Links to Exploration step
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Comparison Between Laparoscopy and Laparotomy in Systematic Para-Aortic Lymphadenectomy for Patients with Endometrial Cancer: A Retrospective Multicenter Study</title><author><name sortKey="Tanaka, Tomohito" sort="Tanaka, Tomohito" uniqKey="Tanaka T" first="Tomohito" last="Tanaka">Tomohito Tanaka</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Terai, Yoshito" sort="Terai, Yoshito" uniqKey="Terai Y" first="Yoshito" last="Terai">Yoshito Terai</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Hayashi, Shigenori" sort="Hayashi, Shigenori" uniqKey="Hayashi S" first="Shigenori" last="Hayashi">Shigenori Hayashi</name><affiliation><nlm:aff id="aff2"></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"></nlm:aff></affiliation></author><author><name sortKey="Aoki, Daisuke" sort="Aoki, Daisuke" uniqKey="Aoki D" first="Daisuke" last="Aoki">Daisuke Aoki</name><affiliation><nlm:aff id="aff2"></nlm:aff></affiliation></author><author><name sortKey="Miki, Michiyasu" sort="Miki, Michiyasu" uniqKey="Miki M" first="Michiyasu" last="Miki">Michiyasu Miki</name><affiliation><nlm:aff id="aff4"></nlm:aff></affiliation></author><author><name sortKey="Kobayashi, Eiji" sort="Kobayashi, Eiji" uniqKey="Kobayashi E" first="Eiji" last="Kobayashi">Eiji Kobayashi</name><affiliation><nlm:aff id="aff5"></nlm:aff></affiliation></author><author><name sortKey="Kimura, Tadashi" sort="Kimura, Tadashi" uniqKey="Kimura T" first="Tadashi" last="Kimura">Tadashi Kimura</name><affiliation><nlm:aff id="aff5"></nlm:aff></affiliation></author><author><name sortKey="Baba, Tsukasa" sort="Baba, Tsukasa" uniqKey="Baba T" first="Tsukasa" last="Baba">Tsukasa Baba</name><affiliation><nlm:aff id="aff6"></nlm:aff></affiliation></author><author><name sortKey="Matsumura, Noriomi" sort="Matsumura, Noriomi" uniqKey="Matsumura N" first="Noriomi" last="Matsumura">Noriomi Matsumura</name><affiliation><nlm:aff id="aff6"></nlm:aff></affiliation></author><author><name sortKey="Ohmichi, Masahide" sort="Ohmichi, Masahide" uniqKey="Ohmichi M" first="Masahide" last="Ohmichi">Masahide Ohmichi</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28611530</idno><idno type="pmc">5466012</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466012</idno><idno type="RBID">PMC:5466012</idno><idno type="doi">10.1089/gyn.2016.0101</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">004079</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004079</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Comparison Between Laparoscopy and Laparotomy in Systematic Para-Aortic Lymphadenectomy for Patients with Endometrial Cancer: A Retrospective Multicenter Study</title><author><name sortKey="Tanaka, Tomohito" sort="Tanaka, Tomohito" uniqKey="Tanaka T" first="Tomohito" last="Tanaka">Tomohito Tanaka</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Terai, Yoshito" sort="Terai, Yoshito" uniqKey="Terai Y" first="Yoshito" last="Terai">Yoshito Terai</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Hayashi, Shigenori" sort="Hayashi, Shigenori" uniqKey="Hayashi S" first="Shigenori" last="Hayashi">Shigenori Hayashi</name><affiliation><nlm:aff id="aff2"></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"></nlm:aff></affiliation></author><author><name sortKey="Aoki, Daisuke" sort="Aoki, Daisuke" uniqKey="Aoki D" first="Daisuke" last="Aoki">Daisuke Aoki</name><affiliation><nlm:aff id="aff2"></nlm:aff></affiliation></author><author><name sortKey="Miki, Michiyasu" sort="Miki, Michiyasu" uniqKey="Miki M" first="Michiyasu" last="Miki">Michiyasu Miki</name><affiliation><nlm:aff id="aff4"></nlm:aff></affiliation></author><author><name sortKey="Kobayashi, Eiji" sort="Kobayashi, Eiji" uniqKey="Kobayashi E" first="Eiji" last="Kobayashi">Eiji Kobayashi</name><affiliation><nlm:aff id="aff5"></nlm:aff></affiliation></author><author><name sortKey="Kimura, Tadashi" sort="Kimura, Tadashi" uniqKey="Kimura T" first="Tadashi" last="Kimura">Tadashi Kimura</name><affiliation><nlm:aff id="aff5"></nlm:aff></affiliation></author><author><name sortKey="Baba, Tsukasa" sort="Baba, Tsukasa" uniqKey="Baba T" first="Tsukasa" last="Baba">Tsukasa Baba</name><affiliation><nlm:aff id="aff6"></nlm:aff></affiliation></author><author><name sortKey="Matsumura, Noriomi" sort="Matsumura, Noriomi" uniqKey="Matsumura N" first="Noriomi" last="Matsumura">Noriomi Matsumura</name><affiliation><nlm:aff id="aff6"></nlm:aff></affiliation></author><author><name sortKey="Ohmichi, Masahide" sort="Ohmichi, Masahide" uniqKey="Ohmichi M" first="Masahide" last="Ohmichi">Masahide Ohmichi</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Gynecologic Surgery</title><idno type="ISSN">1042-4067</idno><idno type="eISSN">1557-7724</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><p><bold><italic>Objective:</italic></bold> Laparoscopic surgery has been developed worldwide due to its minimal invasion as well as noninferiority, compared with laparotomy. However, whether or not laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer is feasible and has advantages of various clinical factors, such as a short hospital stay, less blood loss, and faster recovery, compared with open surgery has not yet been clarified. The aim of this study was to compare a laparoscopic procedure with laparotomy for para-aortic lymphadenectomy for patients with endometrial cancer.</p><p><bold><italic>Study Design:</italic></bold> This was a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer in five institutions.</p><p><bold><italic>Materials and Methods:</italic></bold> The current authors conducted a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer. The study involved patients from five institutions in Japan between January 2008 and March 2016. Clinical data were compared with those of a laparotomic procedure performed around the same period.</p><p><bold><italic>Results:</italic></bold> A total of 54 patients in the laparoscopic group and 99 patients in the laparotomic group were analyzed. In the laparoscopic group, 21 patients had stage IA disease, 19 had stage IB disease, 5 had stage II disease, and 9 had stage III disease. In the laparotomic group, 35 patients had stage IA disease, 19 had stage IB disease, 9 had stage II disease, and 36 had stage III disease. There were no significant differences in characteristics between the groups, including age, body mass index, and histologic type. The mean operative time in the laparoscopic group was 483 ± 102 minutes, while that in the laparotomic group was 481 ± 106 minutes (<italic>p</italic> = 0.9). The laparoscopic group had less intraoperative blood loss (143 ± 253 versus 988 ± 694 mL; <italic>p</italic> < 0.01) and shorter hospital stays (8.4 ± 5.7 versus 16.1 ± 8.0 days; <italic>p</italic> < 0.01). The rates of intraoperative complications were not significantly different between the groups. No cases of ileus occurred in the laparoscopic group. Procedures for 2 of the 54 patients in the laparoscopic group were converted to laparotomy. The number of dissected pelvic lymph nodes (31.8 ± 10.1 versus 39.9 ± 15.9, <italic>p</italic> < 0.01) and para-aortic lymph nodes (26.2 ± 10.9 versus 31.1 ± 13.2; <italic>p</italic> = 0.02) were lower in the laparoscopic group than in the laparotomic group. The postoperative minimum level of hemoglobin was higher in the laparoscopic group than in the laparotomic group (10.4 ± 1.1 g/dL versus 9.9 ± 1.4 g/dL; <italic>p</italic> = 0.02). In contrast, the postoperative maximum level of C-reactive protein was lower in the laparoscopic group than in the laparotomic group (6.3 ± 3.8 mg/dL versus 10.2 ± 4.9 mg/dL; <italic>p</italic> < 0.01). The recurrence rate was not significantly different between the groups in the above time period (7.4% versus 14.3%; <italic>p</italic> = 0.2).