LAPAROSCOPIC PARAAORTIC AND PELVIC LYMPHADENECTOMY - EXPERIENCE WITH 150 PATIENTS AND REVIEW OF THE LITERATURE

Objective. The clinical usefulness of laparoscopic pelvic and para-aor tic lymphadenectomy for staging and therapy of gynecological cancer wa s 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 i n 70 patients, with laparoscopically assisted vaginal hysterectomy and /or bilateral salpingo-oophorectomy and/or appendectomy and/or omentec tomy in 24 patients, with trachelectomy in 2 patients, and with laparo scopic radical hysterectomy in 2 patients; lymphadenectomy alone was p erformed in 52 patients. Right-sided para-aortic lymphadenectomy exten ded to the level of the right ovarian vein; left-sided dissection reac hed the level of the inferior mesenteric artery. In ovarian tumors, di ssection was extended to the level of the renal vessels; in addition, the ovarian vessels were removed with the surrounding tissue. Peri- an d postoperative data were collected prospectively to monitor progress of surgical performance. Results. Mean operative time was 36 min (15-1 05 min) for right-sided para-aortic and 24 min (12-49 min) for left-si ded 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) pam-aortic lymph nodes were sampled. Major vessels were inju red in 7 patients of which 4 patients required laparotomy. Patients un dergoing lymphadenectomy alone were admitted for 3.2 days on average. Conclusions. Laparoscopic pam-aortic and pelvic lymphadenectomy is eff ective for staging and treatment of gynecologic cancers. (C) 1998 Acad emic Press.