{"paper_id":"40c11e3a-2aab-41d0-854d-3740e1d6bd8f","body_text":"Clinical Investigation / Araştırma\n13\nCopyright© 2025 The Author. Published by Galenos Publishing House on behalf of Turkish Society of Obstetrics and Gynecology.\nThis is an open access article under the Creative Commons AttributionNonCommercial 4.0 International (CC BY-NC 4.0) License.\nTurk J Obstet Gynecol 2025;22:13-8\nDOI: 10.4274/tjod.galenos.2025.32654\nCorresponding Author/Sorumlu Yazar: Assoc. Prof. Selçuk Erkılınç, MD,\nİzmir Democracy University Faculty of Medicine, Buca Seyfi Demirsoy Training and Research Hospital, Department of Gynecologic Oncology, İzmir, Türkiye \nE-mail: selcukerkilinc@hotmail.com ORCID ID: orcid.org/0000-0002-6512-9070\nReceived/Geliş Tarihi: 20.01.2025 Accepted/Kabul Tarihi: 23.02.2025 Epub: 28.02.2025Publication Date/Yayınlanma Tarihi: 10.03.2025\nCite this article as: Erkılınç S, İşcan SC, Özcan S, Öztürk B, Atlıhan U, Ata C, et al. Impact of sympathetic denervation via paraaortic lymphadenectomy on blood pressure in endometrial cancer \npatients. Turk J Obstet Gynecol. 2025;22:13-8\nPRECIS: We evaluated the impact of para-aortic lymphadenectomy on blood pressure levels in endometrial cancer patients, demonstrating \nsignificant reductions linked to sympathetic nerve disruption.\nParaaortik lenfadenektomi ile sempatik denervasyonun kan \nbasıncı üzerine etkisi\n1İzmir Democracy University Faculty of Medicine, Buca Seyfi Demirsoy Training and Research Hospital, Department of Gynecologic Oncology, İzmir, Türkiye\n2Isparta City Hospital, Clinic of Obstetrics and Gynecology, Isparta, Türkiye\n3Sarıgöl State Hospital, Clinic of Obstetrics and Gynecology, Manisa, Türkiye\n4Muş State Hospital, Clinic of Obstetrics and Gynecology, Muş, Türkiye\n5Manisa Merkezefendi State Hospital, Clinic of Obstetrics and Gynecology, Manisa, Türkiye\n6İzmir Tınaztepe University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Türkiye\n Selçuk Erkılınç1,  Serhan Can İşcan2,  Sena Özcan3,  Betül Öztürk4,  Ufuk Atlıhan5,  Can Ata1, \n Hüseyin Aytuğ Avşar6,  Tevfik Berk Bildacı1,  İlker Çakır1\nAbstract\nObjective: To evaluate the effect of para-aortic lymphadenectomy on blood pressure changes in endometrial cancer patients.\nMaterials and Methods: This retrospective study included patients with endometrial cancer treated surgically between 2017 and 2023. Patients undergoing \npara-aortic lymphadenectomy, up to the renal artery, in a non-nerve-sparing fashion, were compared with those undergoing pelvic lymphadenectomy or \nsentinel lymph node mapping. Data collected included age, body mass index, comorbidities including hypertension, diabetes mellitus, coronary artery \ndisease, operative time, number of lymph nodes removed, tumor size, and postoperative complications. Preoperative blood pressure was recorded during \noutpatient visits, and postoperative measurements were collected daily during hospitalization and at follow-up visits. Statistical analyses assessed differences \nin systolic and diastolic blood pressure changes, operative outcomes, and complications.\nResults: A total of 264 patients were analyzed. Patients in the para-aortic group had significantly longer operative times. Tumor size was larger in the para-\naortic group than in another group. Systolic blood pressure decreased significantly in the para-aortic group compared to the control group (para-aortic: \n-17 mmHg vs. non-para-aortic: -1.10 mmHg, p<0.05), with a similar trend for diastolic pressure (-8.00 mmHg vs. -0.80 mmHg, p<0.05). Chylous ascites \n(15.6% vs. 5.6%) and ileus (0% vs. 12%) were more common in the para-aortic group, along with the administration of radiotherapy and chemotherapy. \nBoth systolic and diastolic blood pressures were significantly lower in paraaortic group, in both early and late postoperative follow-up measures (p<0.005).