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1099 Is it worth and feasible to apply nerve sparing principles to laparoscopic para-aortic lymphadenectomy?
  1. Andrea Rosati1,
  2. Giacomo Guidi1,
  3. Alice Zampolini1,
  4. Antonella De Palma1,
  5. Carmine Conte1,
  6. Valentina Ghirardi1,
  7. Virginia Vargiu1,
  8. Serena Cappuccio2,
  9. Claudia Marchetti3,
  10. Giovanni Scambia4 and
  11. Anna Fagotti3
  1. 1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
  3. 3Dipartimento Scienze della Salute della Donna, del Bambino e di Sanita` Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
  4. 4Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy


Introduction/Background Para-aortic lymphadenectomy is a component in the surgical staging of early-stage ovarian carcinoma. Its crucial role for staging and prognostic purposes is intensified by the potential access to maintenance therapies, especially in the presence of positive lymph nodes, in the era of Parp inhibitors. From a ‘modern’ standpoint, the surgical aggressiveness should be meticulously gauged considering the impact on the quality of life for our patients. Findings from the LION-PAW study indicate that complete lymphadenectomy affects pelvic neurovegetative function, particularly impairing sexual function.

Methodology We present a cadaveric dissection model showing the complex interaction between nerves and lymphatics in the aorto-caval region. We present the case of a 51-year-old woman who underwent bilateral hysterectomy and salpingoophorectomy and sentinel lymph node dissection for Stage II G2 endometrioid endometrial carcinoma (MMRd). Due to the incidental finding at final pathology of a G3 endometrioid synchronous ovarian carcinoma (MMRp) infiltrating the capsule of the right ovary, the patient was a candidate for complete surgical peritoneal and lymph node staging.

Results Staging procedures were successfully completed via a minimally invasive approach with systematic pelvic and para-aortic nerve sparing lymphadenectomy and infra-colic omentectomy. Surgery lasted 2 hours and 40 minutes with an estimated blood loss of less than 50cc. No intraoperative or postoperative complications occurred and the patient was discharged on postoperative day three.

Conclusion Laparoscopic nerve-sparing para-aortic lymphadenectomy is technically feasible. An in-depth understanding of the complex anatomical interaction between nerves and lymphatic vessels in the aortic region is required. The neurofunctional impact of the procedure needs to be further explored.

Disclosures None.

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