title: Robotically assisted para-aortic lymphadenectomy: surgical results: a cohort study of 487 patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate perioperative outcomes of robotic-assisted laparoscopic para-aortic lymphadenectomy (PAL) in patients with gynecologic cancers during the learning phases of robotic surgery programs and to compare results of extraperitoneal versus transperitoneal approaches of PAL.
  
  
  METHODS
  This study is a retrospective multicentric study of patients who underwent robotically assisted laparoscopic PAL (N = 487). Eleven European centers and 1 US center participated in the study. Abstracted data included age, body mass index, indication, type of surgical approach (transperitoneal or extraperitoneal), associated surgical procedures, operative time, estimated blood loss, lymph node count, hospital length of stay (LOS), and complications. Para-aortic lymphadenectomy was performed by an extraperitoneal approach in 58 cases (12%) and transperitoneal in 429 cases (88%).
  
  
  RESULTS
  The mean (SD) para-aortic lymph node count was 12.6 (8.1), operative time was 217 (85) minutes, estimated blood loss was 105 (110) mL, and LOS was 2.8 (3.2) days. Four (0.8%) conversions to open and 2 (0.4%) conversions to laparoscopy were described. There were 32 lymphocysts (6.6%), 3 deep venous thromboses (0.6%), and 10 transfusions (2.1%). For transperitoneal approach, the average number of lymph nodes removed was higher in isolated PAL group than the hysterectomy combined group (report node counts 95% confidence interval, -7.29 to -3.52, P = 1.5 × 10⁻⁶). For isolated PAL, the LOS was shorter in the extraperitoneal group than in the transperitoneal group (report data 95% CI, -1.35 to -0.35, P = 0.001).
  
  
  CONCLUSIONS
  Robotic-assisted PAL seems safe and feasible. More lymph nodes were removed during an isolated transperitoneal PAL dissection compared with a combined procedure with hysterectomy. Extraperitoneal approach seems attractive relative to transperitoneal dissection, but the superiority of one or the other way is not demonstrated by our study.
authors: *Georges-François Leclerc Cancer Center, Dijon, France; †Florida Hospital Cancer Institute, Orlando, FL; ‡European Institute of Oncology, Milan, Italy; §Centre Oscar Lambret, Lille, France; ∥St Pierre University Hospital, Brussels, Belgium; ¶UZ Leuven, Leuven, Belgium; #Institute of Oncology, IDIBELL, Idibell, Spain; **Charité University Medicine, Berlin, Germany; ††European Hospital, Paris, France; ‡‡University Hospital, Bordeaux, France; §§Claudius Regaud Institute, Toulouse, France; ∥∥Citadelle Hospital, Liège, Belgium; and ¶¶Paoli Calmettes Institute, Marseille, France.
authors: Delphine
authors: D
authors: Hudry
authors: Sarfraz
authors: S
authors: Ahmad
authors: Vanna
authors: V
authors: Zanagnolo
authors: Fabrice
authors: F
authors: Narducci
authors: Maxime
authors: M
authors: Fastrez
authors: Jordi
authors: J
authors: Ponce
authors: Elisabeth
authors: E
authors: Tucher
authors: Fabrice
authors: F
authors: Lécuru
authors: Vanessa
authors: V
authors: Conri
authors: Pierre
authors: P
authors: Leguevaque
authors: Frédéric
authors: F
authors: Goffin
authors: Robert W
authors: RW
authors: Holloway
authors: Eric
authors: E
authors: Lambaudie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D061887:Conversion to Open Surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008210:Lymphocele / Q000209:etiology; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult