Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer

•Infra-renal lymphadenectomy using a center-docked approach for 97 patients with endometrial cancer was accomplished in 91% of cases.•Infra-renal lymphadenectomy was accomplished in 81% cases with BMI > 35 kg/m2.•Isolated aortic lymph node metastasis was present in two (2.1%) cases.

ObjectivesTo assess the clinical performance of robotic-assisted infra-renal aortic lymphadenectomy (IRL) using a single center-docked approach for patients with endometrial cancer.MethodsRobotic-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. Peri-operative data was contemporaneously accessioned and a retrospective database analysis was performed to examine clinical outcomes.ResultsIRL versus infra-mesenteric artery (IMA) dissections were accomplished in 88 (90.7%) and nine (9.3%) 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/m2; p < 0.001). Twenty-five (81%) patients with BMI > 35 kg/m2 underwent successful IRL (range 36-47 kg/m2) compared to 95% of cases < 35 kg/m2 (p = 0.03).ConclusionsIRL was accomplished in 95% of EC patients with BMI < 35 kg/m2 and 81% with BMI > 35 kg/m2 using a single center-docked approach. A strict 35 kg/m2 BMI cut-off for avoiding IRL is therefore not advised.