</p><p><bold><italic>Conclusions:</italic></bold> Laparoscopic systematic para-aortic lymphadenectomy is feasible and can be substituted for laparotomic procedures for patients with early stage endometrial cancer. ( J GYNECOL SURG 33:105)</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kilgore, Lc" uniqKey="Kilgore L">LC Kilgore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fanning, J" uniqKey="Fanning J">J Fanning</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Takeshima, N" uniqKey="Takeshima N">N Takeshima</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Larson, Dm" uniqKey="Larson D">DM Larson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cragun, Jm" uniqKey="Cragun J">JM Cragun</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Trimble, El" uniqKey="Trimble E">EL Trimble</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ayhan, A" uniqKey="Ayhan A">A Ayhan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yenen, Mc" uniqKey="Yenen M">MC Yenen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lo, Kw" uniqKey="Lo K">KW Lo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Todo, Y" uniqKey="Todo Y">Y Todo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Todo, Y" uniqKey="Todo Y">Y Todo</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Fagotti, A" uniqKey="Fagotti A">A Fagotti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fujita, K" uniqKey="Fujita K">K Fujita</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Childers, Jm" uniqKey="Childers J">JM Childers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walker, Jl" uniqKey="Walker J">JL Walker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chu, Lh" uniqKey="Chu L">LH Chu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Obermair, A" uniqKey="Obermair A">A Obermair</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tozzi, R" uniqKey="Tozzi R">R Tozzi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holub, Z" uniqKey="Holub Z">Z Holub</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cho, Yh" uniqKey="Cho Y">YH Cho</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chuang, L" uniqKey="Chuang L">L Chuang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Jk" uniqKey="Chan J">JK Chan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lutman, Cv" uniqKey="Lutman C">CV Lutman</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Gynecol Surg</journal-id><journal-id journal-id-type="iso-abbrev">J Gynecol Surg</journal-id><journal-id journal-id-type="publisher-id">gyn</journal-id><journal-title-group><journal-title>Journal of Gynecologic Surgery</journal-title></journal-title-group><issn pub-type="ppub">1042-4067</issn><issn pub-type="epub">1557-7724</issn><publisher><publisher-name>Mary Ann Liebert, Inc.</publisher-name><publisher-loc>140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28611530</article-id><article-id pub-id-type="pmc">5466012</article-id><article-id pub-id-type="publisher-id">10.1089/gyn.2016.0101</article-id><article-id pub-id-type="doi">10.1089/gyn.2016.0101</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Comparison Between Laparoscopy and Laparotomy in Systematic Para-Aortic Lymphadenectomy for Patients with Endometrial Cancer: A Retrospective Multicenter Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tanaka</surname><given-names>Tomohito</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Terai</surname><given-names>Yoshito</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hayashi</surname><given-names>Shigenori</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff2"><sup>2,</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Aoki</surname><given-names>Daisuke</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Miki</surname><given-names>Michiyasu</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kobayashi</surname><given-names>Eiji</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kimura</surname><given-names>Tadashi</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Baba</surname><given-names>Tsukasa</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Matsumura</surname><given-names>Noriomi</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ohmichi</surname><given-names>Masahide</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><aff id="aff1"><label><sup>1</sup></label>Department of Obstetrics and Gynecology,<institution>Osaka Medical College</institution>, Takatsuki, Osaka,<country>Japan</country>.</aff><aff id="aff2"><label><sup>2</sup></label><institution>Keio University School of Medicine</institution>, Tokyo,<country>Japan</country></aff><aff id="aff3"><label><sup>3</sup></label><institution>Tokyo Medical Center</institution>, Meguro-ku, Tokyo,<country>Japan</country>.</aff><aff id="aff4"><label><sup>4</sup></label><institution>Tenriyorozu Hospital</institution>, Tenri, Nara,<country>Japan</country>.</aff><aff id="aff5"><label><sup>5</sup></label><institution>Osaka University Graduate School of Medicine</institution>, Suita, Osaka,<country>Japan</country>.</aff><aff id="aff6"><label><sup>6</sup></label><institution>Kyoto University Graduate School of Medicine</institution>, Kyoto, Kyoto,<country>Japan</country>.</aff></contrib-group><author-notes><corresp><addr-line>Address correspondence to:</addr-line><addr-line><italic>Yoshito Terai, MD</italic></addr-line><addr-line><italic>Department of Obstetrics and Gynecology</italic></addr-line><institution><italic>Osaka Medical College, 2-7</italic></institution><addr-line><italic>Daigaku-machi</italic></addr-line><addr-line><italic>Takatsuki, Osaka 569-8686</italic></addr-line><country>Japan</country><break></break><italic>E-mail:</italic><email xlink:href="mailto:y-terai@osaka-med.ac.jp">y-terai@osaka-med.ac.jp</email></corresp></author-notes><pub-date pub-type="ppub"><day>01</day><month>6</month><year>2017</year><pmc-comment>string-date: June 2017</pmc-comment>
</pub-date><pub-date pub-type="epub"><day>01</day><month>6</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>6</month><year>2017</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>33</volume><issue>3</issue><fpage>105</fpage><lpage>110</lpage><permissions><copyright-statement>© Tomohito Tanaka et al. 2017; Published by Mary Ann Liebert, Inc.</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mary Ann Liebert, Inc. offers reprint services for those who want to order professionally produced copies of articles published under the Creative Commons Attribution (CC BY) license. To obtain a price quote, email <email xlink:href="mailto:Reprints@liebertpub.com">Reprints@liebertpub.com</email>. Please include the article's title or DOI, quantity, and delivery destination in your email.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="gyn.2016.0101.pdf"></self-uri><abstract><title>Abstract</title><p><bold><italic>Objective:</italic></bold> Laparoscopic surgery has been developed worldwide due to its minimal invasion as well as noninferiority, compared with laparotomy. However, whether or not laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer is feasible and has advantages of various clinical factors, such as a short hospital stay, less blood loss, and faster recovery, compared with open surgery has not yet been clarified. The aim of this study was to compare a laparoscopic procedure with laparotomy for para-aortic lymphadenectomy for patients with endometrial cancer.