\nConclusion: Aortic lymphadenectomy is associated with decreased blood pressure and may have therapeutic potential for hypertensive patients, highlighting \nthe need for prospective randomized studies to explore this effect further.\nKeywords: Cancer of endometrium, hypertension, lymph node excison\nÖz\nAmaç: Bu çalışmanın amacı sinir koruyucu olmayan paraaortik lenfadenektominin paraaortik ve renal bölgedeki sempatik sinir liflerini etkileyerek kan \nbasıncı üzerindeki değişimlerini değerlendirmektir.\nImpact of sympathetic denervation via paraaortic \nlymphadenectomy on blood pressure in endometrial \ncancer patients\n\n14\nTurk J Obstet Gynecol 2025;22:13-8 Erkılınç et al. Paraaortic lymphadenectomy and hypertension\nIntroduction\nHypertension is a common condition in the general population \nand a significant cause of morbidity, particularly among older \nadults(1). In patients with endometrial cancer, hypertension \nis a frequently associated comorbidity, observed both in the \npresence and absence of obesity (2). While obesity is a well-\nknown risk factor for hypertension, the coexistence of metabolic \nsyndrome further increases the prevalence of both hypertension \nand endometrial cancer(2). This suggests that metabolic factors \nmay create a common underlying pathway between these two \nconditions.\nHypertension is a major comorbidity among patients with \nendometrial cancer, with approximately 40% of these patients \nrequiring antihypertensive medication (3,4). The most common \ntype of hypertension is essential hypertension and underlying \nfactors include genetic factors, age, lifestyle factors and \nstress(5). Initial treatment strategies typically involve dietary \nmodifications and antihypertensive medications (5). Numerous \nstudies have demonstrated the involvement of the adrenergic \nsystem in blood pressure regulation. Blocking this system \nis a fundamental mechanism underlying antihypertensive \ntherapy(6). However, sympathetic fibers located in the paraaortic \nregion, particularly in the perirenal area, have been implicated \nas a potential cause of hypertension by increasing sodium \nuptake, renin secretion, and renal arterial vasoconstriction (7). \nBased on this knowledge, angiographic radiofrequency \nablation has been explored as a treatment option for patients \nunresponsive to antihypertensive therapies (8). Studies have \nreported that this method can lead to an average reduction in \nblood pressure by approximately 20 mmHg. In some cases, \npatients no longer required antihypertensive medications (9). \nThe majority of the studies accumulated after 2020. In patients \nwith endometrial cancer, especially in those at higher risk, \nretroperitoneal lymphadenectomy is a standard component of \nsurgical management when sentinel lymph node mapping is \nnot available. The cranial boundary of the lymphadenectomy \nis typically defined at the level of the renal artery. While nerve-\nsparing approaches exist, periaortic neural structures within the \nlymphatic tissue are often excised or damaged during systematic \nlymphadenectomy.\nThis study is based on the following hypothesis: if blocking \nneural structures in the para-aortic region can lead to a \nreduction in blood pressure, it is plausible that para-aortic \nlymphadenectomy in endometrial cancer patients, may similarly \nresult in decreased postoperative blood pressure levels. Our aim \nwas to evaluate the changes in blood pressure measurements \nbetween the preoperative and postoperative periods in patients \nundergoing para-aortic lymphadenectomy up to the level of the \nrenal arteries.