(1) The surgical method of choice for the treatment of endometrial cancer is minimally invasive surgery. In cases of high-risk endometrial cancer, completed paraaortic and pelvic lymphadenectomy are indicated. The aim of this study was to analyze the types of docking during robotic surgery assisted with the da Vinci X system while performing paraaortic and pelvic lymphadenectomy. (2) Methods: A total of 25 patients with high-risk endometrial cancer, with a mean age of 60.07 ± 10.67 (range 34.69-83.23) years, and with a mean body mass index (BMI) of 28.4 ± 5.62 (range 18-41.5) kg/m2, were included in this study. The analyzed population was divided into groups that underwent single or dual docking during surgery. (3) Results: No statistical significance was observed between single and dual docking during paraaortic and pelvic lymphadenectomy and between the type of docking and the duration of the operation. However, there was a statistically significant correlation between the duration of the operation and previous surgery (p < 0.005). The number of removed lymph nodes was statistically associated with BMI (p < 0.005): 15.87 ± 6.83 and 24.5 ± 8.7 for paraaortic and pelvic lymph nodes, respectively, in cases of single docking, and 18.05 ± 7.92 and 24.88 ± 11.75 for paraaortic and pelvic lymph nodes, respectively, in cases of dual docking. (4) Conclusions: The robot-assisted approach is a good surgical method for lymphadenectomy for obese patients, and, despite the type of docking, there are no differences in the quality of surgery.

Department of Obstetrics and Gynecology University Hospital Palacky University Olomouc 779 00 Olomouc Czech Republic

Faculty of Mechanical Engineering Cracow University of Technology Al Jana Pawła 2 37 31 864 Cracow Poland

Faculty of Medicine and Health Sciences Andrzej Frycz Modrzewski Krakow University 30 705 Cracow Poland

Faculty of Medicine Lazarski University 02 662 Warsaw Poland

LUX MED Oncology Hospital św Wincentego 103 03 291 Warsaw Poland

Neo Hospital Kostrzewskiego 47 30 437 Cracow Poland

Zobrazit více v PubMed

Concin N., Matias-Guiu X., Vergote I., Cibula D., Mirza M., Marnitz S., Ledermann J., Bosse T., Chargari C., Fagotti A., et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int. J. Gynecol. Cancer. 2021;31:12–39. doi: 10.1136/ijgc-2020-002230. PubMed DOI

Gray L. Lymph node excision in the treatment of gynecologic malignancies. Am. J. Surg. 1964;108:660–663. doi: 10.1016/0002-9610(64)90109-6. PubMed DOI

Lewis G. Surgery for Endometrial Cancer. Cancer. 1981;48:568–574. doi: 10.1002/1097-0142(19810715)48:1+<568::AID-CNCR2820481321>3.0.CO;2-2. PubMed DOI

Creasman W., Morrow C., Bundy B., Homesley H., Graham J., Heller P. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60:2035–2041. doi: 10.1002/1097-0142(19901015)60:8+<2035::AID-CNCR2820601515>3.0.CO;2-8. PubMed DOI

Aalders J., Thomas G. Endometrial cancer-revisiting the importance of pelvic and para aortic lymph nodes. Gynecol. Oncol. 2007;104:222–231. doi: 10.1016/j.ygyno.2006.10.013. PubMed DOI

Mariani A., Webb M., Rao S., Lesnick T., Podratz K. Significance of pathologic patterns of pelvic lymph node metastases in endometrial cancer. Gynecol. Oncol. 2001;80:113–120. doi: 10.1006/gyno.2000.6050. PubMed DOI

Mariani A., Dowdy S.C., Cliby W.A., Gostout B.S., Jones M.B., Wilson T.O., Podratz K.C. Prospective assessment of lymphatic dissemination in endometrial cancer: A paradigm shift in surgical staging. Gynecol. Oncol. 2008;109:11–18. doi: 10.1016/j.ygyno.2008.01.023. PubMed DOI PMC

Kodama S., Kase H., Tanaka K., Matsui K. Multivariate analysis of prognostic factors in patients with endometrial cancer. Int. J. Gynaecol. Obstet. 1996;53:23–30. doi: 10.1016/0020-7292(95)02643-6. PubMed DOI

Fisher B. The revolution in breast cancer surgery: Science or anecdotalism? World J. Surg. 1985;9:655–666. doi: 10.1007/BF01655177. PubMed DOI

Hellman S. Karnofsky Memorial Lecture. Natural history of small breast cancers. J. Clin. Oncol. 1994;12:2229–2234. doi: 10.1200/JCO.1994.12.10.2229. PubMed DOI

Kitchener H., Swart A., Qian Q., Amos C., Parmar M. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet. 2009;373:125–136. doi: 10.1016/S0140-6736(08)61766-3. PubMed DOI PMC

