Intraoperative complications, treatments and outcomes of lymph node dissection for gynecological malignancies

Background: Lymph node dissection (LND) is crucial in gynecological malignancies for accurate staging, adjuvant therapy and curative intent. Intraoperative vascular injuries, nerve injuries, and ureter injuries may be observed. The aim of our study is to evaluate intraoperative vascular, nerve, and ureteral injuries associated with the LND procedure, along with their treatments and outcomes. Methods: This retrospective study included patients who underwent pelvic ± para-aortic LND due to gynecological malignancies (cervical, endometrial and ovarian) at the Gynecological Oncology Surgery Clinic between 2015 and 2024. Results: Two thousand four hundred ninety-three cases were reviewed. Major intraoperative complications associated with lymph node dissection (LND) occurred in 59 cases (2.3%). In 39 patients (1.5%), small (<1 cm) lacerations of the inferior vena cava (IVC) were observed and were repaired with primary suturing (6.0 Prolene). There were 3 (0.1%) cases of vascular injury requiring repair with a vascular graft. No complications were observed in any patients during postoperative follow-up after grafting. There were eight (0.3%) patients with obturator nerve injury. Ureteral injury occurred in 9 (0.3%) patients. Conclusions: Retroperitoneal lymph node dissection associated with gynecological malignancies, while rare, can lead to complications that may result in serious morbidity or mortality. Follow-ups of intraoperatively diagnosed and repaired complications (such as inferior vena cava injury, vascular injuries requiring graft repair, obturator nerve injury and ureteral injury) generally did not lead to morbidity. Intraoperative diagnosis and appropriate treatment are usually associated with low morbidity and improved quality of life.