CONTEXT: Adjuvant immune checkpoint inhibitors (ICIs) have recently emerged as guideline-recommended treatments of high-risk muscle-invasive urothelial carcinoma (MIUC). However, there is limited evidence regarding the optimal candidates and the differential efficacy of adjuvant ICI regimens. OBJECTIVE: To synthesize and compare the efficacy and safety of adjuvant ICIs for high-risk MIUC using updated data from phase III randomized controlled trials. EVIDENCE ACQUISITION: In April 2024, three databases were searched for eligible randomized controlled trials that evaluated oncologic outcomes in patients with MIUC treated with adjuvant ICIs. Pairwise meta-analysis (MA) and network meta-analyses were performed to compare the hazard ratios of oncological outcomes, including disease-free survival (DFS), overall survival (OS), and adverse events. Subgroup analyses were conducted on the basis of predefined clinicopathological features. EVIDENCE SYNTHESIS: Three randomized controlled trials that assessed the efficacy of adjuvant nivolumab, pembrolizumab, and atezolizumab were included in the MAs and network meta-analyses groups. Pairwise MAs showed that treatment with adjuvant ICIs significantly improved DFS [hazards ratio: 0.77, 95% confidence interval (CI): 0.66-0.90] as well as OS (hazards ratio: 0.87, 95% CI 0.76-1.00) in patients with MIUC compared with in the placebo/observation group. The DFS benefit was prominent in patients who underwent neoadjuvant chemotherapy (P = 0.041) and in those with bladder cancer (P = 0.013) but did not differ across programmed death-ligand 1 and lymph node status. Adjuvant ICI therapy was associated with increased risk of any (OR: 2.98, 95% CI 2.06-4.33) and severe adverse events (OR: 1.78, 95% CI 1.49-2.13). The treatment rankings revealed that pembrolizumab for DFS (84%) and nivolumab for OS (93%) had the highest likelihood of improving survival. CONCLUSIONS: Our analyses demonstrated the DFS and OS benefits of adjuvant ICIs for high-risk MIUC. Furthermore, patients with bladder cancer who underwent neoadjuvant chemotherapy appeared to be the optimal candidates for adjuvant ICIs regarding prolonged DFS. Adjuvant ICIs are the standard of care for high-risk MIUC, and differential clinical behaviors and efficacy will enrich clinical decision-making.

• MeSH
• adjuvantní chemoterapie metody   MeSH
• inhibitory kontrolních bodů * terapeutické užití   farmakologie   MeSH
• invazivní růst nádoru MeSH
• karcinom z přechodných buněk farmakoterapie   patologie   MeSH
• lidé MeSH
• nádory močového měchýře farmakoterapie   patologie   MeSH
• síťová metaanalýza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement. METHODS: This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases). RESULTS: Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days. CONCLUSIONS: This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.

• MeSH
• ezofagektomie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• nádory jícnu * chirurgie   patologie   MeSH
• následné studie MeSH
• pooperační komplikace epidemiologie   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• registrace * MeSH
• roboticky asistované výkony * metody   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. METHODS: A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical-pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records. RESULTS: ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) (n = 8, 18.2%). CONCLUSIONS: Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC.

• Publikační typ
• časopisecké články MeSH

Although the heart atria have a lesser functional importance than the ventricles, atria play an important role in the pathophysiology of heart failure and supraventricular arrhythmias, particularly atrial fibrillation. In addition, knowledge of atrial morphology recently became more relevant as cardiac electrophysiology and interventional procedures in the atria gained an increasingly significant role in the clinical management of patients with heart disease. The atrial chambers are thin-walled, and several vessels enter at the level of the atria. The left and right atrium have different structures and shape. In general, both atrial chambers have the venous part, the appendage, and the vestibule; different aspects of each part allow us to distinguish morphologically between the left and right atrium. The human atrial conduction system consists of the sinus node and the atrioventricular node with no histologically specialized conduction pathways in the atrial chamber and an interatrial connection. The data show that the propagation of the impulse depends mainly on the myocardial architecture in the atria and the orientation of the myocytes plays a significant role in conduction. To complete the picture, it is also important to know how the atria develop and what is the embryonic origin of its different structures, as this may play a role in the development of some pathological conditions such as atrial fibrillation or certain types of congenital heart defects. Functional impairment of the atria can in some situations severely compromise heart pumping function, and conversely, can support it if other areas are damaged, balancing the blood flow to the body for some time. Key words Morphology of atrial chambers, Pectinate muscles, Atrial function.

