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Comparison of surgical and pathological parameters after laparoscopic transperitoneal pelvic/para-aortic lymphadenectomies
  1. Anna Jacob1,
  2. Andrea Plaikner1,
  3. Achim Schneider2,
  4. Giovanni Favero3,
  5. Roberto Tozzi4,
  6. Peter Mallmann5,
  7. Christian Domröse5,
  8. Peter Martus6,
  9. Simone Marnitz7,
  10. Jana Barinoff8 and
  11. Christhardt Kohler1,9
  1. 1Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany
  2. 2Center for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Berlin, Germany
  3. 3Gynecology and Obstetrics, Asklepios Klinik Lich GmbH, Lich, Hessen, Germany
  4. 4Department of Gynaecologic Oncology, Oxford University, Oxford, Oxfordshire, UK
  5. 5Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Nordrhein-Westfalen, Germany
  6. 6Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Baden-Württemberg, Germany
  7. 7Department of Radiooncology, Medical Faculty of the University of Cologne, Cologne, Nordrhein-Westfalen, Germany
  8. 8Department of Gynecology and Obstetrics, Sankt Gertrauden Krankenhaus GmbH, Berlin, Berlin, Germany
  9. 9Department of Gynecology, University of Cologne, Koln, Germany
  1. Correspondence to Anna Jacob, Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, 22763 Hamburg, Hamburg, Germany; an.jacob{at}asklepios.com

Abstract

Objective Lymphadenectomy is an integral part of surgical staging and treatment for patients with gynecologic malignancies. Since its introduction, laparoscopic lymphadenectomy has proved feasible, safe, and oncologically adequate compared with open surgery while morbidity is lower and hospital stay considerably shorter. The aim of this study was to examine if surgical outcomes may be improved after the initial learning curve is complete.

Methods An analysis of 2535 laparoscopic pelvic and/or para-aortic lymphadenectomies was performed between July 1994 and March 2018 by one team of gynecologic oncology surgeons but with the consistent supervision of a consultant surgeon. Data were collected prospectively evaluating operative time, intra-operative and post-operative complications, number of lymph nodes, and body mass index (BMI). Previously published data of 650 patients treated after introduction of the method (period 1, 1994–2003) were compared with the latter 524 patients (period 2, 2014–2018).

Results The median age of the 2535 patients was 43 years (IQR 34–57). The most common indication for pelvic and/or para-aortic lymphadenectomy was cervical cancer (n=1893). Operative time for para-aortic lymph node dissection was shorter in period 2 (68 vs 100 min, p<0.001). The number of harvested lymph nodes was increased for pelvic (19.2 (range 2–52) vs 21.9 (range 4–87)) and para-aortic lymphadenectomy (10.8 (range 1–52) vs 14.4 (range 4–64)), p<0.001. BMI did not have a significant influence on node count or operative time, with BMI ranging from 14.6 to 54.1 kg/m2. In contrast to period 1 (n=18, 2.9%), there were no intra-operative complications in period 2 (n=0, 0.0%, p<0.001) whereas post-operative complications were similar (n=35 (5.8%) in period 1; n=38 (7.6%) in period 2; p=0.32).

Conclusion In this large cohort of patients who underwent laparoscopic transperitoneal lymphadenectomy, lymph node count and peri-operative complications improved after the initial learning curve.

  • cervical cancer
  • gynecologic surgical procedures
  • SLN and lympadenectomy
  • surgical oncology
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Footnotes

  • AJ and AP are joint first authors.

  • Contributors All authors contributed substantially to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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