Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience
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One aim of this study was to assess the efficacy and safety of laparoscopic paraaortic lymphadenectomy for paraaortic lymph node staging in locally advanced cervical carcinoma. The second aim was to identify prognostic factors in the evolution of this disease and to evaluate how the results of the surgery modify the oncological treatment of patients.
Materials and methods
We analyzed 59 patients diagnosed with locally advanced cervical cancer International Federation of Gynecology and Obstetrics stage IB2–IVA who underwent laparoscopic paraaortic lymphadenectomy at our hospital between 2009 and 2015. Depending on the results of the paraaortic lymphadenectomy, treatment consisted of pelvic- or extended-field chemoradiotherapy.
The mean age at diagnosis was 52.3 years. The median operative time was 180 min. The mean hospital stay was 1.7 days. The mean number of paraaortic lymph nodes excised was 16.4. Eight patients (13.5%) had positive paraaortic lymph nodes. Thirteen patients (22%) underwent surgery via the transperitoneal route, and 46 (78%) underwent surgery via the retroperitoneal route. The sensitivity and specificity of computerized axial tomography (CT) scanning for detecting paraaortic lymph node involvement was 75 and 86%, respectively. The statistically significant prognostic factors that affected survival were surgical paraaortic lymph node involvement, radiological pelvic lymph node involvement, and radiological tumor size as assessed with nuclear magnetic resonance. The rate of serious complications was 1.7%.
Pretherapeutic laparoscopic paraaortic lymphadenectomy for locally advanced cervical carcinoma allows the adaption of radiotherapy fields to avoid false-positive and false-negative imaging results.
KeywordsLocally advanced cervical cancer Laparoscopic para-aortic lymphadenectomy Para-aortic surgical staging
Compliance with ethical standards
Conflict of interest
The authors have no disclosure of potential conflicts of interest.
There was no research involving human participants and/or animals.
Prior to joining the study, informed consent of each patient was obtained.
- 2.Choi HJ, Ju W, Myung SK, Kim Y. Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastasic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci. 2010;101(6):1471–9.CrossRefGoogle Scholar
- 3.Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, et al. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer. 2011;117(9):1928–34.CrossRefGoogle Scholar
- 5.Perez-Medina T, Pereira A, Mucientes J, García-Espantaleon M, et al. Prospective evaluation of 18-fluoro-2-deoxy-d-glucose positron emission tomography for the discrimination of paraaortic nodal spread in patients with locally advanced cervical carcinoma. Int J Gynecol Cancer. 2013;23(1):170–5.CrossRefGoogle Scholar