Comparative analysis of surgical approaches for para-aortic lymphadenectomy in endometrial cancer patients

Background. To date, the role of lymphadenectomy in stage I endometrial cancer has been relegated to the background in favor of sentinel lymph node biopsy. Taking into account the new data on the improved survival in patients at high risk of lymph node metastasis after pelvic and para-aortic lymphadenectomy and the tendency to upstaging in accordance with the new FIGO 2023 classification, the problem of performing para-aortic lymphadenectomy becomes relevant again. The study objective : a comparative analysis of surgical accesses used in performing lumbar lymphadenectomy in endometrial cancer patients with an emphasis on the disadvantages and advantages of each surgical approach. Material and Methods . Medical records of 122 endometrial cancer patients treated at the S. P. Botkin Moscow Medical Scientific Center were retrospectively analyzed. The study included patients undergoing pelvic and para-aortic lymphadenectomy, and hysterectomy through four surgical access methods: laparotomy (n=28), laparoscopic transabdominal (n=30), laparoscopic retroperitoneal (n=41) and robot-assisted retroperitoneal (n=23). The following parameters were compared between the subgroups: body mass index of patients, duration of surgery, number of removed pelvic and para-aortic lymph nodes, frequency of achieving III and IV levels of lymphadenectomy, frequency of intraand postoperative complications, length of hospital stay in the postoperative period, and frequency of transfers to intensive care unit. Results. Compared with other subgroups, surgery performed via laparoscopic retroperitoneal access was characterized by the shortest duration of surgery, high frequency of achieving level IV lymphadenectomy and acceptable level of intraand postoperative complications. Conclusion . Laparoscopic retroperitoneal access was found to have greatest advantageous in performing lumbar lymphadenectomy.