Impact of sympathetic denervation via paraaortic lymphadenectomy on blood pressure in endometrial cancer patients.

Abstract

Objective: To evaluate the effect of para-aortic lymphadenectomy on blood pressure changes in endometrial cancer patients.

Materials and methods: This retrospective study included patients with endometrial cancer treated surgically between 2017 and 2023. Patients undergoing para-aortic lymphadenectomy, up to the renal artery, in a non-nerve-sparing fashion, were compared with those undergoing pelvic lymphadenectomy or sentinel lymph node mapping. Data collected included age, body mass index, comorbidities including hypertension, diabetes mellitus, coronary artery disease, operative time, number of lymph nodes removed, tumor size, and postoperative complications. Preoperative blood pressure was recorded during outpatient visits, and postoperative measurements were collected daily during hospitalization and at follow-up visits. Statistical analyses assessed differences in systolic and diastolic blood pressure changes, operative outcomes, and complications.

Results: A total of 264 patients were analyzed. Patients in the para-aortic group had significantly longer operative times. Tumor size was larger in the paraaortic group than in another group. Systolic blood pressure decreased significantly in the para-aortic group compared to the control group (para-aortic: -17 mmHg vs. non-para-aortic: -1.10 mmHg, p<0.05), with a similar trend for diastolic pressure (-8.00 mmHg vs. -0.80 mmHg, p<0.05). Chylous ascites (15.6% vs. 5.6%) and ileus (0% vs. 12%) were more common in the para-aortic group, along with the administration of radiotherapy and chemotherapy. Both systolic and diastolic blood pressures were significantly lower in paraaortic group, in both early and late postoperative follow-up measures (p<0.005).

Conclusion: Aortic lymphadenectomy is associated with decreased blood pressure and may have therapeutic potential for hypertensive patients, highlighting the need for prospective randomized studies to explore this effect further.