Novel para-aortic lymphadenectomy technique for gynecological malignancies prevents postoperative bowel obstruction

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Abstract

Aim

The aim of this study was to evaluate the effect of our novel technique on the prevention of postoperative ileus in patients undergoing systematic para-aortic lymphadenectomy (PALN).

Material and Methods

PALN was performed in 135 gynecological cancer patients (67 with ovarian cancer, 58 with endometrial cancer, 8 with serous surface papillary adenocarcinoma (SSPC) and 2 with fallopian tube cancer) between 2006 and 2011. To prevent postoperative ileus, we performed our novel technique wherein the small bowel and colon are released from pressure and soaked in 2 L of physiological saline for 1 min every 20 min during the lymphadenectomy. We indicated our novel PALN technique and retrospectively analyzed the outcomes of the surgical procedure in terms of the surgical data, and postoperative incidence of gastrointestinal dysfunction in patients with gynecological malignancies.

Results

The mean blood loss was 641.2 ± 800.3 mL in the PALN group and 313.9 ± 278.9 mL in the pelvic lymphadenectomy (PLN) without PALN group (P  < 0.0001). There was no difference in the first passage of flatus between the PALN group and the PLN group (1.8 ± 0.7 days vs 1.6 ± 0.7 days). The mean time to tolerance of a regular diet was significantly longer in the PALN group than in the PLN group (P < 0.0001), whereas the incidence of vomiting was similar in both groups. Surprisingly, there were no cases of postoperative ileus in either group.

Conclusion

Our novel technique is a safe and effective way to prevent the incidence and decrease the severity of postoperative ileus after PALN for gynecological malignancies.

Introduction

Systematic para-aortic lymphadenectomy (PALN) is a common procedure used to stage and treat many primary gynecological cancers. Systematic lymphadenectomy, including PALN, has a prognostic role, and is used to decide the stage of disease in early ovarian cancer. Moreover, many studies have reported that a significant survival impact for systematic lymphadenectomy, including PALN, was observed in patients without residual disease.[1-4] The current recommendations for the surgical management of ovarian cancer include complete resection of all visible intraperitoneal tumors and systematic lymphadenectomy, including PALN.....