Panici P.B., Basile S., Maneschi F., Lissoni A.A., Signorelli M., Scambia G., Angioli R., Tateo S., Mangili G., Katsaros D., et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical trial. J. Natl. Cancer Inst. 2008;100:1707–1716. doi: 10.1093/jnci/djn397. PubMed DOI

Lee H.J., Lee Y.H., Chong G.O., Hong D.G., Lee Y.S. Comparison of robotic-assisted versus laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy in patients with endometrial cancer. J. Obstet. Gynaecol. Res. 2018;44:547–555. doi: 10.1111/jog.13535. PubMed DOI

Heinemann M., Masquin I., Blache G., Sabiani L., Jauffret C., Houvenaeghel G., Lambaudie E. Transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy in 10 steps. J. Gynecol. Oncol. 2019;30:74. doi: 10.3802/jgo.2019.30.e74. PubMed DOI PMC

Venigalla S., Chowdhry A., Shalowitz D. Survival implications of staging lymphadenectomy for non-endometrioid endometrial cancers. Gynecol. Oncol. 2018;149:531–538. doi: 10.1016/j.ygyno.2018.03.046. PubMed DOI

Papathemelis T., Hassas D., Gerken M., Klinkhammer-Schalke M., Scharl A., Lux M., Beckmann M., Scharl S. Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis. J. Cancer Res. Clin. Oncol. 2018;144:2019–2027. doi: 10.1007/s00432-018-2715-4. PubMed DOI PMC

Papathemelis T., Scharl S., Kronberger K., Gerken M., Scharl A., Pauer A., Klinkhammer-Schalke M. Survival benefit of pelvic and paraaortic lymphadenectomy in high-grade endometrial carcinoma: A retrospective population-based cohort analysis. J. Cancer Res. Clin. Oncol. 2017;143:2555–2562. doi: 10.1007/s00432-017-2508-1. PubMed DOI PMC

Konno Y., Asano H., Shikama A., Aoki D., Tanikawa M., Oki A., Horie K., Mitsuhashi A., Kikuchi A., Tokunaga H., et al. Lymphadenectomy issues in endometrial cancer. J. Gynecol. Oncol. 2021;32:25. doi: 10.3802/jgo.2021.32.e25. PubMed DOI PMC

Watari H., Katayama H., Shibata T., Ushijima K., Satoh T., Onda T., Aoki D., Fukuda H., Yaegashi N., Sakuragi N., et al. Phase III trial to confirm the superiority of pelvic and para-aortic lymphadenectomy to pelvic lymphadenectomy alone for endometrial cancer: Japan Clinical Oncology Group study 1412 (SEPAL-P3) Jpn. J. Clin. Oncol. 2017;47:986–990. doi: 10.1093/jjco/hyx108. PubMed DOI

Todo Y., Kato H., Kaneuchi M., Watari H., Takeda M., Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): A retrospective cohort analysis. Lancet. 2010;375:1165–1172. doi: 10.1016/S0140-6736(09)62002-X. PubMed DOI

Marek R., Dzvinčuk P., Hambálek J., Maděrka M., Jančeková V., Kolářová V., Langová K., Pilka R. Robotic paraaortic lymphadenectomy in oncogynecology. Double side docking of daVinci S system increases the success rates of high paraaortic lymph node dissection in endometrial cancer. Ceska Gynekol. 2019;84:4–17. PubMed

Gallotta V., Federico A., Gaballa K., D’Indinosante M., Conte C., Giudice M.T., Naldini A., Lodoli C., Rotolo S., Gallucci V., et al. The role of robotic aortic lymphadenectomy in gynecological cancer: Surgical and oncological outcome in a single institution experience. J. Surg. Oncol. 2019;119:355–360. doi: 10.1002/jso.25335. PubMed DOI

Persson J., Salehi S., Bollino M., Lönnerfors C., Falconer H., Geppert B. Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)-the final step towards a paradigm shift in surgical staging. Eur. J. Cancer. 2019;116:77–85. doi: 10.1016/j.ejca.2019.04.025. PubMed DOI

Geppert B., Persson J. Robotic infrarenal paraaortic and pelvic nodal staging for endometrial cancer: Feasibility and lymphatic complications. Acta Obstet. Gynecol. Scand. 2015;94:1074–1081. doi: 10.1111/aogs.12712. PubMed DOI

Soliman P., Frumovitz M., Spannuth W. Lymphadenectomy during endometrial cancer staging: Practice patterns among gynecologic oncologists. Gynecol. Oncol. 2010;119:291–294. doi: 10.1016/j.ygyno.2010.07.011. PubMed DOI PMC

AlHilli M., Mariani A. The role of para-aortic lymphadenectomy in endometrial cancer. Int. J. Clin. Oncol. 2013;18:193–199. doi: 10.1007/s10147-013-0528-7. PubMed DOI

