Extraperitoneal Laparoscopy for Para-Aortic Lymphadenectomy in Endometrial Carcinoma Staging: An Approach with Higher Efficiency

Abstract Background: To compare the surgical outcomes of extraperitoneal laparoscopic, transperitoneal laparoscopic, and laparotomic para-aortic lymphadenectomy in endometrial carcinoma staging. Methods: We retrospectively reviewed data of all patients diagnosed with primary endometrial carcinoma who were treated at the Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center from 1 January 2017 to 31 December 2019. The numbers of para-aortic lymph nodes, surgical time, complications, blood loss and hospital stay were compared. The patients' medical records and pathological reports were carefully reviewed. Statistical significance was defined as p< 0.05. Results: We retrospectively compared patients who underwent extraperitoneal laparoscopy (Group E, n=20), transperitoneal laparoscopy (Group T, n=21), and laparotomy (Group L, n=135). The median number of para-aortic lymph nodes was significantly higher in Group E than in Group T andL (9.5, 5, and 6, respectively; p=0.004 and 0.0004, respectively). All patients in Group E underwent successfully dissction to the renal vessel level. The median operation time was significantly shorter in Group L than in Groups T and E (94, 174, and 233 minutes, respectively; p<0.0001). The median estimated blood loss volume was higher in Group L than in Groups T and E (200, 100, and 142.5 ml, respectively; all comparisons p<0.001), and the length of hospital stay was significantly longer in Group L than in Groups T and E (6, 56, and 6 days, respectively; all comparisons p<0.001). Conclusion: The extraperitoneal laparoscopic approach for staging endometrial carcinoma harvested higher numbers of para-aortic lymph nodes which could be considered for endometrial carcinoma staging, especially for para-aortic lymph node harvest.