A Control Study Comparing Two Methods Of Lymphadenectomy And Drainage Or Not For Invasive Cervical Cancer.

ObjectiveTo evaluate the postoperative morbidities, especially the lymphocyst formation, pelvic infection and urinary retention,in invasive cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy(RHPL) with intraperitoneal lymphadenectomy and no drainage compared with retroperitoneal lymphadenectomy and drainage. To approach the feasibility of no drainage following intraperitoneal lymphadenectomy. MethodsBetween October 1993 and December 2006, the patients with invasive cervical cancer undergoing RHPL in ShanDong Provincial Hospital were divided into two groups,which received different ways of lymphadenectomy.Group 1 that received intraperitoneal lymphadenectomy and no drainage was called no drained group, the others were undergone retroperitoneal lymphadenectomy and drainage, so called drained group. Not only the characteristics of patients, such as age, tumor histology, disease stage, and the operative time, estimated blood loss and transfusion rate were recorded,but also the postoperative complications were observed intensively, especially the incidence of pelvic lymphocysts, both symptomatic and asymptomatic,the pelvic infections and the urinary retentions. Student's t, chi-square and two-tailed Fisher's tests was performed for statistical analysis of the results. Results152 patients were recorded, in which 69 women had no drainage and 83 did. The two groups were similar for mean age, tumor histology, disease stage, and lymph nodal metastases. The median operative time was (174±35.2) min in the undrained group and (187±29.8)min in the drained group(P<0.05). The median duration of hospitalization was 13 days in the undrained group and 15 days in drained group (P<0.05) . Complications, such as lymphocyst, urinary retention, occurred in 26 patients who had intraperitoneal lymphadenectomy and no drainage and in 36 patients who had retroperitoneal lymphadenectomy and drainage (37.68 % versus 43.37% , NS) . Fourteen patients (20.29% ) in the undrained group had pelvic lymphocysts compared with twelve (14.46%) in the drained group (P> 0.05) , there was no statistic difference in both groups. Among the total, the number of symptomatic pelvic lymphocysts was 3 (4.35%) in the undrained group and 2 (2.41%) in the drained group (P=0.34, NS) , and the number of no symptomatic pelvic lymphocysts was 11 and 10 respectively(15.94% versus 12.05 %), the undrained group was a little higher than the other one, but there was no statistic significance (P>0.05) . And pelvic infections developed 2 in the undrained group (2.90% ) and 9 in drained group (10.84% ) patients (P = 0.045), respectively. There was no significance for the occurrence of urinary retention in both groups (P>0.05) . The incidence of DVT was similar in two groups (2.90 % versus 3.66%,P>0.05) . ConclusionThe incidence of postoperative pelvic lymphocysts was similar in two groups, but the rate of pelvic infection was higher in drained group. Because of the convenient procedure and smaller surface in operation, the median operative time and the median duration of hospitalization were decreased in undrained group. No drainage also can release the patients' pressures and reduce the nurses' work load. In conclusion, with intraperitoneal lymphadenectomy, routine drainage after RHPL for invasive cervical cancer can be safely omitted.