Laparoscopic pelvic and paraaortic lymph node dissection in the obese.

OBJECTIVE: The aim of this study was to determine the utility of laparoscopic pelvic and paraaortic lymph node dissection in obese women.
METHODS: We performed a retrospective analysis from 1/8/96 to 1/14/01 at the University of Oklahoma Health Science Center, evaluating patients who had a Quetelet index (QI) > or =28 and had planned laparoscopic bilateral pelvic and paraaortic lymph node dissections (lnd) for their gynecologic cancer. This group was compared to a matched group of patients that had lnd done by laparotomy. Patients were identified by our institution's database and data were collected by review of their medical records. Data were collected regarding demographics, stage, histology, length of stay, and procedural information including completion rates, estimated blood loss (EBL), operating room (OR) time, lymph node count, assistant, and complications. Associations between variables were analyzed using Student t tests and chi(2) testing, Excel v9.0.
RESULTS: Fifty-five patients had planned laparoscopic lnd (Group 1) and 45 patients had lnd via laparotomy (Group 2). All patients had the diagnosis of endometrial cancer. The percentage of stage I patients did not differ between groups (42/55, 71.2% versus 37/45, 82.2%, P = n.s.). Age and QI were also similar between groups, (64.6 versus 58.4, 40.0 versus 39.3, P = n.s.). Laparoscopy was completed in 35/55 (63.6%) cases. Reasons for conversion included obesity (23.6%), adhesions (1.8%), intraperitoneal cancer (5.5%), and bleeding (5.5%). QI > or =35 was associated with a decreased success rate compared to QI <35 (44.4% versus 82.1%, P = 0.004). There was no difference in successful laparoscopy when the first assistant was a fellow or a community obstetrician/gynecologist (61.0% versus 50.0%, P = n.s.). The patients in Group 1 who had laparoscopy completed had a longer OR time compared to those in Group 2 (265.3 versus 140.7 min, P < 0.0001), EBL and transfusion rates were equivalent (361.8 versus 344.2 ml, 5.6% versus 6.7%, P = n.s.), and length of stay was shorter (2.8 versus 4.5 days, P = 0.0004). Group 1 had significantly fewer postoperative fevers (5.5% versus 31.1%, P = 0.0007), fewer postoperative ileus (0% versus 13.3%, P = 0.005), and a trend for fewer wound infections (9.0% versus 22.2%, P = 0.07).
CONCLUSIONS: Obesity is not a contraindication to laparoscopic pelvic and paraaortic lymph node dissection. The overall success rate was significantly higher in those patients with a QI <35. Advantages include shorter hospital stay, fewer postoperative fevers, fewer postoperative ileus, and possibly fewer wound infections.