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Wang A, Guart JA, Li D, Taros T, Cui H. Laparoscopic Resection of Para-Aortic Mass at the Aortic Bifurcation: An Atypical Presentation of a Tailgut Cyst. Cureus 2024; 16:e62391. [PMID: 39006679 PMCID: PMC11246758 DOI: 10.7759/cureus.62391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
We review the case of a 43-year-old white male who presented with an enlarging pulsatile mass in the periumbilical region. Diagnostic imaging revealed an 8-cm heterogeneous mass abutting the left iliac artery at the aortic bifurcation. Due to the patient's persistently elevated blood pressure and elevated serum and urine catecholamines, a neuroendocrine tumor was suspected. Laparoscopic resection was performed and was well tolerated. However, the mass was characterized as a tailgut cyst upon pathological examination. This case highlights the utility of laparoscopy for the removal of large para-aortic masses, which can be achieved in a safe fashion by an experienced surgeon. In addition, this case highlights the importance of differential diagnoses in surgeries due to the occurrence of unexpected outcomes.
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Affiliation(s)
- Andy Wang
- Surgery, University of Massachusetts Chan Medical School, Worcester, USA
| | - Jiddu A Guart
- General Surgery, University of Massachusetts Chan Medical School, Worcester, USA
| | - Danielle Li
- General Surgery, University of Massachusetts Chan Medical School, Worcester, USA
| | - Trenton Taros
- General Surgery, University of Massachusetts Chan Medical School, Worcester, USA
| | - Hongyi Cui
- General Surgery, University of Massachusetts Chan Medical School, Worcester, USA
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2
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Imai K, Hirooka-Nakama J, Hotta Y, Shigeta H. A Review of Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer: Extraperitoneal Approach May Have the Advantage over Intraperitoneal Approach. Gynecol Minim Invasive Ther 2024; 13:10-18. [PMID: 38487605 PMCID: PMC10936721 DOI: 10.4103/gmit.gmit_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 03/17/2024] Open
Abstract
The importance of lymphadenectomy, including para-aortic nodes, for the accurate staging of endometrial cancer, is well established. Although the therapeutic role of lymph node resection in endometrial cancer is still under debate, some studies support its usefulness for survival benefit. To predict the necessity of lymphadenectomy, several preoperative scoring systems have been proposed as being effective. For endometrial cancer, there is a trend towards minimally invasive surgery, including para-aortic lymphadenectomy. For para-aortic lymphadenectomy, there are two different approaches: the extraperitoneal approach and the transperitoneal approach. The extraperitoneal approach has advantages over the transperitoneal approach in terms of better access to the left aortic nodes, no interference of the bowel, and possibly better options for obese or elderly patients. However, the extraperitoneal approach may have a longer learning curve than the transperitoneal approach. Robot-assisted extraperitoneal para-aortic lymphadenectomy is feasible and safe and may be suitable for patients irrespective of their baseline characteristics.
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Affiliation(s)
- Kazuaki Imai
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Junko Hirooka-Nakama
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Yuichiro Hotta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Hiroyuki Shigeta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
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3
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Sanna E, Madeddu C, Lavra F, Oppi S, Scartozzi M, Giorgio Calò P, Macciò A. Laparoscopic management of isolated nodal recurrence in gynecological malignancies is safe and feasible even for large metastatic nodes up to 8 cm: A prospective case series. Int J Surg 2022; 104:106744. [PMID: 35787955 DOI: 10.1016/j.ijsu.2022.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The surgical treatment of isolated lymph node recurrence (ILNR) of gynecological malignancies is still debated. The feasibility and effectiveness of minimally invasive lymphadenectomy have been reported by few studies; however, it remains unclear what the upper tumor size limit is for a minimally invasive approach. We prospectively analyzed cases of ILNR treated by laparoscopy in our unit while focusing on the safety and feasibility of resecting large tumors suspected of recurrence using a minimally invasive approach. MATERIALS AND METHODS We carried out a prospective observational case-series study. We included all consecutive patients with ILNR from gynecological cancers who underwent minimally invasive lymphadenectomy at our unit from June 2013 to June 2021 to assess the safety and feasibility of such a surgical approach. We also evaluated the oncological outcome in terms of further recurrence, site of recurrence, and survival. RESULTS Twenty-seven patients with ILNR due to gynecological malignancies were included (ovarian cancer, 12; uterine malignancies, 12; cervical cancer, 3). Three had remarkably large LNs up to 8 cm: these emblematic cases have been reported in detail with accompanying videos of the surgical procedure. The most frequent site of ILNR was aortic (67%). Recurrent LNs were completely resected in all cases; none of the procedures was converted to open surgery. The median follow-up duration was 24 months. Ten patients (37%) had a new recurrence. To date five patients (18.5%) have succumbed, four (14.8%) are alive with evidence of disease, and 18 (66.7%) are alive with no evidence of disease. CONCLUSIONS Minimally invasive surgery for ILNR in gynecological malignancies may be an option feasible, safe, and effective in terms of oncological outcomes, even for large tumors. It also allows quicker recovery with early initiation of appropriate postoperative systemic chemotherapy, in the context of an optimal multimodal therapeutic approach.
