James, Jeffrey A., Rakowski, Joseph A., Jeppson, Corinne N., Stavitzski, Nicole M., Ahmad, Sarfraz, Holloway, Robert W.
abstract
Objectives. To assess the clinical performance of robotic-assisted infra-renal aortic lymphadenectomy (IRL) using a single center-docked approach for patients with endometrial cancer. Methods. Robotic-assisted hysterectomy with pelvic and aortic lymphadenectomy was performed in 97 clinical stage I endometrial cancer (EC) patients with the intent to remove infra-renal aortic lymph nodes. Pen-operative data was contemporaneously accessioned and a retrospective database analysis was performed to examine clinical outcomes. Results. IRL versus infra-mesenteric artery (IMA) dissections were accomplished in 88 (90.7%) and nine (93%) cases, respectively. There were no laparotomy conversions. Histology included 20.6% G1, 41.2% G2, and 38.1% G3 (endometrioid and Type II histologies). Forty-four (45.4%) cases had >50% depth-of-invasion and 43 (44.3%) cases had lymphovascular space invasion. Lymph node metastases were detected in 39 (40.2%) cases [37 (38.1%) pelvic, 16 (16.5%) pelvic + aortic, two (2.1%) isolated aortic lymph nodes]. Aortic metastasis was identified in 16/37 (43.2%) pelvic node positive cases, and 6/34 (17.7%) IRL cases with positive pelvic nodes had infra-renal metastasis, yet normal aortic nodes below the IMA. Harvested aortic lymph nodes for IRL exceeded IMA cases (15.9 +/- 6.3 vs. 8.9 +/- 4.6; p < 0.01). Mean BMI for IMA cases exceeded IRL cases (37.4 +/- 3.3 vs. 31.4 +/- 7.1 kg/m(2); p <0.001). Twenty-five (81%) patients with BMI >35 kg/m(2) underwent successful IRL (range 36-47 kg/m(2)) compared to 95% of cases <35 kg/m(2) (p = 0.03). Conclusions. IRL was accomplished in 95% of EC patients with BMI <35 kg/m(2) and 81% with BMI >35 kg/m(2) using a single center-docked approach. A strict 35 kg/m(2) BMI cut-off for avoiding IRL is therefore not advised. (C) 2014 Elsevier Inc. All rights reserved.