臨床婦人科産科69巻1号

2015年01月発行

今月の臨床 ゲノム時代の婦人科がん診療を展望する─がんの個性に応じたpersonalizationへの道

【各論1】子宮頸がん

2．若年子宮頸がんに対する妊孕能温存手術の個別化

著者： 西尾浩¹ 田中京子¹ 岩田卓¹ 青木大輔¹

所属機関： ¹慶應義塾大学医学部産婦人科学教室

ページ範囲：P.53 - P.58

文献概要

●広汎性子宮頸部摘出術は妊孕能温存を希望する患者に対して行う非標準術式であり，症例ごとに適応を検討し，順守する必要がある．

●標準治療にはない合併症の可能性，妊娠するために生殖補助医療が必要になる可能性や早産のリスクを説明する必要がある．

●摘出標本の病理結果に基づき，症例ごとに追加治療の要否を検討する必要がある．

参考文献

1） Koh WJ, et al : Cervical cancer. J Natl Compr Canc Netw 11 : 320─343, 2013

2） Colombo N, et al : Cervical cancer : ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23 （Suppl 7）: vii27─32, 2012

3） Dargent D, et al : Laparoscopic vaginal radical trachelectomy : a treatment to preserve the fertility of cervical carcinoma patients. Cancer 88 : 1877─1882, 2000

4） Plante M, et al : The vaginal radical trachelectomy : an update of a series of 125 cases and 106 pregnancies. Gynecol Oncol 121 : 290─297, 2011

5） Gizzo S, et al : Radical trachelectomy : the first step of fertility preservation in young women with cervical cancer（Review）. Oncol Rep 30 : 2545─2554, 2013

6） Plante M : Evolution in fertility-preserving options for early-stage cervical cancer : radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer 23 : 982─989, 2013

7） Smith JR, et al : Abdominal radical trachelectomy : a new surgical technique for the conservative management of cervical carcinoma. Br J Obstet Gynaecol 104 : 1196─1200, 1997

8） Abu-Rustum NR, et al : Fertility-sparing radical abdominal trachelectomy for cervical carcinoma : technique and review of the literature. Gynecol Oncol 103 : 807─813, 2006

9） Nishio H, et al : Abdominal radical trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer in a series of 61 women. Gynecol Oncol 115 : 51─55, 2009

10） Ebisawa K, et al : Obstetric outcomes of patients undergoing total laparoscopic radical trachelectomy for early stage cervical cancer. Gynecol Oncol 131 : 83─86, 2013

11） Vizza E, et al : Neoadjuvant chemotherapy followed by robotic radical hysterectomy in locally advanced cervical cancer : a multi-institution study. Gynecol Oncol 133 : 180─185, 2014

12） Nishio H, et al : Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies. Hum Reprod 28 : 1793─1798, 2013

13） Reade CJ, et al : Surgery for early stage cervical cancer : how radical should it be? Gynecol Oncol 131 : 222─230, 2013

14） Marchiole P, et al : Oncological safety of laparoscopic-assisted vaginal radical trachelectomy（LARVT or Dargent’s operation）: a comparative study with laparoscopic-assisted vaginal radical hysterectomy（LARVH）. Gynecol Oncol 106 : 132─141, 2007

15） Schneider A, et al : Clinical recommendation radical trachelectomy for fertility preservation in patients with early-stage cervical cancer. Int J Gynecol Cancer 22 : 659─666, 2012

16） Wethington SL, et al : Expanding the indications for radical trachelectomy : a report on 29 patients with stage IB1 tumors measuring 2 to 4 centimeters. Int J Gynecol Cancer 23 : 1092─1098, 2013

17） Li J, et al : Abdominal radical trachelectomy : Is it safe for IB1 cervical cancer with tumors>/=2cm? Gynecol Oncol 131 : 87─92, 2013

18） Rob L, et al : Less radical fertility-sparing surgery than radical trachelectomy in early cervical cancer. Int J Gynecol Cancer 17 : 304─310, 2007

19） Rob L, et al : Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol 12 : 192─200, 2011

20） Rodriguez M, et al : Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer. Am J Obstet Gynecol 185 : 370─374, 2001

21） Niikura H, et al : Prospective study of sentinel lymph node biopsy without further pelvic lymphadenectomy in patients with sentinel lymph node-negative cervical cancer. Int J Gynecol Cancer 22 : 1244─1250, 2012

22） Plante M, et al : The case of a viable pregnancy post vaginal radical trachelectomy followed by combined chemo-radiation therapy. Gynecol Oncol 123 : 421─423, 2011

23） Lanowska M, et al : Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2cm : oncologic, fertility, and neonatal outcome in a series of 20 patients. Int J Gynecol Cancer 24 : 586─593, 2014

24） Katsumata N, et al : Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer : a Japan Clinical Oncology Group trial（JCOG 0102）. Br J Cancer 108 : 1957─1963, 2013