title: Infrarenal lymphadenectomy for gynecological malignancies: two laparoscopic approaches.
abstract: OBJECTIVE
  Compare two approaches for laparoscopic infrarenal lymphadenectomy.
  
  
  METHODS
  Retrospective chart review. Statistical analyses with SPSS.
  
  
  RESULTS
  
  
  
  METHODS
  4 stage II/III cervical carcinoma, 75 clinical stage I/II endometrial carcinoma, 36 clinically stage I/II tubal/ovarian cancer. 36 transperitoneal approaches; 79 extraperitoneal approaches. Both groups had similar age, 58years (range 29-80), BMI of 25 (range 18-41), blood loss, 150cm(3) (range 25-1500), and hospital stay, 1day (range 1-6). The extraperitoneal surgery took longer (240 v 202min; p=.001); yielded more nodes (50 v 41; p=.004). Extraperitoneal approach yielded more inframesenteric (14 v 10; p=.036), and infrarenal nodes (14 v 9; p=.001). 25% of cervical, 19% of endometrial and 14% of ovarian cancer patients had metastases in radiographically negative infrarenal nodes. 50% of cervical, 33% of endometrial and 17% of ovarian cancer patients had therapy altered by aortic lymphadenectomy. When the inframesenteric nodes were positive, 63% of endometrial and 80% of ovarian cancer patients had infrarenal metastases. More metastases were identified with increasing aortic node count. Extraperitoneal lymphadenectomy had no learning curve (p=0.320), while transperitoneal lymphadenectomy did (p=0.016). Higher BMI patients had lower aortic node yields by transperitoneal (p=.057) but not extraperitoneal approach (p=.578). Among the 14 patients whose BMI was 35-41, mean extraperitoneal total aortic nodal yield was 30; transperitoneal yield was 6.
  
  
  CONCLUSIONS
  Infrarenal aortic lymphadenectomy may offer higher aortic nodal yields, even in patients with BMI's of 45. Larger prospective studies are needed to confirm whether this dissection in high-risk patients ensures more accurate therapy, and possibly improves cure rates.
authors.affiliation: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States. Electronic address: Kate.OHanlanMD@gmail.com.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: O'Hanlan
authors.affiliation: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Sten
authors.affiliation: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
authors.forename: Michael S
authors.initials: MS
authors.lastname: O'Holleran
authors.affiliation: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
authors.forename: Niesha N
authors.initials: NN
authors.lastname: Ford
authors.affiliation: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Struck
authors.affiliation: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
authors.forename: Stacey P
authors.initials: SP
authors.lastname: McCutcheon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005185:Fallopian Tube Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Lymphadenectomy, laparoscopic, aortic, staging, infrarenal, inframesenteric