Part 2 book “An atlas of gynecologic oncology” has contents: Vascular access and implantable vascular and peritoneal access devices, surgical management of trophoblastic disease, robotic surgery, gastrointestinal surgery in gynecologic oncology, urologic procedures, plastic reconstructive procedures, and other contents. | 23 Extraperitoneal approach to infrarenal, inframesenteric, and pelvic lymphadenectomies Katherine A. O’Hanlan introduction Pelvic and aortic lymphadenectomy is an essential step in the staging of pelvic malignancies. It is often used to determine primary therapy, to help remove all grossly or occult positive disease, and to enable stratification of malignancies for valid comparisons of treatments, all with the purpose of optimizing survival. A transabdominal laparoscopic approach for pelvic (Querleu et al. 1991) and infrarenal aortic (Querleu et al. 1993) lymphadenectomy was first described by Querleu and colleagues for staging cervical, endometrial, and ovarian malignancies. Urologists (Ferzli et al. 1992) and later gynecologic oncologists (Vasilev and McGonigle 1995) subsequently developed an extraperitoneal approach for pelvic, infrarenal aortic (Vasilev and McGonigle 1996), and suprarenal aortic (Possover et al. 1998) artery lymphadenectomy. Because the predominant drainage of malignancies of the cervix is to pelvic nodes, and of the endometrium and ovaries is to pelvic and aortic nodes (Matsumoto et al. 2002), this chapter focuses on use of a direct extraperitoneal approach for staging or restaging cervical, uterine, and ovarian carcinomas. indications Cervical Carcinoma Resection of bulky nodes prior to combination chemotherapy and radiotherapy has been shown to result in improved overall survival (Cosin et al. 1998). When PET or CT scans show enlarged pelvic nodes, lymphadenectomy and then radiation of the nodal beds and at least one nodal segment higher is indicated. In addition, it is useful to rule out aortic adenopathy when there are bulky nodes in the pelvis, prior to initiating radiotherapy to the pelvis alone (Tillmanns and Lowe 2007). The extraperitoneal approach can avoid the adhesions that can develop during transperitoneal surgery that can complicate radiation therapy. Endometrial Carcinoma The ability to laparoscopically remove pelvic and .
