Evaluation of intraoperative and postoperative complications related to lymphadenectomy in ovarian cancer patients (original) (raw)
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Journal of minimally invasive gynecology, 2017
Lymphatic complications are common occurrence following staging surgery for early-stage ovarian cancer (eEOC). We aimed to investigate whether the introduction of minimally invasive surgery influences the risk of developing lymphoceles and lymphorrhea in patients undergoing staging for eEOC. For this purpose, data of consecutive patients affected by eEOC undergoing staging surgery between January 1980 and January 2016 were retrospectively reviewed, and a systematic review and meta-analysis was performed. This systematic review was registered in the International Prospective Register of Systematic Review. Among 341 patients included in the present study, 47 severe postoperative complications occurred (13.7%), including 40 lymphatic complications: 31 symptomatic lymphoceles (9%) and 9 cases of lymphorrhea (2.6%), respectively. Laparoscopic staging correlated with a lower risk of developing any severe lymphatic complications in comparison to open surgery (p=.02). In particular, laparos...
Archives of Gynecology and Obstetrics, 2011
Introduction The main objective of this study is to illustrate the eVectiveness and the safety of standardized technique of laparoscopic lymphadenectomy (LNE), newly introduced in a University Hospital, in patients with gynecologic malignancy. Materials and methods A cohort of 104 patients with gynaecologic malignancies (71 with endometrial and 33 with cervical cancer), who underwent laparoscopic pelvic with or without para-aortic LNE between September 2008 and March 2010, were analyzed. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH & BSO) was the standard approach for patients with endometrial cancer (n = 71), while laparoscopic (nerve sparing) radical hysterectomy (n = 29), laparoscopic-assisted radical vaginal hysterectomy (n = 2) and radical trachelectomy was the treatment for patients with cervical cancer. All LNE were performed by a learning team under the supervision of an expert surgeon, familiar with the technique. Results The median number of pelvic lymph nodes yielded was 22 (range 16-34) and of para-aortic 14 (range 12-24). The mean operative time § standard deviation for pelvic LNE for each side was 29 § 17 and 64 § 29 min for para-aortic LNE. The overall complication rate was 7.6% (n = 8). Two patients were reoperated laparoscopically, one because of postoperative hemorrhage and the other because of lymphocyst formation; laparoconversion was not necessary. Discussion Laparoscopic lymphadenectomy performed by a learning team with standardized technique is eVective with adequate number of harvested nodes, in acceptable operative time and with low rate of perioperative complications.
Objective: To determine the results of laparoscopic lymphadenectomy in gynecologic oncology patients. Material and Method: Medical records of 31 gynecologic oncology patients who underwent laparoscopic lymphadenectomy between November 1, 2004 and February 28, 2007 were retrospectively reviewed. Results: The median age of the study population was 47 years (range 24-77 years). Sixteen patients (51.6%) had endometrial cancer while 15(48.4%) had ovarian malignancy, with median numbers of resected pelvic and paraaortic nodes of 12 (range 3-30 nodes) and 1 (range . The groups of lymphadenectomy only, lymphadenectomy with total laparoscopic hysterectomy, and lymphadenectomy with laparoscopic assisted vaginal hysterectomy had median blood losses of 100 ml (range 30-220 ml), 350 ml (range 100-800 ml), and 200 ml (range 150-400 ml) respectively. Accidental injuries of common iliac artery and large bowel occurred in two patients, all of whom were converted to a laparotomy for correcting the damaged sites. Overall, the median duration for postoperative recovery was three days (range 2-8 days).
Reducing Morbidity of Pelvic and Retroperitoneal Lymphadenectomy
2013
Lymphadenectomy is utilized in both pelvic and retroperitoneal oncological surgery as a means to eradicate locoregional disease, improve staging accuracy and guide adjuvant therapy. However, pelvic and retroperitoneal lymphadenectomy have the potential for morbidity including lymphatic injury, vascular injury, thromboembolic events and neurologic injury. Across the spectrum of urologic malignancies, the evidence supporting both the necessity and the extent of lymphadenectomy varies considerably. Awareness of the potential for injury and ways to avoid and manage the most common complications is necessary to decrease the morbidity associated with these procedures.
