Minimally invasive salvage lymphadenectomy in gynecological cancer patients: A single institution series

• Published in: European journal of surgical oncology 2018-10, Vol.44 (10), p.1568-1572
• Main Authors: Gallotta, Valerio, Giudice, Maria Teresa, Conte, Carmine, Sarandeses, Alicia Vazquez, D'Indinosante, Marco, Federico, Alex, Tortorella, Lucia, Carbone, Maria Vittoria, Gueli Alletti, Salvatore, Vizzielli, Giuseppe, Costantini, Barbara, Scambia, Giovanni, Ferrandina, Gabriella
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aorta; Celiac Artery; Disease-Free Survival; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Feasibility Studies; Female; Humans; Innovative technologies in surgery; Intraoperative Complications - etiology; Liver; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Lymphatic Metastasis; Metastasectomy - adverse effects; Metastasectomy - methods; Middle Aged; Minimally invasive lymphadenectomy; Minimally Invasive Surgical Procedures - adverse effects; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Pelvis; Personalized medicine; Postoperative Complications - etiology; Recurrence; Recurrent gynecological cancers; Retrospective Studies; Robotic surgery; Salvage Therapy - adverse effects; Salvage Therapy - methods; Secondary cytoreduction; Survival Rate; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2018.08.006

to assess the feasibility of minimally invasive surgery in the management of lymph-nodal recurrences of gynecological cancers, in terms of surgical and oncological outcomes. we retrospectively collected patients with isolated lymph-nodal recurrent disease of gynecological malignancies who underwent to minimally invasive lymphadenectomy at Catholic University of the Sacred Hearth in Rome (Italy), from January 2013 to November 2017. Forty patients were considered eligible (31 LPS, 9 Robot); 24 (60.0%) with an ovarian cancer, 8 (20.0%) with a cervical cancer and 8 (20.0%) with an endometrial cancer recurrence. The most frequent site of lymph-nodal recurrence was represented by the aortic region (47.5%), while 18 patients (45.0%) experiencing pelvic lymph-nodal recurrence, 2 (5.0%) both pelvic and aortic relapse, and only 1 (2.5%) had an hepato-celiac lymph node recurrence. No patient required a laparotomic conversion. Median operative time was 220 min, median EBL was 80 mL, and median post-operative hospital stay was 2 days. There were 2 (5.0%) intra-operative and 4 (10.0%) post-operative complications, of which 2 were grade 3. The median follow-up was 22.5 months, and during this time 15 patients showed another relapse with a median time to progression of 12 months. Seven women died because of the disease. The 2-year post-relapse disease-free survival (PR-DFS) was 54.7%, and the 2-year post-relapse overall survival (PR-OS) was 79.3%. In our experience minimally invasive surgery is a valid therapeutic approach in very select patients with localized lymph-nodal recurrence of gynecological cancers, with benefits about peri and post-operative morbidities and without compromising their oncological outcome.