Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis.

Kun-Peng Li,Xian-Zhong Deng,Tao Wu

doi:10.3389/fsurg.2021.779372

Kun-Peng Li, Xian-Zhong Deng + Show 1 more

Open Access

https://doi.org/10.3389/fsurg.2021.779372

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Abstract

Purpose: The optimal surgical approach for para-aortic lymphadenectomy (PALND) in gynecologic cancers using minimally invasive surgery (laparoscopy or robotic-assisted) is controversial. This study summarizes the current evidence on the extraperitoneal (EP) approach and compares its perioperative, surgical outcomes, and complications to the transperitoneal (TP) approach in an updated meta-analysis.Methods: We performed a systematic search in PubMed, Embase, Web of Science, Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs that compare EP to TP for PALND. The main outcomes included surgical, perioperative outcomes, and complications. The weighted mean difference (WMD) and odds ratio (OR) were applied for the comparison of continuous and dichotomous variables with 95% CIs. Three RCTs and 10 non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis.Results: A total of three RCTs and ten non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. We reported similar results for EP and TP in terms of the hospital stay, estimated blood loss, blood transfusion, conversion to laparotomy, total operative time, and postoperative complications (Clavien grade ≥ 1 and Clavien grade ≥ 3). However, the PALND operative time (WMD −10.46 min, 95% CI −19.04, −1.88; p = 0.02) and intraoperative complications (OR 0.40, 95% CI 0.23, 0.69; p = 0.001) were less with EP. Also, more nodes were removed in EP compared with the TP (WMD 1.45, 95% CI 0.05, 2.86; p = 0.04).Conclusions: The EP approach did not show differences regarding surgical and perioperative parameters compared with the TP approach. However, the number of aortic nodes retrieved was higher. Furthermore, The PALND operative time and intraoperative complications were less in EP.

Highlights

Para-aortic lymphadenectomy (PALND) is a routine method for staging or treatment of gynecological malignancies [1]
In the cervical cancers and advanced vaginal cancers, PALND is to guide the fields of radiation and for the therapeutic benefits [1, 2]
Some recent studies reported that minimally invasive salvage lymphadenectomy is an effective therapeutic approach for the recurrent patients with gynecological cancer bearing lymph-node recurrence

Summary

Introduction

Para-aortic lymphadenectomy (PALND) is a routine method for staging or treatment of gynecological malignancies [1]. In endometrial and adnexal cancer, PALND is performed for therapeutic purposes [3]. PALND is useful for tailoring the optimally therapeutic purposes of patients according to their stage, providing adjuvant treatment for patients with infiltrated lymph nodes, and eliminating recurrence risk [4]. Some recent studies reported that minimally invasive salvage lymphadenectomy is an effective therapeutic approach for the recurrent patients with gynecological cancer bearing lymph-node recurrence. Prodromidou et al compared the outcomes of the EP and TP in 608 patients who underwent laparoscopic lymphadenectomy and conducted a meta-analysis that demonstrated clinically equivalent results between EP and TP [12]. There is no meta-analysis comparing the overall complications, major complications, and conversion to laparotomy between EP and TP. More studies comparing EP with TP should be added to the scientific literature including RCTs and robotic assisted

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