Laparoscopic paraaortic left-sided transperitoneal infrarenal lymphadenectomy in patients with gynecologic malignancies: technique and results

Abstract

Objective: Left-sided paraaortic infrarenal lymphadenectomy is indicated in patients with gynecologic tumors of high metastasing potential. We evaluated whether left-sided paraaortic inframesenteric lymphadenectomy can be extended up to the left renal vein by laparoscopy.

Methods: Between January 2002 and August 2002, 46 consecutive patients with cervical (n = 26), or endometrial (n = 16), or early ovarian cancer (n = 4) underwent right-sided paraaortic lymphadenectomy up to the level of the right ovarian vein and left-sided inframesenteric paraaortic lymphadenectomy. Lymphadenectomy was extended up to the level of the left renal vein in 20 patients with high risk for lymph node metastasis: following elevation of the duodenum and the pancreas infrarenal lymph nodes in the area limited by the vena cava, left renal vein, left ovarian vein, inframesenteric artery, and aorta were laparoscopically removed under preservation of the inferior mesenteric artery.

Results: Patients with infrarenal lymphadenectomy (group 1) and without infrarenal lymphadenectomy (group 2) were comparable in body mass index: the age of patients in group 2 was higher (P = 0.023). Duration of lymphadenectomy was 31.3 min (11-57 min) longer in group 1. There was no intraoperative complication. Number of paraaortic lymph nodes was on average 19.6 (range 5-35) in group 1 compared to a mean of 9 lymph nodes (range 2-19) in group 2 (P = 0,0001). Postoperatively 2 patients (10%) in group 1 developed chylascos.

Conclusions: Left-sided paraaortic infrarenal lymphadenectomy can be performed safely in adequate duration transperitoneally by laparoscopy. Compared to inframesenteric lymphadenectomy the number of removed lymph nodes can be doubled.