Transperitoneal Para-aortic Lymphadenectomy: Surgical Technique, Results, Challenges, and Complications

  • Audrey Tieko Tsunoda
  • Carlos Eduardo Mattos da Cunha Andrade
  • Bruno Roberto Braga Azevedo
  • José Clemente Linhares
  • Reitan Ribeiro


One of the more important prognostic factors in gynecological malignancies is the lymph node status. A combination of risk factors, the organ anatomy and drainage, the histology, and the stage are the key factors related to lymph node metastasis that may range from 1.5% up to 70%.


Para-aortic lymphadenectomy Transperitoneal Staging Debulking 

Supplementary material

Video 26.1

(MOV 650,859 kb)


  1. 1.
    Köhler C, Mustea A, Marnitz S, Schneider A, Chiantera V, Ulrich U, et al. Perioperative morbidity and rate of upstaging after laparoscopic staging for patients with locally advanced cervical cancer: results of a prospective randomized trial. Am J Obstetr Gynecol. 2015;213(4):503.e1–7. Scholar
  2. 2.
    Köhler C, Kyeyamwa S, Marnitz S, Tsunoda A, Vercelino F, Schneider A, Favero G. Prevention of lymphoceles using FloSeal and CoSeal after laparoscopic lymphadenectomy in patients with gynecologic malignancies. J Minim Invasive Gynecol. 2015;22(3):451–5. Scholar
  3. 3.
    Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, Munsell MF, Coleman RL, Ramondetta LM. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer. 2011;117(9):1928–34. Scholar
  4. 4.
    Peña-Fernández M, Solar-Vilariño I, Rodríguez-Álvarez MX, Zapardiel I, Estévez F, Gayoso-Diz P. Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors. Ecancermedicalscience. 2015;9:606. Scholar
  5. 5.
    Melamed A, Keating NL, Clemmer JT, Bregar AJ, Wright JD, Boruta DM, et al. Laparoscopic staging for apparent stage I epithelial ovarian cancer. Am J Obstetr Gynecol. 2016;216:50.e1. Scholar
  6. 6.
    Scribner DR, Walker JL, Johnson GA, McMeekin DS, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 2002;84(3):426–30. Scholar
  7. 7.
    Uccella S, Bonzini M, Palomba S, Fanfani F, Ceccaroni M, Seracchioli R, Ghezzi F. Impact of obesity on surgical treatment for endometrial cancer: a multicenter study comparing laparoscopy vs open surgery, with propensity-matched analysis. J Minim Invasive Gynecol. 2016;23(1):53. Scholar
  8. 8.
    Palomba S, Falbo A, Mocciaro R, Russo T, Zullo F. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol. 2009;112:415. Scholar
  9. 9.
    Zikan M, Fischerova D, Pinkavova I, Slama J, Weinberger V, Dusek L, Cibula D. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol. 2015;137(2):291–8.CrossRefGoogle Scholar
  10. 10.
    Bennich G, Rudnicki M, Lassen PD. Laparoscopic surgery for early endometrial cancer. Acta Obstet Gynecol Scand. 2016;95(8):894–900. PubMed PMID: 27100141.CrossRefPubMedGoogle Scholar
  11. 11.
    Favero G, Anton C, Le X, Silva E, Silva A, Dogan NU, Pfiffer T, Köhler C, Baracat EC, Carvalho JP. Oncologic safety of laparoscopy in the surgical treatment of type II endometrial cancer. Int J Gynecol Cancer. 2016;26(9):1673–8. PubMed PMID: 27552404.CrossRefGoogle Scholar
  12. 12.
    Koskas M, Jozwiak M, Fournier M, Vergote I, Trum H, Lok C, Amant F. Long-term oncological safety of minimally invasive surgery in high-risk endometrial cancer. Eur J Cancer. 2016;65:185–91. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Audrey Tieko Tsunoda
    • 1
  • Carlos Eduardo Mattos da Cunha Andrade
    • 2
  • Bruno Roberto Braga Azevedo
    • 3
  • José Clemente Linhares
    • 4
  • Reitan Ribeiro
    • 1
  1. 1.Gynecologic Oncology DepartmentHospital Erasto Gaertner, Instituto de Oncologia do Paraná, Universidade Positivo and Hospital Marcelino ChampagnatCuritibaBrazil
  2. 2.Gynecologic Oncology DepartmentHospital de Câncer de BarretosBarretosBrazil
  3. 3.Instituto de Hematologia e Oncologia do Paraná and Hospital São VicenteCuritibaBrazil
  4. 4.Breast and Gynecologic Oncology DepartmentInstituto de Oncologia do Paraná, Erasto Gaertner HospitalCuritibaBrazil

Personalised recommendations