TRANSPERITONEAL LAPAROSCOPIC PELVIC LYMPHADENECTOMY FOR GYNECOLOGIC MALIGNANCIES(II) INDICATIONS

Background: We reviewed the published experimental and clinical data, available in MEDLINE, and compared them with our own experience, in a university-affiliated tertiary medical center of obstetrics and gyneco logy in order to report on the accepted indications for laparoscopic p elvic lymphadenectomy. Methods: Surgical staging of cervical carcinoma can be performed via the laparoscopic approach. Intraperitoneal biops ies, washings, and pelvic lymphadenectomy can also be carried out with high accuracy and limited morbidity. Nodenegative women are better tr eated by a radical hysterectomy performed either simultaneously (using frozen sections) or secondarily after routine pathologic examination of the pelvic nodes. Node-positive patients have a poor prognosis, no matter what the treatment is, and are generally considered for radioth erapy and/or chemotherapy. The use of laparoscopic pelvic lymphadenect omy in advanced cervical cancers is limited. Results: Laparoscopy has a direct therapeutic application in endometrial carcinoma. Total hyste rectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy c an all be performed via laparoscopy. Thus, stage I and some stage II e ndometrial cancers can be treated exclusively laparoscopically. This a pproach seems as effective as laparotomy, but it dramatically reduces the costs and morbidity associated with conventional treatment. Conclu sions: Currently, the use of laparoscopy in ovarian and tubal cancers is confined to referral centers. Laparoscopy appears to be as effectiv e as laparotomy for second-look surgery. Treatment of stage II and mor e advanced ovarian cancers has been reported, but it cannot be recomme nded in a routine situation.