{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T01:42:37Z","timestamp":1763602957288,"version":"3.45.0"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the feasibility and safety of laparoscopic systemic para\u2010aortic lymphadenectomy (PALN) for endometrial cancer in a multicenter setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data from 403 patients who underwent laparoscopic PALN for intermediate\u2010 and high\u2010risk endometrial cancer under Japan's advanced medical care procedure between July 2017 and March 2020 were prospectively collected. Clinical background, surgical outcome, perioperative complications, and prognosis were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Histological subtype was 219 (54.4%) G1 or G2 endometrioid carcinoma, 64 (15.9%) G3 endometrioid carcinoma, 64 (15.9%) serous carcinoma, 24 (6.0%) carcinosarcoma, 15 (3.7%) clear cell carcinoma, and 17 (4.2%) others. Simple hysterectomy was performed in 180 cases (44.7%) and modified radical hysterectomy (mRH) in 213 cases (52.9%). Median intraoperative blood loss was 110\u2009mL (range: 0\u20132092), and 7 (1.7%) received blood transfusions. Intraoperative complications occurred in 20 cases (5.0%) including ureteral injuries (1.7%), vascular injuries (1.0%), and bowel injuries (0.5%). High\u2010volume facilities performing more than 15 PALN procedures harvested significantly more para\u2010aortic nodes than facilities performing fewer procedures. Four cases (1.0%) converted to laparotomy. Postoperative complications occurred in 53 cases (13.2%), with approximately related to lymphadenectomy. Multivariate analysis identified intraoperative blood loss, number of pelvic lymph node (PLN) removed, and radical hysterectomy (RH) as risk factors for urological complications. The number of PLNs removed and mRH were associated with lymphadenectomy\u2010related complications. Over a median follow\u2010up of 14\u2009months (1\u201339), 20 patients (5.0%) experienced recurrence, and 7 (1.7%) died of the disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Laparoscopic PALN for intermediate\u2010 and high\u2010risk endometrial cancer could be performed safely.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.70001","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T04:54:06Z","timestamp":1755060846000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surveillance of laparoscopic systemic para\u2010aortic lymphadenectomy for patients with intermediate\u2010 and high\u2010risk endometrial cancer in 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