1. Comparison Between Transperitoneal and Extraperitoneal Laparoscopic Paraaortic Lymphadenectomy in Gynecologic Malignancies
- Author
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Valentine Ronzino, Jean Jacques Baldauf, Cherif Akladios, Karolina Afors, Arnaud Wattiez, Stéphanie Schrot-Sanyan, and Rodrigo Fernandes
- Subjects
Adult ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Genital Neoplasms, Female ,medicine.medical_treatment ,Body Mass Index ,Hospitals, University ,Paraaortic lymphadenectomy ,Laparotomy ,Statistical significance ,medicine ,Humans ,Aorta, Abdominal ,Postoperative Period ,Peritoneal Cavity ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,humanities ,Surgery ,Exact test ,Gynecologic malignancy ,Treatment Outcome ,Lymph Node Excision ,Female ,Laparoscopy ,Lymphadenectomy ,France ,Lymph Nodes ,business - Abstract
Study Objective Two validated laparoscopic approaches for para-aortic lymphadenectomy (PAL) exist: the transperitoneal and the extraperitoneal. The aim of this study was to compare the surgical outcomes of both approaches. Design A retrospective review of all patients who underwent laparoscopic PAL for a gynecologic malignancy between January 2008 and October 2013. Setting University Hospital. Patients Two patients groups were compared: transperitoneal (n = 51) and extraperitoneal (n = 21). Interventions Paraaortic lymphadenectomy. Measurements and Main Results The χ 2 test, Fisher's exact test, or Student's t -test were used for univariate analysis and a stepwise logistic regression for multivariate analysis. The threshold of statistical significance was set at 0.05. All patient characteristics were similar between the 2 groups (p > .05 for all variables). There was only 1 (1.3%) conversion to laparotomy encountered in the transperitoneal PAL group and 3 conversions from extraperitoneal to transperitoneal PAL (14.2%). In 1 case of extraperitoneal PAL, the procedure was abandoned because of inadequate equipment (body mass index 48 kg/m 2 ). The mean duration of surgery was longer in the transperitoneal group: 200 min (35–360) versus 125.6 min (45–180) in the extraperitoneal group (p = .001). The mean number of harvested lymph nodes was higher in the transperitoneal group: 17 (4–37) versus 13 (3–25) in the extraperitoneal group (p = .029). There was no difference in postoperative course and complications between both groups in multivariate analysis. Conclusions In nonobese patients, the extraperitoneal PAL is associated with shorter surgical duration, whereas the transperitoneal approach was associated with a higher number of harvested lymph nodes. As a result of improved ergonomy, the transperitoneal approach enables laparoscopic management of operative complications.
- Published
- 2015