Infrarenal lymphadenectomy for gynecological malignancies: Two laparoscopic approaches

Abstract Objective Compare two approaches for laparoscopic infrarenal lymphadenectomy. Methods Retrospective chart review. Statistical analyses with SPSS. Results Patients: 4 stage II/III cervical carcinoma, 75 clinical stage I/II endometrial carcinoma, 36 clinically stage I/II tubal/ovarian cancer....

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Published in:	Gynecologic oncology Vol. 139; no. 2; pp. 330 - 337
Main Authors:	O'Hanlan, Katherine A, Sten, Margaret S, O'Holleran, Michael S, Ford, Niesha N, Struck, Danielle M, McCutcheon, Stacey P
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-11-2015
Subjects:	Adult Aged Aged, 80 and over Carcinoma - pathology Carcinoma - surgery Cohort Studies Endometrial Neoplasms - pathology Endometrial Neoplasms - surgery Fallopian Tube Neoplasms - pathology Fallopian Tube Neoplasms - surgery Female Hematology, Oncology and Palliative Medicine Humans Kidney Laparoscopy - methods Lymph Node Excision - methods Lymph Nodes - pathology Lymph Nodes - surgery Lymphadenectomy, laparoscopic, aortic, staging, infrarenal, inframesenteric Middle Aged Neoplasm Staging Obstetrics and Gynecology Ovarian Neoplasms - pathology Ovarian Neoplasms - surgery Retroperitoneal Space Retrospective Studies Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - surgery Lymphadenectomy, laparoscopic, aortic, staging, infrarenal, inframesenteric
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Summary:	Abstract Objective Compare two approaches for laparoscopic infrarenal lymphadenectomy. Methods Retrospective chart review. Statistical analyses with SPSS. Results Patients: 4 stage II/III cervical carcinoma, 75 clinical stage I/II endometrial carcinoma, 36 clinically stage I/II tubal/ovarian cancer. 36 transperitoneal approaches; 79 extraperitoneal approaches. Both groups had similar age, 58 years (range 29–80), BMI of 25 (range 18–41), blood loss, 150 cm3 (range 25–1500), and hospital stay, 1 day (range 1–6). The extraperitoneal surgery took longer (240 v 202 min; p = .001); yielded more nodes (50 v 41; p = .004). Extraperitoneal approach yielded more inframesenteric (14 v 10; p = .036), and infrarenal nodes (14 v 9; p = .001). 25% of cervical, 19% of endometrial and 14% of ovarian cancer patients had metastases in radiographically negative infrarenal nodes. 50% of cervical, 33% of endometrial and 17% of ovarian cancer patients had therapy altered by aortic lymphadenectomy. When the inframesenteric nodes were positive, 63% of endometrial and 80% of ovarian cancer patients had infrarenal metastases. More metastases were identified with increasing aortic node count. Extraperitoneal lymphadenectomy had no learning curve (p = 0.320), while transperitoneal lymphadenectomy did (p = 0.016). Higher BMI patients had lower aortic node yields by transperitoneal (p = .057) but not extraperitoneal approach (p = .578). Among the 14 patients whose BMI was 35–41, mean extraperitoneal total aortic nodal yield was 30; transperitoneal yield was 6. Conclusions Infrarenal aortic lymphadenectomy may offer higher aortic nodal yields, even in patients with BMI's of 45. Larger prospective studies are needed to confirm whether this dissection in high-risk patients ensures more accurate therapy, and possibly improves cure rates.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-8258 1095-6859
DOI:	10.1016/j.ygyno.2015.09.019