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 cm3, 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.
Extra-peritoneal laparoscopic para-aortic lymphadenectomy : a prospective cohort study of 293 patients with endometrial cancer / S.C. Dowdy, G. Aletti, W.A. Cliby, K.C. Podratz, A. Mariani. - In: GYNECOLOGIC ONCOLOGY. - ISSN 0090-8258. - 111:3(2008), pp. 418-424.
|Titolo:||Extra-peritoneal laparoscopic para-aortic lymphadenectomy : a prospective cohort study of 293 patients with endometrial cancer|
|Parole Chiave:||Endometrial carcinoma; Laparoscopy; Lymphadenectomy|
|Settore Scientifico Disciplinare:||Settore MED/40 - Ginecologia e Ostetricia|
|Data di pubblicazione:||2008|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.ygyno.2008.08.021|
|Appare nelle tipologie:||01 - Articolo su periodico|