ANATOMIC ABNORMALITIES OF THE RETROPERITONEUM ENCOUNTERED DURING AORTIC AND PELVIC LYMPHADENECTOMY

OBJECTIVE: Our purpose was to describe retroperitoneal abnormalities a nd related surgical problems encountered during lymphadenectomy. STUDY DESIGN: A prospective study was carried out on 309 consecutive patien ts with cervical, endometrial, and ovarian cancer treated with systema tic aortic and pelvic lymphadenectomy at the Department of Gynecologic al Oncology or the Catholic University, Rome. RESULTS: Urinary and Vas cular anomalies were observed in five (1.6%) and 42 (13.6%) cases, res pectively. Preoperative diagnosis was made by intravenous pyelography and computed tomographic scan in 14.9% (seven of 47) Of patients with malformations. in three cases abnormal Vessels were accidentally injur ed during lymphadenectomy with no postoperative sequelae. CONCLUSIONS: Preoperative diagnosis of retroperitoneal abnormalities is rarely mad e during routine preoperative workup. Thus during surgery an accurate surgical technique including adequate exposure of retroperitoneal orga ns and careful blunt dissection together with a knowledge of both norm al and abnormal anatomy are necessary to avoid accidental injury to ab normal retroperitoneal organs.