Safety, feasibility, and costs of outpatient laparoscopic extraperitoneal aortic nodal dissection for locally advanced cervical carcinoma

Abstract

Objective To report on the safety, feasibility, and costs of outpatient laparoscopic extraperitoneal aortic lymph node dissection (LEPSS) for locally advanced cervical carcinoma. Methods A retrospective analysis of all outpatient LEPSS procedures performed at our institution between August 2005 and February 2007 was performed. All patients with clinical stage IIB–IVA cervical carcinoma with no evidence of bulky aortic lymphadenopathy (> 1.0 cm) on pre-operative computed tomography were offered the procedure. If present, pelvic nodal disease could not exceed greater than 1.5 cm. Records were reviewed for demographics, operative findings, complications, length of stay, and CT scan aortic nodal status. As a comparison, the average costs for outpatient LEPSS and outpatient CT, MRI, and PET scan at our institution were calculated. Results A total of eighteen outpatient LEPSS procedures were identified. The median age was 49 (22–72). The median BMI was 29 (18–51). The median operative time was 108 min (60–135 min). The median aortic nodal count was 10 (5–20 nodes). The median blood loss was 25 ml (10–50 ml). There were no intraoperative complications. There was no conversion from a retroperitoneal to a transperitoneal approach. No patient required overnight hospitalization. One patient experienced a lymphocyst postoperatively. There was no delay in the initiation of chemoradiation for any of the patients with a median onset of 10 days from the date of surgery. At least 20% of the patients had one or more medical co-morbidities such as obesity, diabetes, hypertension, or a prior abdominal surgery. Occult aortic nodal metastasis was detected in 11% of the patients with a negative pre-operative CT scan. The average calculated costs at our institution for outpatient LEPSS was $5233 dollars versus $1520 dollars for CT scan, $4830 dollars for MRI and $5494 dollars for a PET scan. Conclusions To our knowledge this is the first reported experience of outpatient laparoscopic extraperitoneal aortic lymph node dissection for locally advanced cervical cancer. Outpatient LEPSS appears to be a safe and feasible procedure in the hands of an experienced surgeon, however further study is warranted. From a cost analysis perspective, outpatient LEPSS appears equivalent to PET scan and MRI, but is more expensive than CT scan.