Laparoscopic pelvic and para-aortic lymphadenectomy

Nam, Joo Hyun; Park, Jeong Yeol

Abstract

Laparoscopic surgery has many benefits over a conventional abdominal approach. These include less blood loss, low morbidity, shorter recovery time, shorter hospital stay, and shorter time interval to adjuvant therapy. With advances of laparoscopic instruments and surgical skills, laparoscopic surgery is becoming a dominant paradigm in the surgical management of gynecologic cancers. Advanced laparoscopic procedures including radical hysterectomy and trachelectomy with pelvic and para-aortic lymphadenectomy are now used in the management of early cervical cancer. For patients with apparent early-stage endometrial and ovarian cancer, laparoscopic complete staging operation including pelvic and para-aortic lymphadenectomy can be applied. Of several laparoscopic surgical procedures, laparoscopic pelvic and para-aortic lymphadenectomy is a cornerstone in the management of gynecological cancers cancers. The evaluation of lymph node status has an important role in diagnosis, treatment, and prognosis of gynecologic cancers because lymphatics are the main pathways of dissemination of gynecologic cancers. Laparoscopic pelvic and para-aortic lymphadenectomy is feasible and safe without increase of perioperative complications and decrease in patient's survival in gynecologic cancers, if it is performed by an experienced laparoscopic oncologic surgeon. During the last 10 years, laparoscopic procedures including pelvic and para-aortic lymphadenectomy in over 600 patients with gynecologic cancers were underwent in our department. We have found that the surgical and oncologic outcomes were similar or even better compared to conventional laparotomic procedures. In conclusion, the gynecologic oncologist should be familiar with lymphatic anatomy and laparoscopic skills to perform pelvic and para-aortic lymphadenectomy, because laparoscopic management of gynecologic cancers will be the choice of surgical treatment in the near future.