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Prospective Randomized Trial Comparing Transperitoneal Versus Extraperitoneal Laparoscopic Aortic Lymphadenectomy for Surgical Staging of Endometrial and Ovarian Cancer: The STELLA Trial

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is an ongoing debate on which approach, transperitoneal or extraperitoneal, is superior for the performance of laparoscopic aortic lymphadenectomy (LPA-LND) for the surgical staging of gynecologic cancer. A prospective randomized trial (STELLA trial) was designed to compare the perioperative outcomes and node retrieval of extraperitoneal versus transperitoneal aortic lymphadenectomy by laparoscopy or robot-assisted laparoscopy.

Methods

Patients with endometrial or ovarian carcinoma requiring aortic lymphadenectomy for surgical staging were randomized to an extraperitoneal or transperitoneal approach by laparoscopy or robot-assisted laparoscopy between June 2012 and July 2014.

Results

A total of 60 patients were entered into the study, 48 with endometrial cancer (80 %) and 12 with ovarian cancer (20 %). Thirty-one patients (51.6 %) were randomly assigned to the extraperitoneal group and 29 to the transperitoneal group (48.3 %). The means LPA-LND operating time was 90 min in both group (p = 0.343). The mean (range) blood loss was 105 (10–400) mL for extraperitoneal versus 100 (5–1000) mL for transperitoneal group (p = 0.541). There were no differences in the number of collected lymph nodes between the two groups [median (range) for extraperitoneal 12 (4–41) vs. 13 (4–29) for transperitoneal (p = 0.719)].

Conclusions

The extraperitoneal and transperitoneal approaches for laparoscopic and robotic aortic lymphadenectomy provide similar perioperative outcomes and nodal yields. Trial registration: The STELLA trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT01810874.

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Acknowledgment

Funding for the STELLA trial was provided by Instituto de Salud Carlos III grant P14/1817, cofinanced by the European Regional Development Fund (ERDE) and by Fundación Mutua Madrileña (C/Fortuny No. 18, 28010 Madrid, Spain).

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain

    Berta Díaz-Feijoo MD, PhD, Alejandro Correa-Paris MD, Assumpció Pérez-Benavente MD, PhD, Silvia Franco-Camps MD, José Luis Sánchez-Iglesias MD, PhD, Silvia Cabrera MD, PhD, Javier de la Torre MD, PhD, Cristina Centeno MD, Oriol Puig Puig MD, Blanca Gil-Ibañez MD, PhD & Antonio Gil-Moreno MD, PhD

  2. Pathological Oncology Group and Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain

    Eva Colas PhD

  3. Department of Gynecology, Mayo Clinic in Arizona, Scottsdale, AZ, USA

    Javier Magrina MD

Authors
  1. Berta Díaz-Feijoo MD, PhD
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  2. Alejandro Correa-Paris MD
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  12. Javier Magrina MD
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  13. Antonio Gil-Moreno MD, PhD
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Corresponding author

Correspondence to Berta Díaz-Feijoo MD, PhD.

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Díaz-Feijoo, B., Correa-Paris, A., Pérez-Benavente, A. et al. Prospective Randomized Trial Comparing Transperitoneal Versus Extraperitoneal Laparoscopic Aortic Lymphadenectomy for Surgical Staging of Endometrial and Ovarian Cancer: The STELLA Trial. Ann Surg Oncol 23, 2966–2974 (2016). https://doi.org/10.1245/s10434-016-5229-9

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  • DOI: https://doi.org/10.1245/s10434-016-5229-9

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