Abstract:
OBJECTIVE:Lymphadenectomy is an integral part of staging and treatment of gynecologic malignancies. We evaluated the feasibility and oncologic value of laparoscopic transperitoneal pelvic and paraaortic lymphadenectomy in correlation to complication rate and body mass index. METHODS:Between August 1994 and September 2003, pelvic and/or paraaortic transperitoneal laparoscopic lymphadenectomy was performed in 650 patients at the Department of Gynecology of the Friedrich-Schiller University of Jena. Retrospective and prospective data collection and evaluation of videotapes were possible in 606 patients. Laparoscopic lymphadenectomy was part of the following surgical procedures: staging laparoscopy in patients with advanced cervical cancer (n = 133) or early ovarian cancer (n = 44), trachelectomy in patients with early cervical cancer (n = 42), laparoscopic-assisted radical vaginal hysterectomy in patients with cervical cancer (n = 221), laparoscopy before exenteration in patients with pelvic recurrence (n = 20), laparoscopic-assisted vaginal hysterectomy or laparoscopic-assisted radical vaginal hysterectomy in patients with endometrial cancer (n = 112), and operative procedures for other indications (n = 34). RESULTS:After a learning period of approximately 20 procedures, a constant number of pelvic lymph nodes (16.9-21.9) was removed over the years. Pelvic lymphadenectomy took 28 min, and parametric lymphadenectomy took 18 min for each side. The number of removed paraaortic lymph nodes increased continuously over the years from 5.5 to 18.5. Right-sided paraaortic, left-sided inframesenteric and left-sided infrarenal lymphadenectomy took an average of 36, 28, and 62 min, respectively. The number of removed lymph nodes was independent from the body mass index of the patient. Duration of pelvic lymphadenectomy was independent of body mass index, but right-sided paraaortic lymphadenectomy lasted significantly longer in obese women (35 vs. 41 min, P = 0,011). The overall complication rate was 8.7% with 2.9% intraoperative (vessel or bowel injury) and 5.8% postoperative complications. No major intraoperative complication was encountered during the last 5 years of the study. CONCLUSION:By transperitoneal laparoscopic lymphadenectomy, an adequate number of lymph nodes can be removed in an adequate time and independent from body mass index. The complication rate is low and can be minimized by standardization of the procedure.
journal_name
Gynecol Oncoljournal_title
Gynecologic oncologyauthors
Köhler C,Klemm P,Schau A,Possover M,Krause N,Tozzi R,Schneider Adoi
10.1016/j.ygyno.2004.07.025subject
Has Abstractpub_date
2004-10-01 00:00:00pages
52-61issue
1eissn
0090-8258issn
1095-6859pii
S0090-8258(04)00519-0journal_volume
95pub_type
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journal_title:Gynecologic oncology
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pub_type: 杂志文章
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journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2019.04.002
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journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1996.0110
更新日期:1996-04-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
doi:10.1016/0090-8258(90)90407-c
更新日期:1990-10-01 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2014-02-01 00:00:00
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journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1995.1226
更新日期:1995-08-01 00:00:00
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journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1006/gyno.1993.1127
更新日期:1993-06-01 00:00:00
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更新日期:2015-04-01 00:00:00
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journal_title:Gynecologic oncology
pub_type: 杂志文章
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更新日期:2007-11-01 00:00:00
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journal_title:Gynecologic oncology
pub_type: 杂志文章
doi:10.1016/j.ygyno.2011.10.019
更新日期:2012-02-01 00:00:00
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journal_title:Gynecologic oncology
pub_type: 杂志文章,评审
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更新日期:2010-05-01 00:00:00