Scientific Program

Abstract:

Objective: Para-aortic lymph node dissection (PALND) is a widely used treatment that causes many complications. This study is to evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND in gynecological malignancies and to prove whether locating the superior hypogastric plexus (SHP) can help reveal the para-aortic nerves.
Methods: This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nerve-sparing was performed. The surgical, functional and oncological outcomes were analyzed retrospectively.
Results: There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, P=0.006), and the incidence of bowel obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, P=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate.
Conclusion: NSPALND can significantly reduce the rate of bowel obstruction and improve post-operative bowel function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.
Keywords: Lymph Node Dissection, Gynecologic Neoplasms, Nerve-sparing Surgery?Superior Hypogastric Plexus?Treatment Outcome

Audience Take Away Notes:

• This is the first study comparing NSPALND and PALND in gynecologic malignancies
• NSPALND significantly improved post-operative bowel function and reduced the rate of bowel obstruction
• Locating the SHP and using it as an anatomical landmark helps reveal the other para-aortic nerves

Biography:

Dr. Qiang Wen graduated from Zhejiang University in 2001 and worked as a gynecologic oncologist from then. He had been a fellow for 7 years and has rich experiences in ovarian cancer, cervical cancer and endometrial cancer, etc. He attended the training program of observership in University of Miami, Miler school of medicine in 2014, participated in series of cilinical trials like SOLO2, NOVA, SUNNY, SENTICOL3. He has published more than 20 research articles. He is now focusing on the nerve-sparing surgeries in gynecologic malignancies.