Transperitoneal Versus Extraperitoneal Laparoscopic Lymphadenectomy for Gynecological Malignancies: A Systematic Review and Meta-analysis

Background/Aim: Para-aortic lymphadenectomy is established as a standard procedure for disease staging and management of patients with advanced cervical, ovarian and high-risk endometrial cancer. Our meta-analysis accumulated the current evidence on the impact of transperitoneal (TLL) and extraperitoneal (ELL) laparoscopic lymphadenectomy for the management of patients with gynecological malignancies. Materials and Methods: A systematic search of the literature was undertaken for articles published up to April 2018. Statistical meta-analysis was performed using the RevMan 5.3 software. Results: Seven studies were eligible for meta-analysis and comprised a total of 608 women. ELL was associated with significantly shorter operative times for lymphadenectomy, whereas total operative times were not different between the two groups. Significantly increased intraoperative complications were found in the TLL group. Conclusion: ELL is safe and efficient with outcomes comparable to TLL in terms of lymph node yield and improved operative outcomes with regard to lymphadenectomy times and intraoperative complications.