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Endometrial cancer poses a risk to obese women in particular, as the excess amount of adipose tissue correlates with increased estrogen levels. It is therefore called by doctors “the disease of welfare”. Every year, 6 thousand people hear the diagnosis of endometrial cancer in Poland. women. For many, it is too late for surgery.
- Endometrial cancer develops in the lining of the uterus
- The incidence and mortality of this type of cancer is increasing
- Surgery is the treatment of choice for early forms of endometrial cancer. Now – thanks to the use of the da Vinci robotic system – the procedure can be performed more easily and the patient’s recovery is faster
- You can find more such stories on the TvoiLokony home page
Malignant neoplasms, according to the 2019 report of the National Cancer Registry, were the second cause of death in Poland, causing 23,2 percent. female deaths. They constitute a significant health problem, first of all, in young and middle-aged women (25–64 years). Among women, cancer is the most common cause of death before the age of 65, accounting for 31,7%. deaths of young and 46,8 percent. deaths of middle-aged women. The reasons for this situation can be seen in the failure of preventive programs, late detection and difficult access to modern methods of treatment.
The most common gynecological neoplasm in Poland
The most common gynecological cancer in Poland is endometrial cancer (about 6 cases a year), also known as endometrial cancer. It is a cancer that develops in the lining of the womb. The incidence and mortality of this type of cancer is increasing. Obesity is the most important risk factor. Excessive adipose tissue correlates with increased estrogen levels, which significantly increases the risk of developing endometrial cancer.
Surgery is the treatment of choice for early forms of endometrial cancer. The undoubted benefit of using the da Vinci robotic system is the minimization of surgical trauma. The surgical robot allows to perform the procedure with high precision thanks to the 3D full HD vision system and miniaturized surgical tools, thus reducing tissue damage and innervation.
It also allows for precise access to hard-to-reach places within the small pelvis, which is often impossible with open techniques and traditional laparoscopy. Patients with gynecological neoplasms, especially those with endometrial cancer, often suffer from comorbidities such as obesity, hypertension, diabetes and cardiovascular diseases, which increase the risk of intra and postoperative complications and may lead to abandoning surgical treatment in favor of other therapeutic methods .
– The use of robotic surgery, especially in obese women, reduces the incidence of complications typical for open surgery related to postoperative wound healing, and enables the procedure to reach hard-to-reach places in the pelvis, which is impossible with other techniques. Thanks to their stability, the robotic arms reduce tremors in the surgeon’s hands, which cannot be reduced in the case of other surgical techniques. In addition, shorter hospitalization and convalescence time affects the quality of life of patients after minimally invasive surgeries with the use of the Da Vinci robot and enables earlier implementation of adjuvant treatment
– says Dr. Magdalena Bizoń specialist in the field of oncological gynecology.
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The youngest patient was 25 years old, the oldest – 85
At the Hospital na Klinach in Krakow, which belongs to the NEO Hospital Group, for several months a program of gynecological cancer treatment, including endometrial cancer, with the use of the da Vinci robot has been carried out. The hospital received funding for the implementation of this innovative program from European Funds. Thanks to this, the treatments are performed free of charge.
– During several months of the program implementation, over 170 women contacted us, we operated almost 80. The youngest patient was 25 years old and the oldest was 85 years old. The results obtained so far indicate that the applied surgical methods, carried out with the assistance of the da Vinci robot, significantly contribute to the improvement of the quality of surgical treatment of patients with endometrial cancer. The achievements of our team have been appreciated and soon, during the 45th International Congress of Hospitals in Dubai, we will be able to present the results of our gynecological procedures using the da Vinci robot – says Joanna Szyman, president of NEO Hospital.
Endometrial cancer. What are the symptoms?
It is worth remembering about prophylaxis and gynecological consultations. The data collected by the hospital shows that as much as 53 percent. ladies who volunteered to participate in the project did not meet the basic criteria, mainly due to the late stage of the disease. Endometrial cancer often causes symptoms early in its development, so the disease is generally diagnosed early.
