センチネルリンパ節生検併用腹腔鏡下早期子宮体がん手術におけるセンチネルリンパ節陽性および再発例の経過と郭清省略を想定した導入時の問題点

抄録

Objective: To assess the feasibility and validity of laparoscopic sentinel node navigation surgery (SNNS) in patients that were preoperatively diagnosed with stage IA endometrial cancer.

Design: Between December 2012 and May 2020, 69 patients that were diagnosed preoperatively with stage IA endometrial cancer and underwent SNNS followed by hysterectomy after SN removal, were enrolled in this study. Clinical data of patients in whom we succeeded in diagnosing and identifying the sentinel node (SN), and those in whom we could not, were analyzed statistically, and the outcomes of patients with positive or recurrent SN were described in detail. To assess the degree of pedal edema, the lymphatic flow in the lower limb was evaluated with ICG lymphography using a fluorescent camera. To evaluate the validity of the introduction of SNNS in each facility, a computer simulation program was developed to determine whether the introduction of SNNS during a given number of SNNS was appropriate.

Results: The detection rate of SN was 94.2% and there were five cases of recurrence, however, no pelvic lymph node recurrence was observed. ICG lymphography findings revealed no abnormal dermal back flow was observed in the examined patients. Two probabilities that SNNS is worse than SN were computed on the basis of the newest recurrence rate of SNNS in a facility and that based on the statistical data. Comparing the probabilities could absorb stochastic fluctuations in the recurrence rate of SNNS.

Conclusion: The data obtained in this study were safe and feasible with no complications or pelvic recurrence. Comparing the two probabilities by the computer simulations helps us to judge whether SNNS is valid with a fewer number of SNNSs.