Impact of Body Mass Index on Pelvic and Para Aortic Lymph Node Count in Laparoscopic Staging for High Risk Early Endometrial Adenocarcinoma

Background: to elucidate the predictors of progression-free survival (PFS) and overall survival (OS) in high-risk endometrial cancer patients. Methods: the medical records of all consecutivewomen with high-risk endometrial cancer were reviewed. Results: among 92 high-risk endometrial cancer patients, 30 women experienced recurrence, and 21 women died. The 5-year PFS and OS probabilities were 65.3% and 75.9%, respectively. Multivariable Cox regression revealed that body mass index (hazard ratio (HR) = 1.11), paraaortic lymph node metastasis (HR = 11.11), lymphovascular space invasion (HR = 5.61), and sandwich chemoradiotherapy (HR = 0.15) were independently predictors of PFS. Body mass index (HR = 1.31), paraaortic lymph node metastasis (HR = 32.74), non-endometrioid cell type (HR = 11.31), and sandwich chemoradiotherapy (HR = 0.07) were independently predictors of OS. Among 51 women who underwent sandwich (n = 35) or concurrent (n = 16) chemoradiotherapy, the use of sandwich chemoradiotherapy were associated with better PFS (adjusted HR = 0.26, 95% CI = 0.08–0.87, p = 0.03) and OS (adjusted HR = 0.11, 95% CI = 0.02–0.71, p = 0.02) compared with concurrent chemoradiotherapy. Conclusion: compared with concurrent chemoradiotherapy, sandwich chemoradiotherapy was associated with better PFS and OS in high-risk endometrial cancer patients. In addition, high body mass index, paraaortic lymph node metastasis, and non-endometrioid cell type were also predictors of poor OS in high-risk endometrial cancer patients.

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Role of a Double Docking to Improve Lymph Node Dissection: When Robotically Assisted Laparoscopy for Para-aortic Lymphadenectomy Is Associated to a Pelvic Procedure

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000338 ◽

2015 ◽

Vol 25 (2) ◽

pp. 331-336 ◽

Cited By ~ 10

Author(s):

Oona Franké ◽

Fabrice Narducci ◽

Elisabeth Chereau-Ewald ◽

Marion Orsoni ◽

Camille Jauffret ◽

...

Keyword(s):

Lymph Node ◽

Operative Time ◽

Da Vinci ◽

Lymph Node Count ◽

Da Vinci System ◽

Vinci System ◽

Estimated Blood Loss ◽

Aortic Lymph Node ◽

Node Count ◽

Robotically Assisted Laparoscopy

ObjectiveThe objective of this study was to demonstrate that robotically assisted laparoscopy for aortic lymph node dissection was improved when double docking (DD) of the Da Vinci system is used for combined surgical procedures [defined by the combination of a pelvic procedure and a para-aortic lymphadenectomy (PAL)].MethodsFrom February 2007 to February 2013, 41 patients underwent combined procedures including PAL up to the left renal vein in 2 cancer centers. We used 2 different approaches as follows: a single docking (SD) of the Da Vinci system (transperitoneal PAL and pelvic surgery) during the first period (22 patients) and a DD during the second period (19 patients). We recorded retrospectively the lymph node count (main criteria), operative time, estimated blood loss, hospital stay, and postoperative complications.ResultsWe observed a statistical difference between SD and DD concerning aortic lymph node count (5.86 vs 10.89,P< 0.005). Operative time is longer in the DD group (326.1 vs 239.4 minutes,P< 0.05). No difference was observed concerning estimated blood loss. Hospital stay was longer in the DD group (4.9 vs 3.2 days,P< 0.05). Only 1 conversion to open was described in the SD group.ConclusionsIn our experience of robotically assisted laparoscopy, when PAL is combined to a pelvic procedure, the use of a DD seems to improve aortic lymph node count.Despite a longer operative time compared to SD, DD seems to be a good solution to combine the advantages of robotic assistance to our quality criteria of aortic dissection.SynopsisWe compare 2 techniques to realize robotic assisted para-aortic lymphadenectomy combined with pelvic procedure. Double docking seems to improve histological results compared to single docking.

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Para-aortic Lymph Node Dissection for Women With Endometrial Adenocarcinoma and Intermediate- to High-Risk Tumors: Does It Improve Survival?

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000008 ◽

2014 ◽

Vol 24 (1) ◽

pp. 91-96 ◽

Cited By ~ 7

Author(s):

Madeleine Courtney-Brooks ◽

Jennifer M. Scalici ◽

A. Rauda Tellawi ◽

Leigh A. Cantrell ◽

Linda R. Duska

Keyword(s):

Lymph Node ◽

High Risk ◽

Lymph Node Dissection ◽

Endometrial Adenocarcinoma ◽

Univariate Analysis ◽

Therapeutic Benefit ◽

Pelvic Lymphadenectomy ◽

Node Dissection ◽

Medical Comorbidities ◽

Aortic Lymph Node

ObjectiveLiterature suggests that para-aortic lymphadenectomy (para-aortic lymph node dissection [PALND]) has a therapeutic benefit for women with intermediate- to high-risk endometrial adenocarcinoma. We hypothesized that the observed survival advantage of PALND is a reflection of the general health of the patient rather than a therapeutic benefit of surgery.MethodsWomen with intermediate- to high-risk endometrial adenocarcinoma diagnosed from 2002 to 2009 at a single institution were identified. Medical comorbidities, pathology, and survival information were abstracted from the medical record. The χ2 test or the t test was used for univariate analysis. Overall survival (OS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.ResultsA total of 253 women with a mean age of 64 years were identified. Of these women, 174 had a pelvic lymphadenectomy (pelvic lymph node dissection [PLND]) and 82 had PLND and PALND. The rate of positive nodes was 13% (23/174) for the women who had PLND and was 7% (6/82) for those who had PLND and PALND. Only 1.2% (1/82) of the women who had PLND and PALND had negative pelvic but positive para-aortic nodes. The patients who had PALND had a lower body mass index and were less likely to have significant medical comorbidities. The patients who had PALND had improved 5-year OS (96% vs 82%, P = 0.007) but no difference in 5-year DSS (96% vs 89%, P value = not significant).ConclusionsWomen with intermediate- to high-risk endometrial adenocarcinoma who undergo PALND have improved OS but no improvement in DSS. The lack of difference in DSS supports the hypothesis that underlying comorbidities as opposed to lack of PALND result in poorer outcome.

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