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Cervical Cancer
Laparoscopic Lymphadenectomy in Advanced Cervical Cancer: Prognostic and Therapeutic Value
  1. Marta del Pino, MD, PhD*,
  2. Pere Fusté, MD*,
  3. Jaume Pahisa, MD, PhD*,
  4. Àngels Rovirosa, MD, PhD†,
  5. Maria Jose Martínez-Serrano, MD*,
  6. Sergio Martínez-Román, MD, PhD*,
  7. Immaculada Alonso, MD, PhD*,
  8. Laura Vidal, MD, MD‡,
  9. Jaume Ordi, MD, PhD§ and
  10. Aureli Torné, MD, PhD*
  1. *Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS);
  2. †Radiation Oncology Department, Gynecological Cancer Unit, Hospital Clinic; and
  3. ‡Clinic Institute of Hematological and Oncological Diseases. Hospital Clinic, Faculty of Medicine-University of Barcelona, Spain; and
  4. §Department of Pathology, Hospital Clinic, Centre de Recerca en Salut Internacional de Barcelona (CRESIB), University of Barcelona, Spain.
  1. Address correspondence and reprint requests to Marta del Pino, MD, PhD, Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Spain, C/Villarroel 170, 08036, Barcelona, Spain. E-mail: mdelpino{at}clinic.ub.es.

Abstract

Objective Clinical benefit of surgical staging in locally advanced cervical cancer has not yet been proved. The goal of this study was to analyze the prognostic and therapeutic value of laparoscopic para-aortic lymphadenectomy with selective excision of suspicious pelvic nodes in patients with locally advanced cervical cancer.

Methods This is a retrospective study including 109 women treated in a single institution from 2000 to 2009. The International Federation of Gynecology and Obstetrics stage was IB2 in 12 women, IIB in 58 women, and IIIB in 39 women. None had suspicious para-aortic nodes by presurgical imaging evaluation. All patients underwent extraperitoneal para-aortic laparoscopic lymphadenectomy with selective excision of enlarged pelvic nodes and received pelvic radiotherapy with concomitant chemotherapy. Extended lumboaortic radiation therapy was added to patients with metastatic para-aortic nodes. The mean ± SD follow-up time was 43.1 ± 33.7 months.

Results Metastatic lymph nodes were identified in 23 (21.1%) of 109 patients in the para-aortic area and in 24 (53.3%) of 45 patients who underwent selective excision of pelvic nodes. Patients with nodal metastases had increased risk of mortality than those with negative nodes independently of the location (pelvic and/or para-aortic) of the metastases (hazard ratio, 4.07; 95% confidence interval, 1.36–12.16 for patients with pelvic metastases [P = 0.012]; and 3.73; 95% confidence interval, 1.38–10.09 for patients with para-aortic metastases [P = 0.010]). In the subset of women with para-aortic metastases treated by extended lumboaortic radiation therapy, neither the number of lymph nodes removed nor the number of positive nodes were associated with survival (P = 0.556 and P = 0.195, respectively).

Conclusion Para-aortic and pelvic lymphadenectomy provides valuable information about mortality risk in patients with locally advanced cervical cancer.

  • Locally advanced cervical cancer (LACC)
  • Extraperitoneal para-aortic laparoscopic lymphadenectomy
  • Extended-field radiation therapy

https://doi.org/10.1097/IGC.0000000000000000

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    Footnotes

    • No financial support was received for this work.

    • Jaume Ordi, MD, PhD, and Aureli Torné, MD, PhD, were the senior authors of this manuscript

    • The authors declare no conflicts of interest.