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Updated: Jun 29, 2026
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Extra-peritoneal laparoscopic para-aortic lymphadenectomy--a prospective cohort study of 293 patients with
Sean C Dowdy1, Giovanni Aletti, William A Cliby
1Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. dowdy.sean@mayo.edu
Objective:
To determine if extra-peritoneal laparoscopic para-aortic (PA) lymphadenectomy allows a reliable assessment of PA nodes in patients with endometrial cancer (EC).
Methods:
In October of 2005, a single surgeon began performing extra-peritoneal laparoscopic PA lymphadenectomy for patients with EC. A prospective cohort study was initiated from October 2005 through October 2007. Staging of Group A included extra-peritoneal laparoscopic PA lymphadenectomy, while Group B underwent staging via laparotomy.
Results:
In a 24 month period, 293 patients underwent surgical treatment for EC, 203 of them underwent complete staging as determined by previously published criteria. Extra-peritoneal laparoscopic PA lymphadenectomy to the renal veins was successful in 35/38 patients (92%). Mean BMI was 33.0 for Group A and 32.3 for Group B (p=NS). Mean EBL and hospital stay were lower in Group A compared to Group B (163 vs 373 cm(3), p<0.0001; median 2 vs 4 nights, p<0.001). The total number of PA nodes harvested was not statistically different between Groups A and B (16.5 vs 19.6). Interestingly, in Group A the total number of PA nodes was greater for patients with BMI>35, (21.6 vs 13.1), while in Group B fewer nodes were removed in obese patients (17.8 vs 20.5).
Conclusions:
Extra-peritoneal laparoscopy is a reliable method to routinely reach the level of the renal veins, even in obese patients. This approach was feasible in over 90% of unselected patients and well-tolerated.
