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The Safety and Feasibility of Robotic-Assisted Lymph Node Staging in Early-Stage Ovarian Cancer
  1. John V. Brown, MD*,
  2. Alberto A. Mendivil, MD*,
  3. Lisa N. Abaid, MD, MPH*,
  4. Mark A. Rettenmaier, MD*,
  5. John P. Micha, MD*,
  6. Marie A. Wabe, MBA and
  7. Bram H. Goldstein, PhD*
  1. *Gynecologic Oncology Associates, Hoag Memorial Hospital Cancer Center; and
  2. The Nancy Yeary Women’s Cancer Research Foundation, Newport Beach, CA.
  1. Address correspondence and reprint requests to Bram Goldstein, PhD, Gynecologic Oncology Associates, 351 Hospital Rd, Suite 507, Newport Beach, CA 92663. E-mail: bram{at}gynoncology.com.

Abstract

Objectives The purpose of this study was to report on the safety and feasibility of robotic-assisted systematic lymph node staging in the management of early-stage ovarian cancer.

Methods We retrospectively reviewed the charts of presumed early-stage (International Federation of Gynecology and Obstetrics (FIGO) stages I and II) ovarian cancer patients who underwent robotic-assisted surgery that incorporated a systematic pelvic and para-aortic lymphadenectomy from January 2009 until December 2013. Patient demographics, operative characteristics, pathology, lymph node counts, surgical complications, and hospital stay were evaluated.

Results A total of 26 early-stage ovarian cancer patients were identified. The mean operating time was 2.90 hours, and the estimated blood loss was 63 mL; there were no intraoperative complications although 1 patient’s surgery was significantly prolonged due to pelvic adhesions. The mean number of pelvic and para-aortic lymph nodes removed was 14.6 (2.3% incidence of pelvic lymph node metastases) and 5.8 (3.3% incidence of para-aortic lymph node metastases), respectively. The patients’ mean duration of hospital stay was 18.4 hours, and 2 patients were readmitted for either a postoperative wound infection or vaginal dehiscence.

Conclusions The results from this study suggest that robotic-assisted surgical staging in the management of presumed early-stage ovarian cancer is both feasible and associated with a minimal patient complication rate. We encountered a low incidence of lymph node metastases, and the readmission rate was favorable. Nevertheless, because the prevalence of lymph node metastases can approach 20% in select patients, physicians should consider a systematic lymph node resection to confer an optimal clinical assessment.

  • Epithelial ovarian cancer
  • Staging procedure
  • Lymphadenectomy
  • Robotic surgery

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Footnotes

  • Supported by the Nancy Yeary Women’s Cancer Research Foundation.

  • The authors declare no conflicts of interest.

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