Periaortic Abdominal Fat Area as a Predictor of Surgical Difficulties during Extraperitoneal Laparoscopic Para-aortic Lymphadenectomy

Study Objective: To evaluate whether obesity is a marker of surgical difficulty during extraperitoneal para-aortic lymphadenectomy. Design: Retrospective observational cohort study. Setting: Tertiary medical center in the Kanazawa area of Japan. Patients: Eighty-four patients with primary endometrial cancer who underwent extraperitoneal laparoscopic para-aortic lymphadenectomy (LPAND) between January 2005 and December 2017 were included. Interventions: We investigated the correlation between operative times and body mass indexes, visceral fat areas, and periabdominal artery fat areas (PAFAs). The number of lymph nodes harvested was used as an indicator of the degree of surgical completion. Measurements and Main Results: There was no correlation between the operative time and body mass index. Significant correlations were observed between operative time and visceral fat area (p =.026; r = 0.243) and between operative time and PAFA (p =.007; r = 0.293). A multivariate analysis showed that PAFA was a significant independent marker that could be used to predict prolonged operative times for extraperitoneal LPAND (p =.045; odds ratio, 3.05). The number of para-aortic lymph nodes harvested was not significant in the high- and low-PAFA groups (22 and 25, respectively; p =.525). Conclusion: PAFA is an adequate marker of prolonged operative time for extraperitoneal LPAND among patients with endometrial cancer.