Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
The role of lymph node assessment in patients with locally advanced cervical cancer and the impact of the discovery and removal of occult nodal disease is still debated.
The value of surgical staging prior to chemoradiation in international guidelines is contradictory, since results published in the literature are controversial,1 and even the PET scan has a high false-negative rate for metastatic lymph nodes involvement.
Marnitz et al published a randomized trial in 2020 (Uterus-11 study)2 processing this question. Minimally invasive surgical staging in patients with locally advanced cervical cancer has demonstrated upstaging rates between 22% and 43% compared with clinical staging.
Studies that specifically search the debulking of macroscopically enlarged lymph nodes show better outcomes for patients in whom enlarged lymph nodes can be removed. The potential oncologic benefit of removing bulky pelvic and para-aortic lymph node metastases prior to primary chemoradiation, from a radiobiological point of view, is to provide higher loco-regional control and it allows adaptation of the extent of irradiation fields.3
The optimal surgical approach for para-aortic lymphadenectomy in gynecologic cancers using minimally invasive surgery is controversial.
In our institution, a team trained in gynecologic oncologic surgery performs systematically transperitoneal laparoscopic staging of patients with bulky or locally advanced cervical carcinoma, without significantly increasing treatment-related morbidity or mortality and without delaying chemoradiotherapy treatment.4 When performing debulking surgery, it is important to use a procedure with a low complication rate to avoid delaying the chemoradiation, which is the definitive oncologic treatment for these patients.
Debulking surgery, prior to chemoradiation treatment, allows the extent of disease to be confirmed, which might not be seen with complementary imaging techniques or with clinical staging.
Removal of larger lymph nodes has a potential oncologic benefit, providing higher loco-regional control prior to primary chemoradiation.
We recommend performing a well-planned lymphadenectomy, with an accurate pre-operative plan and following key surgical steps and dissection landmarks.
Laparoscopic debulking of enlarged para-aortic nodes in patients with locally advanced cervical cancer is a feasible technique, performed by teams trained in gynecologic oncologic surgery.
Data availability statement
All data relevant to the study are included in the article.
Patient consent for publication
This study involves human participants but Hospital Universitario de Navarra, Comité Multidisciplinar Oncología Ginecológica exempted this study. Participants gave informed consent to participate in the study before taking part.
Contributors NV corresponding author. Collaborators: MN, SA, SL, OT, JCMT. Guarantor: JCMT.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.