Introduction/Background Laterally Extended Endopelvic Resection (LEER) has been identified as a valid therapeutic option for women with gynecological malignancies involving the pelvic side wall. The historical approach to LEER is laparotomic, recently we have proposed the so called Laparoscopically Modified Laterally Extended Endopelvic Resection (LM-LEER).The objective of this study is to compare surgical and oncological outcomes between LEER and LM-LEER in a consecutive series of patients with gynecological malignancies infiltrating the pelvic side wall.
Methodology We retrospectively evaluated women submitted to LEER between October 2012 and January 2019. Inclusion criteria for LM-LEER were tumor size <10 cm and Body Mass Index <35. Peri-operative data were analyzed and compared. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan- Meier method.
Results Of the included 39 patients, 18 were submitted to LM-LEER and 21 to LEER. Median operative time (425 vs 600 min, p<0.01) and median blood loss (285 vs 865 ml, p<0.01) were shorter in the laparoscopic group. Complete tumor resection was achieved in all the patients submitted to LM-LEER and in 90.4% of those submitted to LEER. No laparotomic conversions were observed during LM-LEER. Intra and post-operative complication rate was similar. Median length of hospital stays (10 vs 17 days, p<0.01), as well as median time to initiation of adjuvant therapies (38 days vs 54, p: 0.20) was shorter in the laparoscopic group. After a median follow-up of 19 months no differences in terms of RFS (p: 0.95) and OS (p: 0.72) were observed in the two groups.
Conclusion After strict selection, a group of patients with gynecological tumors infiltrating the pelvic side wall may undergo LM-LEER with extremely high rates of complete tumor resection, satisfactory perioperative morbidity, a short interval to adjuvant therapies and encouraging survival outcomes.
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