当科における術前子宮体癌ⅠA期（FIGO 2008）相当に対する腹腔鏡下リンパ節郭清術の郭清範囲の縮小：傍大動脈リンパ節レベルから骨盤リンパ節レベルまでへ

Abstract

Objective: Systematic lymphadenectomy is a necessary procedure for International Federation of Gynecology and Obstetrics (FIGO) staging of endometrial cancer (EC). This study aimed to compare the surgical and survival outcomes between patients with stage IA- EC who underwent laparoscopic pelvic (PLND) and para-aortic lymph node dissection (PALND) and those who underwent the same procedure without PALND. Methods: This was a retrospective study. In this study, we compared two groups treated at our hospital: Group A (n=15) underwent PLND and PALND between 2004 and 2007, and Group B (n=24) underwent PLND between 2008 and 2013. All these cases were staged IA EC (FIGO 2008) preoperatively, as determined by the use of computed tomography, magnetic resonance imaging, glucose analog (18F)-fluoro-2-deoxy-D-glucose positron emission tomography (PET), and endometrial biopsy.Results: The median operating time was 465 min (IQR 438-505.5) for Group A versus 336 min (301.5-367.8) for Group B (p<0.0001). The median blood loss was 269 ml (186.5-667) for Group A versus 112 ml (83-255) for Group B (p=0.005). The median number of lymph nodes removed was 40 pelvic nodes (32.5-53) for Group A versus 41 pelvic nodes (34.5-48.2) for Group B (p=0.89), and 17 para-aortic nodes (12.5-22) for Group A versus 8.5 para-aortic nodes (5.75-11.5) for Group B. The number of metastatic lymph nodes was 1 for Group A and 2 for Group B (p=0.93). The number of patients assigned to post-operative stage IA EC was 12 in Group A and 15 in Group B. For stage IB: 1 in Group A, 5 in Group B; for stage II: 0 in Group A, 1 in Group B; for stage IIIA: 1 in Group A, 1 in Group B; for stage IIIC1: 0 in Group A, 2 in Group B; and for stage IIIC2: 1in Group A, 0 in Group B (p=0.88 ). The number of patients undergoing adjuvant therapy was 4 for Group A and 14 for Group B (p=0.15). The median follow-up period was 98 months (79.5-106.2) for Group A and 32.5 months (11-53.3) for Group B. One patient had a recurrence (Group B). All patients were alive without evidence of disease.Conclusions: Our results suggest that laparoscopic pelvic lymph node dissection without PALND is sufficient for preoperative stage IA EC.