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Pretherapeutic Extraperitoneal Laparoscopic Staging of Bulky or Locally Advanced Cervical Cancer

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To assess the safety, feasibility, and impact on survival of extraperitoneal para-aortic lymphadenectomy in the staging of patients with bulky or locally advanced cervical cancer.

Materials and Methods

Between August 2001 and October 2009, 87 consecutive patients (median age 51 years) with bulky or locally advanced cervical cancer underwent extraperitoneal laparoscopic infrarenal aortic and common iliac dissection as a pretherapeutic staging procedure. Data on pathologic findings, details of surgery, postoperative complications, and disease status at follow-up were collected.

Results

The median operating time was 150 min (range 60–255 min). The mean (± standard deviation) para-aortic nodal yield was 15.5 ± 8.1 (range 4–62). In none of the patients, conversion to the transperitoneal approach or laparotomy was necessary. Histological examination revealed metastasis in 13 patients (macroscopic disease 10, microscopic disease 3). After a median follow-up of 33.4 months (range 13.3–65.9 months), 73.6% of patients were free of disease and 1.1% were alive with disease, 19.5% died from cervical cancer, and 3.3% died from other causes. After a follow-up of 3 years, no deaths or recurrences were documented, with an overall survival rate of 74.8% (95% CI 62.8%–83.4%) and disease-free survival of 86% (95% CI 74.7%–92.5%). There were no significant differences in overall survival and disease-free survival between patients with positive and negative para-aortic lymph nodes.

Conclusion

The extraperitoneal laparoscopic para-aortic lymphadenectomy for pretherapeutic surgical staging in cervical cancer is a safe and feasible procedure that should be considered as a tool to identify lymph node positive patients who require extended-field radiation and/or chemotherapy.

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Acknowledgment

The authors are grateful to Berta Díaz-Feijoo, MD, José Luís Sánchez-Iglesias, MD, Oriol Puig, MD, Ramona Vergés, MD, Ana Oaknin, MD, and José M. Martínez-Palones for their contribution to the care of the patients included in the study, and to Marta Pulido, MD, for editing the manuscript and editorial assistance. The contribution of each author to this study is as follows: A. Gil-Moreno is the principal investigator, designed the study, reviewed the literature, performed surgical procedures, collected and analyzed data, and wrote the paper. S. Franco-Camps, S. Cabrera, A. Pérez-Benavente, and J. Xercavins contributed to the collection of data, care of the patients included in the study, critical revision of the manuscript, and read and approved the final draft. X. Martínez-Gómez performed the statistical analyses, reviewed the manuscript for intellectual and scientific content, and approved the final draft. Finally, A. García performed the histopathological studies, reviewed the manuscript for intellectual and scientific content, and approved the final draft.

Disclosure

The authors did not disclose any financial support or potential conflicts of interest.

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Authors and Affiliations

  1. Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-Infantil Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Antonio Gil-Moreno MD, Silvia Franco-Camps MD, Silvia Cabrera MD, Assumpció Pérez-Benavente MD & Jordi Xercavins MD

  2. Service of Epidemiology and Preventive Medicine, Hospital General Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Xavier Martínez-Gómez MD

  3. Department of Pathology, Hospital General Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Angel Garcia MD

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  1. Antonio Gil-Moreno MD
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  2. Silvia Franco-Camps MD
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  3. Silvia Cabrera MD
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  7. Jordi Xercavins MD
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Correspondence to Antonio Gil-Moreno MD.

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Gil-Moreno, A., Franco-Camps, S., Cabrera, S. et al. Pretherapeutic Extraperitoneal Laparoscopic Staging of Bulky or Locally Advanced Cervical Cancer. Ann Surg Oncol 18, 482–489 (2011). https://doi.org/10.1245/s10434-010-1320-9

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  • DOI: https://doi.org/10.1245/s10434-010-1320-9

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