Surgical complications comparing extraperitoneal vs transperitoneal laparoscopic aortic staging in early stage ovarian and endometrial cancer
| Autor: | Assumpció Pérez-Benavente, Anca Chipirliu, Javier de la Torre, Jaime Segrist, Alicia Hernández, Vicente Bebia, Silvia Franco-Camps, Berta Díaz-Feijoo, Antonio Gil-Moreno, Juan Gilabert-Estalles, Silvia Cabrera |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Intraoperative Complication medicine.medical_treatment 03 medical and health sciences Postoperative Complications 0302 clinical medicine Robotic Surgical Procedures Laparotomy medicine Humans Minimally Invasive Surgical Procedures Robotic surgery Prospective Studies Stage (cooking) Laparoscopy Peritoneal Cavity Neoplasm Staging Ovarian Neoplasms medicine.diagnostic_test business.industry Endometrial cancer Obstetrics and Gynecology Postoperative complication Middle Aged medicine.disease Endometrial Neoplasms Surgery 030104 developmental biology Oncology 030220 oncology & carcinogenesis Lymph Node Excision Female Lymphadenectomy Lymph Nodes business |
| Zdroj: | Gynecologic Oncology. 160:83-90 |
| ISSN: | 0090-8258 |
| Popis: | Objective To determine whether the extraperitoneal approach for paraaortic staging lymphadenectomy results in a lower rate of surgical complications compared to the transperitoneal approach, without compromising oncological outcomes. Methods Prospective randomized multicenter study of patients with early endometrial or ovarian cancer undergoing paraaortic lymphadenectomy in 2010–2019. Patients were randomized to minimally invasive surgery (laparoscopy or robotic-assisted) using an extraperitoneal or a transperitoneal approach. The primary end point measure was a composite outcome that included developing one or more of the following surgical complications: bleeding during paraaortic lymphadenectomy ≥500 mL, any intraoperative complication related to paraaortic lymphadenectomy, severe postoperative complication (Dindo ≥ IIIA), impossibility to complete the procedure, or conversion to laparotomy. Results There were 103 patients in the extraperitoneal group and 100 in the transperitoneal group. Differences in the composite outcome (transperitoneal 26.0% vs, extraperitoneal 18.4%; P = 0.195) were not found. Differences in the operative time, conversion to laparotomy, intraoperative bleeding, or survival were not observed. A higher number of lymph nodes were retrieved through the extraperitoneal approached (median, interquartile range [IQR] 12 [7–17] vs, 14 [10–19]: P = 0.026). Older age and greater body mass index (BMI) or waist-to-hip ratio (WHR) increased the risk for surgical complications independently of the laparoscopic approach. Conclusions The extraperitoneal approach did not show differences regarding surgical and oncological parameters compared with the transperitoneal approach, although the number of aortic nodes retrieved was higher. The decision to use one or another laparoscopic route is a matter of the surgeon preference. Trial registration ClinicalTrials.gov .identifier: NCT02676726 |
| Databáze: | OpenAIRE |
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