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Affiliation(s)
- Elisabetta Sanna
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy.
| | - Clelia Madeddu
- Medical Oncology, Azienda Ospedaliero Universitaria di Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100, Cagliari, Italy.
| | - Fabrizio Lavra
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy.
| | - Sara Oppi
- Hematology and Transplant Center, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy.
| | - Mario Scartozzi
- Medical Oncology, Azienda Ospedaliero Universitaria di Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100, Cagliari, Italy.
| | - Pier Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09100, Cagliari, Italy.
| | - Antonio Macciò
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy; Department of Surgical Sciences, University of Cagliari, 09100, Cagliari, Italy.
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Comparison of retroperitoneal and transperitoneal surgical routes in laparoscopic nodal staging for locally advanced cervical cancers (FIGO IB3-IVA). Eur J Surg Oncol 2022; 48:2061-2067. [DOI: 10.1016/j.ejso.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
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5
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Restaino S, Buda A, Puppo A, Capozzi VA, Sozzi G, Casarin J, Gallitelli V, Murgia F, Vizzielli G, Baroni A, Corrado G, Pasciuto T, Ferrari D, Novelli A, Berretta R, Legge F, Vizza E, Chiantera V, Ghezzi F, Landoni F, Scambia G, Fanfani F. Anatomical distribution of sentinel lymph nodes in patients with endometrial cancer: a multicenter study. Int J Gynecol Cancer 2022; 32:517-524. [PMID: 35110375 DOI: 10.1136/ijgc-2021-003253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Sentinel lymph node (SLN) mapping represents the standard approach in uterine confined endometrial cancer patients. The aim of this study was to evaluate the anatomical distribution of SLNs and the most frequent locations of nodal metastasis. METHODS This was an observational retrospective multicenter study involving eight high volume gynecologic cancer centers in Italy. We reviewed 1576 patients with a histologically confirmed diagnosis of endometrial cancer from September 2015 to June 2020. All patients underwent total hysterectomy with salpingo-ophorectomy and SLN mapping. RESULTS A total of 3105 SLNs were mapped and removed, 2809 (90.5%) of these were bilateral and 296 (9.5%) unilateral. The overall detection rate was 93.4% (77.9% bilateral and 15.5% unilateral). The majority of SLNs (80%) and positive SLNs (77.8%) were found at the external iliac and obturator level in both endometrioid and non-endometrioid endometrial cancer. Negative SLNs were more frequent in patients with endometrioid compared with non-endometrioid cancer (91.9% vs 86.1%, p<0.0001). Older patients, a higher body mass index, and non-endometrioid histology were more likely to have 'no mapping' (p<0.0001). Univariate and multivariate analysis showed that higher body mass index and age at surgery were independent predictive factors of empty node packet and fat tissue (p=0.029 and p<0.01, respectively). CONCLUSION The most frequent sites of SLNs and metastases were located in the pelvic area below the iliac vessel bifurcation. Our findings showed that older age, a higher body mass index, and non-endometrioid histology had a negative impact on mapping.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Giulio Sozzi
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | | | - Ferdinando Murgia
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy.,Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, Udine, Italy
| | | | | | - Tina Pasciuto
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Largo Agostino Gemelli 8, Rome, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonia Novelli
- Department of Gynaecology and Obstetrics, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Legge
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy.,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy .,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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Horikawa N, Horie A, Kawahara S, Sunada M, Chigusa Y, Yamaguchi K, Hamanishi J, Kondo E, Mandai M. Feasibility of Laparoscopic Para-Aortic Lymphadenectomy for Locally Advanced Cervical Cancer. JSLS 2022; 26:JSLS.2021.00096. [PMID: 35444399 PMCID: PMC8993461 DOI: 10.4293/jsls.2021.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Radiological evaluation of para-aortic lymph node metastasis in patients with locally advanced cervical cancer (LACC) possess the risk of missing microscopic metastasis. We commenced laparoscopic para-aortic lymphadenectomy (Lap-PAN) on patients with LACC for surgical staging in 2016. We assessed the feasibility of Lap-PAN in patients with LACC. Methods We retrospectively reviewed the records of 31 patients with LACC who were staged at International Federation of Gynecology and Obstetrics (FIGO) 2009 IIB to IVA without enlargement of the para-aortic lymph nodes who underwent radiation therapy in our hospital between January 1, 2011 and December 31, 2018. The postoperative outcomes of Lap-PAN were analyzed, and distinct parameters for each patient, including sites of recurrence and disease-free survival, were compared between the Lap-PAN (n = 12) and no surgery (n = 19) groups. Results The average operation time for Lap-PAN was 167 min, and the estimated blood loss was less than 50 ml in all patients. There were no perioperative complications. The average number of excised lymph nodes was 25, and no pathological metastases were observed. There was no difference in disease-free survival rates between the Lap-PAN and no surgery groups (p = 0.42). During the follow-up period, there were two cases of recurrence in the cervix in the Lap-PAN group, and three and four cases of lung and para-aortic lymph node recurrence, respectively in the no-surgery group. Conclusions Lap-PAN was safely performed as a pretherapeutic staging method for LACC without worsening patient prognosis. Although Lap-PAN requires a high level of skill, it may be a method to avoid excessive radiation for LACC.
