A. Sam1,2, K. Vangsness1,4, M. Chu3, M. Agko1, J. Chang1, A.L. Carre1 1City Of Hope National Medical Center, Division Of Plastic Surgery, Duarte, CA, USA 2UC Riverside School of Medicine, Riverside, CA, USA 3Kaiser Permanente Medical Group, Division Of Plastic & Reconstructive Surgery, Los Angeles, CA, USA 4Community Memorial Hospital, Division Of General Surgery, Ventura, CA, USA
Introduction:
Pelvic lymphadenectomy is a procedure used in the treatment of malignancies involving the cervix, endometrium, ovaries, and even the testes. Similar to axillary lymph node dissection for breast cancer, pelvic lymphadenectomy is useful for the staging of cancers involving the pelvic region. This surgery can be performed either laparoscopically or in an open approach. Laparoscopic lymphadenectomy offers several advantages over the open approach, as it is minimally invasive and can lead to more favorable postoperative courses, such as a reduced recovery and postoperative complications. In this study, we hope to compare outcomes of pelvic lymphadenectomy performed laparoscopically compared to the open approach, to see if there are any differences in outcome between the methods in a nationwide cohort of patients.
Methods:
A retrospective review of patients undergoing pelvic lymphadenectomy was performed using TrinetX, a database containing de-identified patient information from various healthcare groups globally. For this study, we focused on healthcare organizations within the United States. A cohort was created using the CPT and ICD-10 codes for patients undergoing open or laparoscopic pelvic lymphadenectomy and for the associated postoperative outcomes of interest.
Results:
After review, a total of 11,259 patients were included for analysis. After matching 3,458 patients who underwent pelvic lymphadenectomy were in the open-approach and laparoscopic cohorts. The risk of postoperative infection (2.37% vs. 6.45%, p=.0001) and thromboembolic events after surgery (2.89% vs. 5.58%, p= .0001) were significantly reduced in the laparoscopic cohort. Interestingly, there was a higher risk of lymphedema in the laparoscopic group (6.96% vs. 4.31%, p=.0001) compared to the open-approach cohort. The risk of paresthesias, hematoma, or seroma showed no significance.
Conclusion:
Pelvic lymphadenectomy is a useful procedure used in the treatment of malignancies involving the pelvic region and can be performed in an open-approach or through a minimally invasive laparoscopic approach. In recent years, the laparoscopic method to this procedure has become more popular due to several advantages. However, in this study, we observed a higher risk of lymphedema in patients undergoing laparoscopic pelvic lymphadenectomy. We suspect this may be due to a higher level of precision provided by the laparoscope, allowing surgeons to more adequately respect the lymphatics, explaining a higher rate of lymphedema. As such, we propose immediate lymphatic reconstruction (ILR) to prophylactically address lower extremity lymphedema. In the future, we will prospectively assess this at our institution to see how ILR of the lower extremity at time of lymphadenectomy may reduce the rate of lymphedema.