1
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Li KP, Deng XZ, Wu T. Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:779372. [PMID: 34993228 PMCID: PMC8724245 DOI: 10.3389/fsurg.2021.779372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The optimal surgical approach for para-aortic lymphadenectomy (PALND) in gynecologic cancers using minimally invasive surgery (laparoscopy or robotic-assisted) is controversial. This study summarizes the current evidence on the extraperitoneal (EP) approach and compares its perioperative, surgical outcomes, and complications to the transperitoneal (TP) approach in an updated meta-analysis. Methods: We performed a systematic search in PubMed, Embase, Web of Science, Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs that compare EP to TP for PALND. The main outcomes included surgical, perioperative outcomes, and complications. The weighted mean difference (WMD) and odds ratio (OR) were applied for the comparison of continuous and dichotomous variables with 95% CIs. Three RCTs and 10 non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. Results: A total of three RCTs and ten non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. We reported similar results for EP and TP in terms of the hospital stay, estimated blood loss, blood transfusion, conversion to laparotomy, total operative time, and postoperative complications (Clavien grade ≥ 1 and Clavien grade ≥ 3). However, the PALND operative time (WMD -10.46 min, 95% CI -19.04, -1.88; p = 0.02) and intraoperative complications (OR 0.40, 95% CI 0.23, 0.69; p = 0.001) were less with EP. Also, more nodes were removed in EP compared with the TP (WMD 1.45, 95% CI 0.05, 2.86; p = 0.04). Conclusions: The EP approach did not show differences regarding surgical and perioperative parameters compared with the TP approach. However, the number of aortic nodes retrieved was higher. Furthermore, The PALND operative time and intraoperative complications were less in EP.
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Affiliation(s)
- Kun-Peng Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xian-Zhong Deng
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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2
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Bogani G, DI Donato V, Chiappa V, Lopez S, Monti M, Muzii L, Benedetti Panici P, Ditto A, Raspagliesi F. Minimally invasive surgery in cervical cancer. Minerva Obstet Gynecol 2021; 73:145-148. [PMID: 33306287 DOI: 10.23736/s2724-606x.20.04726-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.
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Affiliation(s)
- Giorgio Bogani
- National Cancer Institute of Milan (INT), Milan, Italy -
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Antonino Ditto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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3
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Bizzarri N, Pedone Anchora L, Cattani P, De Vincenzo R, Marchetti S, Conte C, Chiantera V, Gallotta V, Gueli Alletti S, Vizzielli G, Costantini B, Fagotti A, Fanfani F, Scambia G, Ferrandina G. Peritoneal HPV-DNA test in cervical cancer (PIONEER study): A proof of concept. Int J Cancer 2020; 148:1197-1207. [PMID: 33152105 DOI: 10.1002/ijc.33380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/28/2020] [Accepted: 10/28/2020] [Indexed: 11/12/2022]
Abstract
The aim of this study was to investigate the prevalence of peritoneal human papillomavirus (HPV) infection in different clinical cervical cancer (CC) settings, and its association with potential clinical and/or histological factors. This is a single-center, prospective, observational study. Consecutive patients with newly diagnosed or recurrent/persistent CC, between March 2019 and April 2020, were included. A group of patients undergoing surgery for benign gynecological conditions was included as control group. All patients underwent HPV-DNA test in the cervix and in the peritoneal cavity simultaneously at time of surgery. Two-hundred seventy-two patients had cervical and peritoneal HPV test analyzed. Cervical and peritoneal HPV positivity (PHP) was found in 235 (88.0%) and 78 (28.7%) patients, respectively; the prevalence of PHP was 17.7% in early stage, 28.8% in locally advanced cervical cancer (LACC) and 46.6% in the metastatic/persistent/recurrent setting (P = .001). No control patient was found to have peritoneal HPV infection. Higher frequency of PHP was documented in patients with larger tumor size (P = .003), presence of cervical HPV 16/18 genotypes (P < .001), higher number of cervical high-risk (HR)-HPV per patient (P = .018) and peritoneal carcinomatosis (P < .001). Multivariate analysis demonstrated that lack of preoperative cervical conization in early stages (P = .030), while higher International Federation of Gynecology and Obstetrics (FIGO) stage (P = .021) and presence of cervical HPV 16/18 (P = .001) in LACC, was associated with PHP. This is a proof-of-concept study. A number of potential clinical implications, including prognosis, could be obtained by further studies.
