Para-aortic lymph node dissection with or without nerve-sparing in gynecological malignancies

다국어 초록 (Multilingual Abstract)

Objective: Para-aortic lymph node dissection (PALND) is a widely used treatment thatcauses many complications. This study is to evaluate the efficacy and safety of ner ve-sparingpara-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND ingynecological malignancies and to prove whether locating the superior hypogastric plexus(SHP) can help reveal the para-aortic ner ves.
Methods: This is a retrospective study of the patients who under went para-aorticlymphadenectomy from Januar y 2020 to December 2022 at Zhejiang Cancer Hospital. All ofthem were divided into NSPALND and PALND groups according to whether or not ner ve-sparing was performed. The surgical, functional and oncological outcomes were evaluated.
Results: There were 43 patients enrolled, of which, 20 patients under went NSPALND and23 patients under went PALND. The para-aortic ner ves were successfully revealed by locatingthe SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALNDgroup was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), andthe incidence of acute intestinal obstruction in the NSPALND group was significantly lowerthan that in the PALND group (10% vs. 39%, p=0.029). There was no difference between thetwo groups in terms of catheterization duration, urinar y retention, dysuria, as well as thenumber of lymph nodes removed and the para-aortic recurrence rate.
Conclusion: NSPALND can significantly reduce the rate of acute intestinal obstruction andimprove post-operative intestinal function. Locating the SHP and using it as an anatomicallandmark to reveal the para-aortic ner ves is feasible. Its exact clinical value needs to befurther studied.