\nMaterials and Methods\nOur study received approval from the Institutional Review Board \n(İzmir Democracy University Buca Seyfi Demirsoy Training \nand Research Hospital, Non-Interventional Research Ethics \nCommittee - no: 2023/211, date: 27.12.2023). The study had \nbeen reviewed by the appropriate ethics committee and had been \nperformed in accordance with the ethical standards described \nin an appropriate version of the 1975 Declaration of Helsinki, \nas revised in 2000. Patients treated for endometrial cancer \nwere identified through the hospital database. The records of \npatients who underwent surgery between 2017 and 2023 were \nreviewed. A total of 289 patients with endometrial cancer were \ninitially included in the study. Seven patients who underwent \nbulky lymph node dissection for cytoreduction in advanced-\nstage endometrial cancer, and ten patients who underwent para-\naortic lymphadenectomy up to the level of the inferior mesenteric \nartery were excluded from the study. Additionally, eight patients \nwith missing postoperative blood pressure monitoring data \nwere excluded. Figure 1 shows the flowchart of the study. Data \ncollected from patient files included age, gravida, parity, history \nof previous surgeries, presence of diabetes, coronary artery \ndisease, body mass index, endometrial biopsy results, findings \nfrom preoperative imaging studies, pelvic lymphadenectomy, and \nparaaortic lymphadenectomy. Additionally, those with conditions \naffecting blood pressure, such as bleeding, hypovolemia, and \narrhythmia were excluded from the study. All persons gave their \ninformed consent prior to their inclusion in the study.\nGereç ve Yöntemler: Bu retrospektif çalışma, 2017-2023 yılları arasında cerrahi tedavi uygulanan endometrium kanseri hastalarını içermektedir. Renal arter \nseviyesine kadar sinir koruyucu olmayan paraaortik lenfadenektomi yapılan hastalar, pelvik lenfadenektomi veya sentinel lenf nodu haritalaması yapılan \nhastalarla karşılaştırılmıştır. Toplanan veriler arasında yaş, vücut kitle indeksi, hipertansiyon, diyabet, koroner arter hastalığı gibi komorbiditeler, operasyon \nsüresi, çıkarılan lenf nodu sayısı, tümör boyutu ve postoperatif komplikasyonlar yer almaktadır. Preoperatif kan basıncı ölçümleri ameliyat öncesi poliklinik \ndeğerlendirmesinde, postoperatif ölçümler ise hastanede yatış süresince ve onkolojik takip sırasında kaydedilmiştir. Kan basıncı değişimleri, operasyon \nsonuçları ve komplikasyonlar arasındaki farklar istatistiksel olarak analiz edilmiştir.\nBulgular: Toplam 264 hasta çalışmaya dahil edilmiştir. Paraaortik grupta operasyon süresi daha uzun ve tümör boyutları daha büyük bulunmuştur. Sistolik \nkan basıncı paraaortik grupta kontrol grubuna kıyasla anlamlı olarak daha fazla düşmüştür (-17 mmHg vs. -1,10 mmHg, p<0,05). Benzer şekilde, diyastolik \nkan basıncı da paraaortik grupta daha fazla düşmüştür (-8,00 mmHg vs. -0,80 mmHg, p<0,05). Şilöz asit (%15,6 vs. %5,6), ileus (%12 vs. %0) ve adjuvan \nradyoterapi/kemoterapi uygulaması paraaortik grupta daha sık gözlenmiştir. Postoperatif erken dönemde ve uzun vadeli takiplerde sistolik ve diyastolik kan \nbasınçlarındaki düşüşler anlamlı şekilde korunmuştur (p<0,005).\nSonuç: Paraaortik lenfadenektomi, sistolik ve diastolik kan basınçlarında anlamlı düşüşlerle ilişkilidir ve hipertansif hastalar için tedavi edici potansiyele \nsahip olabilir.\nAnahtar Kelimeler: Endometriyum kanseri, hipertansiyon, lenf nodu diseksiyonu\n\n15\nTurk J Obstet Gynecol 2025;22:13-8Erkılınç et al. Paraaortic lymphadenectomy and hypertension\nThe study group comprised patients with endometrial cancer \nwho underwent para-aortic lymphadenectomy up to the \nlevel of the renal vein via either laparoscopic transperitoneal, \nextraperitoneal, or laparotomy approaches. Patients who \ndid not undergo lymphadenectomy; and who underwent \npelvic lymphadenectomy, pelvic lymph node sampling, or \nsentinel lymph node mapping were included in the control \ngroup. Preoperative blood pressure measurements were taken \nduring outpatient visits, which typically occurred two weeks \nprior to surgery. Blood pressure measurements were taken \nunder ideal conditions, with patients seated comfortably in a \nquiet environment, their back supported, legs uncrossed, and \narms at heart level. A properly calibrated and validated blood \npressure monitor was used, and measurements were obtained \nafter a 5-minute rest period, avoiding recent physical activity, \ncaffeine, or smoking. Postoperative blood pressure readings \nwere collected daily from the hospital system. On the first \npostoperative day, measurements were taken hourly, while on \nsubsequent days, they were recorded every six hours unless an \nunusual situation arose. The daily postoperative blood pressure \nvalues reported in our analysis was presented as the average of \nall measurements taken throughout each day. Patients’ blood \npressure data were collected throughout their hospitalisation \nand at follow-up outpatient clinic visits.\nStatistical Analysis\nStatistical analyses were conducted using the Statistical Package \nfor Social Sciences (SPSS) version 21.0 (IBM Corp., Armonk, \nNY, USA). The Kolmogorov-Smirnov test was used to assess \nthe normality of the data distribution. Comparisons between \ngroups for normally distributed continuous variables were \nperformed using the independent samples t-test, while the \nMann-Whitney U test was used for variables without normal \ndistribution. Categorical variables were analyzed using the \nchi-square test or Fisher’s exact test, as appropriate. The mean \ndifferences in systolic and diastolic blood pressure changes \nbetween the groups were calculated, and their effect sizes were \nassessed using Cohen’s d. Effect sizes were interpreted as small \n(0.2), medium (0.5), or large (0.8), based on Cohen’s criteria.  \nA p-value of <0.05 was considered statistically significant.\nResults\nThe mean age of the patients was similar between the groups \n(61±12 vs. 62±10 years, p=0.528), and there was no significant \ndifference in terms of gravida, platelet count or CA-125 levels \n(p>0.05).\nThe operation time was longer in paraaortic group (4±1 vs. \n3±1 hours, p<0.001) and a greater number of pelvic lymph \nnodes removed (39±17 vs. 21±20, p<0.001) as well as number \nparaaortic lymph nodes collected (42±24 vs. 0±0, p<0.001). \nTumor size at final pathology was larger in the paraaortic \ngroup (4±2 vs. 3±2, p<0.001), and hospital stays were longer \n(p<0.001).\nSuspicious lymph nodes were more frequent in the paraaortic \ngroup (22.9% vs. 9.7%, p=0.016). Additionally, the paraaortic \ngroup had significantly higher rates of radiotherapy (65.6% \nvs. 31.9%, p<0.001); chemotherapy (36.5% vs. 11.1%, \np<0.001). While overall complications like evisceration were \nnot significantly different, chylous ascites was more frequent \nin the paraaortic group (15.6% vs. 5.6%, p=0.030). Similarly, \nileus was more frequent in the paraaortic group. Demographic \nand clinical characteristics of the patients were given in Table \n1 and Table 2. \nBlood pressure changes were significantly greater in the \nparaaortic group, with systolic blood pressure showing a mean \nchange of -17.20 compared to -1.10 in the no paraaortic group \n(p<0.001, Cohen’s d=3.52); and diastolic blood pressure a mean \nchange of -8.00 compared to -0.80 (p<0.001, Cohen’s d=2.89). \nThese findings indicate that paraaortic lymphadenectomy is \nassociated with longer operative times, greater lymph node \nFigure 1.  Patient selection process for the study, showing \nexclusions and final cohort of 264 patients\nTable 1.  