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

Abstract

Background/Aim: This study aimed to compare laparoscopy with laparotomy and evaluate the effectiveness of a laparoscopic combined retroperitoneal and transperitoneal approach for para-aortic lymphadenectomy in patients with endometrial cancer. Patients and Methods: In this singlecenter retrospective study, patients with endometrial cancer who underwent para-aortic lymphadenectomy between December 2016 and November 2019 were analyzed. The patient's clinical and pathologic data were procured from medical records. Statistical analyses were performed using Fisher's exact and the Mann-Whitney U-tests. Results: A total of 37 and 28 patients were included in the laparoscopic and laparotomy groups, respectively. The laparoscopic group had similar operative time, similar number of resected para-aortic and pelvic lymph nodes, less intraoperative blood loss and complications, lower rate of blood transfusion, and shorter postoperative stay than the laparotomy group. Conclusion: Laparoscopic combined retroperitoneal and transperitoneal approach for endometrial cancer is safe and effective compared to laparotomy.Para-aortic lymphadenectomy is the standard staging procedure for endometrial cancer, which is the most common gynecologic malignancy in developed countries (1). Endometrial cancer often initially metastasizes to the pelvic lymph nodes followed by the para-aortic lymph nodes. Paraaortic lymph node metastasis occurs in 11.9% and 23.8% of patients in the intermediate-risk and high-risk groups, respectively (2). According to the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, para-aortic nodal evaluation of the inframesenteric and infrarenal regions could be useful in staging women with high-risk tumors, such as deeply invasive lesions, high-grade histology tumors, serous carcinoma, clear cell carcinoma, and carcinosarcoma (3).With the development of endoscopic equipment and minimally invasive surgical techniques, the utilization of the laparoscopic para-aortic lymphadenectomy as an approach for the management of endometrial cancer has been increasing and has been covered by health insurance since April 2020. However, the effectiveness of laparoscopic procedures in endometrial cancer remains to be determined.Although transperitoneal para-aortic lymphadenectomy has been widely adopted in the surgical staging of endometrial cancer in Japan, this approach does not address the difficulties of small bowel retraction, dissection of adhesions, and identification of the ureters (4). In contrast, retroperitoneal para-aortic lymphadenectomy reportedly decreases enteric complications (4, 5). Therefore, we performed laparoscopic para-aortic lymphadenectomy combined with retroperitoneal and transperitoneal approach in patients with endometrial cancer.This study aimed to compare the safety and effectiveness of laparoscopy with those of laparotomy in the para-aortic lymphadenectomy of patients with endometrial cancer and to evaluate the effectiveness of the laparoscopic combined retroperitoneal and transp...

Ureter Injury in Laparoscopic Para-Aortic Lymphadenectomy for Endometrial Cancer by the Transperitoneal Approach

“…Laparoscopic para-aortic lymphadenectomy for uterine endometrial cancer can be performed using the transperitoneal approach (TPA) or the extraperitoneal approach (EPA), and there are several reports on the safety of these approaches [1][2][3][4][5][6][7]. In EPA, the extraperitoneal cavity is expanded to allow the complete elimination of the intestinal tracts from the field of view.…”