Kim Jeeyeon, Paek Jiheum
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
Curr Oncol. 2024 Dec 5;31(12):7820-7827. doi: 10.3390/curroncol31120576.
Upper para-aortic lymph node dissection (PALND) is one of the most challenging gynecologic robotic procedures. This study aimed to evaluate the oncologic and operative outcomes of robotic staging surgery, including upper PALND, using low pelvic port placement (LP3) in 22 patients with high-risk endometrial cancer. High-risk was defined as patients who showed deep myometrial invasion with grade III, cervical involvement, or high-risk histology. The mean patient age and body mass index were 58 years and 24 kg/m. The mean operative time was 263 min. The mean number of total LNs and upper PALNs obtained was 31 and 10. Two patients received lymphangiography to reduce the amount of drained lymphatic fluid after surgery. The recurrence rate was 13.6% (3/22). There were two LN recurrences and one at the peritoneum in the intra-abdominal cavity. Robotic staging surgery using LP3 was feasible for performing PALND as well as procedures in the pelvic cavity simultaneously. It provides important techniques for performing optimal surgical procedures when surgeons decide to perform comprehensive PALND in instances of isolated recurrence or unexpected LN enlargement as well as high-risk endometrial cancer. Consequently, surgeons can achieve surgical consistency and reproducibility for PALND, leading to improved operative and survival outcomes in high-risk endometrial cancer.
主动脉旁上淋巴结清扫术（PALND）是最具挑战性的妇科机器人手术之一。本研究旨在评估22例高危子宫内膜癌患者采用低位盆腔端口放置（LP3）进行机器人分期手术（包括主动脉旁上淋巴结清扫术）的肿瘤学和手术效果。高危定义为肌层浸润深度达III级、宫颈受累或组织学高危的患者。患者的平均年龄和体重指数分别为58岁和24kg/m²。平均手术时间为263分钟。获取的总淋巴结和主动脉旁上淋巴结的平均数量分别为31个和10个。两名患者接受了淋巴管造影以减少术后引流的淋巴液量。复发率为13.6%（3/22）。有2例淋巴结复发，1例腹腔内腹膜复发。采用LP3的机器人分期手术对于同时进行主动脉旁上淋巴结清扫术和盆腔手术是可行的。当外科医生决定在孤立复发、意外淋巴结肿大以及高危子宫内膜癌病例中进行全面的主动脉旁上淋巴结清扫术时，它为实施最佳手术提供了重要技术。因此，外科医生可以实现主动脉旁上淋巴结清扫术的手术一致性和可重复性，从而改善高危子宫内膜癌的手术和生存效果。
