Laparoscopic lymph-node dissection in gynecological surgery


Authors: M. Mára ;  M. Fanta ;  J. Sláma ;  M. Zikán ;  K. Kubínová ;  D. Kužel ;  D. Cibula
Authors‘ workplace: Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
Published in: Čes. Gynek.2012, 77, č. 4 s. 320-326

Overview

Objective:
To analyze our experience with transperitoneal laparoscopic dissection of lymphatic nodes in women with gynecologic malignancies.

Study design:
Retrospective clinical study.

Setting:
Center of gynecologic endoscopy and minimally invasive surgery; Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty in Prague.

Methods:
Analysis of data from our laparoscopic procedures in the years 2006–2011. The following procedures have been included: systematic pelvic lymphadenectomy (PLN), paraaortic lymphadenectomy (PALN), pelvic sentinel node excision, focused dissection of bulky lymphatic nodes from pelvis or paraaortic area.

Results:
We performed 177 primarily laparoscopic procedures pointed at dissection of pelvic and/or paraaortic lymph-nodes. The mean operating time and the mean number of lymph-nodes was 82 minutes and 26.5 nodes in patients with PLN, and 75 minutes and 12.5 nodes in patients with PALN. The overall rate of laparo-conversions was 4.5%; the incidence of major complications was 6.8% and of serious bleeding 5.6%. Laparoscopic lymphadenectomy could not be performed or completed in 2.3% of cases. Complications were more frequently associated with PALN than with PLN.

Summary:
Laparoscopic approach to PLN and PALN is feasible in vast majority of patients. It provides adequate earnings of the lymphatic nodes, tolerable operative time, and relatively low complication rate. The highly experienced operation team for especially high infrarenal PALN is necessary.

Key words:
laparoscopy, pelvic lymphadectomy, paraaortic lymphadectomy.


Sources

1. Abu-Rustum, NR., Chi, DS., Sonoda, Y., et al. Transperitoneal laparoscopic pelvic and para-aortic lymph node dissection using the argon-beam coagulator and monopolar instruments: an 8-year study and description of technique. Gynecol Oncol, 2003, 89, p. 504–513.

2. Benedetti Panici, P., Plotti, F., Zullo, MA., et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol, 2006, 103, p. 859–864.

3. Boggess, JF., Gehrig, A., Cantrell, L., et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol, 2008, 199, p. 360.e1–9.

4. Burney, TL., Campbell, EC. Jr., Naslund, MJ., Jacobs, SC. Complications of staging laparoscopic pelvic lymphadenectomy. Surg Laparosc Endosc, 1993, 3, p. 184–190.

5. Dottino, PR., Tobias, DH., Beddoe, A., et al. Laparoscopic lymphadenectomy for gynecologic malignancies. Gynecol Oncol, 1999, 73, p. 383–388.

6. Eitan, R., Abu-Rustum, NR., Walker, JL., Barakat, RR. Endometrial cancer metastatic to infrarenal aortic lymph nodes unrecognized during laparoscopic inframesenteric aortic lymph node dissection. Gynecol Oncol, 2004, 93, p. 260–262.

7. Chéreau, E., Feron, JG., Ballester, M., et al. Contribution of pelvic and para-aortic lymphadenectomy with sentinel node biopsy in patients with IB2-IIB cervical cancer. Br J Cancer, 2012, 106, p. 39–44.

8. Childers, JM., Hatch, KD., Tran, AN., Surwit, EA. Laparoscopic para-aortic lymphadenectomy in gynecologic malignancies. Obstet Gynecol, 1993, 82, p. 741–747.

9. Childers, JM., Lang, J., Surwit, EA., Hatch, KD. Laparoscopic surgical staging of ovarian cancer. Gynecol Oncol, 1995, 59, p. 25–33.

10. Kavoussi, LR., Sosa, E., Chandhoke, P., et al. Complications of laparoscopic pelvic lymph node dissection. J Urol, 1993, 149, p. 322–325.

11. Kehoe, SM., Abu-Rustum, NR. Transperitoneal laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic cancers. Curr Treat Options Oncol, 2006, 7, p. 93–101.