</p><p><bold><italic>Study Design:</italic></bold> This was a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer in five institutions.</p><p><bold><italic>Materials and Methods:</italic></bold> The current authors conducted a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer. The study involved patients from five institutions in Japan between January 2008 and March 2016. Clinical data were compared with those of a laparotomic procedure performed around the same period.</p><p><bold><italic>Results:</italic></bold> A total of 54 patients in the laparoscopic group and 99 patients in the laparotomic group were analyzed. In the laparoscopic group, 21 patients had stage IA disease, 19 had stage IB disease, 5 had stage II disease, and 9 had stage III disease. In the laparotomic group, 35 patients had stage IA disease, 19 had stage IB disease, 9 had stage II disease, and 36 had stage III disease. There were no significant differences in characteristics between the groups, including age, body mass index, and histologic type. The mean operative time in the laparoscopic group was 483 ± 102 minutes, while that in the laparotomic group was 481 ± 106 minutes (<italic>p</italic> = 0.9). The laparoscopic group had less intraoperative blood loss (143 ± 253 versus 988 ± 694 mL; <italic>p</italic> < 0.01) and shorter hospital stays (8.4 ± 5.7 versus 16.1 ± 8.0 days; <italic>p</italic> < 0.01). The rates of intraoperative complications were not significantly different between the groups. No cases of ileus occurred in the laparoscopic group. Procedures for 2 of the 54 patients in the laparoscopic group were converted to laparotomy. The number of dissected pelvic lymph nodes (31.8 ± 10.1 versus 39.9 ± 15.9, <italic>p</italic> < 0.01) and para-aortic lymph nodes (26.2 ± 10.9 versus 31.1 ± 13.2; <italic>p</italic> = 0.02) were lower in the laparoscopic group than in the laparotomic group. The postoperative minimum level of hemoglobin was higher in the laparoscopic group than in the laparotomic group (10.4 ± 1.1 g/dL versus 9.9 ± 1.4 g/dL; <italic>p</italic> = 0.02). In contrast, the postoperative maximum level of C-reactive protein was lower in the laparoscopic group than in the laparotomic group (6.3 ± 3.8 mg/dL versus 10.2 ± 4.9 mg/dL; <italic>p</italic> < 0.01). The recurrence rate was not significantly different between the groups in the above time period (7.4% versus 14.3%; <italic>p</italic> = 0.2).</p><p><bold><italic>Conclusions:</italic></bold> Laparoscopic systematic para-aortic lymphadenectomy is feasible and can be substituted for laparotomic procedures for patients with early stage endometrial cancer. ( J GYNECOL SURG 33:105)</p></abstract><kwd-group kwd-group-type="author"><title><bold>Keywords:</bold> </title><kwd>endometrial cancer</kwd><kwd>para-aortic lymphadenectomy</kwd><kwd>laparoscopic surgery</kwd><kwd>ileus</kwd></kwd-group><counts><fig-count count="1"></fig-count><table-count count="2"></table-count><ref-count count="24"></ref-count><page-count count="6"></page-count></counts></article-meta></front><body><sec sec-type="intro" id="s001"><title>Introduction</title><p>P<sc>ara-aortic lymphadenectomy</sc> is a major surgical procedure for patients with gynecologic cancer. This technique has improved the prognosis<sup><xref rid="B1" ref-type="bibr">1–6</xref></sup> and facilitated correct staging<sup><xref rid="B7" ref-type="bibr">7–9</xref></sup> among patients with endometrial cancer. In one study, para-aortic lymph-node metastasis was reported to be 1% in a low-risk of recurrence group, 11.9% in an intermediate-risk group, and 23.8% in a high-risk group, and patients with retroperitoneal lymph-node metastasis were classified as stage IIIC.<sup><xref rid="B10" ref-type="bibr">10</xref></sup> Todo et al. reported that systematic lymphadenectomy, including para-aortic lymphadenectomy, has therapeutic significance for patients at intermediate/high risk of recurrence, such as those with deeply invasive lesions, high-grade histology, and tumors of serous carcinoma, clear cell carcinoma, or carcinosarcoma features of endometrial cancer.<sup><xref rid="B11" ref-type="bibr">11</xref></sup></p><p>According to the National Comprehensive Cancer Network, para-aortic nodal evaluation from the inframesenteric and infrarenal regions may also be utilized for staging of selected high-risk tumors—such as deeply invasive lesions; those with high-grade histology; and tumors with serous carcinoma, clear cell carcinoma, or carcinosarcoma features—in patients undergoing primary surgical management of endometrioid uterine cancer.<sup><xref rid="B12" ref-type="bibr">12</xref></sup> However, para-aortic lymphadenectomy is conventionally performed via laparotomy with a large skin incision, and the incidence of postoperative ileus is 12.9%–50% among patients receiving para-aortic lymphadenectomy.<sup><xref rid="B13" ref-type="bibr">13</xref>,<xref rid="B14" ref-type="bibr">14</xref></sup></p><p>The first laparoscopic para-aortic lymphadenectomy was performed in 1992.<sup><xref rid="B15" ref-type="bibr">15</xref></sup> The main advantages of this minimally invasive approach over conventional laparotomy included a short hospital stay, less blood loss, faster recovery, less pain, less scarring, and a faster return of bowel function with equivalent assessment of lymph-node status.<sup><xref rid="B16" ref-type="bibr">16</xref></sup> However, whether or not the laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer is feasible and has advantages of various clinical factors—such as a short hospital stay, less blood loss, and faster recovery—compared with open surgery has not yet been clarified.</p><p>The current authors conducted a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer in five institutions. Clinical data were compared with those of laparotomic procedures performed in the same five institutions.</p></sec><sec sec-type="materials|methods" id="s002"><title>Materials and Methods</title><sec id="s003"><title>Participants</title><p>This was a multi-institutional cohort study of women with endometrial cancer who underwent systematic para-aortic lymphadenectomy via laparoscopy or laparotomy. A retrospective study was performed. The study involved patients from five institutions in Japan between January 2008 and March 2016: Tokyo Medical Center (Meguro-ku, Tokyo, Japan); Osaka Medical College (Takatsuki-city, Osaka, Japan); Tenriyorozu Hospital (Tenri-city, Nara, Japan); Osaka University (Suita-city, Osaka, Japan); and Kyoto University (Kyoto-city, Kyoto, Japan). The collected data, including information concerning the surgical procedures, intra- and postoperative details, as well as follow-up evaluations, were analyzed retrospectively.</p><p>The inclusion criteria for laparoscopic para-aortic lymphadenectomy were as follows: (1) tissue-proven endometrioid carcinoma of grade 3, or more than half myometrial invasion noted on preoperative magnetic resonance imaging or from an intraoperative frozen section diagnosis; (2) no regional or distal lymph-node enlargement; and (3) a tumor clinically confined to the uterus (clinical stage I) based on a preoperative evaluation.