Management of symptomatic pelvic lymphocyst after radical pelvic or pelvic and paraaortic lymphadenectomy for cervical and endometrial cancer

Abstract

Pelvic and paraaortic lymph node dissection, as part of the staging surgery for cervical and endometrial carcinoma, interrupts the afferent lymphatics. The high acceptance by the community of gyn-oncologists was after finding that laparoscopic lymphadenectomy can be performed in the majority of patients and is associated with low complication rate. Incidence of lymphocele formation and incidence of severe complications associated with lymphocele, such as infection, deep venous thrombosis, or urinary tract occlusion, were retrospectively evaluated in the past years (01.2001–01.2007) after surgery. From January 2001 to January 2007, 226 women underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy for primary gynecological pelvic malignancies, of which 68 (30%) patients had cervical cancer and 158 (60%) patients had endometrial cancer; all of them were retrospectively analyzed. Patients with symptoms such as pain in the pelvic area, lymphedema, or suspicious cyst in the pelvis were sent to our clinic for further evaluation. The identification was made by physical examination and confirmed by US or CT. Twenty three out of 226 (10.2%) patients were diagnosed to have symptomatic pelvic lymphocyst. Additionally, two of the 23 patients had lymphedema, another two patients had lymphocyst infection, one patient had deep venous thrombosis, and one patient had ureteral stenosis. A partial (ventral) resection of the lymphocyst was performed. Median duration of hospital stay was 12.5 days and median duration of drainage was 10 days. Laparoscopic lymphocyst resection and drainage was successful in 22 patients. In one patient, a re-laparoscopy was necessary because of a recurrent lymphocyst formation 6 months after the operation. The laparoscopic lymphocyst resection is a safe and effective procedure and was applied in all 23 patients successfully.