Introduction/Background Lymphoceles are the most frequent complications after systematic lymphadenectomy in gynaecologic cancers. Drainage that is performed after hysterectomy and pelvic lymph node dissection to prevent postoperative lymphocyst formation and surgical morbidity is controversial.
Objectives Determine the clinical effect of absence of peritonization and absence of drainage compared with peritonization and drainage after hysterectomy and bilateral pelvic lymphadenectomy for patients with endometrial cancer.
Methodology 773 endometrial cancer patients underwent hysterectomy and bilateral pelvic lymphadenectomy with laparoscopic and open approach at N.N. Petrov Research Center of Oncology from 2010 to 2018. A total of 430 patients who underwent laparoscopic surgery were compared to 343 patients from open surgery group. According to the type of drainage and peritonization, patients were divided into four subgroups of comparison: A - laparoscopic approach with passive drainage and no peritanization (n=290), B - laparoscopic approach without drainage and peritonization (n=140), C - laparotomic approach with two active drainages and peritanization (n=100), D - laparotomic approach with passive drainage and no peritanization (n=243). Ultrasound examination of the pelvis for all patients after surgery was performed.
Results The overall incidence of lymphoceles was 337/773 (43.5%): 184/430 (42.8%) after laparoscopy and 196/343 (57,1%) after open surgery (p=0,01). Most of cases were asymptomatic (89.3%).
In the subgroups of laparoscopy: A - overall incidence of lymphocysts formation was 42.4%, incidence of symptomatic lymphocysts was 4.5%; B - 15% and 0% respectively. In subgroups of open surgery: C - overall incidence of lymphocysts formation was 65%, incidence of symptomatic lymphocysts was 17%; D - 52.3% and 8.4% respectively.
Conclusion The overall incidence of lymphocele after lymphadenectomy for endometrial cancer is high (43.5%). Laparoscopic approach with no peritonization and no drainage in endometrial cancer susgery is associated with a lower occurrence of both asymptomatic and symptomatic lymphoceles compared to open surgery with drainage and peritonization.
Disclosure Nothing to disclose.
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