原著子宮体癌に対する傍大動脈リンパ節郭清術を含む腹腔鏡下及び開腹手術の後方視的解析

抄録

OBJECTIVE: Our aim was to compare the intra- and postoperative results of total laparoscopic hysterectomy with pelvic and paraaortic lymphadenectomy (TLH) and total abdominal hysterectomy with pelvic and paraaortic lymphadenectomy (TAH) in the surgical treatment of endometrial cancer at a single institute in Japan.

METHOD: Twenty TLHs and 20 TAHs for FIGO stage I-II endometrial cancer were performed between December 2015 and March 2018. The results were analyzed retrospectively by review of patients' medical records and operative reports.

RESULTS: Both groups had similar patient and tumor characteristics. One laparoscopic case was converted to laparotomy. The difference in the median operation time was not significant (431 vs 412.5 min, p=0.33), nor was the difference in the incidence of intraoperative complications (10.0 vs 15.0%, p=1.00). Treatment with TLH was generally superior to that with TAH with respect to blood loss (65 vs 1000 mL, p<0.001), bowel obstruction (0 vs 30%, p=0.02), and CRP value (5.2 vs 9.1 mg/dL, p<0.001). The number of pelvic and paraaortic lymph nodes removed was not significantly different between the two groups (68.1 vs 56.3, p=0.06). Similar trends were observed for comparisons of the intra- and postoperative results of TLH and TAH among cases where radical hysterectomies were not performed.

CONCLUSION: TLH was comparable to and not worse than TAH regarding the intra- and postoperative results in our study group. TLH for patients with FIGO stage I-II endometrial cancer may pose a safe and feasible alternative to TAH in surgical treatments of endometrial cancer.