Ekdahl L., Salehi S., Falconer H. Improving Double Docking for Robot-assisted Para-aortic Lymphadenectomy in Endometrial Cancer Staging: Technique and Surgical Outcomes. J. Minim. Invasive Gynecol. 2016;23:818–824. doi: 10.1016/j.jmig.2016.03.023. PubMed DOI

Mäenpää M., Nieminen K., Tomás E., Luukkaala T., Mäenpää J. Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes. Int. J. Gynecol. Cancer. 2018;28:951–958. doi: 10.1097/IGC.0000000000001249. PubMed DOI

Mariani A., Keeney G., Aletti G., Webb M., Haddock M., Podratz K. Endometrial carcinoma: Paraaortic dissemination. Gynecol. Oncol. 2004;92:833–838. doi: 10.1016/j.ygyno.2003.11.032. PubMed DOI

Morrow C., Bundy B., Kurman R., Creasman W., Heller P., Homesley H., Graham J. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: A Gynecologic Oncology Group study. Gynecol. Oncol. 1991;40:55–65. doi: 10.1016/0090-8258(91)90086-K. PubMed DOI

Lutman C.V., Havrilesky L.J., Cragun J.M., Secord A.A., Calingaert B., Berchuck A., Clarke-Pearson D.L., Soper J.T. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol. Oncol. 2006;102:92–97. doi: 10.1016/j.ygyno.2005.11.032. PubMed DOI

Abu-Rustum N.R., Iasonos A., Zhou Q., Oke E., Soslow R.A., Alektiar K.M., Chi D.S., Barakat R.R. Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma? Am. J. Obstet. Gynecol. 2008;198:457. doi: 10.1016/j.ajog.2008.01.010. PubMed DOI

Bakkum-Gamez J.N., Mariani A., Dowdy S.C., Weaver A.L., McGree M.E., Cliby W.A., Gostout B.S., Stanhope C.R., Wilson T.O., Podratz K.C. The impact of surgical guidelines and periodic quality assessment on the staging of endometrial cancer. Gynecol. Oncol. 2011;123:58–64. doi: 10.1016/j.ygyno.2011.06.018. PubMed DOI

Abu-Rustum N., Gomez J., Alektiar K., Soslow R., Hensley M., Leitao Jr M., Gardner G., Sonoda Y., Dennis S.C., Barakat R. The incidence of isolated paraaortic nodal metastasis in surgically staged endometrial cancer patients with negative pelvic lymph nodes. Gynecol. Oncol. 2009;115:236–238. doi: 10.1016/j.ygyno.2009.07.016. PubMed DOI

Abu-Rustum N., Chi D., Leitao M., Oke E., Hensley M., Alektiar K., Barakat R. What is the incidence of isolated paraaortic nodal recurrence in grade 1 endometrial carcinoma? Gynecol. Oncol. 2008;111:46–48. doi: 10.1016/j.ygyno.2008.06.010. PubMed DOI

Salman L., Cusimano M., Marchocki Z., Ferguson S. Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer. Curr. Oncol. 2022;29:1123–1135. doi: 10.3390/curroncol29020096. PubMed DOI PMC

Li Z., Zhang W., Luo Z., Huang J., Li L. Clinical study of the clinical characteristics and prognosis of 1219 cases of endometrial cancer with lymph node metastasis. Hum. Exp. Toxicol. 2021;40:1601–1611. doi: 10.1177/09603271211008506. PubMed DOI

Nakao K., Sasaki H., Nishimura T., Banno H., Otsuka K., Hirabuki S., Hoshiba T. Periaortic Abdominal Fat Area as a Predictor of Surgical Difficulties during Extraperitoneal Laparoscopic Para-aortic Lymphadenectomy. J. Minim. Invasive Gynecol. 2020;27:1377–1382. doi: 10.1016/j.jmig.2019.10.016. PubMed DOI

Dowdy S., Aletti G., Cliby W., Podratz K., Mariani A. Extra-peritoneal laparoscopic para-aortic lymphadenectomy-a prospective cohort study of 293 patients with endometrial cancer. Gynecol. Oncol. 2008;111:418–424. doi: 10.1016/j.ygyno.2008.08.021. PubMed DOI PMC

Todo Y., Suzuki Y., Azuma M., Hatanaka Y., Konno Y., Watari H., Kato H., Matsuno Y., Yamashiro K., Sakuragi N. Ultrastaging of para-aortic lymph nodes in stage IIIC1 endometrial cancer: A preliminary report. Gynecol. Oncol. 2012;127:532–537. doi: 10.1016/j.ygyno.2012.08.026. PubMed DOI

Jamieson A., Thompson E., Huvila J., Leung S., Lum A., Morin C., Ennour-Idrissi K., Sebastianelli A., Renaud M., Gregoire J., et al. Endometrial carcinoma molecular subtype correlates with the presence of lymph node metastases. Gynecol. Oncol. 2022;165:376–384. doi: 10.1016/j.ygyno.2022.01.025. PubMed DOI