Clinical and Translational Oncology

, Volume 20, Issue 11, pp 1455–1459 | Cite as

Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience

  • D. Vázquez-VicenteEmail author
  • B. Fernández del Bas
  • J. García Villayzán
  • H. A. Di Fiore
  • J. Luna Tirado
  • V. Casado Echarren
  • J. García-Foncillas
  • J. Plaza Arranz
  • L. Chiva
Research Article



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.


Locally 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.

Ethical approval

There was no research involving human participants and/or animals.

Informed consent

Prior to joining the study, informed consent of each patient was obtained.


  1. 1.
    Green JA, Kirwan JM, Tierney JF, Symonds P, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001;358:781–6.CrossRefGoogle Scholar
  2. 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. 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
  4. 4.
    Gouy S, Morice P, Narducci F, Uzan C, et al. Nodal staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol. 2012;13(5):e212–20.CrossRefGoogle Scholar
  5. 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
  6. 6.
    Leblanc E, Narducci F, Frumovitz M, Lesoin A, et al. Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol. 2007;105(2):304–11.CrossRefGoogle Scholar
  7. 7.
    Mackillop WJ, Fu H, Quirt CF, Dixon P, et al. Waiting for radiotherapy in Ontario. Int J Radiat Oncol Biol Phys. 1994;30(1):221–8.CrossRefGoogle Scholar
  8. 8.
    Gil-Moreno A, Magrina JF, Pérez Benavente A, Díaz Feijoo B, et al. Location of aortic node metastases in locally advanced cervical cancer. Gynecol Oncol. 2012;125(2):312–4.CrossRefGoogle Scholar
  9. 9.
    Kyung MS, Kim HB, Seoung JY, Choi IY, et al. Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis. Oncol Lett. 2015;9(5):2218–24.CrossRefGoogle Scholar
  10. 10.
    Macdonald OK, Chen J, Dodson M, Lee CM, et al. Prognostic significance of histology and positive lymph node involvement following radical hysterectomy in carcinoma of the cervix. Am J Clin Oncol. 2009;32(4):411–6.CrossRefGoogle Scholar
  11. 11.
    Nelson JH Jr, Boyce J, Macasaet M, Lu T, et al. Incidence, significance and follow up of para-aortic lymph node metastases in late invasive carcinoma of the cervix. Am J Obstet Gynecol. 1977;128(3):336–40.CrossRefGoogle Scholar
  12. 12.
    Kobayashi R, Yamashita H, Okuma K, Ohtomo K, et al. Details of recurrence sites after definitive radiation therapy for cervical cancer. J Gynecol Oncol. 2016;27(2):e16.CrossRefGoogle Scholar
  13. 13.
    Gold MA, Tian C, Whitney CW, Rose PG, et al. Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma. A gynecologic Oncology Group study. Cancer. 2008;112(9):1954–63.CrossRefGoogle Scholar
  14. 14.
    Gil-Moreno A, Franco-Camps S, Cabrera S, Pérez-Benavente A, et al. Pretherapeutic extraperitoneal laparoscopic staging of bulky or locally advanced cervical cancer. Ann Surg Oncol. 2011;18(2):482–9.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  • D. Vázquez-Vicente
    • 1
    Email author
  • B. Fernández del Bas
    • 2
  • J. García Villayzán
    • 2
  • H. A. Di Fiore
    • 3
  • J. Luna Tirado
    • 2
  • V. Casado Echarren
    • 2
  • J. García-Foncillas
    • 2
  • J. Plaza Arranz
    • 2
  • L. Chiva
    • 1
  1. 1.Clínica Universidad de NavarraMadridSpain
  2. 2.Fundación Jiménez DíazQuirónsaludMadridSpain
  3. 3.Hospital Alta Complejidad FormosaFormosaArgentina

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