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Objective: To present an overview of minimally invasive approaches to suprapelvic lymphadenectomy and compare two different methods of staging robotic transperitoneal paraaortic lymphadenectomies in patients with early stages of endometrial cancer., Design: Retrospective study and literature review., Setting: Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc., Methods: In this retrospective study we enrolled 70 patients with early stages of endometrial cancer undergoing staging robotic surgery at the Department of Obstetrics and Gynecology, University Hospital Olomouc from January 2016 to March 2018. Primary systematic pelvic and paraaortic lymphadenectomy was suggested in all patients. In 39 out of 70 patients single docking was used for robotic staging surgery, whereas in 28 patients the procedure was done using double side docking approach. Number of patients with total and infra-renal suprapelvic lymphadenectomy, number of para-aortic lymphonodes retrieved and the rate of lymphadenectomy complications were compared., Results: Robotic surgery was performed in 67 (96%) out of 70 patients. In three cases (0,4%) laparoscopy was converted to laparotomy. Single side docking was used in 39 cases (58%), whereas in 28 patients (42%) double side docking was used. Paraaortic lymhadenectomy was performed in 45 cases (67%). In 16 patients (24%) the upper limit of the left renal wein was reached. Upper limit of paraaortic lymphadenectomy was above inferior mesenteric artery but did not reach left renal vein in 19 cases (28%). Inferior mesenteric represented upper limit of paraaortic lymphadenectomy in 10 patients (15%). Number of paraaortic lymphonodes retrived (4,9 ± 3,3 vs 3,7 ± 4,9, p = 0,028) as well as number of paraaortic lymphadenectomies with upper limit at the left renal vein (p < 0,0001) was higher in double side docking cases. Complication rates were low in both groups and the differences were not significant., Conclusion: Number of lymphonodes retrieved as well as the number of paraaortic lymphadenectomy cases with upper limit at the left renal vein was higher in double side docking group. Operating time, complication and conversion rates were low without differences between both groups.

Aim: To review contemporary knowledge of the low volume metastatic disease in patients with endometrial cancer., Type of Study: A literatue review., Settings: Department of Obstetrics and Gynecology, University Hospital Olomouc; Department of Clinical and Molecular Pathology, University Hospital Olomouc., Introduction: The presence of micrometastases or isolated tumor cells in the sentinel node detected by ultrastaging leads to the change of tumor stage. Low volume lymph node involvement represents up to 30% of the affected lymph nodes in patients with endometrial cancer. The enhanced sentinel lymph node investigation aims to more accurately determine the extent of illness from stage I to stage IIIC. Particularly important is the detection of low-volume metastatic nodal involvement in low-risk tumors, because compared with macrometastases, micrometastases may occure earlier in tumours with lower carcinologic aggressiveness., Conclusion: Detection of low volume metastatic disease decrease the false negativity of nodal involvement and is helpful for adjuvant treatment planning.

Objective: To review a literature about possible new blood serum gynecologic tumor markers, S100 proteins family, trefoil factor 3 and AIF-1., Design: Literature review., Setting: Department of Obstetrics and Gynecology, Faculty of Medicine, Palacky University and University Hospital in Olomouc., Methods: Literature review of articles published in PubMed database till January 2019., Results: The association of S100A2, S100A4, S100A6, S100A7, S100A8, S100A9 and S100A11 with breast carcinoma has been demonstrated in the literature. The association of S100A2, S100A4, S100A6, S100A7A, S100A10, S100A14, S100A16, S100B, S100P (up-regulation associated with a lower survival) and S100A1, S100A13, S100A5, S100A13 and S100G proteins (up-regulation associated with a better survival) have been demonstrated in ovarian cancer patients. Cervical carcinoma has been shown to be associated with the S100A9 protein. TFF3 association with endometrial cancer, breast cancer (worse prognosis) and ovarian cancer (better prognosis) has been demonstrated. AIF-1 has been shown to increase expression in cervical cancer., Conclusion: Tumor markers can be a very useful tool for patient management when used appropriately. Further research in this area and the search for new tumor markers, including S100, TFF3 and AIF-1, are needed. In future studies, scientists should focus not only on one time point, but assess the trend of the tumor markers for a specific time axis.

