Sefa KURT, Hikmet Tunç TİMUR, Aras Emre CANDA, Hasan Bahadır SAATLİ, Uğur SAYGILI

MALİGN ADNEKSİYAL KİTLELERİN PREOPERATİF DEĞERLENDİRMESİNDE ALT GASTROİNTESTİNAL SİSTEM ENDOSKOPİSİNİN ÖNEMİ

Amaç: Bu çalışmada amacımız; klinik olarak ileri evre over kanseri (OK) düşünülen olgularda, alt gastrointestinal sistem (GİS) endoskopisinin; kolon invazyonunu saptamadaki değerini ve ayrıca primer sekonder OK ayrımındaki önemini araştırmaktır. Gereç ve Yöntem: Eylül 2012 – Mayıs 2017 yıllarında, DEÜTF Hastanesinde opere edilen ve DSÖ ICD-10 2016 versiyonuna göre malign adneksiyal kitle tanısı kodlanan ve laparotomi uygulanan, ileri evre (evre III-IV) 113 olgunun dosya kayıtları alt GİS endoskopisi uygulananlar ve uygulanmayanlar olarak karşılaştırıldı. Bulgular: Malign adneksiyal (en sık over) kitle ön tanısıyla laparotomi uygulanan, evre III- IV,113 olgu, klinik özellikler ve barsak rezeksiyonunu öngörme açısından (alt GİS endoskopik inceme yapılanlar, 51 olgu, yapılmayanlar, 62 olgu) karşılaştırıldı. Kolonoskopi yapılan grupta 6 olguda kolon tutulumu gözlendi, 4 olguda tutulum intraoperatif saptandı. Kolonoskopi yapılmayan grupta 10 olguda intraoperatif rezeksiyon uygulandı. İki grupta da 10’ ar olguya barsak rezeksiyonu gerekti. Rezeksiyon yapılan 20 olgunun ortalama yaşı, 57,35 ± 13,53, rezeksiyon yapılmayan 93 olgunun ortalama yaşı 55,81 ± 12,54 tür. En sık rezeksiyon rektosigmoid bölgede olup, (17 olgu) tüm olguların %85’ini oluşturmaktadır. Kolonoskopinin barsak rezeksiyonunu ön görmedeki pozitif prediktif değeri (PPV); %100, negatif prediktif değeri (NPV); %91 olarak bulundu. Sonuç: İleri evre malign adneksiyal kitlelere cerrahi yaklaşımda alt GİS barsak rezeksiyonları tedavinin önemli bir komponentidir. Alt GİS endoskopisinde tümör tutulumunun saptanması cerrahi tedaviyi planlama, postoperatif dönemde stoma problemleri ve emosyonel sorunlarla baş etmede ve metastatik tümörlerin ayırıcı tanısında önemlidir.

Anahtar Kelimeler:

barsak rezeksiyonu, kolonoskopi, malign adneksiyal kitle

The importance of lower gastrointestinal tract endoscopy regarding the preoperative evaluation of malignant adnexal masses

Objective: Our aim in this study was to investigate the value of lower gastrointestinal system (GIS) endoscopy regarding the detection of colon invasion and its importance in recognizing primary and secondary ovarian cancers in cases clinically prediagnosed as advanced stage ovarian cancers. Materials and Methods: Records of patients, who were operated due to adnexal mass suspicious for malignancy at our clinic between September 2012 and May 2017, were examined. One hundred thirteen cases of advanced stage (Stage III – IV) malignant adnexal masses were detected. Results: Cases that underwent laparotomy because of a prediagnosis of malignant adnexal mass (mostly ovarian), and had stage III and IV disease, were compared regarding clinical characteristics and foreseeing bowel resection (51 patients had undergone lower GIS endoscopy, 62 had not). Six of the 51 patients, who underwent endoscopy, were diagnosed with colon involvement during endoscopy while 4 other patients were diagnosed intraoperatively. Among the 62 patients, without preoperative endoscopy, 10 patients underwent intraoperative bowel resection. The mean age of the patients with bowel resection was 57.35±13.53y; the mean age of the remaining patients was 55.8±12.54y. Rectosigmoid region was the most common area of resection (17/20). The positive predictive value of colonoscopy for predicting bowel resection was 100%, while the negative predictive value was 91%. Conclusion: Bowel resection is a pivotal component of the surgical approach to advanced stage malignant adnexal masses. The detection of tumor spread in lower GIS endoscopy is very important while planning the surgery, dealing with postoperative stoma problems and emotional issues and during the differential diagnosis of metastatic tumors.

Keywords:

malignant adnexal mass, bowel resection, colonoscopy,

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