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).

Methods: In October of 2005, a single surgeon began performing extra-peritoneal laparoscopic PA lymphadenectomy for patients with EC. A prospective cohort study was initiated from October 2005 through October 2007. Staging of Group A included extra-peritoneal laparoscopic PA lymphadenectomy, while Group B underwent staging via laparotomy.

Results: In a 24 month period, 293 patients underwent surgical treatment for EC, 203 of them underwent complete staging as determined by previously published criteria. Extra-peritoneal laparoscopic PA lymphadenectomy to the renal veins was successful in 35/38 patients (92%). Mean BMI was 33.0 for Group A and 32.3 for Group B (p=NS). Mean EBL and hospital stay were lower in Group A compared to Group B (163 vs 373 cm(3), p<0.0001; median 2 vs 4 nights, p<0.001). The total number of PA nodes harvested was not statistically different between Groups A and B (16.5 vs 19.6). Interestingly, in Group A the total number of PA nodes was greater for patients with BMI>35, (21.6 vs 13.1), while in Group B fewer nodes were removed in obese patients (17.8 vs 20.5).

Conclusions: Extra-peritoneal laparoscopy is a reliable method to routinely reach the level of the renal veins, even in obese patients. This approach was feasible in over 90% of unselected patients and well-tolerated.

Conflict of interest statement

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1

Schematic illustrating port placement in the left flank. The lowermost port (10 mm) is located two fingerbreadths medial to, and three to six fingerbreadths superior to, the left anterior superior iliac spine. The remaining trocars are triangulated one finger’s length from the initial incision. The second, more posterior trocar is 10 mm. The third, most cephalad 5 mm trocar is located just inferior to the costal margin.