World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 15, Number 3, June 2024, pages 423-431

A Retrospective Study of Complications Following Pelvic and Para-Aortic Lymphadenectomy in Gynecologic Oncology

Figure 2. Kaplan-Meier survival estimates of the patients with or without complication. (a) Overall complication. (b) Intra-operative complication. (c) Acute complication. (d) Long-term complication.

Figure 3. Kaplan-Meier survival estimates of the subgroup of patients with or without positive lymph node. (a, b) Overall complication. (c, d) Intra-operative complication. (e, f) Acute complication. (g, h) Long-term complication.

**Table 1.** Clinical Characteristics of 399 Patients Who Underwent Pelvic and/or Para-Aortic Lymphadenectomy
Characteristics	Mean ± SD or N (%)
BMI: body mass index; SD: standard deviation.
Age (years)	53.7 ± 12.4
BMI (kg/m²)	25.8 ± 5.8
25 - 29.9	118 (29.6)
30 - 39.9	65 (16.3)
≥ 40	11 (2.8)
Underlying disease
No	160 (40.1)
Yes	239 (59.9)
Diabetes mellitus	85 (21.3)
Hypertension	143 (35.8)
Dyslipidemia	94 (23.6)
Cerebrovascular accident	7 (1.8)
Cardiovascular disease	5 (1.3)
Venous thromboembolism	13 (3.3)
Hyperthyroidism	8 (2.0)
Hypothyroidism	7 (1.8)
HIV infection	7 (1.8)
Obstructive sleep apnea	5 (1.3)
Gynecologic cancers
Cervical cancer	81 (20.3)
Endometrial cancer	174 (43.6)
Ovarian cancer	140 (35.1)
Synchronous cancer	4 (1.0)

Table 1. Clinical Characteristics of 399 Patients Who Underwent Pelvic and/or Para-Aortic Lymphadenectomy

Characteristics

Mean ± SD or N (%)

BMI: body mass index; SD: standard deviation.

Age (years)

53.7 ± 12.4

BMI (kg/m²)

25.8 ± 5.8

25 - 29.9

118 (29.6)

30 - 39.9

65 (16.3)

≥ 40

11 (2.8)

Underlying disease

160 (40.1)

Yes

239 (59.9)

Diabetes mellitus

85 (21.3)

Hypertension

143 (35.8)

Dyslipidemia

94 (23.6)

Cerebrovascular accident

7 (1.8)

Cardiovascular disease

5 (1.3)

Venous thromboembolism

13 (3.3)

Hyperthyroidism

8 (2.0)

Hypothyroidism

7 (1.8)

HIV infection

7 (1.8)

Obstructive sleep apnea

5 (1.3)

Gynecologic cancers

Cervical cancer

81 (20.3)

Endometrial cancer

174 (43.6)

Ovarian cancer

140 (35.1)

Synchronous cancer

4 (1.0)