</p><p>The laparoscopic group was compared with a historical cohort of patients with endometrial cancer who had undergone surgical staging through laparotomy during the same time period. All of the patients underwent hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, and/or omentectomy by either laparoscopy or laparotomy. Extraperitoneal pelvic and para-aortic lymphadenectomy was performed in all patients. Briefly, systematic pelvic and para-aortic lymphadenectomy, which was not performed for sampling, consisted of complete skeletonization of all common, external, and internal iliac vessels, and harvesting of all fatty and lymphatic tissue above and below the obturator nerve. After the peritoneal incision, all lymphatic tissue was harvested from the lateral, anterior, and medial aspects of the vena cava and aorta to the level of the renal veins (<xref ref-type="fig" rid="f1">Fig. 1</xref>).</p><fig id="f1" fig-type="figure" orientation="portrait" position="float"><label><bold>FIG. 1.</bold></label><caption><p>Operating field of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer. The left renal vein is the cranial border of dissection that was exposed. The vena cava and the anterior aspect of the aorta were cleared. The superficial intercavoaortic nodes were also removed.</p></caption><graphic xlink:href="fig-1"></graphic></fig></sec><sec id="s004"><title>Statistical analysis</title><p>All of the statistical analyses were performed using the JMP software package (version 11.1.1; SAS, Cary, NC). Continuous variables were expressed as the mean ± standard deviation (SD). The Mann-Whitney–<italic>U</italic> test was used to compare continuous variables, and Fisher's exact test was used to compare frequencies. <italic>p</italic>-Values of <0.05 were considered to indicate statistical significance.</p></sec></sec><sec sec-type="results" id="s005"><title>Results</title><p><xref ref-type="table" rid="T1">Table 1</xref> shows the characteristics of 153 patients with endometrial cancer who underwent systematic para-aortic lymphadenectomy. Fifty-four patients underwent systematic para-aortic lymphadenectomy with laparoscopy and 99 with laparotomy. In the laparoscopic group, 21 patients had stage IA disease, 19 had stage IB disease, 5 had stage II disease, and 9 had stage III disease. In the laparotomic group, 35 patients had stage IA disease, 19 had stage IB disease, 9 had stage II disease, and 36 had stage III disease. While 74.1% of patients in the laparoscopic group had stage I disease, 54.5% had stage I disease in the laparotomic group; this indicated that the patients in the laparotomic group had more advanced disease than those in the laparoscopic group.</p><table-wrap id="T1" orientation="portrait" position="float"><label><sc>Table</sc> 1.</label><caption><p><sc>Characteristics of Patients with Endometrial Cancer Who Underwent Para-Aortic Lymphadenectomy</sc></p></caption><pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead><tr><th align="left"><italic>Characteristics</italic></th><th align="center"><italic>Laparoscopy</italic> n<italic> = 54</italic></th><th align="center"><italic>Laparotomy</italic> n<italic> = 99</italic></th></tr></thead><tbody><tr><td colspan="3" align="left"><bold>Institution</bold></td></tr><tr><td align="left"> Tokyo Medical Center</td><td align="center">20</td><td align="center">18</td></tr><tr><td align="left"> Osaka Medical College</td><td align="center">10</td><td align="center">14</td></tr><tr><td align="left"> Tenriyorozu</td><td align="center">1</td><td align="center">5</td></tr><tr><td align="left"> Osaka University</td><td align="center">4</td><td align="center">4</td></tr><tr><td align="left"> Kyoto University</td><td align="center">19</td><td align="center">58</td></tr><tr><td colspan="3" align="left"><bold>Stage</bold></td></tr><tr><td align="left"> IA</td><td align="center">21</td><td align="center">35</td></tr><tr><td align="left"> IB</td><td align="center">19</td><td align="center">19</td></tr><tr><td align="left"> II</td><td align="center">5</td><td align="center">9</td></tr><tr><td align="left"> III</td><td align="center">9</td><td align="center">36</td></tr><tr><td colspan="3" align="left"><bold>Histologic type</bold></td></tr><tr><td align="left"> G1</td><td align="center">21</td><td align="center">38</td></tr><tr><td align="left"> G2</td><td align="center">10</td><td align="center">24</td></tr><tr><td align="left"> G3</td><td align="center">17</td><td align="center">18</td></tr><tr><td align="left"> Carcinosarcoma</td><td align="center">2</td><td align="center">4</td></tr><tr><td align="left"> Clear Cell</td><td align="center">0</td><td align="center">2</td></tr><tr><td align="left"> Serous</td><td align="center">3</td><td align="center">9</td></tr><tr><td align="left"> Others</td><td align="center">1</td><td align="center">4</td></tr><tr><td colspan="3" align="left"><bold>Type of hysterectomy</bold></td></tr><tr><td align="left"> Total hysterectomy</td><td align="center">22</td><td align="center">65</td></tr><tr><td align="left"> Extended hysterectomy</td><td align="center">20</td><td align="center">0</td></tr><tr><td align="left"> Modified radical hysterectomy</td><td align="center">12</td><td align="center">23</td></tr><tr><td align="left"> Radical hysterectomy</td><td align="center">0</td><td align="center">11</td></tr><tr><td align="left">Omentectomy</td><td align="center">8 (14.8)</td><td align="center">39 (39.4)</td></tr></tbody></table></table-wrap><p>Histologically, in the laparoscopic group, 21 patients had G1 endometrioid carcinoma, 10 had G2 endometrioid carcinoma, 17 had G3 endometrioid carcinoma, 2 had carcinosarcoma, 3 had serous carcinoma, and 1 had another histologic carcinoma. In the laparotomic group, 38 patients had G1 endometrioid carcinoma, 24 had G2 endometrioid carcinoma, 18 had G3 endometrioid carcinoma, 4 had carcinosarcoma, 2 had clear cell carcinoma, 9 had serous carcinoma, and 4 had other histological carcinoma. The rate of type 1 carcinoma did not differ significantly between the groups (57.4% versus 62.6%).</p><p>In the laparoscopic group, hysterectomy was performed in 22 patients as total laparoscopic hysterectomy, in 20 patients as extended hysterectomy, and in 12 patients as modified radical hysterectomy. In the laparotomic group, hysterectomy was performed in 65 patients as total abdominal hysterectomy, in 23 patients as modified radical hysterectomy, and in 11 patients as radical hysterectomy. Omentectomy was performed in 8 patients (14.8%) in the laparoscopic group and in 39 patients (39.4%) in the laparotomic group.</p><p><xref ref-type="table" rid="T2">Table 2</xref> shows the results of the study. The mean (± SD) age of the patients (57.9 ± 11.0 versus 58.0 ± 10.3; <italic>p</italic> = 0.9) and body mass index (22.8 ± 11.0 versus 22.4 ± 4.3 kg/m<sup>2</sup>; <italic>p</italic> = 0.6) were not significantly different between the groups, nor was the mean operation time (483 ± 102 versus 481 ± 106 minutes; <italic>p</italic> = 0.9). The laparoscopic group had less intraoperative blood loss than the laparotomic group (143 ± 253 versus 988 ± 694 mL; <italic>p</italic> < 0.01). Naturally, the rate of blood transfusion was lower in laparoscopic group than in the laparotomic group (3.7% versus 10.0%; <italic>p</italic> = 0.1). The number of resected pelvic lymph nodes was less in the laparoscopic group than in the laparotomic group (31.8 ± 10.1 versus 39.9 ± 15.9; <italic>p</italic> < 0.01). The number of resected para-aortic lymph nodes was also less in the laparoscopic group than in the laparotomic group (26.2 ± 10.9 versus 31.1 ± 13.2; <italic>p</italic> = 0.02). The postoperative minimum level of hemoglobin was higher in the laparoscopic group than in the laparotomic group (10.4 ± 1.1g/dL versus 9.9 ± 1.4 g/dL; <italic>p</italic> = 0.02). In contrast, the postoperative maximum level of C-reactive protein was lower in the laparoscopic group than in the laparotomic group (6.3 ± 3.8 mg/dL versus 10.2 ± 4.9 mg/dL; <italic>p</italic> < 0.01).</p><table-wrap id="T2" orientation="portrait" position="float"><label><sc>Table</sc> 2.</label><caption><p><sc>Comparison of Para-Aortic Lymphadenectomy Between Laparoscopy and Laparotomy</sc></p></caption><pmc-comment>OASIS TABLE HERE</pmc-comment>