• MeSH
• fibrilace síní patofyziologie   patologie   MeSH
• lidé MeSH
• převodní systém srdeční patofyziologie   MeSH
• srdce - funkce síní fyziologie   MeSH
• srdeční síně * MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Izolovaná srdeční sarkoidóza je vzácné onemocnění, které je často obtížně detekovatelné vzhledem k nízké senzitivitě endomyokardiální biopsie (EMB), a proto obvykle vyžaduje multimodální vyšetření pomocí magnetické rezonance srdce (CMR) a/nebo pozitronové emisní tomografie – výpočetní tomografie (PET-CT) s aplikací 18F fl uordeoxyglukózy (FDG). Klinická manifestace onemocnění zahrnuje pokročilou atrioventrikulární blokádu, maligní komorové arytmie a městnavé srdeční selhání. Cílem práce je ukázat úskalí při diagnostice klinicky izolované sarkoidózy srdce u mladého muže po resuscitaci pro maligní komorovou arytmii. V kontextu tohoto případu poskytneme přehled současných znalostí managementu srdeční sarkoidózy. Popis případu: Osmadvacetiletý muž bez významnějších přidružených onemocnění byl přijat na naše pracoviště po krátké resuscitaci pro mimonemocniční zástavu oběhu při fi brilaci komor v únoru 2022. Na vstupním EKG byl přítomen sinusový rytmus s kompletní atrioventrikulární blokádou a morfologií komplexu QRS charakteru blokády levého Tawarova raménka. Následně byla dokumentována těžká neischemická systolická dysfunkce nedilatované levé komory s ejekční frakcí 25 %. EMB ukázala pouze nespecifický nález. Pro přetrvávající atrioventrikulární blokádu III. stupně byl pacientovi implantován kardioverter-defibrilátor s možností biventrikulární stimulace. Magnetickou rezonanci srdce jsme neindikovali z bezpečnostních důvodů u pacienta dependentního na kardiostimulaci a také jsme očekávali horší kvalitu vyšetření při artefaktech z implantovaných elektrod. V březnu 2022 bylo provedeno PET-CT s aplikací FDG, nicméně nález na srdci byl nediagnostický vzhledem k nedostatečné supresi metabolismu cukrů. Byly však zastiženy tři avidní uzliny v mediastinu. Pro trvající podezření na srdeční sarkoidózu bylo provedeno kontrolní PET-CT v červenci 2022, kdy se již zdařila suprese metabolismu glukózy v myokardu. Byl dokumentován nepoměr mezi fokálně zvýšenou akumulací FDG v oblasti anteroapikální, septální a bazální a výpadkem perfuze, který je charakteristický pro pokročilejší stadia zánětlivých srdečních onemocnění. Současně byla zaznamenána progrese lymfadenopatie na obou stranách bránice. Bronchoskopie a transbronchiální biopsie přinesly negativní nález. Opakovaná EMB verifi kovala sarkoidózu myokardu. V době první manifestace onemocnění se tedy jednalo o klinicky izolovanou srdeční sarkoidózu. Na základě tohoto nálezu byla zahájena imunosupresivní léčba kortikoidy a azathioprinem, kterou pacient toleroval bez komplikací. Postupně došlo ke zlepšení ejekční frakce levé komory, která v září 2023 dosáhla 45 %. Pacient zůstává během sledování klinicky stabilní ve funkční třídě II, bez intervencí přístroje pro komorové tachykardie. Od března 2023 přestal být pacient dependentní na kardiostimulaci. Závěr: Na diagnózu srdeční sarkoidózy je třeba myslet u pacientů s neischemickou dysfunkcí levé komory, zvláště v přítomnosti aneurysmat levé nebo pravé komory. Podezření zvyšuje přítomnost pokročilejší atrio- ventrikulární blokády nebo výskyt maligních komorových arytmií. Diagnostika je zvláště obtížná u izolované srdeční sarkoidózy, kde je obvykle nutno aplikovat kombinaci zobrazovacích metod, včetně CMR a PET-CT, případně opakovat EMB k dosažení správné diagnózy. Ta je důležitá jak z prognostických, tak i terapeutických důvodů.

