婦人科悪性腫瘍に対するstaging laparotomy

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Gynecologic cancers have been routinely staged by clinical means and treatment plans have been decided according to the results of clinical staging. However, it is a well known fact that there is a substantial disparity between clinical and surgical disease extent, which has been reported between 20% and 50%. The purpose of staging laparotomy seems to be; (1) to determine precise histological extent of the disease before treatment, and (2) to individualize treatment on the basis of specific patterns of disease spread. Staging laparotomy consists of adequate midline incision, meticulous exploration of the abdominal cavity and organs with biopsies if necessary, peritoneal cytology, para-aortic lymph node (PAN) biopsy, and pelvic lymph node biopsy or dissection. PAN biopsy was performed 419 patients with cervical cancer. Twenty-three (5.5%) of 419 showed positive PAN. PAN(+) rate according to clinical stage was; Ib 1.4%, IIa 2.0%, IIb 7%, III 18.6%, and IV 25%. Scalene lymph node (SLN) biopsy was also performed on 47 cervical cancer patients. When PAN was positive, 17.6% of SLN was also positive. There was no positive SLN when PAN was negative. Of 125 patients who had peritoneal cytology studied, 14 (11.2%) had positive cytology. About 30% of patients with positive PAN were expected to survive 5 years, however, all patients with positive SLN died within 2 years. Peritoneal cytology was also thought to be an important prognostic factor. Ninety-eight patients with endometrial cancer underwent pelvic lymphadenectomy and 16 (16.3%) had positive nodes. Positive rate according clinical stage was; I 5%, II 33.3% , III 25%, IV 100%. PAN biopsy was performed in 109 patients and 11 (10.1%) had positive PAN; stage I 1.5% , II 18.2% , III 42.9%, and IV 25%. When pelvic node was positive, 64.3% of PAN was positive. However, when pelvic node was negative, only 2.6% of PAN was positive. It seems like that PAN metastasis in endometrial cancer occurs through pelvic node metastasis. Of 61 patients with endometrial cancer who had peritoneal cytology studied, 14 (23%) had positive cytology. In ovarian cancer, meticulous exploration of abdomen is important for accurate staging, especially omentum, surface and mesentery of large and small intestines, diaphragm, surface of liver, para-aortic and pelvic lymph nodes. Pelvic and para-aortic lymph node metastasis in ovarian cancer was 19.0% and 25.6%, respectively. It is not known whether staging laparotomy improves survival of patients. However, it seems to be important to define the real extent of disease before treatment.
社団法人日本産科婦人科学会の論文
1989-08-01

著者

塚本直樹
九州大学婦人科産科

婦人科悪性腫瘍に対するstaging laparotomy

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