The Safety and Feasibility of Robotic-Assisted Lymph Node Staging in Early-Stage Ovarian Cancer

• Published in: International journal of gynecological cancer Vol. 24; no. 8; pp. 1493 - 1498
• Main Authors: Brown, John V, Mendivil, Alberto A, Abaid, Lisa N, Rettenmaier, Mark A, Micha, John P, Wabe, Marie A, Goldstein, Bram H
• Format: Journal Article
• Language: English
• Published: England by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology 01.10.2014; BMJ Publishing Group LTD
• Subjects: Aorta; Carcinoma, Ovarian Epithelial; Feasibility Studies; Female; Humans; Lymph Node Excision - adverse effects; Lymph Node Excision - instrumentation; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Metastasis; Middle Aged; Neoplasm Staging - instrumentation; Neoplasm Staging - methods; Neoplasms, Glandular and Epithelial - epidemiology; Neoplasms, Glandular and Epithelial - pathology; Ovarian cancer; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - pathology; Patients; Pelvis; Postoperative Complications - epidemiology; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Surgical outcomes
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1097/IGC.0000000000000224

OBJECTIVESThe purpose of this study was to report on the safety and feasibility of robotic-assisted systematic lymph node staging in the management of early-stage ovarian cancer. METHODSWe retrospectively reviewed the charts of presumed early-stage (International Federation of Gynecology and Obstetrics (FIGO) stages I and II) ovarian cancer patients who underwent robotic-assisted surgery that incorporated a systematic pelvic and para-aortic lymphadenectomy from January 2009 until December 2013. Patient demographics, operative characteristics, pathology, lymph node counts, surgical complications, and hospital stay were evaluated. RESULTSA total of 26 early-stage ovarian cancer patients were identified. The mean operating time was 2.90 hours, and the estimated blood loss was 63 mL; there were no intraoperative complications although 1 patient’s surgery was significantly prolonged due to pelvic adhesions. The mean number of pelvic and para-aortic lymph nodes removed was 14.6 (2.3% incidence of pelvic lymph node metastases) and 5.8 (3.3% incidence of para-aortic lymph node metastases), respectively. The patients’ mean duration of hospital stay was 18.4 hours, and 2 patients were readmitted for either a postoperative wound infection or vaginal dehiscence. CONCLUSIONSThe results from this study suggest that robotic-assisted surgical staging in the management of presumed early-stage ovarian cancer is both feasible and associated with a minimal patient complication rate. We encountered a low incidence of lymph node metastases, and the readmission rate was favorable. Nevertheless, because the prevalence of lymph node metastases can approach 20% in select patients, physicians should consider a systematic lymph node resection to confer an optimal clinical assessment.