当院での早期子宮体癌に対する低侵襲手術におけるリンパ節郭清についての検討

抄録

　The revised 2023 guidelines for endometrial cancer treatment recommend avoiding lymphadenectomy in early-stage cases (evidence level C). However, some patients initially diagnosed with early-stage cancer are later classified as intermediate or high risk after surgery and pathological evaluation. While pelvic lymphadenectomy remains critical for pathological assessment, its necessity and extent should be tailored to each patient based on therapeutic relevance.

　This retrospective review analyzed 141 minimally invasive surgeries performed between July 2017 and March 2023 to evaluate the appropriateness of lymphadenectomy. Surgical approaches included laparoscopic or robot-assisted hysterectomy, with four lymphadenectomy options (omission, biopsy, limited, or complete pelvic dissection) selected based on patient-specific factors such as comorbidities and quality of life. Intraoperative findings, and preoperative assessments, including MRI and the Mayo Criteria, proved essential in determining the scope of lymphadenectomy.

　An age-adjusted multivariate analysis identified “more than half myometrial invasion” and “positive peritoneal cytology” as significant predictors of lymphovascular space invasion, highlighting their importance in planning lymphadenectomy. Recent studies have suggested that robot-assisted surgery may result in longer operative times and poorer long-term outcomes than laparoscopic surgery. Regular evaluation of surgical outcomes and clinical courses is essential to ensure optimal pathological assessment. Revisiting and refining the necessity and appropriateness of lymphadenectomy is crucial for achieving precise and effective treatment strategies.