<table frame="hsides" rules="groups"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead><tr><th align="left"><italic>Parameter</italic></th><th align="center"><italic>Laparoscopy</italic> n<italic> = 54</italic></th><th align="center"><italic>Laparotomy</italic> n<italic> = 99</italic></th><th align="center"><italic>p-Value</italic></th></tr></thead><tbody><tr><td align="left">Age<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup> (years old)</td><td align="center">57.9 ± 11.0</td><td align="center">58.0 ± 10.3</td><td align="center">0.9</td></tr><tr><td align="left">BMI<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup></td><td align="center">22.8 ± 3.4</td><td align="center">22.4 ± 4.3</td><td align="center">0.6</td></tr><tr><td align="left">Median (SD) duration of surgery (minutes)<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup></td><td align="center">483 ± 102</td><td align="center">481 ± 106</td><td align="center">0.9</td></tr><tr><td align="left">Median (SD) EBL<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup> (mL)</td><td align="center">143 ± 253</td><td align="center">988 ± 694</td><td align="center">< 0.01</td></tr><tr><td align="left">Number of patients receiving transfusions (%)</td><td align="center">2 (3.7)</td><td align="center">10 (10.0)</td><td align="center">0.1</td></tr><tr><td align="left">Median (SD) # of pelvic lymph nodes<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup></td><td align="center">31.8 ± 10.1</td><td align="center">39.9 ± 15.9</td><td align="center">< 0.01</td></tr><tr><td align="left">Median (SD) # of para-aortic lymph nodes<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup></td><td align="center">26.2 ± 10.9</td><td align="center">31.1 ± 13.2</td><td align="center">0.02</td></tr><tr><td align="left">Minimum level of Hb<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup> (SD; g/dL)</td><td align="center">10.4 ± 1.1</td><td align="center">9.9 ± 1.4</td><td align="center">0.02</td></tr><tr><td align="left">Maximum level of CRP<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup> (SD; mg/dL)</td><td align="center">6.3 ± 3.8</td><td align="center">10.2 ± 4.9</td><td align="center">< 0.01</td></tr><tr><td align="left">Number of patients with intraoperative complications</td><td align="center">3</td><td align="center">8</td><td align="center">0.7</td></tr><tr><td align="left"> Vessel injury</td><td align="center">2</td><td align="center">6</td><td align="center">0.6</td></tr><tr><td align="left"> Ureter injury</td><td align="center">0</td><td align="center">1</td><td align="center">0.5</td></tr><tr><td align="left"> Nerve injury</td><td align="center">0</td><td align="center">1</td><td align="center">0.5</td></tr><tr><td align="left"> Compartment syndrome</td><td align="center">1</td><td align="center">0</td><td align="center">0.1</td></tr><tr><td colspan="4" align="left">Number of patients with postoperative complications</td></tr><tr><td align="left"> Urinary-tract infection</td><td align="center">0</td><td align="center">1</td><td align="center">0.5</td></tr><tr><td align="left"> Pelvic cellulitis</td><td align="center">0</td><td align="center">1</td><td align="center">0.5</td></tr><tr><td align="left"> Venous thrombosis</td><td align="center">0</td><td align="center">3</td><td align="center">0.2</td></tr><tr><td align="left"> Pulmonary embolus</td><td align="center">0</td><td align="center">3</td><td align="center">0.2</td></tr><tr><td align="left"> Bowel obstruction</td><td align="center">0</td><td align="center">0</td><td align="left"> </td></tr><tr><td align="left"> Urinary fistula</td><td align="center">0</td><td align="center">0</td><td align="left"> </td></tr><tr><td align="left"> Ileus</td><td align="center">0</td><td align="center">10</td><td align="center">0.02</td></tr><tr><td align="left"> Wound infection</td><td align="center">2</td><td align="center">3</td><td align="center">0.7</td></tr><tr><td align="left"> Lymphocyst</td><td align="center">2</td><td align="center">1</td><td align="center">0.2</td></tr><tr><td align="left"> Chyle or lymphorrhea</td><td align="center">10</td><td align="center">7</td><td align="center">0.02</td></tr><tr><td align="left"> Lymphedema</td><td align="center">2</td><td align="center">13</td><td align="center">0.07</td></tr><tr><td align="left">Median (SD) time (days) to hospital stay<sup><xref ref-type="table-fn" rid="tf1">a</xref></sup></td><td align="center">8.4 ± 5.7</td><td align="center">16.1 ± 8.0</td><td align="center">< 0.01</td></tr><tr><td align="left">Follow-up,<sup><xref ref-type="table-fn" rid="tf2">b</xref></sup> day (quantile)</td><td align="center">364 (110–681)</td><td align="center">693 (267–1222)</td><td align="center">0.01</td></tr><tr><td align="left">Recurrence (%)</td><td align="center">4 (7.4)</td><td align="center">15 (14.3)</td><td align="center">0.2</td></tr></tbody></table><table-wrap-foot><fn id="tf1"><label><sup>a</sup></label><p>Based on an analysis of variance (mean ± SD).</p></fn><fn id="tf2"><label><sup>b</sup></label><p>Median (+ interquartile ranges).</p></fn><fn id="tf3"><p>BMI, body mass index; SD, standard deviation; EBL, estimated blood loss; Hb, hemoglobin; CRP, C-reactive protein.</p></fn></table-wrap-foot></table-wrap><p>The rate of intraoperative complications was not significantly different between the groups (5.6% versus 8.1%; <italic>p</italic> = 0.7). Two vessel injuries and 1 compartment syndrome occurred in the laparoscopic group, and 6 vessel injuries, 1 ureter injury, and 1 obturator nerve injury occurred in the laparotomic group. The 2 patients with vessel injuries in the laparoscopic group were converted to laparotomy for hemostasis; the conversion rate of laparoscopic para-aortic lymphadenectomy was 3.7%.</p><p>Postoperatively, there were 1 urinary-tract infection, 1 case of pelvic cellulitis, 3 cases of venous thrombosis, and 3 cases of pulmonary embolus in the laparotomic group. No complications described above occurred in the laparoscopic group. Bowel obstruction and urinary fistula did not occur in either group. While no cases of ileus occurred in the laparoscopic group, 10 occurred in the laparotomic group. There were 2 wound infections in the laparoscopic group and 3 in the laparotomic group. There were 2 cases of lymphocyst in the laparoscopic group and 1 in the laparotomic group. The rate of chyle or lymphhorrhea was higher in the laparoscopic group than in the laparotomic group (18.5% versus 7.1%; <italic>p</italic> = 0.02). These symptoms resolved spontaneously in a few days with observation and basic support. The rate of lymphedema was lower in the laparoscopic group than in the laparotomic group (3.7% versus 13.1%; <italic>p</italic> = 0.07). The laparoscopic group tended to have shorter hospital stays than the laparotomic group (8.4 ± 5.7 days versus 16.1 ± 8.0 days; <italic>p</italic> < 0.01). The medium (quantile) duration of follow-up was 364 (110–681) days in the laparoscopic group and 693 (267–1222) days in the laparotomic group. The recurrence rate was not significantly different between the groups in the above time period (7.4% versus 14.3%; <italic>p</italic> = 0.2).