Demographic and laboratory parameters of patients \nunderwent paraaortic lymphadenectomy and no paraaortic \nlymphadenectomy\nNo paraaortic \n(n=72)\nParaaortic \n(n=192) p-value\nAge 61±12 62±10 0.528\nGravida 2 (0-12) 2 (0-8) 0.916\nBMI 33±7 32±6 0.167\nPlt 288±71 298±83 0.358\nCA-125 32±70 63±304 0.393\nPreop tumor size 3±2 4±6 0.055\nOp. time 3±1 4±1 0.000\nPelvic LN 21±20 39±17 0.000\nParaaortic LN 0±0 42±24 0.000\nTumor size 3±2 4±2 0.000\nHospital stay 5 (2-31) 9 (2-65) 0.000\nBMI: Body mass index, Plt: Platelet, Op.: Operation, LN: Lymph node\n\n16\nTurk J Obstet Gynecol 2025;22:13-8 Erkılınç et al. Paraaortic lymphadenectomy and hypertension\ndissection, higher utilization of adjuvant therapies, significant \nchanges in blood pressure, and an increased risk of developing \nchylous ascites (Table 3).\nFor systolic blood pressure, the paraaortic group showed a greater \nreduction compared to the no paraaortic group throughout the \n10 days, as depicted by the downward trend in the blue line in \nFigure 1. The mean systolic blood pressure in the no paraaortic \ngroup remained relatively stable around the preoperative mean, \nwhile the paraaortic group showed significant decreases. These \ndifferences reflect the earlier reported mean changes (-1.10 vs. \n-17.20, p<0.001, Cohen’s d=3.52).\nSimilarly, the diastolic blood pressure graph indicates a more \nprominent reduction in the paraaortic group compared to the \nno paraaortic group, consistent with the reported mean changes \n(-0.80 vs. -8.00, p<0.001, Cohen’s d=2.89). The preoperative \nmean diastolic pressure is marked as a reference, and the trends \nshow that the paraaortic group deviates significantly from \nthis baseline over time. Figure 2 and Figure 3 showed blood \npressure changes over time.\nDiscussion\nThis study demonstrates that para-aortic lymphadenectomy, \nperformed up to the level of the renal artery in patients with \nendometrial cancer, is associated with a significant reduction \nin postoperative blood pressure levels. The findings align with \nexisting evidence on the role of neural structures within the \npara-aortic region in blood pressure regulation. Extending \nlymphadenectomy to include the para-aortic area may disrupt \nsympathetic fibers that contribute to renal vasoconstriction, \nsodium uptake, and renin secretion, thereby reducing blood \nTable 2.  Comorbidities and postoperative complications in \nparaaortic and no paraaortic lymphadenectomy groups\nNo \nparaaortic \n(n=72)\nParaaortic \n(n=192) p-value\nHypertension\nNo 30 (41.7%) 68 (35.4%) 0.349\nYes 42 (58.3%) 124 (64.6%)\nDiabetes mellitus\nNo 50 (69.4%) 128 (66.7%) 0.668\nYes 22 (30.6%) 64 (33.3%)\nSuspicious lymph node\nNo 65 (90.3%) 148 (77.1%) 0.016\nYes 7 (9.7%) 44 (22.9%)\nRadiotherapy\nNo 49 (68.1%) 66 (34.4%) 0.000\nYes 23 (31.9%) 126 (65.6%)\nChemotherapy\nNo 64 (88.9%) 122 (63.5%) 0.000\nYes 8 (11.1%) 70 (36.5%)\nEvisceration\nNo 72 (100%) 187 (97.4%) 0.167\nYes 0 (0.0%) 5 (2.6%)\nIleus\nNo 72 (100%) 186 (93.8%) 0.001\nYes 0 (0.0%)  12 (6.2%)\nChylous ascites\nNo 68 (94.4%) 162 (84.4%) 0.030\nYes 4 (5.6%) 30 (15.6%)\nTable 3. The comparison of sistolic and diastolic blood changes in \nparaaortic and no paraaortic groups\nNo \nparaaortic Paraaortic\nMann-\nWhitney U \nstatistic\nCohen’s d\nSystolic \nchange -1.10 -17.20 p<0.001 3.52\nDiastolic \nchange -0.80 -8.00 p<0.001 2.89\nFigure 2. A. Systolic blood pressure trends over 10 days in patients \nundergoing para-aortic lymphadenectomy compared to controls. \nPreoperative systolic blood pressure levels are indicated by the \ngreen dashed line, B. Diastolic blood pressure trends over 10 days \nfor the same groups, showing a similar pattern to systolic pressure. \nPreoperative diastolic levels are marked with a green dashed line\nA.\nB.\n\n17\nTurk J Obstet Gynecol 2025;22:13-8Erkılınç et al. Paraaortic lymphadenectomy and hypertension\npressure. These results are consistent with prior studies \nevaluating interventions such as renal sympathetic denervation, \nwhich have similarly shown significant blood pressure \nreductions through targeted disruption of neural pathways.