Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature

Abstract

Objective: The clinical usefulness of laparoscopic pelvic and para-aortic lymphadenectomy for staging and therapy of gynecological cancer was analyzed prospectively.

Method: Laparoscopic para-aortic and pelvic lymphadenectomy was performed in 150 patients with cervical (n = 96), endometrial (n = 41), or ovarian cancer (n = 13). Lymphadenectomy was combined with laparoscopically assisted vaginal radical hysterectomy in 70 patients, with laparoscopically assisted vaginal hysterectomy and/or bilateral salpingo-oophorectomy and/or appendectomy and/or omentectomy in 24 patients, with trachelectomy in 2 patients, and with laparoscopic radical hysterectomy in 2 patients; lymphadenectomy alone was performed in 52 patients. Right-sided para-aortic lymphadenectomy extended to the level of the right ovarian vein; left-sided dissection reached the level of the inferior mesenteric artery. In ovarian tumors, dissection was extended to the level of the renal vessels; in addition, the ovarian vessels were removed with the surrounding tissue. Peri- and postoperative data were collected prospectively to monitor progress of surgical performance.

Results: Mean operative time was 36 min (15-105 min) for right-sided para-aortic and 24 min (12-49 min) for left-sided para-aortic lymphadenectomy; bilateral pelvic lymphadenectomy took 64 min (44-110 min). On average 26.8 (10-56) pelvic lymph nodes and 7.3 (0-19) para-aortic lymph nodes were sampled. Major vessels were injured in 7 patients of which 4 patients required laparotomy. Patients undergoing lymphadenectomy alone were admitted for 3.2 days on average.

Conclusions: Laparoscopic para-aortic and pelvic lymphadenectomy is effective for staging and treatment of gynecologic cancers.