Comparison of Laparoscopy and Laparotomy for Para-Aortic Lymphadenectomy in Women With Presumed Stage I–II High-Risk Endometrial Cancer

Abstract

Objective: To compare laparoscopic surgery to laparotomy for harvesting para-aortic lymph nodes in presumed stage I-II, high-risk endometrial cancer patients. Methods: Patients with histologically proven endometrial cancer, presumed stage I-II with high-risk tumor features who had undergone hysterectomy, bilateral salpingoophorectomy, or pelvic and para-aortic lymphadenectomy by either laparoscopy or laparotomy in Samsung Medical Center from 2005 to 2017 were retrospectively investigated. The primary outcome was para-aortic lymph node count. Secondary outcomes were pelvic lymph node count, perioperative events, and postoperative complications. Results: A total of 90 patients was included (35 for laparotomy, 55 for laparoscopy) for analysis. The mean (±SD) para-aortic lymph node count was 10.66 (±7.596) for laparotomy and 10.35 (±5.848) for laparoscopy (p = 0.827). Mean pelvic node count was 16.8 (±6.310) in the laparotomy group and 16.13 (±7.626) in the laparoscopy group (p = 0.664). Lower estimated blood loss was shown in the laparoscopy group. There was no difference in perioperative outcome between the groups. Additional multivariate analysis showed that survival outcome was not affected by surgical methods in presumed stage I-II, high-risk endometrial cancer patients. Conclusions: Study results demonstrate comparable para-aortic lymph node count with less blood loss in laparoscopy over laparotomy. In women with presumed stage I-II, high-risk endometrial cancer, laparoscopy is a valid treatment modality.

Effectiveness of Laparoscopic Combined Retroperitoneal and Transperitoneal Approach in Para-aortic Lymphadenectomy for Endometrial Cancer

“…Our findings are similar to those of the current literature (8)(9)(10)(11). In the LAP2 study, a multicenter randomized controlled trial conducted by the Gynecologic Oncology Group comparing laparoscopy and laparotomy, the rate of Kubo-Kaneda et al: Laparoscopic Combined Retroperitoneal and Transperitoneal Lymphadenectomy for Endometrial Cancer intraoperative complications was not significantly different between the laparoscopy (10%) and the laparotomy (8%) groups.…”

The Transumbilical Laparoendoscopic Single-Site Extraperitoneal Approach for Pelvic and Para-Aortic Lymphadenectomy: A Technique Note and Feasibility Study

“…Further exploration and practice of this technique were conducted, and the primary findings of our study confirmed that the TU-LESS extraperitoneal approach is feasible for systematic PLN and PALN. Compared to the node counts of laparoscopic transperitoneal procedure (range 14-22) (11,13,(27)(28)(29), our method yielded a comparable number of pelvic LNs. The median count of para-aortic LNs (18, range 7-30) in our investigation was equivalent to that of the largest case series of single-port lateral extraperitoneal approach reported by Guoy (median 18, range 2-47) (3), but was higher than that of left-sided extraperitoneal approach using multiport laparoscopy (range 9.5-15) (3,5,14,30).…”

“…The median blood loss was 100 ml (range 100-300) and no patient required blood transfusion. Concerning the LN yields, the median count of para-aortic LNs was 18 (range of 7-30), and the retrieved pelvic LNs was 26.5 (range [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Three EC patients had positive LNs, two with pelvic nodal metastasis and one with para-aortic nodal involvement.…”

The role of minimally invasive surgery in gynaecological cancer: an overview of current trends

“…This is the case for patients with locally advanced cervical cancer (stages IB2 to IVA) who undergo pelvic and paraaortic lymphadenectomy for evaluation prior to primary chemoradiation. Technically, MIS lymphadenectomy is feasible in most cases even in the paraaortic field ( Paik et al, 2020 ). There are two MIS methods for access to the retroperitoneum ( Dargent et al, 2000 ).…”