Technical aspects of laparoscopic lymphodissection

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Aim. The studying of laparoscopic lymphodissection results in cancer of different location.

Material and methods. In Ryazan Regional Clinical Hospital 86 laparoscopic operations have been performed during the period 1999/2005. 64 (74,4%) patients have had colorectal cancer, 10 (11,6%) patients have had renal carcinoma and 2 (2,3%) patients - cervical carcinoma. 20 (23,2%) operations have been combined ones.

Lymphodissection technique has been identical. But lymphodissection extent was different, depending upon the spread of cancer. At colorectal cancer aortoiliac and aortoiliopelvic lymphodenectomy has been performed, depending upon tumor location. Radical nephrectomy has been accompanied by monolateral wide removal of retroperitoneal fat in aortal and iliac zones (affected side). Extend of lymphodissection has corresponded to standard radical hysterectomy in 2 patients (Vertheim’s operation).

Action consequence was different, depending upon tumor staging. In colorectal cancer the operation has been started with major vessels ligation followed by lymphodissection in paraaortic, iliac and lateral region. Radical hysterectomy, on the contrary, has been started from fat removal from pelvic lateral walls after dissecting of uterine round ligament with the following shift in medial direction.

Results. We have not had lethal cases and conversions. Intraoperation complication have been registered

in 3 (3,4%) patients. In two (2,3%) cases major vessels have been injured and in one (1,2%) case - ureter edge injury took place. In all cases these complications have been removed, using laparoscopic access. 4 (4,7%) patients have had postoperation complications. Large intestine resection has been performed in all cases. In two (2,3%) patients anastomosis has not been a success, in one case - anastomosis stricture took place and in one case - bilateral hydronephrosis. Functional disturbances have been noticed in 10(11,6%) cases. Large intestine resection has been performed in 9 (10,5%) patients, hysterectomy - in one patient. In 9 (10,5%) cases urination disorders took place, in one case - a patient’s minor motion disturbances, related to obturator nerve injury. Average operation time did not exceed open operation time.

We have got 5-year result investigations only in 10 (11,6%) patients having colorectal cancer, and 3-year result investigations in 32 (37,2%) patients. Preliminary analysis results of relapse frequency corresponded to the results of open expanded operations, and were considerably lower as compared to the number of traditional operations; but still it is too early to come to the final conclusion about lymphodissection efficiency.

Conclusion. Our investigations have shown efficiency of lymphodissection that is accompanied by slight number of complications and have encouraging prognosis.

About the authors

K. V. Puchkov

Email: info@eco-vector.com
Russian Federation, Ryazan

D. A. Khubezov

Email: info@eco-vector.com
Russian Federation, Ryazan

I. V. Yudin

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Ryazan

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