早期子宮体癌に対する系統的骨盤内リンパ節郭清術における腹腔鏡下および開腹手術の後方視的検討

抄録

Objective: This study aimed to compare the safety and efficacy of pelvic lymphadenectomy by laparoscopy or laparotomy during the same period.

Method: The clinical data of 46 patients with endometrial cancer who underwent pelvic lymphadenectomy by laparoscopy or laparotomy in our hospital between April 2019 and March 2022 were analyzed retrospectively. Twenty-eight patients underwent laparotomy, while 18 patients underwent laparoscopy. We compared perioperative complications, the number of pelvic lymph nodes harvested, and the rate of recurrence between the laparotomy group (LG) and the laparoscopic surgery group (LSG).

Result: Compared with the LG, the LSG had a significantly longer operation time (208 minutes vs. 289 minutes, p≤0.001) and significantly less intraoperative blood loss (220 g vs. 139 g, p=0.04). However, the LG and LSG groups were similar regarding the hospitalization period (9 days vs 10 days, p=0.33); the frequencies of postoperative lymphedema (17.9% vs. 22.2%, p=0.72), lymphoceles (7.7% vs. 5.6%, p=1.00), and bowel obstruction (3.6% vs. 0%, p=1.00); and the number of excised lymph nodes (23.5 vs. 21, p=0.09). In this study, the dissection area of the common iliac lymph nodes was smaller with laparoscopy than with laparotomy, but no patients who underwent laparotomy had metastatic lymph nodes in only the common iliac region. Even if the area of potential lymphadenectomy includes all of the common iliac lymph nodes, this may not increase the number of undetectable metastases of these nodes.

Conclusion: At our hospital, laparoscopic pelvic lymphadenectomy in early-stage endometrial cancer was not inferior to laparotomy.