Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer

• Published in: Gynecologic oncology Vol. 136; no. 2; pp. 285 - 292
• Main Authors: James, Jeffrey A, Rakowski, Joseph A, Jeppson, Corinne N, Stavitzski, Nicole M, Ahmad, Sarfraz, Holloway, Robert W
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2015
• Subjects: Aged; Early-stage; Endometrial cancer; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Hematology, Oncology and Palliative Medicine; Humans; Hysterectomy - methods; Infra-renal aortic lymphadenectomy; Kidney - blood supply; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Obstetrics and Gynecology; Pelvis; Robotic surgery; Robotics - methods; Trans-peritoneal; Robotic surgery; Early-stage; Endometrial cancer; Trans-peritoneal; Infra-renal aortic lymphadenectomy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2014.12.028

Abstract Objectives To assess the clinical performance of robotic-assisted infra-renal aortic lymphadenectomy (IRL) using a single center-docked approach for patients with endometrial cancer. Methods Robotic-assisted hysterectomy with pelvic and aortic lymphadenectomy was performed in 97 clinical stage I endometrial cancer (EC) patients with the intent to remove infra-renal aortic lymph nodes. Peri-operative data was contemporaneously accessioned and a retrospective database analysis was performed to examine clinical outcomes. Results IRL versus infra-mesenteric artery (IMA) dissections were accomplished in 88 (90.7%) and nine (9.3%) cases, respectively. There were no laparotomy conversions. Histology included 20.6% G1, 41.2% G2, and 38.1% G3 (endometrioid and Type II histologies). Forty-four (45.4%) cases had > 50% depth-of-invasion and 43 (44.3%) cases had lymphovascular space invasion. Lymph node metastases were detected in 39 (40.2%) cases [37 (38.1%) pelvic, 16 (16.5%) pelvic + aortic, two (2.1%) isolated aortic lymph nodes]. Aortic metastasis was identified in 16/37 (43.2%) pelvic node positive cases, and 6/34 (17.7%) IRL cases with positive pelvic nodes had infra-renal metastasis, yet normal aortic nodes below the IMA. Harvested aortic lymph nodes for IRL exceeded IMA cases (15.9 ± 6.3 vs. 8.9 ± 4.6; p < 0.01). Mean BMI for IMA cases exceeded IRL cases (37.4 ± 3.3 vs. 31.4 ± 7.1 kg/m2 ; p < 0.001). Twenty-five (81%) patients with BMI > 35 kg/m2 underwent successful IRL (range 36–47 kg/m2 ) compared to 95% of cases < 35 kg/m2 ( p = 0.03). Conclusions IRL was accomplished in 95% of EC patients with BMI < 35 kg/m2 and 81% with BMI > 35 kg/m2 using a single center-docked approach. A strict 35 kg/m2 BMI cut-off for avoiding IRL is therefore not advised.