Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy?
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ORIGINAL ARTICLE – GYNECOLOGIC ONCOLOGY
Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy? Y. Kerbage, MD1, A. Kakkos, MD1, F. Kridelka, MD, PhD2, E. Lambaudie, MD, PhD3, A. S. Bats, MD, PhD4, T. He´bert, MD5, F. Goffin, MD, PhD6, J. Wallet, PhD7, E. Leblanc, MD1, D. Hudry, MD1, and F. Narducci, MD1 Oncologic Surgery, Centre Oscar Lambret, Lille, France; 2Oncologic Surgery, CHU de Lie`ge, Lie`ge, Belgium; Oncologic Surgery, Institut Paoli-Calmettes, Marseille, France; 4Oncologic Surgery, Hoˆpital Europe´en Georges Pompidou (HEGP), Paris, France; 5Department of Gynecology, CHRU de Tours, Tours, France; 6Oncologic Surgery, CHR de la Citadelle, Lie`ge, Belgium; 7Statistical Department of Centre Oscar Lambret, Lille, France
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ABSTRACT Background. The outcomes of paraaortic lymphadenectomy were compared for the treatment of gynecological malignancies to identify the most appropriate surgical approach. Methods. Our retrospective, multicentric study included 1304 patients who underwent paraaortic lymphadenectomy for gynecological malignancies. The patients were categorized into the following five groups based on treatment type: transperitoneal laparoscopy (group A, n = 198), extraperitoneal laparoscopy (group B, n = 681), robot-assisted transperitoneal laparoscopy (group C, n = 135), robot-assisted extraperitoneal laparoscopy (group D, n = 44), and laparotomy (group E, n = 246). Results. The prevalence of cancer types differed according to the surgical approach: there were more ovarian cancers in group E and more cervical cancers in groups B and D (p \ 0.001). Estimated blood loss was higher in group E (844.2 mL) than in groups treated with minimally invasive interventions (115.8–141.5 mL, p \ 0.005). For infrarenal dissection, fewer nodes were removed in group C compared with the other approaches (16 vs. 21 nodes, respectively, p \ 0.05). The average operative time ranged
Ó Society of Surgical Oncology 2020 First Received: 5 December 2019 Y. Kerbage, MD e-mail: [email protected]
from 169 min for group A to 247 min for group E (p \ 0.001). Length of hospital stay was 14 days for group E versus 3.5 days for minimally invasive procedures (p \ 0.05). The early postoperative grade 3 and superior Dindo–Clavien complications occurred in 9–10% of the patients in groups B-D, 15% of the patients in group E, and only 3% and 4% for groups A and C, respectively. The most common complication was lymphocele. Conclusions. Laparotomy increases preoperative and postoperative morbidity. The robot-assisted transperitoneal approach demonstrated a poorer lymph node yield than laparotomy and extraperitoneal approaches.
Paraaortic lymphadenectomy (PAL) is a routine procedure for staging or therapeutic purposes of gynecological malignancies. The purpose of conventional interventions in cervical cancers and advanced vaginal cancers is to guide the fields of radiation and for therapeutic benefits.1,2 In endometrial cancer, PAL is therapeutic; however in highrisk endometrial c
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