골반 및 대동맥 주위 림프절 절제술을 포함한 자궁내막암 병기설정 수술에서 수술적 접근 방법 비교
Comparison of surgical approach to staging operation for endometrial cancer including pelvic and paraaortic lymphadenectomy
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목적: 자궁내막암의 병기설정 수술 시 복강경식 병기설정술 (이하 복강경식)과 복식 병기설정술 (이하 복식)을 비교하였다. 연구 방법: 1996년 1월부터 2007년 12월까지 골반 및 대동맥 주위 림프절 절제술을 포함한 자궁내막암의 병기설정 수술을 시행한 272명 (복강경식: 90명, 복식: 182명)을 대상으로 양군 간의 수술 및 임상 결과를 비교해보았다. 결과: 양군 간에 평균나이, 체질량 지수, 암의 조직학적 유형에 차이가 없었으나 암의 분화도와 수술적 병기는 복식이 더 높았다. 절제된 골반 림프절과 대동맥 주위 림프절수는 복강경식에서 각각 33.1±13.2, 16.1±11.6, 복식에서 각각 32.5±14.5, 19.0±12.7으로 유의한 차이는 없었다. 복강경식이 복식에 비하여 수술시간과 수술 후 입원기간이 짧았으며, 수술 전후 혈색소 변화도 더 적었다. 수술 후 합병증의 유의한 차이는 없었으나 양성 림프절 전이나 수술 후 항암 보조요법 시행은 복식이 더 많았다. 교란요인 교정 후 수술 방법은 생존율에 영향을 미치지 않았다. 결론: 골반 및 대동맥 주위 림프절 절제술을 포함한 자궁내막암의 병기설정 수술 시, 절제된 림프절수는 비슷하나 복강경식이 복식에 비하여 수술시간, 입원기간, 출혈량에서 우수하므로 우선적 수술 방법으로 고려해볼 수 있겠다.
Abstract
Objective: To compare laparoscopic surgery with laparotomy in comprehensive surgical staging of endometrial cancer. Methods: We retrospectively analyzed the medical records of 272 patients with endometrial adenocarcinoma treated by staging operation including pelvic and paraaortic lymphadenectomy between January, 1996 and December, 2007. Results: There was no significant difference between the two groups in terms of age, body mass index, or histologic type, but in the laparotomy group, grade and surgical stage were significantly higher. All the patients, 182 in the laparotomy and 90 in the laparoscopy group, had lymphadenectomy, and the mean number of pelvic and paraaortic lymph nodes (LNs) obtained were 33.1±13.2 and 16.1±11.6 in the laparoscopy group, and 32.5±14.5 and 19.0±12.7 in the laparotomy group, respectively; these differences were not statistically significant. In the laparoscopy group, the operating time and postoperative hospital length of stay were shorter than in the laparotomy group, as were the pre- and post-operative hemoglobin changes. There were no significant differences between the two groups in terms of intra- or post-operative complications, but positive lymph nodal metastasis and conducting of postoperative adjuvant therapy were highter in the laparotomy group. The operative technique did not influence overall or disease-free survival after adjusting for several confounding factors. Conclusion: Laparoscopic-assisted surgical staging for endometrial cancer required a shorter operating time, shorter postoperative hospital stay, and lower blood loss compared to traditional laparotomy staging, and can be a good therapeutic option for staging operation including lymphadenectomy of endometrial cancer.
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