Deura Imari, Shimada Muneaki, Azuma Yukihiro, Komatsu Hiroaki, Nagira Kei, Sawada Mayumi, Harada Tasuku
Department of Obstetrics and Gynecology, Tottori University Fucluty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan; Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugeo, Miyamae-ku, Kawasaki, 216-8511, Japan.
Department of Obstetrics and Gynecology, Tottori University Fucluty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan; Department of Gynecology, Tohoku University Hospital, Seiryo-cho 1-1, Aoba-ku, Sendai, 980-8574, Japan.
Taiwan J Obstet Gynecol. 2019 Jan;58(1):99-104. doi: 10.1016/j.tjog.2018.11.019.
National health insurance coverage for the laparoscopic staging surgery for patients with stage IA endometrial cancer started from April 2014 in Japan. We conducted this retrospective study to evaluate the surgical outcomes of the laparoscopic surgery for patients with low-risk endometrial cancer compared with those of the laparotomy.
A total of 120 patients with presumed low-risk endometrial cancer, who were treated at Tottori University Hospital between 2005 and 2016, were eligible for this study. The laparoscopic staging surgery included only the pelvic lymphadenectomy and not the para-aortic lymphadenectomy. We evaluated the discrepancy between preoperative presumption and postoperative diagnosis of recurrent risk factors.
Forty patients underwent the laparoscopic surgery and 80 patients received the laparotomy. The laparoscopic surgery resulted in less intraoperative blood loss and shorter hospital stay. The operative time was significantly longer for the laparoscopic surgery compared with the laparotomy, but this difference was not seen in obese patients with a body mass index ≥30 kg/m. The type of the surgical procedure did not affect the incidence of perioperative complications. Among 120 patients, 104 (86.6%) were diagnosed as FIGO stage IA, 118 (98.3%) with endometrioid adenocarcinoma grade 1 or 2, and 107 (89.1%) with myometrial invasion depth <50%.
The laparoscopic staging surgery is a feasible and safe alternative to the laparotomy for patients with presumed low-risk endometrial cancer, especially for obese patients. To perform the laparoscopic surgery for patients with stage IA endometrial cancer under the current national health insurance system, it is important to limit the candidates to low-risk disease based on a precise diagnosis before the surgery.
日本自2014年4月起，为IA期子宫内膜癌患者的腹腔镜分期手术提供国民健康保险覆盖。我们进行了这项回顾性研究，以评估低风险子宫内膜癌患者腹腔镜手术与开腹手术相比的手术结果。
2005年至2016年期间在鸟取大学医院接受治疗的120例疑似低风险子宫内膜癌患者符合本研究条件。腹腔镜分期手术仅包括盆腔淋巴结清扫术，不包括腹主动脉旁淋巴结清扫术。我们评估了复发危险因素术前推测与术后诊断之间的差异。
40例患者接受了腹腔镜手术，80例患者接受了开腹手术。腹腔镜手术术中失血更少，住院时间更短。与开腹手术相比，腹腔镜手术的手术时间明显更长，但在体重指数≥30kg/m的肥胖患者中未观察到这种差异。手术方式类型不影响围手术期并发症的发生率。120例患者中，104例（86.6%）被诊断为FIGO IA期，118例（98.3%）为子宫内膜样腺癌1级或2级，107例（89.1%）肌层浸润深度<50%。
对于疑似低风险子宫内膜癌患者，尤其是肥胖患者，腹腔镜分期手术是开腹手术的一种可行且安全的替代方案。在当前国民健康保险制度下，为IA期子宫内膜癌患者进行腹腔镜手术时，重要的是在手术前基于精确诊断将手术候选人限制在低风险疾病患者。