Isolated cardiac sarcoidosis is a rare disease with a challenging diagnostic process reflecting a low sensitivity of endomyocardial biopsy (EMB). Therefore, it often requires a multimodal imaging using cardiac magnetic resonance imaging (CMR) and/or positron emission tomography (PET-CT) with administration of 18Ffluordeoxyglucose (FDG). Its clinical manifestation includes advanced atrioventricular block, ventricular tachyar- rhythmias and congestive heart failure. We aimed to illustrate pitfalls in the diagnosis of clinically isolated cardiac sarcoidosis in a young male with an aborted cardiac arrest due to ventricular fibrillation. This case inspired us to provide an updated review of the management of cardiac sarcoidosis. Case description: A 28-year-old male without any comorbidities was admitted to our department after an aborted out-of-hospital cardiac arrest due to ventricular fibrillation in February 2022. His first electrocardiogram showed sinus rhythm and a complete atrioventricular block with left bundle branch block QRS morphology. Echocardiogram and coronary angiography revealed severe non-ischemic systolic dysfunction of the non-dilated left ventricle with an ejection fraction of 25%. Findings in EMB specimens were non-specific. A biventricular cardioverter-defibrillator was implanted due to a persistent complete atrioventricular block. Cardiac magnetic resonance imaging was not done from the safety reasons due to dependency of the subject on cardiac pacing and expected poor quality due to artefacts from the implanted electrodes. In March 2022, PET-CT with administration of FDG was performed. Unfortunately, the examination was not diagnostic due to an incomplete suppression of the metabolism of carbohydrates. However, three avid lymphatic nodes were detected in mediastinum. Repeated PET-CT was performed in July 2022 with successful suppression of the metabolism of carbohydrates. The examination revealed a mismatch between focally increased accumulation of FDG and absent perfusion in anteroapical, septal, and basal segments, which is a typical finding for an inflammatory cardiac disease. In addition, there was an obvious progression of lymphadenopathy both above and under the diaphragm. Subsequently, we performed a repeated EMB, which verified cardiac sarcoidosis. This suggested a diagnosis of isolated cardiac sarcoidosis at the time of disease manifestation. These results enabled to start immunosuppression with corticosteroids and azathioprine, which was tolerated without complications. A gradual improvement in left ventricular ejection fraction up to 45% was observed and documented in September 2023. The patient remains clinically stable in the functional class II, without interventions from the implanted cardioverter-defibrillator. Since March 2023, the patient is not dependent on cardiac pacing. Conclusion: The diagnosis of cardiac sarcoidosis should be considered in patients with non-ischemic dysfunction of the left ventricle, especially if accompanied with aneurysms of cardiac ventricles. The suspicion rises in the presence of atrioventricular blocks or occurrence of ventricular tachyarrhythmias. The difficult diagnosis of isolated cardiac sarcoidosis can be established in selected cases by multimodal imaging including CMR and PET-CT, or repeate

