Lymphadenectomy, also called lymph node dissection, is a surgery to remove lymph nodes. It may be done to examine the pelvic and para-aortic lymph nodes to determine the exact stage and grade of cancer and may reduce the spread of the cancer. It is defined as the entire dissection and removal of fat and nodal tissues around the aorta, inferior vena cava and renal vessels. There are two types of Para-aortic lymphadenectomy: laparoscopic para-aortic lymphadenectomy (LPAL) and open para-aortic lymphadenectomy (PALND).

Para-aortic lymphadenectomy is performed in women with early-stage ovarian / endometrial cancers (tumor size 2 cm or less) and advanced-stage ovarian ? cervical cancers. It may be needed, if:

• Cancer cells are found in selected lymph nodes that were removed in an earlier surgical procedure.
• Pelvic lymph nodes are enlarged.
• Chemotherapy
• Cancer cells are a higher grade (faster-growing).
• The cancer is large.

Dr Naresh will ask the patient to get preoperative imaging like MRI, PET scan and serum markers and CA 125. The surgeon will prepare the patient’s bowel from before 5 days of the surgery by giving fibre-rich diet and laxatives 2 days prior to the surgery.

Para-aortic lymph node dissection is a complex surgical procedure and requires special surgical expertise to perform the procedure, thereby minimizing the complications.
The surgery is performed under general anesthesia. Laparoscopic surgery may take longer than open surgery. But if the procedure is done with a laparoscope rather than by open abdominal incision, recovery time may be shorter.
The paraaortic lymph node dissection separates all of the lymphatic tissue from the great vessels; it is left attached to the peritoneum above it. Once this is completed, the lymphatic tissue is separated from the intact posterior peritoneum and duodenum.
It begins over the right common iliac artery from the mid-level caudad to cephalad direction. Precaval and preaortic lymph nodes are dissected to the level of left renal vein.

There are some risks associated with this procedure like lymphedema, bleeding, infection and collection of lymph fluid in the pelvis. A physiotherapist will be assigned to the patient postoperatively to reduce long-term swelling and improve quality of life.