Laparoscopic pelvic and paraaortic lymph node dissection: Analysis of the first 100 cases

Objective. The aim of this study was to analyze the first 100 cases of plan ned laparoscopic pelvic and paraaortic lymph node dissection (LND) done for staging of gynecologic cancers. The goal of the study was to assess progno stic factors for conversion to laparotomy and document complications. Methods. A retrospective review of patients who had planned laparoscopic bi lateral pelvic and bilateral paraaortic LND for staging of their gynecologi c cancer was performed. Patients were identified by our institutional datab ase and data were collected by review of their medical records. Data were o btained regarding demographics, stage, histology, length of stay, and proce dural information including completion rates, operating room time, estimate d blood loss, assistant, lymph node count, and complications. Associations between variables were analyzed using Student t tests, analysis of variance , and chi (2) testing (Excel v7.0). Results. A total of 103 patients were identified from 12/15/95 to 8/28/00. Demographics included mean age of 66.2 (25-92) and mean Quetelet index (QI) of 30.8 (15.9-56.1). A total of 34/103 (33.0%) had greater than or equal t o1 previous laparotomy. Ninety-five patients had endometrial cancer and 8 h ad ovarian cancer. Eighty-six of 103 (83.5%) were stage I or II. The length of stay was shorter for those who had laparoscopy than for those who neede d conversion to laparotomy (2.8 vs 5.6 days, P < 0.0001). Laparoscopy was c ompleted in 73/103 (70.9%) of the cases. Completion rates were 62/76 (81.6% ) with QI < 35 vs 11/27 (40.7%) with QI greater than or equal to 35, P < 0. 001. Significantly more patients had their laparoscopy completed when an at tending gynecologic oncologist was the first assistant compared to a fellow or a community obstetrician/gynecologist (92.9%, 69.0%, 64.5%, P < 0.0001) . The top three reasons for conversion to laparotomy were obesity, 12/30 (2 9.1%), adhesions, 5/30 (16.7%), and intraperitoneal disease, 5/30 (16.7%). Pelvic, common iliac, and paraaortic lymph node counts did not differ when compared to those of patients who had conversion to laparotomy (18.1, 5.1, 6.8 vs 17.3, 5.7, 6.8, P = ns). Complications included 2 urinary tract inju ries, 2 pulmonary embolisms, and 6 wound infections (all in the laparotomy group). Two deaths occurred, 1 due to a vascular injury on initial trocar i nsertion and 1 due to a pulmonary embolism after a laparotomy for bowel her niation through a trocar incision. Conclusion. Laparoscopic bilateral pelvic and paraaortic LND can be complet ed successfully in 70.9% of patients. Age, obesity, previous surgery, and t he need to perform this procedure in the community were not contraindicatio ns. Advantages include a shorter hospital stay, similar nodal counts, and a cceptable complications. (C) 2001 Academic Press.