Surveillance of laparoscopic systemic para-aortic lymphadenectomy for patients with intermediate- and high-risk endometrial cancer in Japan

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-08-12 DOI:10.1111/jog.70001

Michiko Kodama, Yoshito Terai, Makoto Fujii, Masahide Ohmichi, Nao Suzuki, Masaki Mandai, Aikou Okamoto

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引用次数: 0

Abstract

Aim

To evaluate the feasibility and safety of laparoscopic systemic para-aortic lymphadenectomy (PALN) for endometrial cancer in a multicenter setting.

Methods

Clinical data from 403 patients who underwent laparoscopic PALN for intermediate- and high-risk endometrial cancer under Japan's advanced medical care procedure between July 2017 and March 2020 were prospectively collected. Clinical background, surgical outcome, perioperative complications, and prognosis were analyzed.

Results

Histological subtype was 219 (54.4%) G1 or G2 endometrioid carcinoma, 64 (15.9%) G3 endometrioid carcinoma, 64 (15.9%) serous carcinoma, 24 (6.0%) carcinosarcoma, 15 (3.7%) clear cell carcinoma, and 17 (4.2%) others. Simple hysterectomy was performed in 180 cases (44.7%) and modified radical hysterectomy (mRH) in 213 cases (52.9%). Median intraoperative blood loss was 110 mL (range: 0–2092), and 7 (1.7%) received blood transfusions. Intraoperative complications occurred in 20 cases (5.0%) including ureteral injuries (1.7%), vascular injuries (1.0%), and bowel injuries (0.5%). High-volume facilities performing more than 15 PALN procedures harvested significantly more para-aortic nodes than facilities performing fewer procedures. Four cases (1.0%) converted to laparotomy. Postoperative complications occurred in 53 cases (13.2%), with approximately related to lymphadenectomy. Multivariate analysis identified intraoperative blood loss, number of pelvic lymph node (PLN) removed, and radical hysterectomy (RH) as risk factors for urological complications. The number of PLNs removed and mRH were associated with lymphadenectomy-related complications. Over a median follow-up of 14 months (1–39), 20 patients (5.0%) experienced recurrence, and 7 (1.7%) died of the disease.

Conclusion

Laparoscopic PALN for intermediate- and high-risk endometrial cancer could be performed safely.

Abstract Image

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腹腔镜下腹主动脉旁淋巴结切除术对日本中高危子宫内膜癌患者的监测

目的探讨多中心腹腔镜下经主动脉旁淋巴结切除术（PALN）治疗子宫内膜癌的可行性和安全性。方法前瞻性收集2017年7月至2020年3月在日本先进医疗程序下接受腹腔镜PALN治疗中高危子宫内膜癌的403例患者的临床资料。分析临床背景、手术结果、围手术期并发症及预后。结果G1、G2子宫内膜样癌219例（54.4%），G3子宫内膜样癌64例（15.9%），浆液性癌64例（15.9%），癌肉瘤24例（6.0%），透明细胞癌15例（3.7%），其他17例（4.2%）。单纯子宫切除术180例（44.7%），改良根治性子宫切除术213例（52.9%）。术中失血量中位数为110 mL（范围：0-2092），7例（1.7%）接受输血。术中出现并发症20例（5.0%），包括输尿管损伤（1.7%）、血管损伤（1.0%）、肠损伤（0.5%）。进行超过15次PALN手术的大容量设施比进行较少手术的设施收获的主动脉旁淋巴结明显更多。4例（1.0%）转为剖腹手术。术后并发症53例（13.2%），与淋巴结切除术有关。多因素分析发现术中出血量、盆腔淋巴结（PLN）切除数量和根治性子宫切除术（RH）是泌尿系统并发症的危险因素。切除的pln数量和mRH与淋巴结切除术相关的并发症有关。中位随访14个月（1-39），20例（5.0%）复发，7例（1.7%）死亡。结论腹腔镜下PALN治疗中、高危子宫内膜癌是安全可行的。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.