Laparoscopic lymph node dissection in the evaluation and management of patients with pelvic malignancy

This retrospective investigation describes our experience with laparoscopic pelvic and paraaortic lymph node dissection at a military medical center.

The charts of all patients undergoing laparoscopic pelvic and paraaortic lymph node dissection between July 1992 and May 1994 were reviewed for age, weight, cancer type, tumor stage, operative procedures, estimated blood loss, complications, number and pathologic results of lymph nodes removed, preoperative computed tomography findings, and postoperative therapy.

The study group was composed of 20 patients, of which 15 had cervical cancer, 2 had ovarian cancer, and the rest had other pelvic malignancies. The mean age was 46 years old, with a mean weight of 155 pounds. The average number of lymph nodes removed was 26, with 9 of the 20 patients having positive nodes. Only one patient had preoperative radiographic evidence of lymphadenopathy. Mean estimated blood loss was 224 cc. Four patients required open procedures, two for bleeding during the laparoscopic node dissection and two who were unable to be completed through the laparoscope for technical reasons. Radical hysterectomy was avoided in two of the studied patients after finding positive lymph nodes. We conclude that in a military medical center, laparoscopic pelvic and paraaortic lymph node dissection in patients with certain pelvic malignancies is feasible and helps guide the management of these patients.