Reality of pelvic lymphadenectomy by laparoscopic surgery

Abstract

ObjectivePelvic lymphadenectomy, as part of the surgical management in many gynaecological malignancies, has so far been performed by laparotomy. Laparoscopy offers a new surgical route for lymphadenectomy. Although numerous papers report on laparoscopic lymphadenectomy, the adequacy at each centre has to be proven. If indicated, the surgery can be combined with laparoscopic‐assisted vaginal hysterectomy.DesignA retrospective clinical study.SettingOver a period of 2 years, 50 laparoscopic pelvic lymphadenectomies and laparoscopic‐assisted vaginal hysterectomies, as total and radical hysterectomies, were performed at the Department of Obstetrics and Gynecology, University of Kiel, Germany and at the Oncological Center in Warsaw, Poland. The lymphadenectomy strategies were identical in all cases, the aim being primarily a lymph node sampling. A transperitoneal route was chosen. A total of 36 cases of endometrial cancer stage I, treated by laparoscopy, were compared with 20 cases of total hysterectomy by laparotomy.ResultsFrom the 50 patients treated for cervical cancer, borderline ovarian lesions and endometrial cancer stage I, the average number of removed lymph nodes was 14. The aim of these operations was primarily lymph node sampling. No intra‐operative complications were observed. The operation time varied from 2 to a maximum of 4 h. The blood loss did not exceed 250 ml for any case. In three patients tumour metastases were found in 1–3 lymph nodes.ConclusionAs no symptoms indicating a disadvantage owing to the laparoscopic path of the lymphadenectomy were encountered, laparoscopic lymphadenectomy was found to be a feasible operation, giving identical surgical results but saving the patients a laparotomy. The vaginal hysterectomy, together with a laparoscopic lymphadenectomy, gives the patient a better quality of life within the extensive treatment of genital cancer. The organ itself, that is the uterus with parametrial surroundings and adnexae can be obtained as radically as by laparotomy.