'En bloc' peritoneal mesometrial resection (PMMR) and pelvic targeted compartmental lymphadenectomy (TCL) for management of patients with endometrial cancer - feasibility and safety study of a 'new kid on the block' in robotic surgery.

BACKGROUND

Robotic Peritoneal Mesometrial Resection and Targeted Compartmental Lymphadenectomy (PMMR + TCL) is a procedure following Cancer Field Surgery concept for endometrial cancer (EC), enabling superior locoregional control without adjuvant irradiation. We aimed to test the feasibility and safety of performing the PMMR + TCL by a newly trained team in a robotic approach.

METHODS

A single-institution, retrospective analysis of patients undergoing robotic surgery (DaVinci) for EC was performed. The PMMR + TCL was compared to a robotic simple hysterectomy (rSH) and sentinel lymph node dissection (SLND). The primary outcomes were the rate of PMMR + TCL among all robotic surgeries and the 30-day complications (Clavien-Dindo classification).

RESULTS

The PMMR + TCL was performed on 79 (66.9%), rSH + SLND with afferent lymphatic vessels on 17 (14.4%), rSH + SLND alone on 20 (16.9%), and radical hysterectomy with SLND/lymphadenectomy on 2 (1.6%) patients, with the median number (range) of removed lymph nodes of 8 (2-12), 6 (2-10), 6 (1-7), and 26 (4-26), respectively. Patients in whom the PMMR + TCL was performed were younger, had lower BMI, and fewer co-morbidities as compared to those who underwent other procedures. Thirteen (11%) patients experienced complications, with 3 (2.5%) grade IIIb, of which none could be directly linked to any type of procedure. Ten (8.5%) patients experienced postoperative grade I-II complications, which tended to be more frequent after PMMT + TCL. Endometriosis and carcinoma deposits were found between uterus and lymph nodes in 7 (8.8%) of PMMR + TCL specimens.

CONCLUSIONS

Performing PMMT + TCL by a team newly trained in robotic surgery was feasible and relatively safe. Further research on locoregional control after PMMR + TLC without adjuvant irradiation should be conducted.