Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona Institut d'Investigacions Biome'diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Gynecol Oncol. 2021 Jan;160(1):83-90. doi: 10.1016/j.ygyno.2020.10.038. Epub 2020 Nov 5.
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.
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.
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.
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.
确定与经腹腔途径相比，腹膜外途径用于腹主动脉旁分期淋巴结切除术是否会降低手术并发症的发生率，同时不影响肿瘤学结果。
这是一项 2010 年至 2019 年间对接受腹主动脉旁淋巴结切除术的早期子宫内膜或卵巢癌患者进行的前瞻性随机多中心研究。患者被随机分配接受微创外科手术（腹腔镜或机器人辅助手术），采用腹膜外或经腹腔途径。主要终点测量指标是包括以下一种或多种手术并发症的复合结局：腹主动脉旁淋巴结切除术中出血量≥500mL，与腹主动脉旁淋巴结切除术相关的任何术中并发症，严重术后并发症（Dindo≥IIIa 级），无法完成手术或转为开腹手术。
腹膜外组有 103 例患者，经腹腔组有 100 例患者。复合结局（经腹腔组 26.0%，腹膜外组 18.4%；P=0.195）无差异。手术时间、中转开腹、术中出血或生存率无差异。腹膜外入路可获得更多的淋巴结（中位数，四分位距[IQR]：12[7-17]vs.14[10-19]；P=0.026）。年龄较大、体重指数（BMI）或腰臀比（WHR）较大与腹腔镜入路无关，会增加手术并发症的风险。
与经腹腔途径相比，腹膜外途径在手术和肿瘤学参数方面没有差异，尽管主动脉旁淋巴结的检出数量较高。选择使用一种或另一种腹腔镜入路是外科医生偏好的问题。临床试验注册ClinicalTrials.gov 标识符：NCT02676726。
