Extra-peritoneal laparoscopic para-aortic lymphadenectomy — A prospective cohort study of 293 patients with endometrial cancer

Dowdy, Sean C.; Aletti, Giovanni; Cliby, William A.; Podratz, Karl C.; Mariani, Andrea

doi:10.1016/j.ygyno.2008.08.021

Cited by 69 publications

(44 citation statements)

References 26 publications

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“…On the other hand, with regard to the extra-peritoneal approach, Dowdy et al have shown that this technique can be performed safely and systematically in obese patients. It enables thorough inspection and sampling with the number of retrieved lymph nodes being greater in obese patients operated upon using the extra-peritoneal approach in comparison to those undergoing laparotomy [45]. The success rate in this study was 90% and the mean BMI was 33.…”

Section: Surgical Management Of Malignancy In Obese Womenmentioning

confidence: 67%

“…The success rate in this study was 90% and the mean BMI was 33. Dowdy et al have described the extra-peritoneal approach as more advantageous by minimizing the need for an expert assistant as only three operating ports are used such that the first assistance is required only to direct the optic [45]. Ergonomically speaking, however, the positioning of the trocars may limit range of movement and dexterity making it more difficult to manage intra-operative complications.…”

Section: Surgical Management Of Malignancy In Obese Womenmentioning

confidence: 99%

See 1 more Smart Citation

Obesity in laparoscopic surgery

Afors

Centini

Murtada

et al. 2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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Section: Surgical Management Of Malignancy In Obese Womenmentioning

confidence: 67%

Section: Surgical Management Of Malignancy In Obese Womenmentioning

confidence: 99%

Obesity in laparoscopic surgery

Afors

Centini

Murtada

et al. 2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Laparoscopic pelvic LAE was introduced by Querleu et al [20] in 1991 and since then, was further developed by a number of oncology centers. There is consensus opinion that 20–50 procedures are adequate to pass the learning curve for pelvic and/or para-aortic transperitoneal, retroperitoneal and, more recently, robotic-assisted LAE [18,21,22]. In our study, all 3 involved gynecologic oncologists had a history of at least 100 laparoscopic LAEs performed in a standardized fashion prior to this investigation [19].…”

Section: Discussionmentioning

confidence: 99%

Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

Lanowska¹,

Vasiljeva²,

Chiantera³

et al. 2010

Oncology

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Objective: The lymph node number as benchmark in oncologic operations depends on the patient’s anatomy, surgeon’s skill and pathologist’s accuracy. The influence of the pathologist is barely evaluated. Methods: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. Results: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. Conclusion: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards.

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“…This apparent "conflict" between a minimally invasive procedure and a comprehensive staging including complete lymphadenectomy could be resolved with the use of other techniques, such as the extraperitoneal laparoscopic approach [76] or robotic-assisted laparoscopy [77], in order to overcome the limitations of conventional laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up after laparoscopic management of endometrial cancer: a 15-year cohort study

et al. 2011

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The objective of this study was to evaluate longterm oncological outcomes of laparoscopic management of endometrial carcinoma (EC) in a large series of consecutive patients from two referral cancer centres. The study is a large retrospective study with 15-year follow-up. The clinical records of 207 consecutive women with clinical stage I EC managed by laparoscopy between 1990 and 2005 were reviewed. Laparoscopy included peritoneal washing, inspection of abdominal cavity, total laparoscopic hysterectomy + bilateral salpingo-oophorectomy and pelvic/para-aortic lymphadenectomy depending on the preoperative histology or frozen section results. Data collected included conversion rate, operative time, hospital stay, surgical complications, FIGO 1988 stage and 5-year survival. Laparoscopic procedures were converted to laparotomy in nine (4.3%) cases. Mean operative time was 173.2 min (70-300 min). Mean hospital stay was 5 days. The mean number of lymph nodes removed was 10 (2-25). Lymphadenectomy was considered not feasible in 20 cases (12.9%) due to technical difficulties. Intraoperative and postoperative complications were seen in 11 (5.6%) and 13 (6.6%) women, respectively. Histopathological results led to upstaging in 11.6% of cases. After a mean follow-up of 74.8 months (14-204 months), 5-year causespecific and disease-free survival rates were 93.2% and 89.3%, respectively. Twenty-one (10.6%) patients developed recurrences. No port site metastases were identified. Laparoscopic management of EC is feasible, reproducible and does not worsen patient prognosis. It allows comprehensive surgical staging and the option of lymphadenectomy in a single surgical procedure without compromising the oncological radicality required. Our results show minimal morbidity and similar long-term outcomes than those obtained by laparotomy in the literature.

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Extra-peritoneal laparoscopic para-aortic lymphadenectomy — A prospective cohort study of 293 patients with endometrial cancer

Abstract: Objective-To determine if extra-peritoneal laparoscopic para-aortic (PA) lymphadenectomy allows a reliable assessment of PA nodes in patients with endometrial cancer (EC).

Cited by 69 publications

References 26 publications

Obesity in laparoscopic surgery

Obesity in laparoscopic surgery

Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

Long-term follow-up after laparoscopic management of endometrial cancer: a 15-year cohort study

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