title: Comparison between transperitoneal and extraperitoneal laparoscopic paraaortic lymphadenectomy in gynecologic malignancies.
abstract: OBJECTIVE
  Two validated laparoscopic approaches for para-aortic lymphadenectomy (PAL) exist: the transperitoneal and the extraperitoneal. The aim of this study was to compare the surgical outcomes of both approaches.
  
  
  METHODS
  A retrospective review of all patients who underwent laparoscopic PAL for a gynecologic malignancy between January 2008 and October 2013.
  
  
  METHODS
  University Hospital.
  
  
  METHODS
  Two patients groups were compared: transperitoneal (n = 51) and extraperitoneal (n = 21).
  
  
  METHODS
  Paraaortic lymphadenectomy.
  
  
  RESULTS
  The χ(2) test, Fisher's exact test, or Student's t-test were used for univariate analysis and a stepwise logistic regression for multivariate analysis. The threshold of statistical significance was set at 0.05. All patient characteristics were similar between the 2 groups (p > .05 for all variables). There was only 1 (1.3%) conversion to laparotomy encountered in the transperitoneal PAL group and 3 conversions from extraperitoneal to transperitoneal PAL (14.2%). In 1 case of extraperitoneal PAL, the procedure was abandoned because of inadequate equipment (body mass index 48 kg/m(2)). The mean duration of surgery was longer in the transperitoneal group: 200 min (35-360) versus 125.6 min (45-180) in the extraperitoneal group (p = .001). The mean number of harvested lymph nodes was higher in the transperitoneal group: 17 (4-37) versus 13 (3-25) in the extraperitoneal group (p = .029). There was no difference in postoperative course and complications between both groups in multivariate analysis.
  
  
  CONCLUSIONS
  In nonobese patients, the extraperitoneal PAL is associated with shorter surgical duration, whereas the transperitoneal approach was associated with a higher number of harvested lymph nodes. As a result of improved ergonomy, the transperitoneal approach enables laparoscopic management of operative complications.
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France. Electronic address: cherif.akladios@gmail.com.
authors.forename: Cherif
authors.initials: C
authors.lastname: Akladios
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Valentine
authors.initials: V
authors.lastname: Ronzino
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Schrot-Sanyan
authors.affiliation: IRCAD: Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France.
authors.forename: Karolina
authors.initials: K
authors.lastname: Afors
authors.affiliation: IRCAD: Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Fernandes
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Baldauf
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD: Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Wattiez
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D015992:Body Mass Index; D005260:Female; D005602:France / Q000453:epidemiology; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extraperitoneal; Gynecologic malignancy; Para-aortic lymphadenectomy; Transperitoneal