Transperitoneal laparoscopic pelvic lymphadenectomy for gynecologic malignancies (II). Indications

We reviewed the published experimental and clinical data, available in MEDLINE, and compared them with our own experience, in a university-affiliated tertiary medical center of obstetrics and gynecology in order to report on the accepted indications for laparoscopic pelvic lymphadenectomy.

Surgical staging of cervical carcinoma can be performed via the laparoscopic approach. Intraperitoneal biopsies, washings, and pelvic lymphadenectomy can also be carried out with high accuracy and limited morbidity. Node-negative women are better treated by a radical hysterectomy performed either simultaneously (using frozen sections) or secondarily after routine pathologic examination of the pelvic nodes. Node-positive patients have a poor prognosis, no matter what the treatment is, and are generally considered for radiotherapy and/or chemotherapy. The use of laparoscopic pelvic lymphadenectomy in advanced cervical cancers is limited.

Laparoscopy has a direct therapeutic application in endometrial carcinoma. Total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy can all be performed via laparoscopy. Thus, stage I and some stage II endometrial cancers can be treated exclusively laparoscopically. This approach seems as effective as laparotomy, but it dramatically reduces the costs and morbidity associated with conventional treatment.

Currently, the use of laparoscopy in ovarian and tubal cancers is confined to referral centers. Laparoscopy appears to be as effective as laparotomy for second-look surgery. Treatment of stage II and more advanced ovarian cancers has been reported, but it cannot be recommended in a routine situation.