2024 年 39 巻 2 号 p. 9-13
Laparoscopic para-aortic lymphadenectomy (LAPPAN) for endometrial cancer is a highly difficult new technique that has been performed at facilities that meet the implementation requirements.
In September 2019, we began performing LAPPAN as advanced medical treatment A. After insurance began covering it in 2020, we performed primary laparoscopic endometrial carcinoma surgery for stage IA cases with high-risk histologies, in addition to secondary LAPPAN.
We had performed 12 LAPPAN procedures by March 2022. In these cases (six with endometrial carcinoma grades 1/2, and six with high-risk endometrial carcinoma histologies), the average blood loss was 71 ml, and no intraoperative complications were observed. Recurrence was observed in three patients with high-risk histologies (vaginal cuffs in two cases and omentum in one case). We then compared laparoscopic surgery (six cases) and open surgery (seven cases) in high-risk histology performed during the same period. Recurrence was observed in one of seven cases (pelvic lymph nodes) in the laparotomy group. Total blood loss was significantly less in the laparoscopic group. No significant difference in dissected para-aortic lymph node number was observed. Also, no recurrence in para-aortic lymph nodes was observed in LAPPAN cases. Therefore, we confirmed the safety and efficacy of LAPPAN at our hospital.
