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Laparoscopic Pelvic Lymphadenectomy in 32 Pregnant Patients With Cervical Cancer: Rationale, Description of the Technique, and Outcome
  1. Giuseppe Filiberto Vercellino, MD*,
  2. Christardt Koehler, MD,
  3. Evrim Erdemoglu, MD,
  4. Mandy Mangler, MD,
  5. Malgorzata Lanowska, MD,
  6. Al-Hakeem Malak, MD*,§,
  7. Achim Schneider, MD*, and
  8. Vito Chiantera, MD*
  1. *Department of Gynecology, Charité-Campus Benjamin Franklin, Hindenburgdamm,
  2. Department of Gynecology, Charité-Campus Charité Mitte, Charité Platz, Berlin, Germany;
  3. Department of Gynecology and Gynecologic Oncology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey; and
  4. §Department of Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  1. Address correspondence and reprint requests to Evrim Erdemoglu, MD, Department of Gynecology and Gynecologic Oncology, Faculty of Medicine, Suleyman Demirel University, Cunur, 32040, Isparta, Turkey. E-mail: evrimmd{at}yahoo.com.

Abstract

Objective Individualized treatment of pregnant patients with cervical cancer is mandatory; hence, information on nodal status is pivotal to allow a waiting strategy in early-stage disease.

We aimed to verify the oncological safety and surgical reproducibility of a standardized laparoscopic pelvic lymphadenectomy in pregnant patients with cervical cancer.

Methods We standardized laparoscopic pelvic lymphadenectomy during the first and second term of gestation in 32 patients with cervical cancer since 1999. According to gestational week (GW) of less than 16 GWs or more than 16 GWs, 2 different techniques were used.

Results The International Federation of Gynecology and Obstetrics stages were IA in 10 patients, IB1 in 17 patients, IB2 in 4 patients, and IIA in 1 patient. Mean (SD) GW was 17.5 (5.1) weeks. Mean (SD) operative time was 105.4 (29) minutes. Mean (SD) blood loss was 5.3 (10.2) mL. There were no conversion to laparotomy and no intraoperative complications. A median number of 14 pelvic lymph nodes (range, 8–57) were harvested. Median hospital stay was 6 days. Median follow-up is 42.5 months (range, 17–164). Four patients had lymph node metastases. Five patients interrupted their pregnancy. Fourteen patients were given neoadjuvant platin-based systemic therapy. All patients are alive and disease free. All children born through cesarean delivery at a mean (SD) 34 (1.9) GWs are well and show normal clinical neurological development.

Conclusions To the best of our knowledge, this is the largest series so far reported on laparoscopic pelvic lymphadenectomy during pregnancy. This procedure is safe and associated with good oncological and obstetrical outcomes.

  • Cervical cancer
  • Pregnancy
  • Laparoscopy
  • Staging
  • Lymphadenectomy

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Footnotes

  • The authors declare no conflicts of interest.

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