Para-aortic lymph node dissection with or without nerve-sparing in gynecological malignancies

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Nerve-Sparing Techniques

Background:

• Para-aortic lymph node dissection (PALND) is a standard treatment for gynecological malignancies.
• Conventional PALND is associated with significant post-operative complications.
• Minimally invasive surgical approaches are being explored to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND).
• To compare NSPALND with conventional PALND in patients with gynecological malignancies.
• To determine if locating the superior hypogastric plexus (SHP) facilitates para-aortic nerve identification.

Main Methods:

• Retrospective study of 43 patients undergoing para-aortic lymphadenectomy (January 2020 - December 2022).
• Patients divided into NSPALND (n=20) and conventional PALND (n=23) groups.
• Evaluation of surgical, functional, and oncological outcomes.

Main Results:

• Para-aortic nerves were successfully identified in all NSPALND cases using the SHP landmark.
• NSPALND group showed significantly shorter post-operative anal exhaust time (2.5 vs. 4 days, p=0.006).
• Acute intestinal obstruction incidence was significantly lower in the NSPALND group (10% vs. 39%, p=0.029).
• No significant differences in urinary function, lymph node yield, or recurrence rates between groups.

Conclusions:

• NSPALND is effective in reducing acute intestinal obstruction and improving post-operative intestinal function.
• Utilizing the SHP as an anatomical landmark for para-aortic nerve identification is feasible.
• Further research is needed to fully establish the clinical value of NSPALND.