**Table 2.** Surgical Characteristics and Complications of 399 Patients Distinguished by Types of Cancer
	Total (N = 399)	Types of cancer
^aSynchronous cancer: ovarian cancer with endometrium cancer in four cases. ^bType 2 or 3 hysterectomy. BSO: bilateral salpingo-oophorectomy; LN: lymph node; SD: standard deviation; USO: unilateral salpingo-oophorectomy.
Surgical approach (%)
Laparotomy	354 (88.7)	73 (90.1)	139 (79.9)	138 (98.6)	4 (100.0)
Laparoscopy	45 (11.3)	8 (9.9)	35 (20.1)	2 (1.4)	0 (0.0)
Lymphadenectomy (%)
Pelvic lymphadenectomy	103 (25.8)	66 (81.5)	22 (12.6)	15 (10.7)	0 (0.0)
Para-aortic lymphadenectomy	5 (1.3)	4 (4.9)	1 (0.6)	0 (0.0)	0 (0.0)
Pelvic and para-aortic lymphadenectomy	291 (72.9)	11 (13.6)	151 (86.8)	125 (89.3)	4 (100.0)
Operations (%)
Hysterectomy (± BSO ± omentectomy)	372 (93.2)	72 (88.9)^b	171 (98.3)	125 (89.3)	4 (100.0)
USO/BSO (± omentectomy)	13 (3.3)	0 (0.0)	1 (0.6)	12 (8.6)	0 (0.0)
Other operations	8 (2.0)	4 (4.9)	1 (0.6)	3 (2.1)	0 (0.0)
Lymphadenectomy alone	6 (1.5)	5 (6.2)	1 (0.6)	0 (0.0)	0 (0.0)
Operative time (min) (mean ± SD)	273.9 ± 88.2	275.0 ± 81.3	259.6 ± 79.3	293.2 ± 98.5	197.5 ± 74.1
Total blood loss (mL) (mean ± SD)	689.7 ± 757.3	559.3 ± 416.5	432.4 ± 428.5	1,077.1 ± 1,033.0	962.5 ± 363.7
Total number of LN (mean ± SD)	20.4 ± 10.3	19.7 ± 10.6	21.1 ± 10.7	19.7 ± 9.5	27.5 ± 10.1
LN status (%)
Negative	318 (79.7)	69 (85.2)	143 (82.2)	102 (72.9)	4 (100.0)
Positive	81 (20.3)	12 (14.8)	31 (17.8)	38 (27.1)	0 (0.0)
Overall complication (%)	169 (42.4)	32 (39.5)	52 (29.9)	83 (59.3)	2 (50.0)
Intra-operative complication (%)	104 (26.1)	16 (19.8)	22 (12.6)	65 (46.4)	1 (25.0)
Vessel injury	13 (3.3)	0 (0.0)	6 (3.4)	7 (5.0)	0 (0.0)
Bowel injury	13 (3.3)	1 (1.2)	3 (1.7)	9 (6.4)	0 (0.0)
Bladder injury	5 (1.3)	0 (0.0)	1 (0.6)	4 (2.9)	0 (0.0)
Ureteric injury	3 (0.8)	1 (1.2)	0 (0.0)	2 (1.4)	0 (0.0)
Blood loss ≥ 1,000 mL	83 (20.3)	15 (18.5)	15 (8.6)	52 (37.1)	1 (25.0)
Acute post-operative complication (%)	44 (11.0)	8 (9.9)	17 (9.8)	19 (13.6)	0 (0.0)
Surgical site infection	16 (4.0)	1 (1.2)	10 (5.7)	5 (3.6)	0 (0.0)
Urinary retention	3 (0.8)	3 (3.7)	0 (0.0)	0 (0.0)	0 (0.0)
Bowel obstruction	3 (0.8)	0 (0.0)	0 (0.0)	3 (2.1)	0 (0.0)
Bowel ileus	8 (2.0)	1 (1.2)	3 (1.7)	4 (2.9)	0 (0.0)
Cystitis	6 (1.5)	1 (1.2)	3 (1.7)	2 (1.4)	0 (0.0)
Lymphocele	4 (1.0)	0 (0.0)	0 (0.0)	4 (2.9)	0 (0.0)
Venous thromboembolism	3 (0.8)	2 (2.5)	0 (0.0)	1 (0.7)	0 (0.0)
Hospital acquired pneumonia	2 (0.5)	0 (0.0)	1 (0.6)	1 (0.7)	0 (0.0)
Long-term complication (%)	56 (14.0)	13 (16.0)	21 (12.1)	21 (15.0)	1 (25.0)
Lymphedema	8 (2.0)	2 (2.5)	4 (2.3)	2 (1.4)	0 (0.0)
Lymphocele	24 (6.0)	3 (3.7)	7 (4.0)	14 (10.0)	0 (0.0)
Venous thromboembolism	12 (3.0)	3 (3.7)	8 (4.6)	1 (0.7)	0 (0.0)
Urinary retention	3 (0.8)	3 (3.7)	0 (0.0)	0 (0.0)	0 (0.0)
Others (bowel obstruction, vaginal stump evisceration, cystocele)	11 (2.8)	2 (2.5)	4 (2.3)	4 (2.9)	1 (25.0)

Table 2. Surgical Characteristics and Complications of 399 Patients Distinguished by Types of Cancer

Total (N = 399)

Types of cancer

Cervix (N = 81)

Endometrium (N = 174)

Ovary (N = 140)

Synchronous^a (N = 4)

^aSynchronous cancer: ovarian cancer with endometrium cancer in four cases. ^bType 2 or 3 hysterectomy. BSO: bilateral salpingo-oophorectomy; LN: lymph node; SD: standard deviation; USO: unilateral salpingo-oophorectomy.

Surgical approach (%)

Laparotomy

354 (88.7)

73 (90.1)

139 (79.9)

138 (98.6)

4 (100.0)

Laparoscopy

45 (11.3)

8 (9.9)

35 (20.1)

2 (1.4)

0 (0.0)

Lymphadenectomy (%)

Pelvic lymphadenectomy

103 (25.8)

66 (81.5)

22 (12.6)

15 (10.7)

0 (0.0)

Para-aortic lymphadenectomy

5 (1.3)

4 (4.9)

1 (0.6)

0 (0.0)

Pelvic and para-aortic lymphadenectomy

291 (72.9)

11 (13.6)

151 (86.8)

125 (89.3)

4 (100.0)

Operations (%)

Hysterectomy (± BSO ± omentectomy)

372 (93.2)

72 (88.9)^b

171 (98.3)

125 (89.3)

4 (100.0)

USO/BSO (± omentectomy)

13 (3.3)

0 (0.0)

1 (0.6)

12 (8.6)

0 (0.0)

Other operations

8 (2.0)