• MeSH
• atrioventrikulární blokáda etiologie   MeSH
• azathioprin aplikace a dávkování   MeSH
• biopsie metody   MeSH
• dospělí MeSH
• dysfunkce levé srdeční komory etiologie   MeSH
• lidé MeSH
• nemoci srdce diagnóza   epidemiologie   farmakoterapie   patologie   MeSH
• PET/CT metody   MeSH
• prednison aplikace a dávkování   MeSH
• sarkoidóza * diagnóza   epidemiologie   farmakoterapie   patologie   MeSH
• zástava srdce mimo nemocnici * etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

The university student population is particularly vulnerable to depression, which was identified during the COVID-19 pandemic. Understanding how depressive symptoms are interrelated with mental and physical health in students is essential. The aim of this study was to reveal the network of depressive and anxiety symptoms with respect to well-being (life satisfaction, physical health, physical activity, and perceived stress) during a difficult situation-the COVID-19 pandemic-at two measurement points of different pandemic severities. A repeated cross-sectional study was conducted in June 2020 (T1) (lower pandemic severity) and March 2021 (T2) (higher pandemic severity) among 592 and 1230 Czech university students, respectively. The measurements used were the PHQ-9, GAD-7, PSS-10, SWLS, self-rated physical health (SRH), and sociodemographic survey. The network analysis approach was utilized. For the significance of differences, the χ2 test, Student's t test, and ANOVA were performed. The results revealed that scale-level depression, stress, and worse SRH increased over time, whereas life satisfaction decreased. Scale-level anxiety and physical activity were stable over time. PHQ2 Sad mood was the most central and influential node at T1 and T2. PHQ9 Suicidal Ideation was closely related to other variables at T1, whereas PHQ1 Anhedonia was closely related to other variables at T2. The most influential risk factors were the PHQ-2 score and the GAD-2 score, which are associated with uncontrollable worrying, whereas life satisfaction, physical health, and physical activity were the most protective factors. It is crucial to recognize and decrease the PHQ2 score and increase life satisfaction to improve the mental health of university students.

• MeSH
• COVID-19 * psychologie   epidemiologie   MeSH
• cvičení psychologie   MeSH
• deprese * epidemiologie   psychologie   MeSH
• dospělí MeSH
• duševní zdraví MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• osobní uspokojení MeSH
• pandemie MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• psychický stres epidemiologie   psychologie   MeSH
• SARS-CoV-2 izolace a purifikace   MeSH
• sebevražedné myšlenky MeSH
• studenti * psychologie   MeSH
• univerzity MeSH
• úzkost * epidemiologie   psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

CONTEXT: The optimal therapeutic agent with respect to metastatic sites is unclear in advanced urothelial carcinoma (UC). OBJECTIVE: To investigate the metastatic organotropism differential treatment response in patients with advanced or metastatic UC. EVIDENCE ACQUISITION: A systematic search and network meta-analysis (NMA) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The primary endpoints of interest were the objective response rate, overall survival (OS), and progression-free survival with respect to different metastatic sites. EVIDENCE SYNTHESIS: Twenty-six trials comprising 9082 patients met our eligibility criteria, and a formal NMA was conducted. Durvalumab plus tremelimumab as first-line systemic therapy was significantly associated with better OS than chemotherapy in visceral metastasis (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.67-0.98). Pembrolizumab as second-line systemic therapy was significantly associated with better OS than chemotherapy in patients with visceral metastasis (HR 0.75, 95% CI 0.60-0.95). Atezolizumab as second-line systemic therapy was significantly associated with better OS than chemotherapy in patients with liver metastasis (in the population of >5% of tumor-infiltrating immune cells) and lymph node metastasis (HR 0.51, 95% CI 0.28-0.96, and HR 0.59, 95% CI 0.37-0.96, respectively). CONCLUSIONS: Administration of immune-oncology treatments with respect to metastatic sites in patients with advanced or metastatic UC might have a positive impact on survival outcomes in both the first- and the second-line setting. Nevertheless, further investigations focusing on metastatic organotropism differential response with reliable oncological outcomes are needed to identify the optimal management strategy for these patients. PATIENT SUMMARY: Although the supporting evidence for oncological benefits of therapeutic systemic agents with respect to metastatic sites is not yet strong enough to provide a recommendation in advanced or metastatic urothelial carcinoma, clinicians may take into account tumor organotropism only in discussion with the patient fully informed on the optimal treatment decision to be taken.

