Introduction/Background Para-aortic lymphadenectomy is performed for disease staging to tailor the optimal treatment in a plethora of gynecological malignancies such as in advanced cervical, ovarian and high-risk endometrial cancer. With the advances in minimally invasive procedures, laparoscopic lymphadenectomy approaches have become the gold standard. The present study aimed to evaluate the impact of laparoscopic transperitoneal (TLL) and extraperitoneal (ELL) lymphadenectomy in patients with gynecological malignancies.
Methodology The Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases were searched for articles published up to April 2019. Prospective and retrospective trials reporting outcomes for women with gynecological malignancies who underwent laparoscopic extraperitoneal or transperitoneal lymphadenectomy were enrolled. Statistical meta-analysis was performed using the RevMan 5.3 software.
Results Of the 137 records screened, 7 were eligible for meta-analysis. A total of 608 women (329 TLL and 279 ELL) were included in the meta-analysis. Despite the fact that a significantly prolonged lymphadenectomy time was observed in TLL when compared to ELL (284 patients MD 35.18 min 95% CI 5.59 to 64.76 p=0.02) total operative time was not different among the two groups (407 patients MD -10.43 min 95% CI −20.55 to 41.42 p=0.51). No difference was observed with regards to postoperative complications, hospital stay and mean number of resected lymph nodes.
Conclusion ELL is a safe and feasible. It presents with favorable outcomes in terms of shorter lymphadenectomy times and improved intraoperative outcomes as well as comparable to TLL lymph node yield. Further larger-volume studies are warranted to define the optimal approach in patients with gynecological malignancies.
Disclosure Nothing to disclose.
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