Aim: Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides might be used as markers for neoplastic uterine disease., Design: Experimental study., Setting: Department of Obstetrics and Gynaecology, University Hospital, Medical Faculty, Palacký University, Olomouc; Department of Laboratory Biochemistry, Central Moravian Hospital Trust, Member of Agel holding, Prostějov., Methods: During the time period from 2012 to 2015 eighty-nine women underwent hysteroscopy and endometrial biopsy for postmenopausal bleeding. Fifty three patients, at the age of (mean ± standard deviation) 63,4 ± 9,5 (33-80) years were diagnosed with endometrial cancer, six patients at the age of 62,9 ± 6,4 (55-74) years were diagnosed with endometrial hyperplasia and thirty patients at the age of 63,3 ± 9,3 (48-62) years diagnosed with endometrial atrophy represented control group. At the day of surgery the venous blood was sampled and subsequently examined for the levels of TFF1, TFF2 and TFF3., Results: TFF3 levels were significantly higher in patients with endometrial carcinoma but not in endometrial hyperplasia subgroup. The levels of TFF1 and TFF2 were not different in selected histopathological subgroups., Conclusion: We have shown elevated levels of TFF3 but not of TFF1 and TFF2 in patients with endometrial cancer. TFF1, TFF2 and TFF3 levels were not elevated in patients with endometrial hyperplasia.

Aim: To study inflammatory response and nutritional biomarkers in operated endometrial cancer (EC) patients., Materials and Methods: A total 109 consecutive EC patients undergoing open laparotomy (LT), laparoscopic (LS) or robot-assisted surgery (RS) were studied. Twenty four patients served as controls. Pre- and postoperative levels of inflammatory and nutritional biomarkers were analyzed prospectively., Results: The estimated blood loss was significantly lower in RS compared to all other groups. C-reactive protein (CRP) and interleukin-6 (IL-6) correlated with each other and exhibited positive correlation with age, body-mass index (BMI), leukocyte count, platelet count, kynurenine, kynurenine/tryptophan ratio and urinary neopterin and a negative correlation with vitamin D and retinol. Hemoglobin, retinol, alpha-tocopherol, vitamin D and citrulline concentrations decreased and inflammatory biomarkers increased after surgery to a different extent in LT, LS, RS and control groups., Conclusion: The present data demonstrate a differential response to surgical trauma in patients with endometrial carcinoma., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Objective: To describe and evaluate our experience with robotically assisted laparoscopic staging of endometrial cancer in first hundred cases as compared with the first and last 30 cases of patients staged by this method., Design: Comparative retrospective study., Setting: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic. Institute of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic., Methods: The robotic centre at the Faculty Hospital in Olomouc was opened in August 2009 which enabled to perform robotically assisted laparoscopic staging of endometrial cancer. Retrospectively we evaluated the first hundred patients with the early stage of endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy using four-armed da Vinci S HD surgical robotic system. In the second stage of the evaluation we compared the first and the last 30 cases operated by the above mentioned minimally invasive approach. All cases were performed by two surgeons (P.R., D.P.), within the same institution in the course of learning this technique. Age, body mass index (BMI), clinical stage of disease, length of operation, nodal yield, blood loss, the pre-operative and post-operative hemoglobin concentration difference and operating complications were documented and compared., Results: The first hundred patients were operated by the above mentioned minimally invasive method between September 2009 nad June 2014. All patients were between 33 and 85 years of age. The average age of the entire group of patients was 65 years of age, the average BMI reached 31.0 (ranging from 18.0 to 49.0), the operating times median was 206 minutes. The estimated median of blood loss was 100 ml. The conversion of robotic surgery to a laparotomy was recordedin 6 cases. When comparing the first and the last30 operated patients there was observed a statistically significant increase in BMI in the group of the last30 operations (29.5 vs. 33.0, p = 0.004) and there was a decrease in the number of conversions from 4 to 1.In particular, however, there was a statistically significant increase in the total number of the obtained lymph nodes in the group of the last 30 vs. the first30 patients (27 vs. 17), and the increase in the number of removed pelvic lymph nodes (21 vs. 17) and the paraaortic nodes (4 vs. 0)., Conclusion: The robotically assisted laparoscopic staging is one of several possible surgical approaches in the treatment of patients with endometrial cancer and it can be performed adequately in this way. According to the results from our patients group it is a surgical modality with significantly low blood loss, safe even for patients with high BMI and age. The increasing erudition of the surgeon is linked to the shortening of the operating time, reducing the number of conversions and the higher yield of lymph nodes and a reduction in blood loss which was reflected in particular in the comparison of the pre-operative and post-operative hemoglobin difference.