\nThe aorticorenal splanchnic nerves are constituted by the \nleast and lesser splanchnic nerves, which play a critical role \nin regulating renal vascular tone and renin secretion (10). \nSympathetic activation via these nerves induces renal \nvasoconstriction, reducing blood flow and glomerular filtration \nrate to maintain systemic hemodynamic stability. Additionally, \ntheir adrenergic signaling stimulates renin release, activating the \nrenin-angiotensin-aldosterone system to support blood pressure \nand fluid balance(11). The sympathetic nerves give fibers to the \nrenal plexus and reach the kidney, traversing the renal artery. \nRenal denervation has emerged as a promising interventional \ntherapy for hypertension, targeting the renal sympathetic \nnervous system to achieve blood pressure reduction. This \nprocedure disrupts sympathetic efferent and sensory afferent \nfibers, reducing renin secretion, sodium reabsorption, and \nsystemic sympathetic outflow, which collectively contribute to \nregulation(12). Similar mechanisms may explain blood pressure \nreductions observed following para-aortic lymphadenectomy, \nwhere the renal nerves could usually be affected due to their \nanatomical proximity to the para-aortic lymphatic structures. \nEvidence from experimental studies indicates that ablative or \ninhibitory interventions targeting renal nerves can significantly \nalter sympathetic activity, suggesting that such surgical \napproaches could share mechanistic similarities with renal \ndenervation procedures in modulating blood pressure(13,14).\nWe observed in our study a significant reduction in blood \npressure following paraaortic lymphadenectomy, with systolic \nblood pressure showing a mean decrease of 17.20 mmHg in \nthe paraaortic group. This reduction exceeds the systolic blood \npressure decrease of approximately 13 mmHg reported in renal \ndenervation studies(15), which involve angiographic ablation of \nsympathetic nerves as a treatment for resistant hypertension. \nWhile renal denervation has been widely studied, with long-\nterm follow-up data demonstrating sustained blood pressure \nreductions, there is currently no comparable data in the literature \nto show the impact of paraaortic lymphadenectomy on blood \npressure changes. The lack of studies exploring the disruption \nof sympathetic nerves during paraaortic lymphadenectomy and \nits effects on blood pressure highlights the originality of our \nfindings. This suggests that surgical interruption of sympathetic \npathways during lymphadenectomy may play a role in \npostoperative blood pressure regulation, offering a new area for \nfuture research.\nThe findings from the study conducted Wen et al. (16) highlight \nthe potential adverse effects of para-aortic lymphadenectomy, \nparticularly in non-nerve-sparing procedures. Complications \nsuch as lymphorrhea, lymphocele, and acute intestinal \nobstruction were observed more frequently in the para-\naortic group compared to the nerve sparing para-aortic \nlymphadenectomy group, consistent with our study’s findings \nof increased rates of ileus, chylous ascites, and longer hospital \nstays in the para-aortic lymphadenectomy cohort. Despite these \ncomplications, our study revealed a significant reduction in \nsystolic blood pressure following para-aortic lymphadenectomy. \nThese results indicate a dual perspective: while para-aortic \nlymphadenectomy carries a risk of postoperative complications, \nit also offers a potential therapeutic benefit for hypertension \nmanagement. \nIn our study, significant reductions in both systolic and \ndiastolic blood pressure were observed following para-aortic \nlymphadenectomy, with consistent effects seen in both short-\nterm and long-term follow-ups. The changes in blood pressure \nalign with findings from renal denervation studies, where \nsustained systolic blood pressure reductions of approximately \n12.7 mmHg were reported over 36 months, and similar long-\nterm decreases were observed over 10 