子宮を温存した腹腔鏡下仙骨腟固定術後に発症した子宮体癌に対して腹腔鏡下手術を完遂した一例

抄録

　The incidence of uterine cancer is increasing due to obesity and an aging population. Minimally invasive surgery is now covered by insurance and the number of surgeries is increasing. Pelvic organ prolapse (POP) is also increasing owing to an aging population. Laparoscopic sacrocolpopexy (LSC) is now covered by insurance and widely performed, with supracervical hysterectomy being the mainstay of the procedure. Some uterus-sparing techniques are reported, however, we did not search the literature for cases of uterine malignancies that occur after uterus-sparing LSC. Here, we describe a case of uterine carcinoma in a patient with a preserved uterus. The 67-year-old woman underwent uterus-sparing LSC for POP in the urology department. Five months after surgery, the patient developed irregular bleeding, and a preoperative diagnosis of stage IA uterine cancer (endometrial carcinoma, grade 2) was made upon further examination. We performed a modified laparoscopic radical hysterectomy. We completed the planned procedure by amputating the uterine side as appropriate to preserve the mesh. The final pathological diagnosis was stage IB uterine cancer (endometrial carcinoma grade 3) and the patient was treated postoperatively. Eighteen months after surgery, there was no evidence of uterine cancer recurrence or POP. It is important to reduce the possibility of postoperative uterine malignancy by including preoperative imaging and endometrial biopsies. It is also necessary to determine the appropriate line of resection, because mesh preservation may prevent POP recurrence.