A retrospective review was performed on patients who underwent extraperitoneal or transperitoneal para-aortic lymphadenectomy for endometrial cancer staging from January 2007 to November 2012. Three patient groups were compared: extraperitoneal laparoscopic para-aortic lymphadenectomy, robotic hysterectomy and pelvic lymphadenectomy (鈥渆xtraperitoneal group鈥? N = 34); laparoscopic hysterectomy and transperitoneal pelvic and para-aortic lymphadenectomy (鈥渢ransperitoneal laparoscopic group鈥? N = 108); and robotic hysterectomy and transperitoneal pelvic and para-aortic lymphadenectomy (鈥渢ransperitoneal robotic group鈥? N = 52). Fisher's exact test and Kruskal-Wallis test were used for statistical analysis, and statistical significance was defined as P < 0.05.
The median number of para-aortic lymph nodes obtained was higher in the extraperitoneal group than in the transperitoneal laparoscopic and robotic groups (10, 5, and 4.5 nodes, respectively; P < 0.001). BMI was higher in the extraperitoneal group (median, 35.1 kg/m2) than in the transperitoneal groups but did not differ between the transperitoneal laparoscopic group (median, 28.4 kg/m2) and the transperitoneal robotic group (median, 30.2 kg/m2). Among patients with a BMI < 35 kg/m2, the median number of para-aortic nodes harvested was higher in the extraperitoneal group than in the transperitoneal laparoscopic and robotic groups (9, 4, and 5 nodes, respectively; P < 0.01). The same pattern was observed among patients with a BMI 鈮?#xA0;35 kg/m2 (10, 6, and 3 nodes, respectively), but only the extraperitoneal group and the transperitoneal robotic group were significantly different (P = 0.001). There was no significant difference in median estimated blood loss between the extraperitoneal group and either the transperitoneal laparoscopic group (100 vs. 112.5 mL; P = 0.06) or the transperitoneal robotic group (100 vs. 67.5 mL; P = 0.23). The median operative time was longer in the extraperitoneal group (339.5 min; range, 242-453 min) than in the transperitoneal laparoscopic group (286 min; range, 101-480 min) and the transperitoneal robotic group (297.5 min, range 182-633 min) (P < 0.01).
Extraperitoneal laparoscopic para-aortic lymphadenectomy resulted in a higher number of para-aortic lymph nodes removed than transperitoneal laparoscopic or robotic lymphadenectomy. The extraperitoneal approach should be considered for endometrial cancer staging.