title: Embryologically based radical hysterectomy as peritoneal mesometrial resection (PMMR) with pelvic and para-aortic lymphadenectomy for loco-regional tumor control in endometrial cancer: first evidence for efficacy.
abstract: To evaluate the feasibility and efficacy of embryologically based compartmental surgery for locoregional tumor control in intermediate and high risk endometrial cancer: peritoneal mesometrial resection with therapeutic pelvic and para-aortic lymphadenectomy by robotically assisted laparoscopy.
  
  
  
  75 consecutive surgically treated patients with uterine malignancies have been analyzed. 68 patients with histologically proven endometrial cancer and complete robotically assisted surgery have been included in this study on morbidity and oncological outcome. 56 % of the patients were at intermediate/high risk with either stage IAG3 or IB (n = 22) or stage II-IV (n = 16). Adjuvant EBRT was offered to three patients only (4 %), whereas five received isolated vaginal brachytherapy (7 %). Indocyanine-green (ICG) fluorescence lymphography is demonstrated being useful for additional intraoperative visualization of the compartment borders and lymphatic drainage to the postponed lymph compartments.
  
  
  
  After a mean follow-up of 32 months, there were only two loco-regional recurrences (2.9 %). Both recurrences were apparently cured by salvage therapy. 9 patients died; 6 (8.8 %) from metastatic disease (5) or unknown cause (1), 3 (4.4 %) from intercurrent disease without evidence of disease. One patient (1.4 %) experienced a peritoneal carcinosis and is alive. There were 8/68 perioperative complications (12 %). No perioperative mortality was observed.
  
  
  
  Embryologically defined compartmental surgery by robotically assisted laparoscopy seems to be feasible and safe in endometrial cancer. The low loco-regional recurrence rate of 2.9 % in spite of a very low percentage of adjuvant radiotherapy and 56 % of intermediate/high risk tumors should stimulate to initiate a multicentre trial to evaluate the value of compartmental surgery for prevention of locoregional recurrence in endometrial cancer.
authors.affiliation: Department of Gynaecology and Obstetrics, West-German Tumour Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany. rainer.kimmig@uk-essen.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kimmig
authors.affiliation: Department of Gynaecology and Obstetrics, West-German Tumour Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
authors.forename: Antonella
authors.initials: A
authors.lastname: Iannaccone
authors.affiliation: Department of Gynaecology and Obstetrics, West-German Tumour Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
authors.forename: Bahriye
authors.initials: B
authors.lastname: Aktas
authors.affiliation: Department of Gynaecology and Obstetrics, West-German Tumour Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Buderath
authors.affiliation: Department of Gynaecology and Obstetrics, West-German Tumour Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Heubner
mesh_terms: D000328:Adult; D001918:Brachytherapy; D002277:Carcinoma / Q000473:pathology; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods; D008648:Mesoderm / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000601:surgery; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery; D014621:Vagina / Q000473:pathology
keywords: Embryologically based compartmental surgery; Endometrial cancer; ICG; Indocyanine-green; PMMR; Pelvic and para-aortic lymphadenectomy; Peritoneal mesometrial resection; Robotic surgery