Laparoscopic lymphocele fenestration as first-line measure for gynecologic cancer patients after retroperitoneal lymph node dissection: 10-year analysis of safety, feasibility, efficacy, and recurrence rate.

Abstract

e15566 Background: The occurrence of lymphoceles is a notorious complication occurring after retroperitoneal lymph node dissection (LND) frequently treated by repetitive percutaneous needle punctures associated with a high risk of wound infection or bowel injury. Methods: We analyzed 10 years of single-center experience with laparoscopic lymphocele fenestration as a first-line measure in gynecologic cancer 102 consecutive patients with a history of retroperitoneal LND (53.4 years; range: 22–80) who underwent laparoscopic lymphocele fenestration at our department between January 2001 and December 2010 for a symptomatic lymphocele. Results: A total of 132 lymphoceles have been fenestrated in 102 patients by laparoscopy, onaverage 5.3 months (SD: 6.3 months) after the initial LND. Mean follow-up of the patients was 60.4 months. Mean duration of surgery was 115.6 minutes and the average intra-operative blood loss per patient was 146 ml. Overall conversion rate to laparotomy was 7.8 %. The rate of intraoperative and postoperative minor and major complications was significantly higher in patients after pelvic plus paraaortic LND (23.8 %) compared to those after pelvic LND alone (3.6 %; p>0.01). Two-year cumulative risk of lymphocelerecurrence was only 4.2 % with a total of 7 recurrences of lymphoceles observed. Conclusions: Laparoscopic lymphocele fenestration was safe and feasible as well as efficacious as a surgical first-line treatment option for symptomatic lymphocele following retroperitoneal LND in gynecological cancer patients with a particularly low recurrence rate.