[Laparoscopic Surgery for isolated lymph nodes recurrence in gynecology. Experience in Argentina.]

Objectives: to describe the perioperative and oncological outcomes of a serie of cases treated with laparoscopic surgery for isolated nodal metastasis of gynecologic malignancies at the Gynecology Service of Hospital Italiano de Buenos Aires and conduct a literature review on the surgical treatment provided to patients with this condition.

Methods: A search was conducted in the surgery records of the Gynecology Service of Hospital Italiano of patients who underwent laparoscopic cytoreductive surgery for isolated nodal recurrence of a gynecologic primary tumor in the period 2009-2015. The medical records were reviewed and data on the patients’ characteristics, the tumor, the surgery and its complications were collected and analyzed. A literature search was conducted in Pubmed by the term “isolated nodal recurrence in gynecology” and a subsequent snowball search was performed.

Results: As results, nine patients are presented. The median age was 66 years old (RI 7). The initial cancer location was: ovary (n=3), endometrium (n=3), cervix (n=2) and breast (n=1). The location site of the single nodal recurrence was the para-aortic area (n=8) and the pelvic area (n=1). The median of the disease-free interval to recurrence was 42.8 months (RI 40.2). Either the retroperitoneal or the transperitoneal approach was used based on the location of the recurrence. The median surgery time was 120 minutes (RI 36). No conversion to laparotomy was performed in any patient. No intraoperative or postoperative complications were reported, nor any requirement for blood transfusion. The median hospital stay was 36 hours. Adjuvant treatment with chemotherapy was applied to 8/9 patients. Only one patient recurred in para-aortic lymph nodes and peritoneal carcinomatosis after eight months and died of her disease. The literature review confirms the possibility of laparoscopic resection of the single nodal recurrence with low complication rate.

Conclusion: The laparoscopic lymph node cytoreductive surgery is a valid and safe treatment option considering the perioperative and oncological outcomes in our hospital.