早期子宮体癌に対し腹腔鏡下子宮全摘術を施行した症例についての検討

抄録

Objective: According to the Treatment Guidelines for Uterine Body Cancer by the Japan Society of Gynecologic Oncology, pelvic lymphadenectomy can be omitted in patients with endometrial adenocarcinoma G1 or G2, ≤1/2 myometrial invasion, and no findings of extrauterine lesion. We aimed to identify indications for omitting pelvic lymphadenectomy in selected cases by reviewing cases of total laparoscopic hysterectomy (TLH) for early-stage endometrial cancer retrospectively.

Methods: The study subjects were 17 patients with atypical endometrial hyperplasia complex (AEHC) or stage IA endometrial cancer (endometrial adenocarcinoma G1/G2) who underwent TLH in our department between April 2013 and March 2015. We compared preoperative histopathological diagnosis and imaging findings with postoperative histopathological diagnosis.

Result(s): Twelve patients (AEHC, n = 6 and endometrial cancer, n = 6) had no myometrial invasion and 5 (AEHC, n = 1 and endometrial cancer, n = 4) had ≤1 or 2 myometrial invasions on preoperative magnetic resonance imaging. In the postoperative histopathological study of the patients with endometrial cancer, none of the patients had a myometrial invasion before surgery, 1 patient had no myometrial invasion, 2 had <1 or 2 myometrial invasion, and 3 had ≥1 or 2 myometrial invasion. In the comparison between the preoperative and postoperative histology, 4 cases of AEHC and 3 cases of stage IA endometrial cancer showed progression. Five patients received postoperative adjuvant therapy, and 2 patients had a recurrence.

Conclusion(s): Pelvic lymphadenectomy in patients with a low risk of recurrence could be omitted. However, some cases showed progression based on postoperative histology. Thus, further study about the indication for omitting lymphadenectomy seems necessary.