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Paraaortic Laparoscopic Node Dissections

  • Eric Leblanc
  • Fabrice Narducci
  • Delphine Hudry
  • Lucie Bresson
  • Arnaud Wattiez
  • Audrey Tsunoda
  • Denis Querleu
Chapter

Abstract

Paraaortic lymph node dissection (PA lnd) is an important staging technique, with significant implications. Beyond the poor prognostic impact of involved paraaortic nodes, this knowledge alters further primary tumor management. Although not considered in FIGO staging system of cervix carcinoma, demonstration of paraaortic node involvement usually triggers the extension of pelvic chemoradiation fields up to the renal pedicle. In endometrial carcinoma, positive nodes upstage the disease to stage IIIC2, and extended-field radiation therapy and chemotherapy are considered. In ovarian carcinomas, this situation corresponds to a FIGO IIIC disease and implies chemotherapy.

Keywords

Laparoscopy Lymphadenectomy Para-aortic node dissection Extraperitoneal Transperitoneal 

References

  1. 1.
    Nezhat CR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol. 1992;166(3):864–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Querleu D. Laparoscopic paraaortic node sampling in gynecologic oncology: a preliminary experience. Gynecol Oncol. 1993;49(1):24–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Vasilev SA, McGonigle KF. Extraperitoneal laparoscopic paraaortic lymph node dissection: development of a technique. J Laparoendosc Surg. 1995;5(2):85–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Dargent D, Ansquer Y, Mathevet P. Technical development and results of left extraperitoneal laparoscopic paraaortic lymphadenectomy for cervical cancer. Gynecol Oncol. 2000;77(1):87–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Panici PB, et al. Anatomical study of para-aortic and pelvic lymph nodes in gynecologic malignancies. Obstet Gynecol. 1992;79(4):498–502.PubMedGoogle Scholar
  6. 6.
    Haberstich R, et al. [Left colon necrosis after endoscopic para-aortic lymph node exploration in a cervical carcinoma stage IIB]. Ann Chir. 2006;131(9): 553–5.Google Scholar
  7. 7.
    Pomel C, et al. Systematic (complete) para-aortic lymphadenectomy: description of a novel surgical classification with technical and anatomical considerations. BJOG. 2012;119(2):249–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Klemm P, et al. Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecol Oncol. 2005;96(2):278–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Spentzouris G, et al. The clinical anatomy of the inferior vena cava: a review of common congenital anomalies and considerations for clinicians. Clin Anat. 2014;27(8):1234–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Reisner DC, et al. Congenital and acquired disorders of ureteral course. Curr Probl Diagn Radiol. 2016.Google Scholar
  11. 11.
    Natsis K, et al. Horseshoe kidney: a review of anatomy and pathology. Surg Radiol Anat. 2014;36(6):517–26.PubMedCrossRefGoogle Scholar
  12. 12.
    Zhao Y, et al. Chylous ascites after laparoscopic lymph node dissection in gynecologic malignancies. J Minim Invasive Gynecol. 2014;21(1):90–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim EA, et al. Octreotide therapy for the management of refractory chylous ascites after a staging operation for endometrial adenocarcinoma. J Obstet Gynaecol Res. 2014;40(2):622–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Todo Y, et al. Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol. 2010;119(1):60–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Salani R, et al. Swelling among women who need education about leg lymphedema: a descriptive study of lymphedema in women undergoing surgery for endometrial cancer. Int J Gynecol Cancer. 2014;24(8):1507–12.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Scribner DR Jr, et al. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 2002;84(3):426–30.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Pakish J, et al. A comparison of extraperitoneal versus transperitoneal laparoscopic or robotic para-aortic lymphadenectomy for staging of endometrial carcinoma. Gynecol Oncol. 2014;132(2):366–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Scribner DR Jr, et al. Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible? Gynecol Oncol. 2001;83(3):563–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Gouy S, et al. Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy for locally advanced cervical cancer: assessment after 52 consecutive patients. Surg Endosc. 2014;28(1):249–56.PubMedCrossRefGoogle Scholar
  20. 20.
    Diaz-Feijoo B, et al. Comparison of robotic-assisted vs conventional laparoscopy for extraperitoneal paraaortic lymphadenectomy. Gynecol Oncol. 2014;132(1):98–101.PubMedCrossRefGoogle Scholar
  21. 21.
    Narducci F, et al. Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy in gynecologic oncology: preliminary experience and advantages and limitations. Int J Gynecol Cancer. 2015;25(8):1494–502.PubMedCrossRefGoogle Scholar
  22. 22.
    Leblanc E, et al. A new laparoscopic method of bowel radio-protection before pelvic chemoradiation of locally advanced cervix cancers. Surg Endosc. 2014;28(9):2713–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Leblanc E, et al. Should systematic infrarenal para-aortic dissection be the rule in the pretherapeutic staging of primary or recurrent locally advanced cervix cancer patients with a negative preoperative para-aortic PET imaging? Int J Gynecol Cancer. 2016;26(1):169–75.PubMedCrossRefGoogle Scholar
  24. 24.
    Kleppe M, et al. Lymph node metastasis in stages I and II ovarian cancer: a review. Gynecol Oncol. 2011;123(3):610–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Muyldermans K, et al. Primary invasive mucinous ovarian carcinoma of the intestinal type: importance of the expansile versus infiltrative type in predicting recurrence and lymph node metastases. Eur J Cancer. 2013;49(7):1600–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Kumar S, et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol. 2014;132(1):38–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Kohler C, et al. Perioperative morbidity and rate of upstaging after laparoscopic staging for patients with locally advanced cervical cancer: results of a prospective randomized trial. Am J Obstet Gynecol. 2015;213(4):503.e1–7.CrossRefGoogle Scholar
  28. 28.
    Gouy S, et al. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol. 2012;13(5):e212–20.PubMedCrossRefGoogle Scholar
  29. 29.
    Vergote I, et al. Laparoscopic lower para-aortic staging lymphadenectomy in stage IB2, II, and III cervical cancer. Int J Gynecol Cancer. 2002;12(1):22–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Morales S, et al. Surgical outcome of extraperitoneal paraaortic lymph node dissections compared with transperitoneal approach in gynecologic cancer patients. J Minim Invasive Gynecol. 2013;20(5):611–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Akladios C, et al. Comparison between transperitoneal and extraperitoneal laparoscopic paraaortic lymphadenectomy in gynecologic malignancies. J Minim Invasive Gynecol. 2015;22(2):268–74.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Eric Leblanc
    • 1
  • Fabrice Narducci
    • 1
  • Delphine Hudry
    • 1
  • Lucie Bresson
    • 1
  • Arnaud Wattiez
    • 2
  • Audrey Tsunoda
    • 3
  • Denis Querleu
    • 4
  1. 1.Department of Gynecologic OncologyCentre Oscar LambretLilleFrance
  2. 2.University of Strasbourg - FranceHead of Gynecology department Latifa HospitalDubaiUAE
  3. 3.Department of Gynecologic OncologyHospital Israelita Albert Einstein CuritibaSão PauloBrazil
  4. 4.Department of SurgeryInstitut BergoniéBordeauxFrance

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