</p></sec><sec sec-type="discussion" id="s006"><title>Discussion</title><p>In the current study, laparoscopic surgery with para-aortic lymph node dissection for patients at intermediate/high risk of recurrence, such as those with deeply invasive lesions, high-grade histology, and tumors of serous carcinoma, clear cell carcinoma, or carcinosarcoma features of endometrial cancer had roughly the same operation time, less intraoperative blood loss, and a shorter hospital stay than laparotomic surgery. The rate of intraoperative complication was not significantly different between the groups.</p><p>There have been several studies demonstrating the feasibility of laparoscopic surgery for patients with endometrial cancer. In these studies, laparoscopic surgery involved less intraoperative blood loss and shorter hospital stays than laparotomic surgery.<sup><xref rid="B16" ref-type="bibr">16–21</xref></sup> The Gynecologic Oncology Group's LAP 2 study, which was a multicenter randomized trial comparing treatment of endometrial cancer performed by laparoscopy versus laparotomy, demonstrated not only the short-term feasibility of laparoscopy but also its noninferiority with regard to long-term prognosis, compared with laparotomy. In this study, both pelvic lymphadenectomy and para-aortic lymphadenectomy were performed in 91.5% of laparoscopy patients and in 95.8% of laparotomy patients. The median operation time was 204 minutes for laparoscopy and 130 minutes for laparotomy.<sup><xref rid="B16" ref-type="bibr">16</xref></sup> However, there was substantial variation between the procedures in operative time, which is based on the extent of the procedure, how radical it is, the number of yielded nodes, and the experience and learning curve of the surgical team. In the current study, similar feasibility was found for laparoscopy, including relatively little blood loss, a similar operative time, and shorter hospital stays than for laparotomy.</p><p>The number of dissected lymph nodes was fewer in the laparoscopic group than in the laparotomic group. The appropriate number of lymph nodes to be removed remains controversial. What is adequate lymph-node dissection? How many lymph nodes should be removed? While these questions remain unanswered, several studies have clarified the median number of removed lymph nodes. In Kilgore et al.'s study, the median number of removed lymph nodes for a biopsy was 11,<sup><xref rid="B1" ref-type="bibr">1</xref></sup> while Chuang et al. removed a median of 9 lymph nodes.<sup><xref rid="B22" ref-type="bibr">22</xref></sup> In Chan et al.'s retrospective review of the SEER [Surveillance, Epidemiology, and End Results] database, extensive lymph node dissection improved the 5-year disease-specific survival in patients with >20 lymph nodes removed.<sup><xref rid="B23" ref-type="bibr">23</xref></sup> Lutman et al. reported that ≥12 removed lymph nodes was a major influential factor affecting the outcome of patients with high-risk endometrial cancer.<sup><xref rid="B24" ref-type="bibr">24</xref></sup> In the SEPAL [survival effect of para-aortic lymphadenectomy] study, Todo showed that para-aortic lymphadenectomy improved the prognosis of patients with intermediate- to high-risk endometrial cancer. The median number of para-aortic lymph nodes removed in that study was 23.<sup><xref rid="B11" ref-type="bibr">11</xref></sup></p><p>In the current study, 26.2 lymph nodes was the median number of para-aortic lymph nodes resected by laparoscopy, which the current authors believe was a permissible number, although a longer follow-up will be needed before long-term survival can be evaluated accurately.</p><p>There have been several studies on complications associated with laparoscopic para-aortic lymphadenectomy. In the LAP 2 study described above, the rate of intraoperative complications was not significantly different between the laparoscopy and laparotomy groups (10% versus 8%). However, the percentage of patients with arterial bleeding was significantly higher in the laparoscopy group than in the laparotomy group (1.8% versus 0.7%). Of the 30 laparoscopy patients who had arterial bleeding, 11 cases were controlled without conversion to laparotomy. The rate of postoperative complications was lower in the laparoscopy patients than in the laparotomy patients. Ileus and cardiac arrhythmia were more common in the laparotomy group.<sup><xref rid="B16" ref-type="bibr">16</xref></sup> In the current study, 2 patients in the laparoscopic group had intraoperative vessel injury, which resulted in conversion to laparotomy. Postoperatively, the rate of complications was lower in the laparoscopic group than in the laparotomic group.</p><p>Several limitations associated with the present study warrant mention. First, a multivariate analysis could not be performed due to the small sample size. Second, long-term prognosis could not be determined within the short follow-up period. However, the current authors believe that laparoscopic para-aortic lymphadenectomy is feasible and can be substituted for laparotomic procedures for patients with early stage endometrial cancer.</p></sec><sec sec-type="conclusions" id="s007"><title>Conclusions</title><p>This laparoscopic procedure had a similar mean operation time, lower rate of intraoperative hemorrhaging, and shorter hospital stay than the laparotomic procedure. The rate of intra- and postoperative complications was not significantly different between the groups. While fewer lymph nodes were dissected in the laparoscopic group than in the laparotomic group, the numbers were still in the permissible range. Taken together, these findings suggest that laparoscopic systematic para-aortic lymphadenectomy was safe and feasible, compared with laparotomic systematic para-aortic lymphadenectomy.</p></sec></body><back><sec id="s008" sec-type="COI-statement"><title>Author Disclosure Statement</title><p>The authors declare no conflicts of interest in association with this study.</p></sec><ref-list content-type="parsed"><title>References</title><ref id="B1"><label>1</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kilgore</surname><given-names>LC</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Partridge</surname><given-names>EE</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Alvarez</surname><given-names>RD</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Austin</surname><given-names>JM</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Shingleton</surname><given-names>HM</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Noojin</surname><given-names>F</given-names><suffix>3rd</suffix></name></person-group>, <person-group person-group-type="author"><name><surname>Conner</surname><given-names>W</given-names></name></person-group><article-title>Adenocarcinoma of the endometrium: Survival comparisons of patients with and without pelvic node sampling</article-title>. <source>Gynecol Oncol</source><year>1995</year>;<volume>56</volume>:<fpage>29</fpage><pub-id pub-id-type="pmid">7821843</pub-id></mixed-citation></ref><ref id="B2"><label>2</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fanning</surname><given-names>J</given-names></name></person-group><article-title>Long-term survival of intermediate risk endometrial cancer (stage IG3, IC, II) treated with full lymphadenectomy and brachytherapy without teletherapy</article-title>. <source>Gynecol Oncol</source><year>2001</year>;<volume>82</volume>:<fpage>371</fpage><pub-id pub-id-type="pmid">11531297</pub-id></mixed-citation></ref><ref