Systematic pelvic and aortic lymphadenectomy in cervical, endometrial and ovarian malignant tumours: patterns of spread and surgical implications

ABSTRACT

Pelvic and aortic nodes are common sites of metastasis from gynaecologic malignancies, and there is no question that evaluation of lymph node status provides an important prognostic infomation. The aim of the study was to assess the patterns of lymphatic spread of gynaecologic malignancies, the number of nodes which can be excised from each pelvic and aortic group, and the impact of this surgical procedure on the perioperative complications and survival. Between January 1998 and December 2002, 50 patients with previously untreated and biopsy-proven gynaecologic malignancies cervix [n=15], ovary [n=17], and endometrium [n=18] Were operated upon in the Departments of General Surgery, and Gynaecology and Obstetrics, Minoufnya University Hospital. The surgical procedure consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy and/or omentectomy, in addition to systematic pelvic and Para-aortic Iymphadenectomy. The median number of nodes removed was 21 pelvic [range 11-38] and 8 aortic [range 5-18]. Positive nodes were found in 22 patients [44%], 12 having pelvic, 4 aortic, and 6 both pelvic and aortic metastasis. The median number of positive nodes was 5 pelvic [range 1-12] and one aortic [range 1-6] nodes. The most frequently involved node groups were the obturator group with both cervical and ovarian carcinomas, and the external iliac group with endometrial carcinoma. The higher prevalence of aortic metastasis was observed in ovarian carcinoma. Lymphocele was the most frequent postoperative complication in 20% of patients. No postoperative mortality occurred in this series. The 5-year survival rate of patients with lymph node metastasis was significantly worse than that of patients without node metastasis [31% versus 84% P=<0.001]. These data may be useful for tailoring lymphadenectomy in relation to the preferred sites of retroperitoneal lymph node metastasis and the median number of nodes resected from each group, and confirms that systematic pelvic and aortic lymphadenectomy is a feasible procedure and can be performed with acceptable morbidity and no mortality. However, to provide solid evidence that this procedure has a therapeutic benefit, randomized controlled studies are needed