title: Extraperitoneal Robotic-Assisted Para-Aortic Lymphadenectomy in Gynecologic Cancer Staging: Current Evidence.
abstract: We reviewed the current evidence on the safety, effectiveness, and applicability of extraperitoneal robotic-assisted para-aortic lymphadenectomy (ExtRA-PAL) as the staging procedure of gynecologic malignancies. PubMed (MEDLINE), Scopus, Web of Science databases, and ClinicalTrials.gov were searched for original studies reporting outcomes of ExtRA-PAL. Quality of the included studies and their level of recommendation were assessed using the Grading of Recommendations, Assessment, Development, and Evaluation and the American College of Obstetricians and Gynecologists guidelines, respectively. Overall, 62 studies were identified; after a process of evidence acquisition 5 original investigations were available for this review that included 98 patients undergoing ExtRA-PAL. The main surgical indication was staging for cervical cancer (n = 71, 72%). The mean (SD) number of para-aortic node yielded was 15.4 (±4.7) nodes. Blood transfusion and intraoperative complication rates were 2% and 6%, respectively. ExtRA-PAL was completed in 88 patients (90%). Six (6%) and 4 (4%) patients had conversion to other minimally invasive procedures and open surgery, respectively. Success rate was 99% among patients undergoing ExtRA-PAL without concomitant procedures. Overall, mean (SD) length of hospital stay was 2.8 (±0.5) days. Twenty-four patients (24%) developed postoperative events. According to the Clavien-Dindo grading system, grades IIIa and IIIb morbidity rates were 12% and 2%, respectively. No grades IV and V morbidity occurred. ExtRA-PAL is associated with a high success rate and a relative low morbidity rate. However, because of the limited data on this issue, further studies are warranted to assess the long-term effectiveness of this procedure.
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy. Electronic address: gorgio.bogani@istitutotumori.mi.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Sabatucci
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Cono
authors.initials: C
authors.lastname: Scaffa
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000368:Aged; D001803:Blood Transfusion; 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 / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D010298:Parity; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Extraperitoneal; Para-aortic lymphadenectomy; Retroperitoneal; Robotic