id="B3"><label>3</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Takeshima</surname><given-names>N</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Hirai</surname><given-names>Y</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Tanaka</surname><given-names>N</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Yamawaki</surname><given-names>T</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Yamauchi</surname><given-names>K</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Hasumi</surname><given-names>K</given-names></name></person-group><article-title>Pelvic lymph node metastasis in endometrial cancer with no myometrial invasion</article-title>. <source>Obstet Gynecol</source><year>1996</year>;<volume>88</volume>:<fpage>280</fpage><pub-id pub-id-type="pmid">8692516</pub-id></mixed-citation></ref><ref id="B4"><label>4</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Larson</surname><given-names>DM</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Broste</surname><given-names>SK</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Krawisz</surname><given-names>BR</given-names></name></person-group><article-title>Surgery without radiotherapy for primary treatment of endometrial cancer</article-title>. <source>Obstet Gynecol</source><year>1998</year>;<volume>91</volume>:<fpage>355</fpage><pub-id pub-id-type="pmid">9491859</pub-id></mixed-citation></ref><ref id="B5"><label>5</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cragun</surname><given-names>JM</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Havrilesky</surname><given-names>LJ</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Calingaert</surname><given-names>B</given-names></name>, <etal>et al.</etal></person-group><article-title>Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer</article-title>. <source>J Clin Oncol</source><year>2005</year>;<volume>23</volume>:<fpage>3668</fpage><pub-id pub-id-type="pmid">15738538</pub-id></mixed-citation></ref><ref id="B6"><label>6</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Trimble</surname><given-names>EL</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kosary</surname><given-names>C</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Park</surname><given-names>RC</given-names></name></person-group><article-title>Lymph node sampling and survival in endometrial cancer</article-title>. <source>Gynecol Oncol</source><year>1998</year>;<volume>71</volume>:<fpage>340</fpage><pub-id pub-id-type="pmid">9887227</pub-id></mixed-citation></ref><ref id="B7"><label>7</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ayhan</surname><given-names>A</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Tuncer</surname><given-names>R</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Tuncer</surname><given-names>ZS</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Yuce</surname><given-names>K</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kucukali</surname><given-names>T</given-names></name></person-group><article-title>Correlation between clinical and histopathologic risk factors and lymph node metastases in early endometrial cancer (a multivariate analysis of 183 cases)</article-title>. <source>Int J Gynecol Cancer</source><year>1994</year>;<volume>4</volume>:<fpage>306</fpage><pub-id pub-id-type="pmid">11578422</pub-id></mixed-citation></ref><ref id="B8"><label>8</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yenen</surname><given-names>MC</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Dilek</surname><given-names>S</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Dede</surname><given-names>M</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Goktolga</surname><given-names>U</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Deveci</surname><given-names>MS</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Aydogu</surname><given-names>T</given-names></name></person-group><article-title>Pelvic-paraaortic lymphadenectomy in clinical stage I endometrial adenocarcinoma: A multicenter study</article-title>. <source>Eur J Gynaecol Oncol</source><year>2003</year>, <volume>24</volume>(<issue>3–4</issue>):<fpage>327</fpage>–<lpage>329</lpage><pub-id pub-id-type="pmid">12807250</pub-id></mixed-citation></ref><ref id="B9"><label>9</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lo</surname><given-names>KW</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Cheung</surname><given-names>TH</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Yu</surname><given-names>MY</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Yim</surname><given-names>SF</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Chung</surname><given-names>TK</given-names></name></person-group><article-title>The value of pelvic and para-aortic lymphadenectomy in endometrial cancer to avoid unnecessary radiotherapy</article-title>. <source>Int J Gynecol Cancer</source><year>2003</year>;<volume>13</volume>:<fpage>863</fpage><pub-id pub-id-type="pmid">14675325</pub-id></mixed-citation></ref><ref id="B10"><label>10</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Todo</surname><given-names>Y</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Okamoto</surname><given-names>K</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Hayashi</surname><given-names>M</given-names></name>, <etal>et al.</etal></person-group><article-title>A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy</article-title>. <source>Gynecol Oncol</source><year>2007</year>;<volume>104</volume>:<fpage>623</fpage><pub-id pub-id-type="pmid">17097721</pub-id></mixed-citation></ref><ref id="B11"><label>11</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Todo</surname><given-names>Y</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kato</surname><given-names>H</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kaneuchi</surname><given-names>M</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Watari</surname><given-names>H</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Takeda</surname><given-names>M</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Sakuragi</surname><given-names>N</given-names></name></person-group><article-title>survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): A retrospective cohort analysis</article-title>. <source>Lancet</source><year>2010</year>;<volume>375</volume>:<fpage>1165</fpage><pub-id pub-id-type="pmid">20188410</pub-id></mixed-citation></ref><ref id="B12"><label>12</label><mixed-citation publication-type="other"><collab>National Comprehensive Cancer Network (NCCN)</collab>. <article-title>NCCN Guidelines, Version 2.2016: Uterine Neoplasms</article-title>, <year>2016</year></mixed-citation></ref><ref id="B13"><label>13</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fagotti</surname><given-names>A</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Fanfani</surname><given-names>F</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Ercoli</surname><given-names>A</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Giordano</surname><given-names>MA</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Sallustio</surname><given-names>G</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Scambia</surname><given-names>G</given-names></name></person-group><article-title>Postoperative ileus after para-aortic lymphadenectomy: A prospective study</article-title>. <source>Gynecol Oncol</source><year>2007</year>;<volume>104</volume>:<fpage>46</fpage><pub-id pub-id-type="pmid">16919717</pub-id></mixed-citation></ref><ref id="B14"><label>14</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fujita</surname><given-names>K</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Nagano</surname><given-names>T</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Suzuki</surname><given-names>A</given-names></name>, <etal>et al.