Extra-peritoneal laparoscopic para-aortic lymphadenectomy--a prospective cohort study of 293 patients with endometrial cancer.
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 cm(3), 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.
Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. dowdy.sean@mayo.edu
Sean C
SC
Dowdy
Giovanni
G
Aletti
William A
WA
Cliby
Karl C
KC
Podratz
Andrea
A
Mariani
D000368:Aged; D001011:Aorta; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010529:Peritoneal Cavity; D011446:Prospective Studies