The most common symptom of endometrial cancer there is abnormal vaginal bleeding or spotting in postmenopausal women. The characteristic symptoms in the form of abnormal bleeding occur in over 90% of patients. Other symptoms of endometrial cancer include persistent discharge, blood in the urine, pain during intercourse or when urinating. Pain in the pelvic region and unexplained weight loss are usually symptoms of an advanced stage of this cancer.
In the Krakow hospital, the data obtained during the qualification for the procedure, during the operation and during the postoperative observation in all cases of robotic-assisted women in the period from April 1, 2021 to May 31, 2022, were analyzed. The assessment of the frequency and type of intra-and postoperative complications (Clavien Dindo classification), the number of conversions to laparotomy, quality of life (EORTC questionnaire), and the VAS pain scale showed that robot-assisted procedures are safe and of particular value in patients with diseases comorbidities, especially obesity and diabetes.
Optimistic information also comes from scientific publications based on the experiences of centers in Japan. There are over 360 da Vinci robots in operation in Japan. In the period 2009-2019, the number of minimally invasive procedures performed in Japan increased from 200 a year to over 4000. In Japan, as in many European countries, gynecology treatments using the da Vinci robot are reimbursed.
So far, over 26 scientific papers on the use of the da Vinci robot have been published, many of them in recent years related to gynecology and indicate the benefits of using the robot in relation to traditional open surgery and laparoscopy. Among others, Johansson CYM, Chan FKH. in Robotic-assisted versus conventional laparoscopic hysterectomy for endometrial cancer. Eur J Obstet Gynecol Reprod Biol X. 000; 2020: 8. indicate that in patients operated for endometrial cancer, the estimated blood loss was significantly higher in traditional laparoscopy than in robot-assisted procedures (100116 ml vs 78 ml, p = 22). Women who underwent surgery using a robot had a shorter stay in hospital.
Currently, women have a choice of three methods of performing a hysterectomy procedure: classical (open) and minimally invasive techniques such as laparoscopy or robotic surgery. In Park DA, Lee DH, Kim SW, Lee SH. Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2016; 42: 1303-1314, as many as twenty-four studies comparing these methods have been identified.
The results of interest included safety (perioperative and postoperative complications, death within 30 days and certain medical conditions), effectiveness (survival, relapse, length of hospital stay, estimated blood loss, and operation time) and patient reported results (pain score, use of painkillers, duration of painkillers use, and time to return to work).
Nie stwierdzono istotnych różnic w wynikach przeżycia. Czas pobytu w szpitalu był krótszy, było mniejsze krwawienie, a odsetek powikłań, ponownej hospitalizacji i transfuzji był niższy w przypadku operacji z wykorzystaniem robota w porównaniu z chirurgia otwartą. W porównaniu z tradycyjna laparoskopią czas pobytu w szpitalu był również krótszy, była mniejsza utrat krwi, a odsetek konwersji do laparotomii, powikłań śródoperacyjnych, urazów dróg moczowych i cystotomii był niższy w operacji wspieranej robotem. Kilka wyników zgłoszonych przez pacjentów wykazało znaczną korzyść chirurgii z wykorzystaniem robota.
– The conclusions from the presented research indicate that robotic surgery may be generally a safer and better option than open surgery and traditional laparoscopy for patients with endometrial cancer. Of course, further prospective studies with long-term follow-up are required, says Dr. Magdalena Bizoń. This is one of the reasons why NEO Hospital makes efforts and has engaged in research and development work to improve the quality of medical care for patients suffering from endometrial cancer.
In Poland, in 2021, over 2000 robotic devices were made. Gynecological operations accounted for over 17 percent. Treatments performed at NEO Hospital in 2022 account for nearly 20 percent. all procedures with the use of the da Vinci robot performed in Poland in 2022 in the field of gynecology.
Endometrial cancer surgery with the use of the da Vinci robot at the Hospital na Klinach in Krakow can be performed free of charge. The hospital is co-financed by European funds. Patients from all over Poland can apply to the program by phone at 785 170 300, or by sending an e-mail to the following address [email protected]
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