Lymphadenectomy for oncogynecological pathology: evaluation of lymph cyst formation and detection of metastases depending on the number of lymph nodes removed

Abstract

Introduction. Lymphadenectomy in gynecological oncology allows performing adequate surgical staging, determining the need for adjuvant therapy, and reducing the risk of disease recurrence. An increase in the volume of lymphadenectomy leads to an increase in the incidence of postoperative complications — the formation of lymphatic cysts. There are no clear recommendations on the required number of removed lymph nodes in order to identify their metastatic lesions. The aim of the study was to study the possible dependence of the number of removed lymph nodes and the formation of lymphatic cysts. Materials and methods. A retrospective study of 219 patients after surgical treatment from 2020 to 2021 was carried out on the basis of GBUZ Chelyabinsk Regional Center of Oncology and Nuclear Medicine. The study included cases of stage I-IV uterine cancer of all histological types, which underwent radical hysterectomy with bilateral pelvic or bilateral pelvic and paraaortic lymphadenectomy; cases of cervical cancer stage IA1-IIA disease after radical hysterectomy II-III type according to the classification of M.S. Piver, F. Rutledge (1974) with performing bilateral pelvic lymphadectomy. Statistical processing of the results was carried out. Results. The percentage of complications (lymphatic cysts) in the cervical cancer group was 2.06% (N = 2), in the uterine body cancer group 1.72 (N = 2). There was no statistically significant relationship between the removed lymph nodes and their metastatic lesions. Removing more than 27 lymph nodes is a risk factor for developing lymphatic cysts. Discussion. Lymphadenectomy allows for adequate surgical staging and reduces the risk of disease recurrence. Complicated lymphatic cysts occur in 0.9-34% of cases, which was reflected in our study, but the percentage of these complications is quite low. Conclusion. The increase in the volume of lymphadenectomy (removal of more lymph nodes) is justified by the desire for accuracy in the surgical staging of the tumor process. Despite this, there is a risk of complications after lymphadenectomy — the formation of lymphatic cysts that occurs when 27 or more lymph nodes are removed.