Ovarian cancer in Czech Republic takes first place in mortality among gynecological malignant tumours. In most cases it is diagnosed in advanced stages. Initial treatment is based on combination of radical surgery and adjuvant chemotherapy. In more than two thirds of cases ovarian cancer relapses sooner or later, very often without a chance to cure the patient. Unsatisfying result of standard treatment is reason of looking for more effective procedures. Targeted therapy is subject of research in last years. Positive effect of bevacizumab has been proved. Through inhibition of angiogenesis it leads to prolonging of interval to cancer progression.

OBJECTIVEEvaluation of the benefits of laparoscopy and the fertility preserving approach in the borderline ovarian tumors. These tumors often occur in young women of childbearing age. The patient and the surgeon face a serious problem, especially for women who wish to maintain the possibility of pregnancy. Laparoscopy in these situations appear to be one of the preferred treatment methods.DESIGNRetrospective study.SETTINGThird Faculty of Medicine, Charles University Prague, Gynecology and Obstetrics Department; P. J. Safarik University, L. Pasteur University Hospital, Košice, Gynecology and Obstetrics Department; Hospital České Budějovice.METHODSAnalysis of the data in 23 women who desired fertility and were operated laparoscopically for borderline ovarian tumors. We evaluated the extend of laparoscopic surgery, peri- and postoperative complications and final results of histopathological findings.RESULTSMean age of the patients was 30,4 years. All patients were completely staged during second laparoscopic operation. In 14 of 23 (60.9%) cases serous borderline tumor was identified, in 8 of 23 (34.8%) cases mucinous borderline tumor was identified and in one case Brenner tumor was diagnosed. Peritoneal implants were present in 5/14 (35.7%) of serous tumors and in 3/8 (25%) of mucinous tumors. Involvement of contralateral ovary is also calculated.CONCLUSIONBorderline ovarian tumors occur in women who wish to maintain the possibility of pregnancy. For these patients, we choose based on their desire, conservative surgery. This treatment can be done by laparoscopy. Intraoperative ruptures of the tumor are more likely during lapaparoscopic procedures compared with laparotomy. In contrast, laparoscopy provides, besides well-known advantages, better optical evaluation of the abdominal cavity, including the detection of superficial peritoneal implants. For the objective evaluation of the laparoscopic approach in patients with fertility desire, further prospective comparative study are needed.

OBJECTIVE:To evaluate risk factors for development of recurrent disease in borderline ovarian tumors.DESIGN:Retrospective study of 10-years single institution population.SETTING:Dept. of Gynecology and Obstetrics, 3rd Medical Faculty of Charles University in Prague.METHOD:59 consecutive cases of borderline ovarian tumors (BOT) were analyzed for age, histopathological type, DNA ploidy, stage, presence of invasive and non-invasive peritoneal implants, type of surgical procedure, residual disease, adjuvant therapy, recurrence and long-time prognosis of the patients.RESULTS:Median follow-up was 47 months (range 1-144). There were 5 (8.5%) patients with DNA aneuploid tumors in the study group; 4 of them were younger than 50 years, 4 of them were early stage serous BOT; no one recur so far. No death of disease was described in the whole study group; only 2 patients (3.4%) developed recurrent disease - both were young patients after conservative surgery for serous diploid stage I/II BOT. Conservative surgery was the only significant factor for recurrence in univariate analysis (p = 0.0159) in our setting.CONCLUSION:DNA ploidy was not proved to be prognostic factor in borderline ovarian tumors in our study group. The only significant risk factor for development of recurrent disease was conservative surgery, with no influence on overall survival.

OBJECTIVE To develop guideline for primary surgical treatment of endometrial carcinoma. DESIGN Review, consensus of expert group. SETTING Dept. of Gynaecology and Obstetrics, 3rd Medical Faculty of Charles University in Prague. METHOD A retrospective review of published data, analysis of statistic data from Czech Republic, consensus among proposers and opponents. RESULTS The guideline recognizes endometrial carcinoma patients based on their risk and recommends type of surgical treatment for certain group. It emphasizes the importance of centralized oncogynaecological treatment. Surgical staging remains the basic principle for treatment of endometrial carcinoma patients. The aim of pre-operative diagnostics is to estimate the extent of the disease--interim staging, that can be different from definitive histopathological staging. Based on risk factors patients are divided into low or high risk group. Standard procedure for low risk patients is hysterectomy and bilateral salpingoophorectomy. It is advisable to use peroperative biopsy in these patients that can shift the patient to high risk group. High risk patients are recommended for hysterectomy, bilateral salpingoophorectomy, and systematic aortopelvic lymphadenectomy. The guideline contains recommendation for young patients wishing to preserve their fertility, for cases of inadequate surgery and for follow-up. CONCLUSION Guideline for treatment of endometrial carcinoma is recommendation for clinicians and other subjects who participate on the process of the diagnostics/treatment of endometrial carcinoma patients. All points of the guideline were discussed and voted about by all participants of expert group.