NATIONAL HARBOR, MD. – Extraperitoneal para-aortic lymphadenectomy can result in more harvested nodes than standard laparoscopic or robot-assisted laparoscopic staging of patients with endometrial cancer, according to Dr. Janelle Pakish.
Harvesting the nodes does take longer this way – about 50 minutes longer than a standard laparoscopic staging and 40 minutes longer than a robotic-assisted one. But a retrospective study of 194 cases found that it secured twice as many para-aortic nodes, with half the conversion rate to open surgery as with laparoscopic staging, Dr. Pakish said at a meeting sponsored by the AAGL.
"It is safe and feasible, and especially effective for obese patients," in whom the technique yielded the largest node retrieval, said Dr. Pakish, a gynecologic oncologist at Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
The study included data on patients who underwent extra- or transperitoneal laparoscopic lymphadenectomy for endometrial cancer staging at M.D. Anderson Cancer Center in Houston, from 2007 to 2012. The cohort was divided into three groups: those who had extraperitoneal para-aortic sampling followed by robot-assisted total laparoscopic lymphadenectomy (extraperitoneal group, 34); those who had a transperitoneal para-aortic lymphadenectomy followed by robot-assisted total laparoscopic hysterectomy (transperitoneal robotic group, 52); and those who had transperitoneal laparoscopic lymphadenectomy followed by a total laparoscopic hysterectomy (transperitoneal laparoscopic group, 108).
Significantly more para-aortic nodes were harvested in the extraperitoneal group than in the transperitoneal laparoscopic or the transperitoneal robotic groups (median of 10 vs. 5 and 4.5, respectively). The number of pelvic nodes was not significantly different between the three groups (median of 14, 13, and 13.5, respectively).
The extraperitoneal method was particularly effective in patients with a body mass index of 35 kg/m2 or more, harvesting a median of four more nodes than transperitoneal laparoscopy and seven more than transperitoneal robot-assisted laparoscopy.
The method was more time consuming, however, Dr. Pakish said. The median operative time for extraperitoneal lymphadenectomy was 339 minutes, compared with 286 minutes for the transperitoneal laparoscopy group and 297 for the transperitoneal robotic group.
There were three conversions to transperitoneal laparoscopy and three to laparoscopy in the extraperitoneal group (8.8%). In the transperitoneal laparoscopy group, there were 17 conversions to laparotomy (15.7%). The transperitoneal robotic group had the lowest conversion rate (two patients, 3.8%).
Dr. Pakish said she had no relevant financial disclosures.