腹腔鏡下子宮全摘術２年後にポート部再発した子宮体部類内膜腺がんＧ１の１例

抄録

　Approaches such as laparoscopy and robotic surgery are the current standards of care for malignancies in multiple medical specialties. Among them, there are rare instances of “port-site recurrence,” which have been reported most frequently in cases of bladder, colorectal, and gallbladder cancers. In gynecology, reports are limited to a few instances of ovarian cancer. Here we present a case of port-site recurrence that emerged 2 years after laparoscopic total hysterectomy with bilateral salpingo-oophorectomy for grade 1 endometrioid adenocarcinoma of the uterine corpus. A 41-year-old nulliparous woman with abnormal uterine bleeding was examined in detail and diagnosed with grade 1 endometrioid adenocarcinoma (stage IA) of the uterine corpus. A laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was subsequently performed using the parallel technique (three ports, including the bilateral upper anterior iliac spine and left navel height). Preoperatively, the fallopian tubes were sealed and the uterus placed in a retrieval bag and removed vaginally. At 2 years postoperative, a mass was detected just below the port site. Fine-needle aspiration cytology (III) and various imaging examinations indicated port-site recurrence with liver and lung metastases. The mass was then surgically removed. However, the pathological diagnosis revealed recurrent endometrioid adenocarcinoma with high microsatellite instability. The patient underwent six courses of paclitaxel carboplatin therapy. As brain metastases were discovered immediately after the end of six courses of treatment, she underwent brain tumor resection, whole-brain irradiation, and simultaneous pembrolizumab treatment. However, her condition deteriorated, and she died 3 years after the initial surgery and 8 months after the recurrent tumor removal. Review of the surgical video did not aid the identification of the cause of the port-site recurrence. Although rare, port-site recurrence may occur even in gynecological malignancies and should be more widely recognized to ensure prompt treatment.