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

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.