Early experience with laparoscopic pelvic lymphadenectomy in women with gynecologic malignancy.

STUDY OBJECTIVES

To compare the results of laparoscopic pelvic lymphadenectomy with those of open lymphadenectomy; to assess differences in lymph node yield, operating time, and rate of positive nodes based on experience (early and late); and to evaluate the clinical course of laparoscopic lymphadenectomy.

DESIGN

Retrospective case review (Canadian Task Force classification II-2).

SETTING

University-affiliated hospital.

PATIENTS

Sixty-one women with cervical cancer, one with vaginal cancer, and one with endometrial cancer.

INTERVENTIONS

Laparoscopic lymphadenectomy followed by laparotomy or radical vaginal hysterectomy was performed in 19 women between 1994 and 1995, and radical abdominal hysterectomy with pelvic lymphadenectomy was performed in 44 women between 1993 and 1995. MEASUREMENTS AND MAIN RESULTS. Mean lymph node yields at laparoscopic pelvic lymphadenectomy were significantly increased in the group operated during the last 6 months compared with the first 6 months (16.2 +/- 6.8 vs 33.2 +/- 10. 5, p <0.05). After 6 months' experience, lymph node yields were 23.9 +/- 10.3 for laparoscopic lymphadenectomy followed by laparotomy and 23.2 +/- 10.2 for laparoscopic lymphadenectomy followed by radical vaginal hysterectomy (NS). The rate of positive lymph nodes was not significantly different between procedures, 16% and 14%, respectively. Operating time for laparoscopic lymphadenectomy was significantly shorter in the last 6 months (143 +/- 34 vs 78 +/- 18 min, p <0.05). Major complications of the procedure were injury to aberrant obturator and iliac veins in two cases in the early period. Average blood loss was 150 to 350 ml. Two women died due to disease recurrence at minimum of 2.5 years' follow-up; the others were alive without recurrence.

CONCLUSION

Laparoscopic pelvic lymphadenectomy was feasible and safe, and did not compromise short-term survival. A learning curve was associated with the procedure, but after a period of learning, pelvic lymphadenectomy can be performed as effectively by laparoscopy as by laparotomy. (J Am Assoc Gynecol Laparosc 6(1):59-63, 1999)