Comparison Between Laparoscopy and Laparotomy in Systematic Para-Aortic Lymphadenectomy for Patients with Endometrial Cancer: A Retrospective Multicenter Study.

Tomohito Tanaka,Noriomi Matsumura,Masahide Ohmichi,Tsukasa Baba,Michiyasu Miki,Daisuke Aoki,Yoshito Terai,Shigenori Hayashi,Eiji Kobayashi,Tadashi Kimura

doi:10.1089/gyn.2016.0101

Abstract

Objective: Laparoscopic surgery has been developed worldwide due to its minimal invasion as well as noninferiority, compared with laparotomy. However, whether or not laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer is feasible and has advantages of various clinical factors, such as a short hospital stay, less blood loss, and faster recovery, compared with open surgery has not yet been clarified. The aim of this study was to compare a laparoscopic procedure with laparotomy for para-aortic lymphadenectomy for patients with endometrial cancer.Study Design: This was a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer in five institutions.Materials and Methods: The current authors conducted a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer. The study involved patients from five institutions in Japan between January 2008 and March 2016. Clinical data were compared with those of a laparotomic procedure performed around the same period.Results: A total of 54 patients in the laparoscopic group and 99 patients in the laparotomic group were analyzed. In the laparoscopic group, 21 patients had stage IA disease, 19 had stage IB disease, 5 had stage II disease, and 9 had stage III disease. In the laparotomic group, 35 patients had stage IA disease, 19 had stage IB disease, 9 had stage II disease, and 36 had stage III disease. There were no significant differences in characteristics between the groups, including age, body mass index, and histologic type. The mean operative time in the laparoscopic group was 483 ± 102 minutes, while that in the laparotomic group was 481 ± 106 minutes (p = 0.9). The laparoscopic group had less intraoperative blood loss (143 ± 253 versus 988 ± 694 mL; p < 0.01) and shorter hospital stays (8.4 ± 5.7 versus 16.1 ± 8.0 days; p < 0.01). The rates of intraoperative complications were not significantly different between the groups. No cases of ileus occurred in the laparoscopic group. Procedures for 2 of the 54 patients in the laparoscopic group were converted to laparotomy. The number of dissected pelvic lymph nodes (31.8 ± 10.1 versus 39.9 ± 15.9, p < 0.01) and para-aortic lymph nodes (26.2 ± 10.9 versus 31.1 ± 13.2; p = 0.02) were lower in the laparoscopic group than in the laparotomic group. The postoperative minimum level of hemoglobin was higher in the laparoscopic group than in the laparotomic group (10.4 ± 1.1 g/dL versus 9.9 ± 1.4 g/dL; p = 0.02). In contrast, the postoperative maximum level of C-reactive protein was lower in the laparoscopic group than in the laparotomic group (6.3 ± 3.8 mg/dL versus 10.2 ± 4.9 mg/dL; p < 0.01). The recurrence rate was not significantly different between the groups in the above time period (7.4% versus 14.3%; p = 0.2).Conclusions: Laparoscopic systematic para-aortic lymphadenectomy is feasible and can be substituted for laparotomic procedures for patients with early stage endometrial cancer. ( J GYNECOL SURG 33:105)

Highlights

Para-aortic lymphadenectomy is a major surgical procedure for patients with gynecologic cancer
Todo et al reported that systematic lymphadenectomy, including para-aortic lymphadenectomy, has therapeutic significance for patients at intermediate/high risk of recurrence, such as those with deeply invasive lesions, high-grade histology, and tumors of serous carcinoma, clear cell carcinoma, or carcinosarcoma features of endometrial cancer.[11]
According to the National Comprehensive Cancer Network, para-aortic nodal evaluation from the inframesenteric and infrarenal regions may be utilized for staging of selected high-risk tumors—such as deeply invasive lesions; those with high-grade histology; and tumors with serous carcinoma, clear cell carcinoma, or carcinosarcoma features—in patients undergoing primary surgical management of endometrioid uterine cancer.[12]

Summary

Introduction

Para-aortic lymphadenectomy is a major surgical procedure for patients with gynecologic cancer This technique has improved the prognosis[1,2,3,4,5,6] and facilitated correct staging[7,8,9] among patients with endometrial cancer. According to the National Comprehensive Cancer Network, para-aortic nodal evaluation from the inframesenteric and infrarenal regions may be utilized for staging of selected high-risk tumors—such as deeply invasive lesions; those with high-grade histology; and tumors with serous carcinoma, clear cell carcinoma, or carcinosarcoma features—in patients undergoing primary surgical management of endometrioid uterine cancer.[12] para-aortic lymphadenectomy is conventionally performed via laparotomy with a large skin incision, and the incidence of postoperative ileus is 12.9%–50% among patients receiving para-aortic lymphadenectomy.[13,14]

Results

Discussion

Conclusion