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Di Donna MC, Giallombardo V, Lo Balbo G, Cucinella G, Sozzi G, Capozzi VA, Abbate A, Laganà AS, Garzon S, Chiantera V. Conventional Laparoscopy versus Robotic-Assisted Aortic Lymph-Nodal Staging for Locally Advanced Cervical Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11123332. [PMID: 35743403 PMCID: PMC9224749 DOI: 10.3390/jcm11123332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Aortic lymph node metastases are a relative common finding in locally advanced cervical cancer. Minimally invasive surgery is the preferred approach to perform para-aortic lymph nodal staging to reduce complications, hospital stay, and the time to primary treatment. This meta-analysis (CRD42022335095) aimed to compare the surgical outcomes of the two most advanced approaches for the aortic staging procedure: conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RAL). The meta-analysis was conducted according to the PRISMA guideline. The search string included the following keywords: "Laparoscopy" (MeSH Unique ID: D010535), "Robotic Surgical Procedures" (MeSH Unique ID: D065287), "Lymph Node Excision" (MeSH Unique ID: D008197) and "Aorta" (MeSH Unique ID: D001011), and "Uterine Cervical Neoplasms" (MeSH Unique ID: D002583). A total of 1324 patients were included in the analysis. Overall, 1200 patients were included in the CL group and 124 patients in the RAL group. Estimated blood loss was significantly higher in CL compared with RAL (p = 0.02), whereas hospital stay was longer in RAL compared with CL (p = 0.02). We did not find significant difference for all the other parameters, including operative time, intra- and postoperative complication rate, and number of lymph nodes excised. Based on our data analysis, both CL and RAL are valid options for para-aortic staging lymphadenectomy in locally advanced cervical cancer.
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Affiliation(s)
- Mariano Catello Di Donna
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Vincenzo Giallombardo
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Giuseppina Lo Balbo
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Giuseppe Cucinella
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Giulio Sozzi
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy;
| | - Antonino Abbate
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
- Correspondence:
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, Italy;
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
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Capozzi VA, Sozzi G, Monfardini L, Di Donna MC, Giallombardo V, Lo Balbo G, Butera D, Berretta R, Chiantera V. Transperitoneal versus extraperitoneal laparoscopic aortic lymph nodal staging for locally advanced cervical cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:2256-2264. [PMID: 33972143 DOI: 10.1016/j.ejso.2021.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Cervical cancer is the fourth most common neoplasm in women. In locally advanced cervical cancers, the international guidelines recommend nodal aortic assessment. Two techniques have been described to perform laparoscopic aortic lymphadenectomy: transperitoneal laparoscopic lymphadenectomy (TLL) and extraperitoneal laparoscopic lymphadenectomy (ELL). This meta-analysis aims to compare the surgical outcomes of TLL and ELL for staging purposes. The systematic review was carried out in agreement with the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). Two hundred and twenty studies were analyzed, and 19 studies were included in the review (7 for TLL and 12 for ELL group). 1112 patients were included in the analysis: 390 patients were included in group 1 and 722 patients in group 2.38 patients (9.7%) in the TLL group and 69 (9.5%) patients in the ELL group developed major complications. The analysis of all complications (intraoperative and postoperative) rate through pooled analysis did not show a significant difference between the two groups (p = 0.979), although a significantly higher intraoperative complication rate (p = 0.018) occurred in the TLL group compared to ELL. No significant differences were found between groups for BMI (p = 0.659), estimated blood loss (p = 0.889), length of stay (p = 0.932), intraoperative time (p = 0.932), conversion to laparotomy rate (p = 0.404), number of lymph node excised (p = 0.461) and postoperative complication (p = 0.291). TLL approach shows a higher rate of intraoperative complications, while no significant difference was found between the two techniques when postoperative complications were analyzed.
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Affiliation(s)
| | - Giulio Sozzi
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Vincenzo Giallombardo
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppina Lo Balbo
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Diana Butera
- Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
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