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Laparoscopic pelvic and paraaortic lymph node dissection in the obese.
Dennis R Scribner1, Joan L Walker, Gary A Johnson
1Division of Gynecologic Oncology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma 73190, USA. dennis-scribner@ouhsc.edu
Gynecologic Oncology
|February 22, 2002
Summary
Laparoscopic pelvic and paraaortic lymph node dissection is feasible in obese women with gynecologic cancer. While success rates decrease with higher body mass index (BMI), the procedure offers benefits like shorter hospital stays and fewer complications.
Area of Science:
- Gynecologic Oncology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Obesity presents challenges in gynecologic cancer surgery.
- Laparoscopic approaches are increasingly utilized for staging and treatment.
Purpose of the Study:
- To evaluate the utility and outcomes of laparoscopic pelvic and paraaortic lymph node dissection (LND) in obese women with gynecologic cancer.
- To compare laparoscopic LND with traditional open laparotomy.
Main Methods:
- Retrospective analysis of patients with a Quetelet index (QI) > or =28 undergoing LND for gynecologic cancer.
- Comparison between a laparoscopic group (Group 1) and a laparotomy group (Group 2).
- Data collected on demographics, cancer stage, procedure details, and complications.
Main Results:
- Laparoscopic LND was completed in 63.6% of cases, with obesity being a primary reason for conversion.
- Higher QI (>=35) was associated with significantly lower laparoscopic success rates (44.4% vs. 82.1%).
- Completed laparoscopic LND resulted in longer operating room time but shorter hospital stays, equivalent blood loss, and fewer postoperative fevers, ileus, and wound infections compared to laparotomy.
Conclusions:
- Obesity is not an absolute contraindication for laparoscopic pelvic and paraaortic lymph node dissection.
- Laparoscopic LND offers advantages including reduced hospital stay and fewer postoperative complications.
- Careful patient selection, particularly considering BMI, is important for optimizing success rates.