Introduction/Background Cervical cancer is the 4th most common malignancy in women. It is essential to stage the disease. International Guidelines recommend para-aortic lymphadenectomy as staging procedure in patients diagnosed as Locally Advanced Cervical Cancer (defined as Bulky tumor >4 cm and/or parametrial involvement) and determining level of radiotherapy.
We aim to describe surgical approach and technical landmarks in retroperitoneal laparoscopic para-aortic lymphadenectomy.
Methodology We present a case report of a 51-year-old woman presenting 12-month history of lumbar pain and irregular menses. Physical examination revealed a 4 cm cervical tumour with bilateral parametrial involvement. Biopsy informed squamous carcinoma. MRI and PET-CT described a 30x36x47 mm tumor with bilateral parametrial involvement and bilateral infracentimetric hyper-metabolic iliac lymph nodes.
Results The patient was classified as FIGO stage IIIC1r (T2bN1M0). After discussion in multidisciplinary committee, retroperitoneal lymphadenectomy was indicated.
Surgical strategy consisted in creating retroperitoneal space, identifying left ureter and gonadal vessels and remaining adherent to the peritoneum anteriorly. Left common iliac artery, aorta and inferior mesenteric artery (IMA) were identified. Left ovarian vein was followed until left renal vein.
Lymphadenectomy started at the level of left iliac bifurcation, respecting the ureter, IMA and left sympathetic chain, continuing along the aorta. Upper limit of the lymphadenectomy was the left renal vein. Infra- and supra-mesenteric left para-aortic nodes were dissected from the level of the iliac bifurcation until IMA and from IMA to left renal vein, respectively. Pre-caval and para-caval lymph nodes were removed. In visual screening of pelvis an enlarged external right iliac node was identified and removed.
Postoperative course was uneventful. The patient was discharged on the 2nd-day. Histopathological analysis revealed 52 para-aortic and one iliac lymph node free of malignancy.
Conclusion Retroperitoneal laparoscopic para-aortic lymphadenectomy is a safe reproducible technique in referral centres.
Disclosure Nothing to disclose
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