摘要
Lymphadenectomy is an integral part of staging and treatment of gynecologic malignancies.We evaluated the feasibility and oncologic value of l aparoscopic transperi-toneal pelvic and paraaortic lymphadenectomy in correla-tion to complication rate and body ma ss index.Between August 1994and September 2003,pelv ic and /or paraaortic transperitoneal laparo scopic lymphadenectomy was performed in 650patients at the D epartment of Gy-necology of the Friedrich -Schiller University of Jena.Retrospective and prospective data collection and evalua-tion of videotapeswere possible in 606patients.Laparo-scopic lymphadenectomy was part of t he following surgi-cal procedures:staging laparoscop y in patientswith ad-vanced 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 re-currence(n =20),laparoscopic -assisted vaginal hys-terectomy or laparoscopic -assiste d radical vaginal hys-terectomy in patients with endometr ial cancer(n =112),and operative procedures for other i ndications(n =34).After a learning period of approxima tely 20procedures,a constant number of pelvic lymph nodes(16.9-21.9)was removed over the years.Pelvic lymphadenectomy took 28min,and parametric lymphadenectom y took 18min for each side.The number of removed para aortic lymph nodes increased continuously over the yea rs from 5.5to 18.5.Right -sided paraaortic,left -sided inframesenteric and left -sided infrarenal lymphadenec tomy took an average of36,28,and 62min,respectively.The number of removed lymph nodeswas independent from the body mass index of the patient.Duration of pelvic lymp hadenectomywas inde-pendent of body mass index,but right -sided paraaortic lymphadenectomy lasted significan tly longer in obese women(35vs.41min,P =0,011).The overall com-plication rate was 8.7%with 2.9%int raoperative(vessel or bowel injury)and 5.8%postoperative complicatio ns.No major intraoperative complicati on was encountered during the last 5years of the study.B y transperitoneal laparoscopic lymphadenectomy,an a dequate 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 theprocedure.
Lymphadenectomy is an integral part of staging and treatment of gynecologic malignancies.We evaluated the feasibility and oncologic value of l aparoscopic transperi-toneal pelvic and paraaortic lymphadenectomy in correla-tion to complication rate and body ma ss index.Between August 1994and September 2003,pelv ic and /or paraaortic transperitoneal laparo scopic lymphadenectomy was performed in 650patients at the D epartment of Gy-necology of the Friedrich -Schiller University of Jena.Retrospective and prospective data collection and evalua-tion of videotapeswere possible in 606patients.Laparo-scopic lymphadenectomy was part of t he following surgi-cal procedures:staging laparoscop y in patientswith ad-vanced 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 re-currence(n =20),laparoscopic -assisted vaginal hys-terectomy or laparoscopic -assiste d radical vaginal hys-terectomy in patients with endometr ial cancer(n =112),and operative procedures for other i ndications(n =34).After a learning period of approxima tely 20procedures,a constant number of pelvic lymph nodes(16.9-21.9)was removed over the years.Pelvic lymphadenectomy took 28min,and parametric lymphadenectom y took 18min for each side.The number of removed para aortic lymph nodes increased continuously over the yea rs from 5.5to 18.5.Right -sided paraaortic,left -sided inframesenteric and left -sided infrarenal lymphadenec tomy took an average of36,28,and 62min,respectively.The number of removed lymph nodeswas independent from the body mass index of the patient.Duration of pelvic lymp hadenectomywas inde-pendent of body mass index,but right -sided paraaortic lymphadenectomy lasted significan tly longer in obese women(35vs.41min,P =0,011).The overall com-plication rate was 8.7%with 2.9%int raoperative(vessel or bowel injury)and 5.8%postoperative complicatio ns.No major intraoperative complicati on was encountered during the last 5years of the study.B y transperitoneal laparoscopic lymphadenectomy,an a dequate 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 theprocedure.
