Extraperitoneal pelvic lymphadenectomy to complement vaginal operations for cervical and endometrial cancer

Objective: The aim of the current study was to test the applicability of a personal modification of Mitra extraperitoneal pelvic lymphadenectomy in co mbination with radical vaginal operations for treatment of endometrial and cervical cancer. Method: In a prospective series, 82 patients were submitte d to extraperitoneal pelvic lymphadenectomy. In 34 cases of stage I endomet rial cancer the procedure was combined with a class I vaginal hysterectomy and in 48 cases of cervical cancer stage Ib-IIIb lymphadenectomy was associ ated with a class II or III radical vaginal hysterectomy. Type of anesthesi a, number of lymph nodes removed, operating time, blood loss and postoperat ive complications were recorded. Result: The operation was performed with s pinal anesthesia in 43% of the cases. Thirty-seven patients (45%) were high surgical risk because of associated diseases. The median operative time fo r lymphadenectomy was 20 min for each side; the vaginal procedures took a m edian of 25 min (class I) and 40 min (class II-III). Blood transfusions wer e necessary in seven cases (8.5%). A median of 26 lymph nodes were removed from each patient. Lymphocyst occurred in seven patients (8.5%), retroperit oneal hematoma in two and retroperitoneal abscess in one. Conclusion: Extra peritoneal pelvic lymphadenectomy has proven to be a safe and quick techniq ue to complement vaginal operations for endometrial and cervical cancer. Sp ecific features of this approach are: (1) fast, timesaving procedure; (2) p ossible use of spinal anesthesia; and (3) applicability in high surgical ri sk patients. (C) 2000 International Federation of Gynecology and Obstetrics .