uterus}}

Adnexa: {{negative, positive}} for malighancy

R’t pelvic nodes: {{ negative, positive _______}}.

L’t pelvic nodes: {{ negative, positive _______}}.

R’t paraaortic nodes: {{ negative, positive _______}}.

R’t paraaortic nodes: {{ negative, positive _______}}.

Vagina: {{negative, positive}}

ER: {{-, +}}

PR: {{-, +}}

DNA index: ________

Dr:________________. Date: _______________.