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Affiliation(s)
- Naoki Horikawa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Shunsuke Kawahara
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Masumi Sunada
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Eiji Kondo
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
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7
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Li W, Jiang J, Fu Y, Shen Y, Zhang C, Yao S, Xu C, Xia M, Lou G, Liu J, Lin B, Wang J, Zhao W, Zhang J, Cheng W, Guo H, Guo R, Xue F, Wang X, Han L, Zhao X, Li X, Zhang P, Zhao J, Ma J, Yao Q, Yang X, Dou Y, Wang Z, Liu J, Fang Y, Li K, Wang B, Chen G, Cheng X, Sun C, Kong B. Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study. Front Med (Lausanne) 2021; 8:754890. [PMID: 34746191 PMCID: PMC8566710 DOI: 10.3389/fmed.2021.754890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy. Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated. Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively. Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.
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Affiliation(s)
- Wenting Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, China
| | - Yu Fu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanming Shen
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Chuyao Zhang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Min Xia
- Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong, China
| | - Ge Lou
- Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jihong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China
| | - Jianliu Wang
- Peking University People's Hospital, Beijing, China
| | - Weidong Zhao
- Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, China
| | - Jieqing Zhang
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Wenjun Cheng
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongyan Guo
- The Third Hospital of Peking University, Beijing, China
| | - Ruixia Guo
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xipeng Wang
- Department of Gynecology and Obstetrics, Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Lili Han
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Xiaomao Li
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhang
- Department of Gynecology, The Second Hospital of Shandong University, Jinan Shandong, China
| | - Jianguo Zhao
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, Tianjin, China.,Tianjin Clinical Research Center for Gynecology and Obstetrics, Branch of National Clinical Research Center for Gynecology and Obstetrics, Tianjin, China
| | - Jiezhi Ma
- Department of Obstetrics and Gynecology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Qin Yao
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohang Yang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yingyu Dou
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zizhuo Wang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingbo Liu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Fang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kezhen Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Beibei Wang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Chen
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Cheng
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Chaoyang Sun
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, China
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8
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Doğan Durdağ G, Alemdaroğlu S, Yılmaz Baran Ş, Alkaş Yağınç D, Yüksel Şimşek S, Çelik H. Laparoscopic para-aortic lymphadenectomy: Technique and surgical outcomes. J Gynecol Obstet Hum Reprod 2020; 50:101917. [PMID: 32961327 DOI: 10.1016/j.jogoh.2020.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pelvic and para-aortic lymph node dissection is an important part of staging surgery. Aim of this study is to evaluate perioperative outcomes of patients, who underwent laparoscopic para-aortic lymphadenectomy for gynecological cancer in a single center over a period of 7 years, based on body mass index (BMI), and to present the surgical technique in steps. METHODS Data of patients who underwent para-aortic lymphadenectomy at gynecological oncology department of a tertiary center in between March 2013 and July 2020 were analyzed retrospectively. Patients were evaluated in two groups according to their BMI (< 30 kg/m2 as non-obese and ≥ 30 kg/m2 as obese groups). Surgical technique is described in steps. Perioperative outcomes of the two groups were evaluated. RESULTS A total of 230 patients were included in the study. BMI was ≥30 at 58.46 % of the patients. Peri-operative features were not significantly affected by the patient's BMI with the presented surgical technique, however, collected para-aortic lymph node numbers were higher in the group with BMI < 30, though sufficient number of lymph nodes were achieved in both groups. CONCLUSION Although some technical difficulties may be encountered, laparoscopic para-aortic lymphadenectomy is feasable in gynecologic oncological surgery independent of BMI. However, surgical experience is important.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey.