12. Köhler, C., Klemm, P., Schau, A., et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol, 2004, 95(1), p. 52–61.

13. Leblanc, E., Querleu, D., Narducci, F., et al. Laparoscopic surgeries in gynaecological oncology. In Ayhan, A., Reed, N., Gultekin, M., Dursun, P., eds. Textbook of Gynaecological Oncology. Günes Publishing, 2012, p. 580–587.

14. Liang, Z., Xu, H., Chen, Y., et al. Laparoscopic radical trachelectomy or parametrectomy and pelvic and para-aortic lymphadenectomy for cervical or vaginal stump carcinoma: report of six cases. Int J Gynecol Cancer, 2006, 16, p. 1713–1716.

15. Malur, S., Possover, M., Michels, W., Schneider, A. Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer - a prospective randomized trial. Gynecol Oncol, 2001, 80, p. 239–244.

16. Nezhat, CR., Burrell, MO., Nezhat, FR., et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol, 1992, 166, p. 864–865.

17. Nezhat, C., Childers, J., Nezhat, F., et al. Major retroperitoneal vascular injury during laparoscopic surgery. Hum Reprod, 1997, 12, p. 480–483.

18. Nezhat, FR., Datta, MS. Laparoscopic lymphadenectomy. In Nezhat, C., Nezhat, F., Nezhat C., eds. Nezhat’s Operative Gynecologic Laparoscopy and Hysteroscopy. Cambridge University Press, 2008, p. 436–446.

19. Obermair, A., Ginbey, P., McCartney, AJ. Feasibility and safety of total laparoscopic radical hysterectomy. J Am Assoc Gynecol Laparosc, 2003, 10, p. 345–9.

20. Occelli, B., Narducci, F., Lanvin, D., et al. Learning curves for transperitoneal laparoscopic and extraperitoneal endoscopic paraaortic lymphadenectomy. J Am Assoc Gynecol Laparosc, 2000, 7, p. 51–3.

21. Pilka, R., Marek, R., Táborská, S., Dzvinčuk, P. Robotem asistovaný laparoskopický staging karcinomu endometria – srovnání se standardní laparotomií. Čes Gynek, 2011, 76, s. 462–468.

22. Plante, M., Renaud, M.C., Tźtu, B., et al. Laparoscopic sentinel node mapping in early-stage cervical cancer. Gynecol Oncol, 2003, 91, p. 494–503.

23. Pomel, C., Rouzier, R., Pocard, M., et al. Laparoscopic total a pelvic exenteration for cervical cancer relapse. Gynecol Oncol, 2003, 91, p. 616–618.

24. Possover, M., Krause, N., Plaul, K., et al. Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature. Gynecol Oncol, 1998, 71, p. 19–28.

25. Querleu, D., Dargent, D., Ansquer, Y., et al. Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Cancer, 2000, 88, p. 1883–1891.

26. Querleu, D., Leblanc, E., Cartron, G., et al. Audit of preoperative and early complications of laparoscopic lymph node dissection in 1000 gynecologic cancer patients. Am J Obstet Gynecol, 2006, 195, p. 1287–1292.

27. Renaud, MC., Plante, M., Roy, M. Combined laparoscopic and vaginal radical surgery in cervical cancer. Gynecol Oncol, 2000, 79, p. 59–63.

28. Scribner, DR. Jr., Walker, JL., Johnson, GA., et al. Laparoscopic pelvic and paraaortic lymph node dissection: analysis of the first 100 cases. Gynecol Oncol, 2001, 82, p. 498–503.

29. Scribner, DR. Jr., Walker, JL., Johnson, GA., et al. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol, 2002, 84, p. 426–430.

30. Sláma, J., Dundr, P., Dušek, L., et al. Sentinel lymph node status in patients with locally advanced cervical cancers and impact of neoadjuvant chemotherapy. Gynecol Oncol, 2012 Feb 14. [Epub ahead of print].

31. Spirtos, NM., Eisenkop, SM., Schlaerth, JB., Ballon, SC. Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. Am J Obstet Gynecol, 2002, 187, p. 340–348.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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2012 Issue 4

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