Clinical outcomes of hysterectomies for benign and malignant etiologies using the NSQIP database

Abstract

Objectives: To report on the safety, feasibility, and surgicopathologic outcomes of a laparoscopic retroperitoneal approach for aortic (inframesenteric [IM] and infrarenal [IR]) lymphadenectomy in earlystage gynecologic cancers. Methods: We conducted a chart review of 76 patients who underwent comprehensive laparoscopic retroperitoneal lymphadenectomy from the ureter up to the inferior mesenteric artery (IM) and then up to the renal veins (IR). All also underwent pelvic lymphadenectomy from the deep circumflex ileac vein crossing over the external ileac artery to the ureter crossing the common ileac artery (pelvic): 4 by retroperitoneal approach and 72 by transperitoneal approach. Fifty-one patients had clinical stage I or II endometrial carcinoma; 21 had clinically early peritoneal, tubal, or ovarian carcinoma; and 4 had early cervical carcinoma. Results: The mean age was 57 years (range, 31–77 years), and mean body mass index (BMI) was 26 (range, 19–39). Mean duration of entire surgery, including hysterectomy, was 238 min (range, 146– 406 min). Mean estimated blood loss for each entire procedure was 210 mL (range, 25–1500 mL), requiring a mean of 0 transfusions (range, 0–3). Mean hospital stay was 1 day (range, 1–5 days). The mean node yields were: pelvic 14 (range, 1–36), IM 13 (range, 3– 31), IR 14 (range, 1–36), and total from all basins 49 (range, 20–90). Nodal metastases were found in 22% of pelvic, 21% of IM, and 17% of IR node basins. Overall, 31% of patients had positive nodes that affected their postoperative therapeutic decisions. Complications included two conversions to laparotomy for high blood loss and failure to complete and one transection of the left renal artery with saphenous vein interposition by laparotomy. The retroperitoneal approach showed no learning curve, and nodal yields remained high, even in patients with BMIs up to 39. Conclusions: Comprehensive laparoscopic pelvic and retroperitoneal IM and IR aortic lymphadenectomy for early gynecologic carcinoma is safe and readily feasible and may affect staging and treatment decisions in one third of patients. A retroperitoneal approach may be easier to learn and be more effective for larger patients.