原尾 美智子

Various surgical energy devices are used for axillary lymph-node dissection. However, those that reduce seroma during axillary lymph-node dissection are unknown. We aimed to determine the best surgical energy device for reducing seroma by performing a network meta-analysis to synthesize the current evidence on the effectiveness of surgical energy devices for axillary node dissection for breast cancer patients. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform Search Portal. Two reviewers independently selected randomized controlled trials (RCTs) comparing electrosurgical bipolar vessel sealing (EBVS), ultrasonic coagulation shears (UCS), and conventional techniques for axillary node dissection. Primary outcomes were seroma, drained fluid volume (mL), and drainage duration (days). We analyzed random-effects and Bayesian network meta-analyses. We evaluated the confidence of each outcome using the CINeMA tool. We registered with PROSPERO (CRD42022335434). We included 34 RCTs with 2916 participants. Compared to the conventional techniques, UCS likely reduces seroma (risk ratio [RR], 0.61; 95% credible interval [CrI], 0.49-0.73), the drained fluid volume (mean difference [MD], - 313 mL; 95% CrI - 496 to - 130), and drainage duration (MD - 1.79 days; 95% CrI - 2.91 to - 0.66). EBVS might have little effect on seroma, the drained fluid volume, and drainage duration compared to conventional techniques. UCS likely reduce seroma (RR 0.44; 95% CrI 0.28-0.69) compared to EBVS. Confidence levels were low to moderate. In conclusion, UCS are likely the best surgical energy device for seroma reduction during axillary node dissection for breast cancer patients.

症例は67歳,女性.乳癌検診異常で受診した.左乳房に低エコー腫瘤を認め,針生検の結果,腺様嚢胞癌が疑われた.左乳房温存術およびセンチネルリンパ節生検を施行し,病理組織学的診断はpT1N0M0 StageIA,腺様嚢胞癌(ER-,PgR-,HER2-,Ki-67 5%)であった.補助化学療法を考慮する症例であったが,予後良好と考えられたため,化学療法は省略し放射線治療のみ施行した.術後2年6ヵ月でCTにて左肺結節を指摘されたが,原発か転移性かの鑑別が困難であったため,胸腔鏡下左肺上葉切除およびリンパ節郭清を施行した.病理組織学的診断では腺様嚢胞癌の肺転移と診断された.他の特殊型乳癌が通常の浸潤性乳管癌に準じて補助化学療法を行うことが推奨されているが,乳腺腺様嚢胞癌は多くがtriple negative症例にも関わらず予後良好と言われ,腋窩リンパ節転移が陰性ならば補助化学療法は必要としないことが多い.今回,乳腺腺様嚢胞癌で術後肺転移を認めた症例を経験したので,若干の文献的考察を加え報告する.(著者抄録)