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Affiliation(s)
- Nicolò Bizzarri
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luigi Pedone Anchora
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Paola Cattani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa De Vincenzo
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Marchetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Carmine Conte
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Ospedali Civico Di Cristina Benfratelli, University of Palermo, Palermo, Italy
| | - Valerio Gallotta
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Salvatore Gueli Alletti
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Vizzielli
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Barbara Costantini
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Anna Fagotti
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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4
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Kerbage Y, Kakkos A, Kridelka F, Lambaudie E, Bats AS, Hébert T, Goffin F, Wallet J, Leblanc E, Hudry D, Narducci F. Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy? Ann Surg Oncol 2020; 27:3891-3897. [DOI: 10.1245/s10434-020-08471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 11/18/2022]
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5
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Zhou Q, Chen X. A deadly trap for para-aortic lymph node dissection in patients with horseshoe kidney as a complication: a case report. J Int Med Res 2019; 47:2754-2763. [PMID: 31109221 PMCID: PMC6567728 DOI: 10.1177/0300060519845989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Horseshoe kidney is a rare congenital renal dysplasia. It is often associated with various anatomical abnormalities, including renal vessel and ureter variability, which increase unpredictable surgical risks. This current report describes the case of a 42-year-old woman diagnosed as having cervical squamous cell carcinoma complicated by horseshoe kidney. She underwent laparoscopic radical hysterectomy, bilateral oophorectomy and lymph node dissection, including dissection of the pelvic, presacral and para-aortic lymph nodes. The surgery was challenging, but no serious complications occurred. Postoperative multi-slice computed tomography angiography confirmed the anatomical variation of the renal location, ureter and renal vessels. To our knowledge, this is the first reported case of cervical carcinoma complicated with horseshoe kidney.
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Affiliation(s)
- Qian Zhou
- 1 The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,2 Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,3 Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Xinliang Chen
- 1 The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,2 Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,3 Shanghai Municipal Key Clinical Specialty, Shanghai, China
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6
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Tantitamit T, Huang KG, Htay WT. Treatment of Documented Liver Metastasis from Cervical Cancer with High Dose of Chemoradiation. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Tanitra Tantitamit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou Medical Center, Kweishan, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou Medical Center, Kweishan, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Wint Thida Htay
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine 2, Yangon, Myanmar
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7
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Perioperative morbidity and rate of upstaging after laparoscopic staging for patients with locally advanced cervical cancer: results of a prospective randomized trial. Am J Obstet Gynecol 2015; 213:503.e1-7. [PMID: 25986030 DOI: 10.1016/j.ajog.2015.05.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/30/2015] [Accepted: 05/13/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The International Federation of Gynecology and Obstetrics (FIGO) staging for cervical cancer is based on clinical examination. Previous studies have demonstrated significant upstaging with surgical staging. However, no randomized trial has ever shown a survival benefit when radiation combined with chemoradiation (RCTX) is modified according to surgical staging. The objective of the study was to evaluate the feasibility and outcomes of surgical staging prior to radical RCTX treatment among patients with locally advanced cervical cancer in the setting of a larger, prospective, randomized study (the Uterus-11 study of the German Gynecologic Oncology Group). STUDY DESIGN Between 2009 and 2013, 255 patients with advanced cervical cancer (FIGO IIB-IVA) were randomized to surgical staging and RCTX (arm A) or RCTX (arm B). RCTX in both arms included pelvic external beam radiotherapy with weekly cisplatin at 40 mg/m(2) and brachytherapy. Extended-field radiation was performed in cases of confirmed paraaortic metastases. RESULTS One hundred thirty patients were randomized to surgical staging; 121 were eligible for this analysis. The mean patient age was 47.2 years, and the mean body mass index was 26.2 kg/m(2); the FIGO stages were IIB, IIIA, IIIB, and IVA in 85 (70.2%), 4 (3.3%), 29 (24%), and 3 (2.5%) patients, respectively. Arm A and arm B were similar with respect to Karnofsky performance status, histology, comorbidities, and lymphovascular space involvement. The surgical approach was transperitoneal laparoscopy in nearly all patients (93.4%), with no operative mortality. One patient (0.8%) had a conversion to laparotomy; 2 patients had more than 500 mL blood loss; the early postoperative complication rate was 7.3%. A mean of 19 pelvic and 17 paraaortic nodes were removed, with means of 2.4 and 1.3 positive nodes, respectively. RCTX began between 7 and 21 days after surgery. Operative staging led to upstaging in 40 of 121 (33%). CONCLUSION Surgical staging in patients with locally advanced cervical cancer is safe and does not delay primary RCTX in a randomized study.
