Beytout Clémentine, Laas Enora, Naoura Iptissem, Bendifallah Sofiane, Canlorbe Geoffroy, Ballester Marcos, Daraï Emile
Department of Gynaecology and Obstetrics. Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie, Paris 6, France.
Service de Gynécologie-Obstétrique, Hôpital Tenon, 4 rue de la Chine, Paris, France.
Ann Surg Oncol. 2016 Mar;23(3):952-8. doi: 10.1245/s10434-015-4874-8. Epub 2015 Oct 5.
Endoscopic paraaortic lymphadenectomy (PALN), an important step in the management of gynecologic cancers, is associated with low morbidity. However, some concerns exist about the completeness of PALN according to the route (transperitoneal vs. single-port extraperitoneal).
This study retrospectively reviewed the records of patients who had undergone an endoscopic PALN for a gynecologic cancer from May 2010 to August 2014 at the authors' center. The findings showed that 44 patients had a single-port extraperitoneal PALN and 56 had a transperitoneal PALN. The factors independently related to technical performances were tested with a multivariate model adjusted for a propensity score.
A median of 16 lymph nodes were removed by the transperitoneal route and 12 by the extraperitoneal route (p = 0.04). No difference in the number of lymph nodes removed was observed after adjustment for the propensity score of patients who underwent the extraperitoneal approach (p = 0.9). The transperitoneal route was associated with more lymphocysts (20 vs. 2% for the extraperitoneal approach) (p = 0.008). The success rate for the extraperitoneal PALN was 91% (n = 40), with the three remaining patients requiring conversion to the transperitoneal route due to a peritoneal breach.
This propensity-score-adjusted study supports the conclusion that the efficacy of the single-port extraperitoneal route is similar to that of the transperitoneal route for PALN.
内镜下腹主动脉旁淋巴结切除术（PALN）是妇科癌症治疗中的重要步骤，其并发症发生率较低。然而，根据手术路径（经腹与单孔腹膜外），对于PALN的彻底性存在一些担忧。
本研究回顾性分析了2010年5月至2014年8月在作者所在中心接受内镜下PALN治疗妇科癌症患者的记录。结果显示，44例患者接受了单孔腹膜外PALN，56例接受了经腹PALN。采用倾向评分调整的多变量模型对与技术操作独立相关的因素进行了检验。
经腹途径切除的淋巴结中位数为16个，腹膜外途径为12个（p = 0.04）。在对接受腹膜外手术患者的倾向评分进行调整后，观察到切除淋巴结数量无差异（p = 0.9）。经腹途径与更多的淋巴囊肿相关（腹膜外途径为2%，经腹途径为20%）（p = 0.008）。腹膜外PALN的成功率为91%（n = 40），其余3例患者因腹膜破裂需要转为经腹途径。
这项倾向评分调整研究支持以下结论，即单孔腹膜外途径在PALN方面的疗效与经腹途径相似。
