Mathey Marie-Pierre, Romito Fabien, Huber Daniela E
Department of Gynaecological Surgery, Hospital de Sion, Sion, Switzerland.
Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland.
Case Rep Oncol. 2022 Mar 21;15(1):291-299. doi: 10.1159/000523735. eCollection 2022 Jan-Apr.
Endometrial cancer is the most commonly diagnosed gynecological malignancy. Feasibility and safety of laparoscopy are no longer to be demonstrated in patients with uterine-confined endometrial carcinoma. Vaginally assisted natural orifices endoscopic transluminal endoscopic surgery (vNOTES) is a new endoscopic approach over the past decade with significant evidence in benign pathology. Publications exploring VNOTES surgery in gynecological cancer were published first in 2014. We hereby report our first experience with vNOTES surgery in endometrial cancer. A 64-year-old patient presented with postmenopausal bleeding. Endometrial biopsy identified a G1 endometrioid adenocarcinoma. MRI suspected deep invasion of myometrium with no abnormal lymph node. She underwent a total hysterectomy with bilateral adnexectomy and retroperitoneal pelvic sentinel node biopsy by vNOTES. The final histopathology confirmed G1 endometrial adenocarcinoma FIGO II (proximal focal invasion of cervical stroma and superficial invasion of myometrium). The patient was discharged 2 days postoperatively with no complications. vNOTES offers a closer approach and a better view of afferent lymphatics and probably the best chances to identify the true sentinel node. This approach presents several advantages compared to abdominal laparoscopy such as faster postoperative recovery, reduced pain, decreased postoperative wound infections, and no abdominal trocar port complications. The future research should focus on oncological safety, accuracy, and reliability of this technique, and an international registry should help to gather rapidly these informations.
子宫内膜癌是最常被诊断出的妇科恶性肿瘤。对于局限于子宫的子宫内膜癌患者，腹腔镜手术的可行性和安全性已无需再论证。经阴道自然腔道内镜手术（vNOTES）是过去十年出现的一种新的内镜手术方式，在良性疾病的治疗方面有大量证据支持。2014年首次发表了关于在妇科癌症中探索vNOTES手术的相关文献。在此，我们报告我们首例vNOTES手术治疗子宫内膜癌的经验。一名64岁患者出现绝经后出血。子宫内膜活检确诊为G1级子宫内膜样腺癌。磁共振成像怀疑肌层有深度浸润，未发现异常淋巴结。她接受了经vNOTES行全子宫切除术、双侧附件切除术及腹膜后盆腔前哨淋巴结活检。最终组织病理学确诊为G1级子宫内膜腺癌，国际妇产科联盟（FIGO）分期为II期（宫颈间质近端局灶性浸润和肌层浅表浸润）。患者术后2天出院，无并发症。vNOTES能提供更接近的手术入路，能更好地观察输入淋巴管，可能是识别真正前哨淋巴结的最佳机会。与腹部腹腔镜手术相比，这种手术方式有诸多优势，如术后恢复更快、疼痛减轻、术后伤口感染减少，且无腹部套管针穿刺口并发症。未来的研究应聚焦于该技术的肿瘤学安全性、准确性和可靠性，一个国际登记系统应有助于快速收集这些信息。
