Comparison of the Efficacy of Laparoscopic Extraperitoneal versus Transperitoneal Para-Aortic Lymphadenectomy in the Treatment of Gynecological Malignancies: A Meta-Analysis

Background: To evaluate the efficacy of laparoscopic para-aortic lymphadenectomy in the treatment of gynecologic malignancies through a literature review comparing the extraperitoneal and transperitoneal approaches. Methods: A comprehensive computerized search of PubMed, Embase, the Cochrane Library, Medline, Web of Science, and other relevant databases was conducted, covering the period from January 2010 to January 2025, to collect studies that compared the transperitoneal and extraperitoneal approaches to laparoscopic para-aortic lymphadenectomy in the treatment of gynecologic malignancies. Relevant data were extracted and analyzed using the Review Manager (RevMan) version 5.4.1 statistical software. Outcome indexes included operation time, intraoperative blood loss, number of para-aortic lymph nodes dissected, hospitalization days, and incidence of surgical complications. Results: A total of 525 manuscripts were retrieved, of which 8 were included. Our analysis showed no statistically significant differences between the extraperitoneal and transperitoneal groups in terms of operative time, intraoperative bleeding, and hospitalization days. However, the complication rate was significantly lower in the extraperitoneal group than in the transperitoneal group. Additionally, the number of para-aortic lymph nodes (PAL) retrieved was significantly higher in the extraperitoneal group compared to the transperitoneal group [mean difference (MD) = 0.43, 95% confidence intervals (CI) (0.13 to 0.72, p = 0.004)]. Conclusion: Laparoscopic para-aortic lymphadenectomy for gynecologic malignancies offers several advantages when performed via the extraperitoneal route. This approach reduces surgical trauma, shortens hospital stay, lowers the rate of complication, and increases the number of lymph nodes that can be resected compared to the transperitoneal route. Registration: The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251033897; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251033897).