Laparoscopic para-aortic lymphadenectomy for uterine endometrial cancer: a retrospective analysis

<p>The outcomes of laparoscopic surgery for uterine endometrial cancer that include para-aortic lymphadenectomy have not been fully elucidated in Japan. The aim of this study was to investigate the feasibility and outcomes of laparoscopic surgery that includes para-aortic lymphadenectomy as an initial treatment of endometrial cancer. Between January 2012 and January 2016, 17 patients with medium- to high-risk endometrial cancer who underwent laparoscopic surgery with para-aortic lymphadenectomy in our department were enrolled and retrospectively reviewed in this study. As controls, 45 patients who underwent open laparotomy for the same disease and at the same period were evaluated. Operation time was similar between the two groups. The amount of blood loss (p<0.0001) and length of hospital stay (p<0.001) were significantly less in the laparoscopy group than in the control group. Among the perioperative complications, lymphocele occurred significantly less frequently in the laparoscopy group (31.1% vs. 0%, p<0.05). Ileus (11.1% vs. 5.9%) and lymphedema (22.2% vs. 5.9%) tended to be less in the laparoscopy group, although the difference did not reach statistical significance. One case was switched from laparoscopy to laparotomy because of intraoperative bleeding from a large vessel injury. Although the number of dissected pelvic lymph nodes was smaller in the laparoscopy group (median, 43 vs. 32, p=0.008), no significant difference in the number of dissected para-aortic nodes (31 vs. 23) was observed. This study excluded cases in which lymph node swelling was observed on preoperative imaging. However, pathological examination revealed lymph node metastasis in nine cases in the laparotomy group (20%) and two cases in the laparoscopy group (12%). Recurrence was observed in three cases in the laparotomy group (6.7%) and one case in the laparoscopy group (5.9%). While operation time strongly correlated with body mass index (BMI) in the control group (p=0.0001), such correlation was not present in the laparoscopy group and deviation was minimal in this group. Similarly, blood loss correlated with BMI in the control group (p=0.01) but not in the laparoscopy group. In conclusion, the laparoscopic approach that includes para-aortic lymphadenectomy did not compromise the treatment outcome in endometrial cancer while reducing operative complications, blood loss, and length of hospital stay. Furthermore, with laparoscopy, long operation duration and large amounts of blood loss might be avoided in obese patients. [Adv Obstet Gynecol, 69 (1) : 1-7, 2017 (H29.2)]</p>