Vascular complication during staging lymphadenectomy in early-stage ovarian cancer
Gynecology and Pelvic Medicine
Ovarian cancer (OC) is the fifth most frequent cancer in Europe and currently represents the main cause of death in women presenting gynecological cancer. In 70% of cases, the disease may be diagnosed at an advanced stage with nonspecific symptoms. In the early stages OC, surgical staging is needed to assess the extent of the disease. According to the National Comprehensive Cancer Network (NCCN), surgical staging includes total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, and pelvic and lumboaortic lymphadenectomy. The classic surgical approach provides a median laparotomic longitudinal incision. However, in specialized centers, staging surgery may be performed through laparoscopic surgery for selected patients. Laparoscopic approach showed minor intra and postoperative complications, shorter hospital stay, faster return to work, and better aesthetic satisfaction when compared to laparotomic surgery. Nonetheless, even minimally invasive surgery is not without complications. In case of major complications occurring during laparoscopy rapid and prompt life-saving treatments could be necessary. We present a 63-year-old woman case with a 55 mm, multilocular-solid left adnexal mass, Color Score 2, with abnormal CA 125, requiring comprehensive staging surgery. The study aims to show a possible and dangerous vascular complication that may occur during staging lymphadenectomy in early-stage OC. In this case, a rapid laparotomic conversion was needed to quickly stop bleeding.
Annals of Surgical Oncology, 2012
Background. The prognostic role of systematic lymphadenectomy remains unclear in advanced ovarian cancer (AOC). Only few retrospective case series have investigated the percentage of lymph node metastases after neoadjuvant chemotherapy. This multi-institutional casecontrol study analyzed the prognostic role of systematic lymphadenectomy in AOC patients at the time of interval debulking surgery (IDS). Methods. From January 2005 to December 2010, the records of patients with AOC admitted to IDS at the Catholic University of Rome (n = 101, controls) and at the University of Bologna (n = 50, cases) were retrospectively analyzed. The cases, routinely submitted to systematic pelvic and aortic lymphadenectomy, were matched 1:2 with the controls, who did not routinely undergo lymphadenectomy. To correctly assess the prognostic role of lymphadenectomy, only patients with optimally debulked disease were included. Progression-free survival and overall survival were analyzed by a log-rank test. Results. After an overall mean follow-up of 36 months (95 % confidence interval 33-39), 35 and 63 recurrences (70.0 vs. 62.4 %; p = NS) and 15 and 24 deaths due to disease (30 vs. 23.7 %; p = NS) were observed in the case and controls, respectively. The 2-year progression-free survival rate was 36 versus 25 % (p = 0.834), and the 2-year overall survival rate was 69 versus 88 % (p = 0.777), in the case and controls, respectively. The median operating time was longer, and the percentage of patients requiring blood transfusions was higher in the cases than in the controls (225 vs. 210 min, p = 0.023, and 54 vs. 22.8 %, p = 0.0001, respectively). Conclusions. Lymphadenectomy at the time of IDS could be omitted, at least in high-risk patients.
International Journal of Gynecological Cancer, 2015
Objective: This study aimed to compare the incidence of lower extremity lymphedema in patients with uterine cancer after robotic staging using the following 2 methods: standard and selective pelvic lymphadenectomy. Materials and Methods: Three hundred forty-four consecutive patients who presented with endometrial cancer from March 2007 to October 2012 underwent robotic staging. Surgeon A performed standard pelvic lymphadenectomy and surgeon B performed selective lymphadenectomy. Selective pelvic lymphadenectomy spared the lateral chain of the external iliac lymph nodes (LNs). The incidence of lymphedema and staging adequacy between the 2 groups were analyzed. Results: Standard pelvic lymphadenectomy was performed in 238/344 (69.2%) patients and selective pelvic lymphadenectomy was performed in 106/344 (30.8%) patients. Conversion to laparotomy occurred in 2/344 cases (0.6%). Mean age for 344 patients was 63.6 (10) years and body mass index was 34.8 (10.1) kg/m 2 . The mean operative time was 162.3 (54.6) minutes. Postoperative hospitalization was 1.62 (1.93) days. Histology included 80.8% endometrioid adenocarcinomas and 19.2% clear cell, serous, and carcinosarcomas. Mean pelvic LN counts for the standard and selective pelvic lymphadenectomy groups were 16 (8.6) and 15.5 (7.1), respectively (P = 0.31). Mean numbers of para-aortic LNs retrieved for the standard and selective lymphadenectomy groups were 3.1 (4.1) and 4.9 (4.5), respectively (P G 0.01). Median follow-up was 29.3 months (interquartile range, 15.6Y43.1 months). The difference in the incidence of lower extremity lymphedema was statistically significant: 4.6% (11/ 238 patients) in the standard lymphadenectomy group versus 0.9% (1/106 patients) in the selective lymphadenectomy group (P = 0.03). Conclusions: When compared to the standard technique, selective pelvic lymphadenectomy with sparing of the lateral chain of the external iliac LNs is adequate and results in a lower incidence of lower extremity lymphedema.