Saemathong Thitima, Chaowawanit Woraphot
Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
World J Oncol. 2024 Jun;15(3):423-431. doi: 10.14740/wjon1824. Epub 2024 May 7.
Lymphadenectomy plays an essential role in the staging protocols for gynecologic cancers, as recommended by International Federation of Gynecology and Obstetrics (FIGO). While its benefits vary, complications may arise during intra-operative, acute post-operative, or long-term periods. Notably, lymphadenectomy-associated systemic morbidity and specific complications such as lymphocele and lymphedema have been reported.
This retrospective study involved 399 patients with cervical, endometrial, and ovarian cancers who underwent pelvic and para-aortic lymphadenectomy. The follow-up period was at least 3 months. Intra-operative complications encompassed adjacent organ injury and significant blood loss, while acute post-operative complications occurred within 29 days. Post-30-day complications included lymphocele and lymphedema. Logistic regression analysis identified predictors for complications.
The overall complication rate was 42.4%, with intra-operative, acute post-operative, and long-term rates of 26.1%, 11.0%, and 14.0%, respectively. Predictors for overall complications included laparotomy, positive lymph nodes, and operative time > 240 min. For intra-operative complications, age > 60 years, laparotomy, positive lymph nodes, and operative time > 240 min were significant predictors. Symptomatic lymphocele and lymphedema occurred in 6.0% and 2.0% of patients, respectively, mainly in the long-term period.
Although the overall complication rate after gynecologic surgery was found to be almost half of all cases, the rate of severe complications was low. Additionally, the rates of symptomatic lymphocele and lymphedema were low. Lymphadenectomy in gynecologic cancer surgery can be performed safely.
正如国际妇产科联合会（FIGO）所推荐的，淋巴结切除术在妇科癌症的分期方案中起着至关重要的作用。虽然其益处各不相同，但在术中、术后急性期或长期都可能出现并发症。值得注意的是，已经报道了与淋巴结切除术相关的全身发病率以及诸如淋巴囊肿和淋巴水肿等特定并发症。
这项回顾性研究纳入了399例行盆腔和腹主动脉旁淋巴结切除术的宫颈癌、子宫内膜癌和卵巢癌患者。随访期至少为3个月。术中并发症包括邻近器官损伤和大量失血，而术后急性期并发症发生在29天内。术后30天的并发症包括淋巴囊肿和淋巴水肿。逻辑回归分析确定了并发症的预测因素。
总体并发症发生率为42.4%，术中、术后急性期和长期发生率分别为26.1%、11.0%和14.0%。总体并发症的预测因素包括开腹手术、淋巴结阳性和手术时间>240分钟。对于术中并发症，年龄>60岁、开腹手术、淋巴结阳性和手术时间>240分钟是显著的预测因素。有症状的淋巴囊肿和淋巴水肿分别发生在6.0%和2.0%的患者中，主要发生在长期。
虽然发现妇科手术后的总体并发症发生率几乎占所有病例的一半，但严重并发症的发生率较低。此外，有症状的淋巴囊肿和淋巴水肿的发生率也较低。妇科癌症手术中的淋巴结切除术可以安全地进行。
