当院における保険収載後の腹腔鏡下子宮体癌手術

抄録

Objective: The objective of this study was to evaluate the results of laparoscopic surgery for endometrial cancer covered by statutory health insurance-based care in our hospital.

Methods: The patients who received a diagnosis of stageIA endometrial cancer on preoperative pathological, magnetic resonance imaging, and computed tomographic examinations were treated with laparoscopic total hysterectomy and bilateral salpingo-oophorectomy. In some cases, additional pelvic lymphadenectomy and para-aortic lymph node biopsy were performed. After surgery, we evaluated patient age, operative time, blood loss, number of extirpated lymph nodes, pathological diagnosis, and surgery-related complications.

Results: This procedure was performed in 19 patients. The mean age was 56.5 ± 10.6 years; mean operative time, 309 ± 98 minutes; mean number of extirpated pelvic lymph nodes, 39.6±12.3; and mean blood loss, 250.3 ± 227.8 g. When reviewing 16 patients, excluding those with marked adhesion or large uterine myomas, the mean duration of total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy was 274 ± 76 minutes. The mean blood loss was 151.1 ± 185.8 g. The mean number of extirpated lymph nodes was 33.5 ± 7.7. To date, no surgery-related complications or relapses have been reported. Postoperative chemotherapy was performed for 7 patients (33%), and postoperative radiotherapy for 1 (6%). No adjuvant therapy was performed in the other 11 patients.

Conclusions: Laparoscopic surgery for early endometrial cancer is minimally invasive and postoperative recovery is short. It will be one of the standard treatments in the near future. Therefore, long-term prognosis should be analyzed among the different operative procedures in order to effectively introduce insurance coverage of such new medical technology.