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

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. © 2012 Japan Society of Obstetrics and Gynecology.