4 (4.9)

1 (0.6)

3 (2.1)

0 (0.0)

Lymphadenectomy alone

6 (1.5)

5 (6.2)

1 (0.6)

0 (0.0)

Operative time (min) (mean ± SD)

273.9 ± 88.2

275.0 ± 81.3

259.6 ± 79.3

293.2 ± 98.5

197.5 ± 74.1

Total blood loss (mL) (mean ± SD)

689.7 ± 757.3

559.3 ± 416.5

432.4 ± 428.5

1,077.1 ± 1,033.0

962.5 ± 363.7

Total number of LN (mean ± SD)

20.4 ± 10.3

19.7 ± 10.6

21.1 ± 10.7

19.7 ± 9.5

27.5 ± 10.1

LN status (%)

Negative

318 (79.7)

69 (85.2)

143 (82.2)

102 (72.9)

4 (100.0)

Positive

81 (20.3)

12 (14.8)

31 (17.8)

38 (27.1)

0 (0.0)

Overall complication (%)

169 (42.4)

32 (39.5)

52 (29.9)

83 (59.3)

2 (50.0)

Intra-operative complication (%)

104 (26.1)

16 (19.8)

22 (12.6)

65 (46.4)

1 (25.0)

Vessel injury

13 (3.3)

0 (0.0)

6 (3.4)

7 (5.0)

0 (0.0)

Bowel injury

13 (3.3)

1 (1.2)

3 (1.7)

9 (6.4)

0 (0.0)

Bladder injury

5 (1.3)

0 (0.0)

1 (0.6)

4 (2.9)

0 (0.0)

Ureteric injury

3 (0.8)

1 (1.2)

0 (0.0)

2 (1.4)

0 (0.0)

Blood loss ≥ 1,000 mL

83 (20.3)

15 (18.5)

15 (8.6)

52 (37.1)

1 (25.0)

Acute post-operative complication (%)

44 (11.0)

8 (9.9)

17 (9.8)

19 (13.6)

0 (0.0)

Surgical site infection

16 (4.0)

1 (1.2)

10 (5.7)

5 (3.6)

0 (0.0)

Urinary retention

3 (0.8)

3 (3.7)

0 (0.0)

Bowel obstruction

3 (0.8)

0 (0.0)

3 (2.1)

0 (0.0)

Bowel ileus

8 (2.0)

1 (1.2)

3 (1.7)

4 (2.9)

0 (0.0)

Cystitis

6 (1.5)

1 (1.2)

3 (1.7)

2 (1.4)

0 (0.0)

Lymphocele

4 (1.0)

0 (0.0)

4 (2.9)

0 (0.0)

Venous thromboembolism

3 (0.8)

2 (2.5)

0 (0.0)

1 (0.7)

0 (0.0)

Hospital acquired pneumonia

2 (0.5)

0 (0.0)

1 (0.6)

1 (0.7)

0 (0.0)

Long-term complication (%)

56 (14.0)

13 (16.0)

21 (12.1)

21 (15.0)

1 (25.0)

Lymphedema

8 (2.0)

2 (2.5)

4 (2.3)

2 (1.4)

0 (0.0)

Lymphocele

24 (6.0)

3 (3.7)

7 (4.0)

14 (10.0)

0 (0.0)

Venous thromboembolism

12 (3.0)

3 (3.7)

8 (4.6)

1 (0.7)

0 (0.0)

Urinary retention

3 (0.8)

3 (3.7)

0 (0.0)

Others (bowel obstruction, vaginal stump evisceration, cystocele)

11 (2.8)

2 (2.5)

4 (2.3)

4 (2.9)

1 (25.0)

**Table 3.** Five-Year Survival Rate of 399 Patients With or Without Positive LN
	5-year survival rate (%)
LN: lymph node.
All patients	97.39	92.31	0.017	96.27	92.31	0.080	94.93	97.73	0.3892	95.92	91.07	0.077
Positive LN	100.00	97.87	0.221	100.00	97.30	0.089	98.63	100	0.719	98.57	100.00	0.719
Negative LN	96.94	90.16	0.030	95.62	89.55	0.163	93.97	97.22	0.424	92.49	88.89	0.058

Table 3. Five-Year Survival Rate of 399 Patients With or Without Positive LN

5-year survival rate (%)

Overall complication

Intra-operative complication

Acute complication

Long-term complication

Yes

P-value

Yes

P-value

Yes

P-value

Yes

P-value

LN: lymph node.

All patients

97.39

92.31

0.017

96.27

92.31

0.080

94.93

97.73

0.3892

95.92

91.07

0.077

Positive LN

100.00

97.87

0.221

100.00

97.30

0.089

98.63

100

0.719

98.57

100.00

0.719

Negative LN

96.94

90.16

0.030

95.62

89.55

0.163

93.97

97.22

0.424

92.49

88.89

0.058