years (17). However, \nthe magnitude of blood pressure reduction in our study, \nparticularly during the early postoperative period, was more \npronounced, with systolic blood pressure showing a median \ndecrease of approximately 17 mmHg. This suggests that the \nFigure 3. A. Distribution of diastolic blood pressure differences \n(preoperative vs. follow-up) in patients undergoing para-aortic \nlymphadenectomy and controls, B. Distribution of systolic blood \npressure differences (preoperative vs. follow-up) in the same \ngroups, highlighting significant reductions in the para-aortic group\nA.\nB.\n\n18\nTurk J Obstet Gynecol 2025;22:13-8 Erkılınç et al. Paraaortic lymphadenectomy and hypertension\nsurgical disruption of para-aortic sympathetic nerves during \nlymphadenectomy may result in both immediate and sustained \nantihypertensive effects. While renal denervation has been \nwidely studied as a therapy for resistant hypertension, our \nfindings highlight a potential additional benefit of para-aortic \nlymphadenectomy in reducing blood pressure.\nStudy Limitations\nThe limitation of the study is it’s retrospective design inherently \nintroduces potential biases and limits the ability to establish \ncausal relationships. The variability in follow-up periods \namong patients may have influenced the consistency of the \nresults. Additionally, the absence of ambulatory blood pressure \nmonitoring, such as Holter measurements, restricts the ability \nto evaluate more detailed fluctuations and patterns in blood \npressure changes over time. However, the study also has \nnotable strengths. The inclusion of a strictly defined cohort of \npatients who underwent para-aortic lymphadenectomy up to \nthe renal vein level ensures a high degree of consistency in the \nsurgical approach. This uniformity strengthens the validity of \nthe observed blood pressure changes as an independent effect \nof para-aortic lymphadenectomy on the sympathetic nerves, \nenhancing the reliability of the findings in demonstrating the \ndirect impact of the procedure on blood pressure regulation\nConclusion\nPara-aortic lymphadenectomy has a blood pressure-lowering \neffect and may reduce the need for antihypertensive medication \nin hypertensive patients.\nEthics\nEthics Committee Approval:  Our study received approval \nfrom the Institutional Review Board ( İzmir Democracy \nUniversity Buca Seyfi Demirsoy Training and Research Hospital, \nNon-Interventional Research Ethics Committee - no: 2023/211, \ndate: 27.12.2023).\nInformed Consent:  All persons gave their informed consent \nprior to their inclusion in the study.\nFootnotes\nAuthorship Contributions\nSurgical and Medical Practices: S.E., B. Ö., C.A., İ.Ç., Concept: \nS.E., S.Ö., U.A., C.A., H.A.A., T.B.B., İ. Ç., Design: S.E., S.C.İ., \nS.Ö., B.Ö., U.A., T.B.B., Data Collection or Processing: S.C. İ., \nU.A., H.A.A., T.B.B., İ. Ç., Analysis or Interpretation: S.E., \nS.C.İ., S. Ö., B. Ö., H.A.A., İ. Ç., Literature Search: S.E., B.B., \nWriting: S.E., S.Ö., C.A.\nConflict of Interest:  No conflict of interest was declared by \nthe authors.\nFinancial Disclosure:  The authors declared that this study \nreceived no financial support.\nReferences\n1. Zhang X, Yuan Y, Li C, Feng X, Wang H, Qiao Q, et al. Effect of a \nsalt substitute on incidence of hypertension and hypotension \namong normotensive adults. J Am Coll Cardiol. 2024;83:711-22.\n2. Yang X, Wang J. The role of metabolic syndrome in endometrial cancer: \na review. Front Oncol. 2019;9:744.\n3. Wang L, Du Z-H, Qiao J-M, Gao S. Association between metabolic \nsyndrome and endometrial cancer risk: a systematic review and meta-\nanalysis of observational studies. Aging (Albany NY). 2020;12:9825.\n4. 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High Blood Press Cardiovasc Prev. 2024;31:687-94.","source_license":"CC0","license_restricted":false}