Reyes Claret Albert, Martínez Canto María Cristina, Robles Gourley Ana, Llull Gomila Marina, Martín Jiménez Ángel
Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain.
Obstetrics and Gynaecology Department, Hospital Comarcal d'Inca, Inca, Spain.
J Laparoendosc Adv Surg Tech A. 2020 Apr;30(4):416-422. doi: 10.1089/lap.2019.0529. Epub 2020 Feb 5.
To explore if obesity measured by body mass index (BMI) ≥30 kg/m represents a limiting factor for para-aortic lymphadenectomy done with a transperitoneal laparoscopic approach. Retrospective observational study with 146 consecutive patients, diagnosed with a gynecological cancer submitted to para-aortic surgical staging between January 2010 and December 2018. The mean age was 52 years and the mean BMI was 27 kg/m. 72.6% (106 patients) had BMI <30 kg/m and 27.4% (40 patients) had BMI ≥30 kg/m. Half of the patients did not have prior abdominal surgeries. The statistical analysis showed that there were no significant differences between two groups depending on their BMI in the lymph node count: BMI <30 kg/m 14 nodes versus BMI ≥30 kg/m 10 nodes ( = .122); rate of intraoperative complications: BMI <30: 6.3% versus BMI ≥30: 0% ( = .180), postoperative complications: BMI <30: 6.6% versus BMI ≥30: 5% ( = .723); feasibility rate: BMI <30: 97.1% versus BMI ≥30: 95.6% ( = .063) or the mean hospital stay BMI <30: 2.47 ± 2.05 days (standard deviation [SD]), BMI ≥30: 2.64 ± 0.93 days (SD) ( = .171). The only significant difference observed was due to the operating time: BMI <30: 103.1 ± 60.8 (SD) versus BMI ≥30: 146.9 ± 82.5 (SD) ( = .019), being longer in obese patients. Obesity, estimated by BMI, does not seem to represent a limiting factor for this surgical procedure in our series. We feel it is a feasible and justified approach in obese patients when other surgical procedures have to be carried out in the same surgical act. Probably, other factors and anthropometric measurements are more accurate to select patients in which this approach is feasible.
探讨以体重指数（BMI）≥30kg/m²衡量的肥胖是否是经腹腹腔镜主动脉旁淋巴结清扫术的限制因素。对2010年1月至2018年12月期间连续146例被诊断为妇科癌症并接受主动脉旁手术分期的患者进行回顾性观察研究。平均年龄为52岁，平均BMI为27kg/m²。72.6%（106例患者）的BMI<30kg/m²，27.4%（40例患者）的BMI≥30kg/m²。一半的患者既往没有腹部手术史。统计分析表明，根据BMI分组，两组在淋巴结计数方面无显著差异：BMI<30kg/m²组为14个淋巴结，BMI≥30kg/m²组为10个淋巴结（P = 0.122）；术中并发症发生率：BMI<30组为6.3%，BMI≥30组为0%（P = 0.180），术后并发症发生率：BMI<30组为6.6%，BMI≥30组为5%（P = 0.723）；可行性率：BMI<30组为97.1%，BMI≥30组为95.6%（P = 0.063），或平均住院时间BMI<30组为2.47±2.05天（标准差[SD]），BMI≥30组为2.64±0.93天（SD）（P = 0.171）。观察到的唯一显著差异是手术时间：BMI<30组为103.1±60.8（SD），BMI≥30组为146.9±82.5（SD）（P = 0.019），肥胖患者的手术时间更长。在我们的系列研究中，以BMI评估的肥胖似乎不是该手术的限制因素。当在同一手术操作中必须进行其他手术时，我们认为这对肥胖患者是一种可行且合理的方法。可能，其他因素和人体测量指标对于选择可行该方法的患者更为准确。
