A prospective observational study on the incidence of lymphatic complications following laparoscopic pelvic node dissection in gynecological malignancies

Objectives: Laparoscopic pelvic lymph node dissection (LPLND) is an integral part of surgical staging and treatment of gynecologic malignancies. Although the laparoscopic approach has reduced postoperative morbidity compared to open surgery, lymphatic complications such as lymphorrhea, lymphocele, and lower limb lymphedema continue to occur. This study aimed to determine the incidence, pattern, and clinical outcome of lymphatic complications following LPLND in gynecological malignancies. Material and Methods: A prospective observational study was conducted, including 68 patients with carcinoma of the endometrium or cervix who underwent LPLND between January 2023 and April 2024 in a tertiary care oncology center. Results: Of 68 patients, 41 (60.3%) had carcinoma of the cervix and 27 (39.7%) had carcinoma of the endometrium. Lymphatic complications occurred in 7 patients (10.3%). Among them, 5 (7.3%) developed lower limb lymphedema, 4 (5.8%) developed lymphocele (with one symptomatic case requiring aspiration), and 1 (1.4%) experienced transient lymphorrhea. Six out of seven (85.7%) affected patients had received radiotherapy. The mean number of lymph nodes retrieved in the complication group was 11. The average time to presentation of lymphocele was 5 months. Conclusion: Lymphatic complications following LPLND are infrequent and mostly subclinical, and radiotherapy increases susceptibility. Regular postoperative imaging follow-up enables early detection and conservative management. Laparoscopic PLND remains a safe and effective approach with minimal lymphatic morbidity.