Definition of Compartment Based Radical Surgery in Uterine Cancer—Part I: Therapeutic Pelvic and Periaortic Lymphadenectomy by Michael H？ckel Translated to Robotic Surgery
Objective. To define compartment based therapeutic pelvic and periaortic lymphadenectomy in cervical and endometrial cancer. Compartment based oncologic surgery appears to be favorable for patients in terms of radicality as well as complication rates, and the same appears to be true for robotic surgery. We describe a method of robotically assisted compartment based lymphadenectomy step by step in uterine cancer and demonstrate feasibility data from 35 patients. Methods. Patients with the diagnosis of endometrial or cervical cancer were included. Patients were treated by rTMMR (robotic total mesometrial resection) or rPMMR (robotic peritoneal mesometrial resection) and pelvic or pelvic/periaortic rtLNE (robotic therapeutic lymphadenectomy) with cervical cancer FIGO IB-IIA or endometrial cancer FIGO I-III. Results. No transition to open surgery was necessary. Complication rates were 13% for endometrial cancer and 21% for cervical cancer. Within follow-up time median (22/20) month we noted 1 recurrence of cervical cancer and 2 endometrial cancer recurrences. Conclusions. We conclude that compartment based rtLNE is a feasible and safe technique for the treatment of uterine cancers and is favorable in aspects of radicality and complication rates. It should be analyzed in multicenter studies with extended followup on the basis of the described technique. 1. Introduction Lymphadenectomy in gynecological cancer is intensively discussed with respect to prognostic, predictive, and therapeutic aspects [1–5]. The prognostic and predictive approach aims primarily on detection of node metastases without inducing additional relevant morbidity. Thus, the sentinel node concept and different types of not well defined “staging lymphadenectomies” were developed. The therapeutic approach aims on removal of all nodes of certain lymph basins and the intercalated nodes at risk, implying cure in case of involvement. However, for potential surgical cure of a patient with lymph node involvement the nodes of risk have to be defined and removed completely. There is evidence that tumor spread is bound to permissive ontogenetic compartments for a long time [6]. This has first been demonstrated in rectal cancer [7] resulting in modification of surgical treatment by “Total Mesorectal Excision (TME)” [8] and later in cervical cancer resulting in “Total Mesometrial Resection (TMMR)” [9, 10]. The same tumor permissive or inhibitory compartment mechanisms related to embryologically derived compartments seem to be true for lymph basins as demonstrated by H？ckel for lymphatic spread in
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