title: [A propensity score evaluation of single-port or multiport extraperitoneal para-aortic lymphadenectomy and the transperitoneal approach for gynecological cancers].
abstract: BACKGROUND
  Endoscopic para-aortic lymphadenectomy (PALN) is a crucial step in the management of gynecological cancers. However, some concerns exist on the completeness of PALN according to the route (transperitoneal vs. extraperitoneal single-port or multiport). We compared these three surgical techniques using a propensity score.
  
  
  METHODS
  We retrospectively reviewed all patients undergoing an endoscopic PALN for a gynecological cancer from May 2010 to Mars 2015. Fifty-one patients had a single-port extraperitoneal PALN, 16 a multiport extraperitoneal PALN and 62 a transperitoneal PALN. Factors independently related to technique performances were tested on a multivariate model adjusted for a propensity score.
  
  
  RESULTS
  The number of lymph nodes removed by transperitoneal route was 15 and extraperitoneal route single and multiport was 12. After adjustment for the propensity score of undergoing the extraperitoneal approach, no difference in the number of lymph node removed was noted (P=0.17). There was more lymphocyst after transperitoneal (17%) and multiport extraperitoneal PALN (19%) than after extraperitoneal PALN (2%) (P=0.04). Success rate of single-port extraperitoneal PALN was 94% (n=48). Four patients required a conversion to an open route due to vascular injury.
  
  
  CONCLUSIONS
  Using a propensity score, single-port extraperitoneal route offers similar efficacy to perform PALN than transperitoneal or multiport extraperitoneal route but with less lymphocysts.
authors.affiliation: Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France. Electronic address: iptissem.naoura@aphp.fr.
authors.forename: Iptissem
authors.initials: I
authors.lastname: Naoura
authors.affiliation: Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France.
authors.forename: Enora
authors.initials: E
authors.lastname: Laas
authors.affiliation: Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Beytout
authors.affiliation: Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Bendifallah
authors.affiliation: Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France; Inserm UMRS-938, 75011 Paris, France.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.affiliation: Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France; Inserm UMRS-938, 75011 Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008210:Lymphocele / Q000209:etiology; D008875:Middle Aged; D010537:Peritoneum; D057216:Propensity Score; D012187:Retroperitoneal Space; D012189:Retrospective Studies
keywords: Cancer gynécologique; Gynecological cancer; Lymphadenectomie; Monotrocart; Multiport extraperitoneal lymphadenectomy; Propensity score; Rétropéritonéal; Score de propension; Single-port extraperitoneal lymphadenectomy; Transperitoneal lymphadenectomy; Transpéritonéal