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Prognostic Value and Therapeutic Implication of Laparoscopic Extraperitoneal Paraaortic Staging in Locally Advanced Cervical Cancer: A Spanish Multicenter Study

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

Abstract

Purpose

To assess the impact of laparoscopic extraperitoneal paraaortic staging in therapeutic planning and prognosis of patients with locally advanced cervical cancer (LACC) as compared with imaging staging.

Methods

Retrospective multicenter study of stage IB2 and IIA2 to IVA (FIGO 2009) LACC patients who were candidates for primary chemoradiotherapy. The study (surgical) group included 634 patients undergoing laparoscopic/robotic extraperitoneal paraaortic staging treated with extended-field radiotherapy (EFRT) if lymph node involvement was confirmed. The control (imaging) group included 288 patients treated with EFRT when lymph node involvement was suspected on positron emission tomography-computed tomography scans and/or magnetic resonance imaging.

Results

In the study group, a median of 13 (range 9–17) lymph nodes were removed, with a rate of positive paraaortic nodes of 18%, with metastatic size ≤ 5 mm in 20.4% of cases. Paraaortic EFRT was administered to 18% of patients in the study group and in 58% of controls. In 34% of patients from the surgical group, EFRT was modified according to surgical findings with respect to imaging staging. The median follow-up in the study and control groups was 3.7 and 4.8 years, respectively. In both groups, the overall survival and cancer-specific disease-free survival were similar. The time interval between diagnosis and starting EFRT was 18 days longer in the study group, without differences in overall survival as compared with controls (hazard ratio 1.00, 95% confidence interval 0.998–1.005; p = 0.307).

Conclusions

Laparoscopic extraperitoneal paraaortic staging in LACC patients is safe and modified therapeutic planning, allowing better selection of candidates for EFRT.

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Acknowledgements

The authors thank Marta Pulido, MD, PhD, for editing the manuscript and editorial assistance. SEGO Spain-GOC Group (Spanish Society of Obstetrics and Gynecology [SEGO] Spain-Gynecologic Oncology [GOG): Berta Díaz-Feijoo (coordinator), Aureli Torné, and Blanca Gil-Ibáñez, Hospital Clínic de Barcelona, Barcelona; Antonio Gil-Moreno (general coordinator) and Vicente Bebia, Hospital Universitari Vall d’Hebron, Barcelona; Álvaro Tejerizo and José F. Pérez-Regadera, Hospital Universitario 12 de Octubre, Madrid; Virginia Benito and Amina Lumbrano, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria; Alicia Hernández and Cristina González, Hospital Universitario La Paz, Madrid; Santiago Domingo and Víctor Lago, Hospital Universitari i Politècnic La Fe, Valencia; Rubén Ruiz and Paloma Cobos, Hospital Universitario Donostia, Donostia-San Sebastián; Rocío Luna-Guibourg and Ramón Rovira, Hospital de la Santa Creu i Sant Pau, Barcelona; Juan Gilabert-Estelles and Dra. Chipiriliu, Hospital General Universitario de Valencia, Valencia; Antonio Llueca and Lola Piquer, Hospital General Universitari de Castelló, Castelló de la Plana; and Pluvio Coronado and Miriam Gracia, Hospital Clínico San Carlos, Madrid, Spain.

Author information

Authors and Affiliations

  1. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain

    Berta Díaz-Feijoo MD, PhD, Aureli Torné MD, PhD & Blanca Gil-Ibáñez MD, PhD

  2. Department of Obstetrics and Gynecology, Hospital Universitario, Madrid, Spain

    Álvaro Tejerizo MD, PhD

  3. Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain

    Virginia Benito MD, PhD

  4. Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain

    Alicia Hernández MD, PhD

  5. Service of Gynecology and Obstetrics, Hospital Universitario Donostia, Donostia-San Sebastián, Spain

    Rubén Ruiz MD, PhD

  6. Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Santiago Domingo MD, PhD

  7. Department of Obstetrics and Gynecology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Rocío Luna-Guibourg MD

  8. Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, Castelló de la Plana, Spain

    Antonio Llueca MD, PhD

  9. Women’s Health Institute, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain

    Pluvio Coronado MD, PhD

  10. Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain

    Juan Gilabert-Estelles MD, PhD

  11. Gynecological Oncology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Vicente Bebia MD & Antonio Gil-Moreno MD, PhD

  12. Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain

    Antonio Gil-Moreno MD, PhD

Authors
  1. Berta Díaz-Feijoo MD, PhD
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Consortia

the SEGO Spain-GOG Group

  • Berta Díaz-Feijoo
  • , Aureli Torné
  • , Blanca Gil-Ibáñez
  • , Antonio Gil-Moreno
  • , Vicente Bebia
  • , Álvaro Tejerizo
  • , José F. Pérez-Regadera
  • , Virginia Benito
  • , Amina Lumbrano
  • , Alicia Hernández
  • , Cristina González
  • , Santiago Domingo
  • , Víctor Lago
  • , Rubén Ruiz
  • , Paloma Cobos
  • , Donostia-San Sebastián
  • , Rocío Luna-Guibourg
  • , Ramón Rovira
  • , Juan Gilabert-Estelles
  • , Dra. Chipiriliu
  • , Antonio Llueca
  • , Lola Piquer
  • , Pluvio Coronado
  •  & Miriam Gracia

Contributions

BD-F and AG-M: conception and design, data acquisition, analysis and interpretation, writing of the manuscript; AT, ATe, VB, AH, RR, SD, RL-G, ALl, PC, JG-E, VB, and BG-I: acquisition of data and revision for important intellectual content. All authors have seen and approved the final draft submitted.

Corresponding author

Correspondence to Berta Díaz-Feijoo MD, PhD.

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Disclosures

P. Coronado: nonfinancial support from Abex and personal fees from Medtronic. The remaining authors have no conflicts to declare.

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Díaz-Feijoo, B., Torné, A., Tejerizo, Á. et al. Prognostic Value and Therapeutic Implication of Laparoscopic Extraperitoneal Paraaortic Staging in Locally Advanced Cervical Cancer: A Spanish Multicenter Study. Ann Surg Oncol 27, 2829–2839 (2020). https://doi.org/10.1245/s10434-020-08329-5

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