</etal></person-group><article-title>Incidence of postoperative ileus after paraaortic lymph node dissection in patients with malignant gynecologic tumors</article-title>. <source>Int J Clin Oncol</source><year>2005</year>;<volume>10</volume>:<fpage>187</fpage><pub-id pub-id-type="pmid">15990967</pub-id></mixed-citation></ref><ref id="B15"><label>15</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Childers</surname><given-names>JM</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Surwit</surname><given-names>EA</given-names></name></person-group><article-title>Combined laparoscopic and vaginal surgery for the management of two cases of stage I endometrial cancer</article-title>. <source>Gynecol Oncol</source><year>1992</year>;<volume>45</volume>:<fpage>46</fpage><pub-id pub-id-type="pmid">1534780</pub-id></mixed-citation></ref><ref id="B16"><label>16</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Walker</surname><given-names>JL</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Piedmonte</surname><given-names>MR</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Spirtos</surname><given-names>NM</given-names></name>, <etal>et al.</etal></person-group><article-title>Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2</article-title>. <source>J Clin Oncol</source><year>2009</year>;<volume>27</volume>:<fpage>5331</fpage><pub-id pub-id-type="pmid">19805679</pub-id></mixed-citation></ref><ref id="B17"><label>17</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chu</surname><given-names>LH</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Chang</surname><given-names>WC</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Sheu</surname><given-names>BC</given-names></name></person-group><article-title>Comparison of the laparoscopic versus conventional open method for surgical staging of endometrial carcinoma</article-title>. <source>Taiwan J Obstet Gynecol</source><year>2016</year>;<volume>55</volume>:<fpage>188</fpage><pub-id pub-id-type="pmid">27125400</pub-id></mixed-citation></ref><ref id="B18"><label>18</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Obermair</surname><given-names>A</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Manolitsas</surname><given-names>TP</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Leung</surname><given-names>Y</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Hammond</surname><given-names>IG</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>McCartney</surname><given-names>AJ</given-names></name></person-group><article-title>Total laparoscopic hysterectomy for endometrial cancer: Patterns of recurrence and survival</article-title>. <source>Gynecol Oncol</source><year>2004</year>;<volume>92</volume>:<fpage>789</fpage><pub-id pub-id-type="pmid">14984942</pub-id></mixed-citation></ref><ref id="B19"><label>19</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tozzi</surname><given-names>R</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Malur</surname><given-names>S</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Koehler</surname><given-names>C</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Schneider</surname><given-names>A</given-names></name></person-group><article-title>Laparoscopy versus laparotomy in endometrial cancer: First analysis of survival of a randomized prospective study</article-title>. <source>J Minim Invasive Gynecol</source><year>2005</year>;<volume>12</volume>:<fpage>130</fpage><pub-id pub-id-type="pmid">15904616</pub-id></mixed-citation></ref><ref id="B20"><label>20</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Holub</surname><given-names>Z</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Jabor</surname><given-names>A</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Bartos</surname><given-names>P</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Eim</surname><given-names>J</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Urbanek</surname><given-names>S</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Pivovarnikova</surname><given-names>R</given-names></name></person-group><article-title>Laparoscopic surgery for endometrial cancer: Long-term results of a multicentric study</article-title>. <source>Eur J Gynaecol Oncol</source><year>2002</year>;<volume>23</volume>:<fpage>305</fpage><pub-id pub-id-type="pmid">12214729</pub-id></mixed-citation></ref><ref id="B21"><label>21</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cho</surname><given-names>YH</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kim</surname><given-names>DY</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kim</surname><given-names>JH</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kim</surname><given-names>YM</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kim</surname><given-names>YT</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Nam</surname><given-names>JH</given-names></name></person-group><article-title>Laparoscopic management of early uterine cancer: 10-year experience in Asan Medical Center</article-title>. <source>Gynecol Oncol</source><year>2007</year>;<volume>106</volume>:<fpage>585</fpage><pub-id pub-id-type="pmid">17583776</pub-id></mixed-citation></ref><ref id="B22"><label>22</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chuang</surname><given-names>L</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Burke</surname><given-names>TW</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Tornos</surname><given-names>C</given-names></name>, <etal>et al.</etal></person-group><article-title>Staging laparotomy for endometrial carcinoma: Assessment of retroperitoneal lymph nodes</article-title>. <source>Gynecol Oncol</source><year>1995</year>;<volume>58</volume>:<fpage>189</fpage><pub-id pub-id-type="pmid">7622103</pub-id></mixed-citation></ref><ref id="B23"><label>23</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>JK</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Cheung</surname><given-names>MK</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Huh</surname><given-names>WK</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Osann</surname><given-names>K</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Husain</surname><given-names>A</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Teng</surname><given-names>NN</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Kapp</surname><given-names>DS</given-names></name></person-group><article-title>Therapeutic role of lymph node resection in endometrioid corpus cancer: A study of 12,333 patients</article-title>. <source>Cancer</source><year>2006</year>;<volume>107</volume>:<fpage>1823</fpage><pub-id pub-id-type="pmid">16977653</pub-id></mixed-citation></ref><ref id="B24"><label>24</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lutman</surname><given-names>CV</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Havrilesky</surname><given-names>LJ</given-names></name></person-group>, <person-group person-group-type="author"><name><surname>Cragun</surname><given-names>JM</given-names></name>, <etal>et al.</etal></person-group><article-title>Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology</article-title>. <source>Gynecol Oncol</source><year>2006</year>;<volume>102</volume>:<fpage>92</fpage><pub-id pub-id-type="pmid">16406063</pub-id></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 004079 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 004079 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= LymphedemaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé=
|texte=
}}
| This area was generated with Dilib version V0.6.31. |  |