Pfannenstiel Scar Recurrences in Endometrial Cancers: A Case Series and Review of Literature
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CASE REPORT
Pfannenstiel Scar Recurrences in Endometrial Cancers: A Case Series and Review of Literature Deepak Bose1 • J. Siva Ranjith1,2
•
P. Rema1 • S. Suchetha1 • Dhanya Dinesh1
Received: 27 May 2020 / Revised: 11 July 2020 / Accepted: 25 July 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Background Endometrial cancer recurrences are usually either pelvic or distant metastases. Isolated scar recurrence is a rare entity, with approximately 43 cases being reported in the literature. Purpose The study highlights that most scar recurrences can be offered curative treatment with radical surgery. In our series, all the recurrences were in a previous Pfannenstiel incision scar. Methods We report a series of four cases of isolated Pfannenstiel scar recurrences in patients with endometrial cancer who had undergone total abdominal hysterectomy and salpingo-oophorectomy. Results All four patients underwent curative radical surgery. Two patients had associated inguinal lymph node involvement, for which ilio-inguinal block dissection was done for one patient and en bloc resection of the node along with the recurrent disease was done for the other patient. We reviewed the previous literature to ascertain the possible aetiology of incisional recurrence, especially the isolated scar recurrences. Conclusion In patients presumed to be having carcinoma endometrium, proper incision and surgical technique with good exposure, during the initial surgery, is important so as to minimise scar recurrence. Most of the isolated scar recurrences can be surgically resected with a curative intent. Keywords Resectable isolated scar recurrences Curative Pfannenstiel scar recurrences Surgery for scar recurrences in endometrial cancer
Introduction Endometrial cancer recurrences are usually either pelvic or distant metastases [1]. Recurrences in the laparotomy scar are extremely rare, with a prevalence rate of 0.1% of endometrial cancers [2]. Most of the scar recurrences are isolated recurrences and are curable with radical surgical resection. We present a series of four cases of Pfannenstiel laparotomy scar site recurrences in patients who underwent surgery for endometrial cancer from elsewhere and presented to our institution with scar recurrences between July
& J. Siva Ranjith [email protected] 1
Division of Gynecological Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
2
Division of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
2017 and February 2020. The relevant available literature has been discussed.
Case 1 A 63-year-old woman, a diabetic and hypertensive, with symptoms of post-menopausal bleeding was evaluated elsewhere and found to have thickened endometrium. Her endometrial curettings was suggestive of endometrial carcinoma. She underwent total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) from a nearby hospital in 2015. Lymph nodes were not addressed. The final histopathological report was well differentiated endomet
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