Transperitoneal Laparoscopic Para-Aortic Lymphadenectomy and Body Mass Index: Is It Really a Limiting Factor for the Procedure?

Objective: To explore if obesity measured by body mass index (BMI) >= 30 kg/m(2) represents a limiting factor for para-aortic lymphadenectomy done with a transperitoneal laparoscopic approach. Materials and Methods: Retrospective observational study with 146 consecutive patients, diagnosed with a gynecological cancer submitted to para-aortic surgical staging between January 2010 and December 2018. The mean age was 52 years and the mean BMI was 27 kg/m(2). 72.6% (106 patients) had BMI <30 kg/m(2) and 27.4% (40 patients) had BMI >= 30 kg/m(2). Half of the patients did not have prior abdominal surgeries. Results: The statistical analysis showed that there were no significant differences between two groups depending on their BMI in the lymph node count: BMI <30 kg/m(2) 14 nodes versus BMI >= 30 kg/m(2) 10 nodes (P = .122); rate of intraoperative complications: BMI <30: 6.3% versus BMI >= 30: 0% (P = .180), postoperative complications: BMI <30: 6.6% versus BMI >= 30: 5% (P = .723); feasibility rate: BMI <30: 97.1% versus BMI >= 30: 95.6% (P = .063) or the mean hospital stay BMI <30: 2.47 +/- 2.05 days (standard deviation [SD]), BMI >= 30: 2.64 +/- 0.93 days (SD) (P = .171). The only significant difference observed was due to the operating time: BMI <30: 103.1 +/- 60.8 (SD) versus BMI >= 30: 146.9 +/- 82.5 (SD) (P = .019), being longer in obese patients. Conclusions: Obesity, estimated by BMI, does not seem to represent a limiting factor for this surgical procedure in our series. We feel it is a feasible and justified approach in obese patients when other surgical procedures have to be carried out in the same surgical act. Probably, other factors and anthropometric measurements are more accurate to select patients in which this approach is feasible.