Prospective Randomized Trial Comparing Transperitoneal Versus Extraperitoneal Laparoscopic Aortic Lymphadenectomy for Surgical Staging of Endometrial and Ovarian Cancer: The STELLA Trial.
There is an ongoing debate on which approach, transperitoneal or extraperitoneal, is superior for the performance of laparoscopic aortic lymphadenectomy (LPA-LND) for the surgical staging of gynecologic cancer. A prospective randomized trial (STELLA trial) was designed to compare the perioperative outcomes and node retrieval of extraperitoneal versus transperitoneal aortic lymphadenectomy by laparoscopy or robot-assisted laparoscopy.



Patients with endometrial or ovarian carcinoma requiring aortic lymphadenectomy for surgical staging were randomized to an extraperitoneal or transperitoneal approach by laparoscopy or robot-assisted laparoscopy between June 2012 and July 2014.



A total of 60 patients were entered into the study, 48 with endometrial cancer (80 %) and 12 with ovarian cancer (20 %). Thirty-one patients (51.6 %) were randomly assigned to the extraperitoneal group and 29 to the transperitoneal group (48.3 %). The means LPA-LND operating time was 90 min in both group (p = 0.343). The mean (range) blood loss was 105 (10-400) mL for extraperitoneal versus 100 (5-1000) mL for transperitoneal group (p = 0.541). There were no differences in the number of collected lymph nodes between the two groups [median (range) for extraperitoneal 12 (4-41) vs. 13 (4-29) for transperitoneal (p = 0.719)].



The extraperitoneal and transperitoneal approaches for laparoscopic and robotic aortic lymphadenectomy provide similar perioperative outcomes and nodal yields.



The STELLA trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT01810874.
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. bdiaz@vhebron.net.
Berta
B
Díaz-Feijoo
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Alejandro
A
Correa-Paris
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Assumpció
A
Pérez-Benavente
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Silvia
S
Franco-Camps
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
José Luis
JL
Sánchez-Iglesias
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Silvia
S
Cabrera
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Javier
J
de la Torre
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Cristina
C
Centeno
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Oriol Puig
OP
Puig
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Blanca
B
Gil-Ibañez
Pathological Oncology Group and Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain.
Eva
E
Colas
Department of Gynecology, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
Javier
J
Magrina
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Antonio
A
Gil-Moreno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures