同一術者による初期子宮体癌に対する腹腔鏡下子宮悪性腫瘍手術の治療経験―合併症およびLearning Curve の検討

抄録

Objective: Laparoscopic surgery has been proposed extensively as an alternative to laparotomy for the treatment of early endometrial cancer. The aim of this study was to evaluate the safety, complications, and oncological outcomes and to assess the feasibility of this procedure.

Methods: Twenty-eight patients diagnosed preoperatively with clinical stage IA, G1-G2 endometrial adenocarcinoma underwent laparoscopic surgeries between 2014 and 2016 at Osaka University Hospital by a single surgeon. Surgical procedures included hysterectomy, salpingo-oophorectomy and pelvic lymphadenectomy. Clinical outcomes were evaluated retrospectively.

Results: Except for 2 cases in which laparotomic para-aortic lymphadenectomy was performed, laparoscopic surgery was successful. The mean operation time of cases in which pelvic lymphadenectomy was performed was 264 minutes (range: 190-359 minutes), the mean amount of blood loss was 59 mL (range: 0-300 mL), and the mean number of lymph nodes removed was 21 (range: 3-44 lymph nodes removed). Complications were noted in 3 cases (cases 12-14) in which pelvic lymphadenectomy was performed. In case 12, postoperative bleeding from the left obturator artery was observed and hemostasis was achieved under interventional radiology. In case 13, bladder muscles were injured during the dissection of the left vesicouterine ligament and the injury was successfully repaired laparoscopically. In case 14, vaginal cuff abscess was observed and conservatively treated using antibiotics. No recurrences were observed in any case during the observation period.

Conclusion: Laparoscopic surgery is feasible for the treatment of early endometrial cancer; however, it appears that a well-designed learning curve is required for surgeons to acquire laparoscopic surgery skills. Once skills are acquired, surgeons can substitute laparoscopic for laparotomic procedures.