• MeSH
• karcinom z přechodných buněk * farmakoterapie   sekundární   mortalita   patologie   MeSH
• lidé MeSH
• metastázy nádorů MeSH
• randomizované kontrolované studie jako téma * MeSH
• síťová metaanalýza * MeSH
• urologické nádory farmakoterapie   patologie   mortalita   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

PURPOSE: Despite advancements in radiation techniques, concerns persist regarding the adverse effects of radiation therapy, particularly cardiotoxicity or radiation-induced heart disease. Recently, arrhythmogenic toxicity has come to the forefront-the impact of radiation therapy on the cardiac conduction system. Our objective was to conduct a dosimetric study and subsequently investigate the feasibility of optimizing the sinoatrial (SA) and atrioventricular (AV) nodes as organs at risk (OARs) in proton radiation therapy for non-small cell lung cancer with N3 disease. PATIENTS AND METHODS: Thirty-two non-small cell lung cancer patients with N3 disease undergoing proton radiation therapy were included. Sinoatrial and AV nodes, along with standard OARs, were delineated. Dosimetric analysis and optimization were performed using intensity-modulated proton therapy. RESULTS: Patients surpassing a predefined SA node dose threshold underwent dose optimization. Proton radiation therapy with pencil beam scanning demonstrated a significant reduction in SA and AV node doses without compromising target volume coverage or significant shift in the dose to other monitored OARs. CONCLUSION: Dose reduction to the SA and AV nodes for pencil beam scanning is a relatively simple task, and the reduction can be very substantial. Larger cohort studies and diverse radiotherapeutic modalities are needed for further validation and refinement of dose constraints.

• Publikační typ
• časopisecké články MeSH

A growing proportion of head and neck cancer (HNC), especially oropharyngeal cancer (OPC), is caused by human papillomavirus (HPV). There are several markers for HPV-driven HNC, one being HPV early antigen serology. We aimed to investigate the diagnostic accuracy of HPV serology and its performance across patient characteristics. Data from the VOYAGER consortium was used, which comprises five studies on HNC from North America and Europe. Diagnostic accuracy, that is, sensitivity, specificity, Cohen's kappa and correctly classified proportions of HPV16 E6 serology, was assessed for OPC and other HNC using p16INK4a immunohistochemistry (p16), HPV in situ hybridization (ISH) and HPV PCR as reference methods. Stratified analyses were performed for variables including age, sex, smoking and alcohol use, to test the robustness of diagnostic accuracy. A risk-factor analysis based on serology was conducted, comparing HPV-driven to non-HPV-driven OPC. Overall, HPV serology had a sensitivity of 86.8% (95% CI 85.1-88.3) and specificity of 91.2% (95% CI 88.6-93.4) for HPV-driven OPC using p16 as a reference method. In stratified analyses, diagnostic accuracy remained consistent across sex and different age groups. Sensitivity was lower for heavy smokers (77.7%), OPC without lymph node involvement (74.4%) and the ARCAGE study (66.7%), while specificity decreased for cases with <10 pack-years (72.1%). The risk-factor model included study, year of diagnosis, age, sex, BMI, alcohol use, pack-years, TNM-T and TNM-N stage. HPV serology is a robust biomarker for HPV-driven OPC, and its diagnostic accuracy is independent of age and sex. Future research is suggested on the influence of smoking on HPV antibody levels.

