An Update of Laparoscopy in Cervical Cancer Staging: Is It a Useful Procedure?

Abstract

Objective: It was the aim of this study to report on the role of laparoscopic staging in a large series of locally advanced cervical cancer (LACC) patients and its impact on prognosis. Methods: Consecutive patients with LACC were considered for surgical staging: gynecological examination, cystoscopy and laparoscopy with peritoneal biopsies and peritoneal fluid cytology. Results: Between February 2000 and September 2010, a total of 167 women were evaluated. In 5 patients, laparoscopy could not be performed. One hundred and sixty-two patients had correct laparoscopic staging: 49 International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA (>4 cm), 67 IIB, 39 III, and 7 IVA. Abdominal spread was found in 33 cases (20%). There was a minor laparoscopy complication rate of 1%. We found a significant difference in the distribution of peritoneal spread for tumor grade and FIGO stage (p = 0.01 and p < 0.0001, respectively), whereas no statistically significant difference for the histological type was found [p = not significant (NS)]. The median follow-up was 80 months (range 4-144). The median overall survival was 65 months. The patients without abdominal spread did not benefit from a significantly longer survival (median overall survival of 59 vs. 70 months; p = NS). Conclusions: Laparoscopic staging in cervical cancer is a safe and feasible technique but it does not modify the prognosis of LACC patients.

Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

“…Intra-abdominal spread was detected in only 1 patient with FIGO stage IIIA (0.9%), lower than the incidence of 5 or 6% reported by Gouy et al [35] and Vidaurreta et al [27] , respectively and the incidence of 20% observed in the series by Benedetti Panici et al [33] . Surprisingly, there was no difference in survival between patients affected by intra-abdominal spread and those without spread in the study by Benedetti Panici et al Upstaging with regards to tumor spread to adjacent organs from stage IIB and III to IVA was detected in 8 of our patients (6.7%).…”

“…However, the oncological benefits of surgical staging and consequent therapy modification remain controversial. Some retrospective and prospective studies have demonstrated a significant benefit, particularly after the removal of bulky lymph nodes and the adoption of planned CRTx [14,21,24,35,43] , whereas others have not observed a significant oncological advantage [9,33] . Indeed, the only randomized trial by Lai et al [12] failed to demonstrate a benefit in survival.…”

“…After adjustment for tumor stage, the incidence of para-aortic lymph node metastases in stages IB2, IIB, IIIB, and IVA is 2.35-20, 0-27, 9-60, and 0-100%, respectively [21][22][23][24][25][26][27][28][29][30][31][32] . Intra-abdominal tumor spread is detected in 5-20% of patients with locally advanced cervical cancer [19,27,[33][34][35][36][37] . However, these data have not been confirmed in a randomized trial.…”

“…Some retrospective and prospective data have indicated a survival benefit after surgical (laparoscopic) staging and the removal of bulky lymph nodes followed by primary CRTx according to histological findings [14,35,43] , whereas others did not observe any oncological benefit [21,33,44] . The only randomized trial comparing surgical with clinical staging failed to demonstrate an improvement in survival and was closed prematurely.…”

Endoscopy in Gynecologic Oncology

“…Despite a 15.2 % rate of surgery related complications, all patients completed the planned radiotherapy. In 2013 Benedetti Panici et al [ 4 ] reported a series of 167 consecutive patients with local advanced cervical cancer who had laparoscopic staging. Minor laparoscopy complication rate was 1 %.…”