Kim Eun Bi, Hong Hyeon Myeong, Lee Won Moo, Choi Joong Sub, Bae Jaeman Bae, Jung Un Suk, Eom Jeong Min, Keum Jihyun
Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2022 Nov;65(6):522-530. doi: 10.5468/ogs.22236. Epub 2022 Nov 8.
We investigated the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer.
This retrospective study included eight patients who underwent laparoscopic restaging surgery for Iran University uterine cancer after a prior hysterectomy or myomectomy.
The median age of the patients and their body mass index were 55 years (range, 44-78) and 23.8 kg/m2 (range, 20.75- 31.89), respectively. The median interval between the prior hysterectomy and the restaging surgery was 21 days (range, 10-35). The median operating time and time for the return of bowel activity were 325 minutes (range, 200-475) and 35 hours (range, 18-50), respectively. The median numbers of harvested pelvic and para-aortic lymph nodes were 17.5 (range, 14-29) and 20.5 (range, 7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. The final International Federation of Gynecology and Obstetrics stage was IA in all patients. Intraoperative and postoperative complications did not occur in any of the patients, except for the need for transfusion. Patient 4 had synchronous primary cancer (stage IA) of the endometrium and left ovary. Two of the eight patients with clear cell carcinoma received chemotherapy, and none received radiotherapy. All patients survived without disease recurrence.
Restaging surgery might be necessary for highly selective patients with unexpected uterine malignancies. This would be an alternative surgical modality for complete staging and planning tailored adjuvant treatments. However, lymphadenectomy might not be performed in patients with early uterine cancer.
我们研究了腹腔镜再分期手术在意外发现子宫癌患者中的可行性。
这项回顾性研究纳入了8例在先前子宫切除术或肌瘤切除术后因伊朗大学子宫癌接受腹腔镜再分期手术的患者。
患者的中位年龄和体重指数分别为55岁（范围44 - 78岁）和23.8kg/m²（范围20.75 - 31.89）。先前子宫切除术与再分期手术之间的中位间隔时间为21天（范围10 - 35天）。中位手术时间和肠道恢复活动时间分别为325分钟（范围200 - 475分钟）和35小时（范围18 - 50小时）。盆腔和腹主动脉旁淋巴结清扫的中位数量分别为17.5个（范围14 - 29个）和20.5个（范围7 - 36个）。8例患者中有7例通过阴道或电动粉碎术进行子宫切除。所有患者最终国际妇产科联盟分期均为IA期。除输血需求外，所有患者术中及术后均未发生并发症。患者4患有子宫内膜和左卵巢同步原发性癌（IA期）。8例透明细胞癌患者中有2例接受了化疗，均未接受放疗。所有患者均存活且无疾病复发。
对于意外发现子宫恶性肿瘤的高度选择性患者，再分期手术可能是必要的。这将是一种用于完整分期和规划定制辅助治疗的替代手术方式。然而，早期子宫癌患者可能无需进行淋巴结清扫。