• MeSH
• infekce papilomavirem * MeSH
• lidé MeSH
• lidské papilomaviry MeSH
• lidský papilomavirus 16 MeSH
• nádory hlavy a krku * diagnóza   MeSH
• nádory orofaryngu * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Hlavním cílem této studie z jednoho onkologického centra bylo analyzovat perioperační komplikace po minimálně invazivní chirurgii (MIS) pro karcinom dělohy, jakož i celkové přežití a míru recidivy v zemích s nízkými příjmy. Metody: Tato retrospektivní studie byla provedena na základě záznamů 117 pacientek s endometriálním karcinomem, které podstoupily operaci mezi lety 2018 a 2024. Kritéria pro zařazení zahrnovala endometroidní i neendometroidní typy rakoviny, histologické stupně I-III a hodnocení pánevních a paraaortálních lymfatických uzlin. Ze 117 pacientek podstoupilo 95 laparoskopickou disekci pánevních lymfatických uzlin a hysterektomii. Studie vyloučila 22 žen, které podstoupily laparotomickou hysterektomii s disekcí pánevních a aortálních lymfatických uzlin. Výsledky: Devadesát pět pacientek podstoupilo MIS kvůli endometriálnímu karcinomu. Nejčastějšími zákroky, provedenými u devadesáti dvou (96,9 %) pacientek, byly TLH, BSO a BPLND. Šedesát devět (72,6 %) pacientek mělo BMI nad 30. Nedošlo k žádné konverzi z laparoskopie (LPS) na laparotomii (LPT). V 65 (68,4 %) případech zákrok trval déle než 120 minut a 74 (77,9 %) pacientek bylo hospitalizováno čtyři dny nebo méně. Nejdelší sledování trvalo 77 měsíců, s dvanácti (12,6 %) recidivami a mírou přežití 87,4 % (n=83). Závěr: Naše studie naznačuje, že LPS je efektivní při léčbě endometriálního karcinomu ohraničeného na dělohu, nabízí srovnatelnou disekci lymfatických uzlin s laparotomií, kratší hospitalizaci a méně pooperačních infekcí pro zkušené chirurgy. Přestože jsou zapotřebí prospektivní randomizované kontrolované studie k potvrzení těchto zjištění, naše výsledky slouží jako cenná klinická reference. MIS by měla být podporována při léčbě endometriálního karcinomu, zejména v nízkopříjmových zemích.

Background: The main objective of this single-center study was to analyze the perioperative complications following minimally invasive surgery (MIS) for uterine cancer, as well as the overall survival and recurrence rate in low-income countries. Methods: This retrospective study was conducted with the records of 117 endometrial cancer patients who had surgery between 2018 and 2024 were reviewed. Inclusion criteria encompassed both endometrioid and non-endometrioid cancer types, histological grades I-III, and assessment of pelvic and periaortic lymph nodes. Among the patients, 95 underwent laparoscopic pelvic lymph node dissection and hysterectomy. The study excluded 22 women who had laparotomic hysterectomy with dissection of pelvic and aortic lymph nodes. Results: Ninety-five patients underwent MIS for endometrial cancer. The most common procedures, performed in ninety- two (96.9%) patients, were TLH, BSO, and BPLND. Sixty-nine (72.6%) patients had a BMI over 30. There were no conversions from laparoscopic surgery (LPS) to laparotomic (LPT). In 65 (68.4%) cases, the procedure took over 120 minutes, and 74 (77.9%) patients had hospital stays of 4 days or less. The longest follow-up was 77 months, with twelve (12.6%) recurrences and an 87.4% (n=83) survival rate. Conclusion: Our study indicates that LPS is effective for treating uterine-confined endometrial carcinoma, offering comparable lymph node dissection to laparotomy, shorter hospital stays, and fewer postoperative infections for experienced surgeons. While prospective randomized controlled studies are needed to confirm these findings, our results serve as a valuable clinical reference. MIS should be promoted for endometrial cancer treatment, especially in low-income countries.