Comparison of robotic-assisted versus laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy in patients with endometrial cancer

Abstract

Aim: This study was conducted to evaluate the clinical feasibility of robotic-assisted transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) in patients with endometrial cancer.

Methods: From June 2006 to October 2016, we retrospectively analyzed 42 patients who underwent laparoscopic (n = 16) or robotic-assisted (n = 26) staging operations, including TIPAL for endometrial cancer. Perioperative data including age; body mass index; operation duration; the number of lymph nodes retrieved and the ratio of time to lymph node retrieval during pelvic, infrarenal para-aortic and total lymphadenectomy; estimated blood loss and postoperative complications were compared.

Results: The operative duration of pelvic (21.7 ± 5.31 vs 30.7 ± 10.8 min; P = 0.002), and total (62.6 ± 14.0 vs 87.0 ± 30.4 min; P = 0.010) lymphadenectomy was significantly shorter in the robotic-assisted than the laparoscopic group, whereas there was no statistical difference in the duration of infrarenal para-aortic lymphadenectomy. By contrast, the number of infrarenal para-aortic lymph nodes retreived was significantly higher (29.4 ± 10.7 vs 23.3 ± 9.16; P = 0.016) in the robotic-assisted group. Consequently, the ratio of time to number of lymph nodes retrieved during infrarenal (1.51 ± 0.49 vs 2.62 ± 1.34; P = 0.002) and total (1.43 ± 0.48 vs 2.15 ± 0.93; P = 0.014) lymphadenectomy was lower in the robotic-assisted compared to the laparoscopic group.

Conclusions: The robotic-assisted approach took less time per infrarenal para-aortic and total lymph nodes retrieved compared to the conventional laparoscopic approach. Robotic-assisted TIPAL could be feasible and effective for the staging and treatment of patients with endometrial cancer.

Keywords: endometrial cancer; robotic surgery; transperitoneal infrarenal para-aortic lymphadenectomy.