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8
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Ditto A, Martinelli F, Carcangiu M, Lorusso D, Raspagliesi F. Peritoneal cytology as prognostic factor in cervical cancer. Diagn Cytopathol 2015; 43:705-9. [PMID: 26139073 DOI: 10.1002/dc.23296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/02/2015] [Accepted: 04/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND To investigate the prognostic role of peritoneal cytology (PC) in cervical cancer patients undergoing radical hysterectomy. METHODS We retrospectively analyzed 120 stage IA1-IIIB patients with cervical cancer who underwent peritoneal fluid collection for cytology during radical hysterectomy. Neoadjuvant chemotherapy and/or radiotherapy was performed in 48% of the cases. All PC specimens were obtained by aspiration of free-fluid when present or by peritoneal washing. The relationships between cytological diagnosis, histological variables, and prognosis were investigated. RESULTS PC was positive in 4 out of 120 (3.3%) cases. All were advanced stage adenocarcinomas. Overall, 4 out of 26 (15.3%) cases with adenocarcinoma were positive, and all presented with free fluid in the pelvis. No positive PC was found among squamous cancers. Histological subtype (P: 0.002) and parametrial (P < 0.001) and vaginal (P: 0.002) involvement presented a statistically significant correlation with PC positivity. The prognostic analysis of histological parameters demonstrated that parametrial (P: 0.007), vaginal (P: 0.04), and lymph node involvements (P: 0.003) were significantly correlated with a shorter disease-free survival. CONCLUSIONS The series indicates that PC in squamous cell cervical cancer is not a significant prognostic factor. Its routine collection in squamous cancer should be abandoned in this setting. On the other hand, the unfavorable prognostic profile of PC positive cases in our investigation suggest a possible impact of this variable on outcome. The significant link between PC and locally advanced adenocarcinomas underwent neoadjuvant therapy before surgery warrants a further investigation to assess its real prognostic value and its indication in this particular clinical setting.
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Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marialuisa Carcangiu
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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9
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Afors K, Centini G, Murtada R, Castellano J, Meza C, Wattiez A. Obesity in laparoscopic surgery. Best Pract Res Clin Obstet Gynaecol 2015; 29:554-64. [PMID: 25770750 DOI: 10.1016/j.bpobgyn.2015.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
Abstract
Since the 1980s, minimally invasive techniques have been applied to an increasing number and variety of surgical procedures with a gradual increase in the complexity of procedures being successfully performed laparoscopically. In the past, obesity was considered a contraindication to laparoscopy due to the higher risk of co-morbid conditions such as diabetes, hypertension, coronary artery disease and venous thromboembolism. Performing laparoscopic gynaecological procedures in morbidly obese patients is no longer a rare phenomenon; however, it does necessitate changes in clinical practice patterns. Understanding of the physiological changes induced by laparoscopy, particularly in obese patients, is important so that these may be counteracted and adverse outcomes avoided. Laparoscopy in obese patients confers certain advantages such as shorter hospital stay, less post-operative pain and fewer wound infections. In addition to these benefits, minimal-access surgery has been demonstrated as safe and effective in obese patients; however, specific surgical strategies and operative techniques may need to be adopted.
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Affiliation(s)
- K Afors
- Specialist Registrar at King's College Hospital NHS Trust, Denmark Hill, London SE5 9RS, UK.
| | - G Centini
- Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - R Murtada
- Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - J Castellano
- Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - C Meza
- Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - A Wattiez
- Head of Gynaecology Department, Strasbourg University Hospital, Strasbourg, France
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Akladios C, Ronzino V, Schrot-Sanyan S, Afors K, Fernandes R, Baldauf JJ, Wattiez A. Comparison Between Transperitoneal and Extraperitoneal Laparoscopic Paraaortic Lymphadenectomy in Gynecologic Malignancies. J Minim Invasive Gynecol 2015; 22:268-74. [DOI: 10.1016/j.jmig.2014.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 01/21/2023]
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