| | - Songül Alemdaroğlu
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Şafak Yılmaz Baran
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Didem Alkaş Yağınç
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Seda Yüksel Şimşek
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Hüsnü Çelik
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
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Learning curve of laparoscopic extraperitoneal para-aortic lymphadenectomy for endometrial carcinoma: A cumulative sum analysis. Surg Oncol 2020; 35:254-260. [PMID: 32932223 DOI: 10.1016/j.suronc.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Minimally invasive surgery including lymphadenectomy for endometrial cancer is widely standardized for the management of endometrial cancer in recent decades. However, the learning curve for laparoscopic para-aortic lymphadenectomy is poorly reported, specifically that for the extraperitoneal approach. METHODS We examined the learning curve for laparoscopic extraperitoneal para-aortic lymphadenectomy by cumulative sum (CUSUM) analysis by retrospectively analyzing 134 patients with early-stage endometrial cancer who had undergone laparoscopic extraperitoneal para-aortic lymphadenectomy, including the first case. Data on the surgical factors that improved and were statistically correlated with the number of procedures experienced were extracted and used to create CUSUM curves. RESULTS The average time for para-aortic lymphadenectomy was 149.4 min to harvest an average of 65.3 para-aortic lymph nodes. Intra- and postoperative complications were observed in nine cases (6.7%). A switch to the transperitoneal approach was necessary in three cases (2.2%). The number of harvested para-aortic lymph nodes and the procedure time were strongly correlated with the number of procedures the patient underwent (p < 0.01). The CUSUM curve of the number of harvested para-aortic lymph nodes indicated an inflection point at the 51st case. The procedure time for para-aortic lymphadenectomy stabilized after the 59th case. CUSUM analysis of "unexpected events," including intra- and postoperative complications and switch to the transperitoneal approach, showed an improved incidence at 60 cases and later. CONCLUSION Gaining proficiency in laparoscopic extraperitoneal thorough para-aortic lymphadenectomy is associated with a long learning curve of over 60 procedures. Careful management is required when introducing the procedure.
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Mabuchi S, Matsumoto Y, Matsubara S. New Peritoneal Traction Device for Laparoscopic Paraaortic Lymphadenectomy. JSLS 2020; 24:JSLS.2019.00062. [PMID: 32265583 PMCID: PMC7112986 DOI: 10.4293/jsls.2019.00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The development of devices that can be used to tract organs or other structures and secure an appropriate surgical field during laparoscopic surgery is clinically important. Methods We developed a novel traction stitch, the Laptraction, which can be used to achieve peritoneal traction during laparoscopic surgery. This study examines the utility and safety of using the Laptraction to achieve peritoneal traction during laparoscopic transperitoneal paraaortic lymphadenectomy (as part of comprehensive staging surgery) in seven endometrial cancer patients. Results Peritoneal traction was successfully and safely achieved using the Laptraction in all cases, without causing any complications. In all cases, time to deploy Laptraction was <5 min. Conclusions Laptraction, a newly developed stitch, allows peritoneal traction to be achieved easily and facilitates the identification of essential landmarks during robotic-assisted laparoscopic hysterectomy, which helps to save time and prevent surgical complications.
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Affiliation(s)
- Seiji Mabuchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuri Matsumoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sho Matsubara
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
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