TY - JOUR T1 - Laparoscopic Lymphadenectomy in Advanced Cervical Cancer: Prognostic and Therapeutic Value JF - International Journal of Gynecologic Cancer JO - Int J Gynecol Cancer SP - 1675 LP - 1683 DO - 10.1097/IGC.0000000000000000 VL - 23 IS - 9 AU - Marta del Pino AU - Pere Fusté AU - Jaume Pahisa AU - Àngels Rovirosa AU - Maria Jose Martínez-Serrano AU - Sergio Martínez-Román AU - Immaculada Alonso AU - Laura Vidal AU - Jaume Ordi AU - Aureli Torné Y1 - 2013/11/01 UR - http://ijgc.bmj.com/content/23/9/1675.abstract N2 - 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. ER -