子宮体癌における腹腔鏡アプローチによるセンチネルリンパ節関連手術の実施妥当性

抄録

Objective: The aim of this study was to verify the validity of laparoscopic approach in Sentinel lymph node (SLN) mapping.

Design: This retrospective study was carried out using data for 118 patients with endometrial cancer who had undergone SLN mapping. Technetium colloid (Tc^99m) and/or indocyanine green (ICG) was injected into the uterine cervix and a gamma-detecting probe and/or photodynamic eye camera system was used intraoperatively to locate hot spots. SLN detection rate and incidence of complications were compared between open approach (O group, n=65) and laparoscopic approach (L group, n=53).

Results: Patients' median age was 60 years. One hundred and nine (92%) had FIGO Stage I disease. There was no difference in patients' age, BMI, FIGO stage, and histology between the two groups. SLN mapping with a combination of two tracers (Tc99m and ICG) was performed more frequently in the L group than in the O group (49% vs. 20%, P=0.0008). Successful bilateral or unilateral mapping occurred in 91 patients (77%) and 19 (16%), respectively. There was no difference in SLN detection rate between the two groups (P=0.73). However, perioperative complication rates were lower in the L group among both patients with back-up lymphadenectomies (10.0% vs. 20.4%, P=0.49) and those with no back-up lymphadenectomy (3.0% vs. 12.5%, P=0.25).

Conclusion: Laparoscopic approach might obtain a SLN detection ability equal to open approach without increasing the number of perioperative complication despite limitation of the present study.