Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

Abstract

Objective: To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. Methods: From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. Results: Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. Conclusion: Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.

Persistent human papillomavirus DNA is associated with local recurrence after radiotherapy of uterine cervical cancer

“…Nodal status was determined by magnetic resonance imaging of the pelvis 6 positron emission tomography except for 36 patients who also underwent laparoscopic lymph node staging as a part of our previous clinical trial. 14,15 HPV status was evaluated from the cervical smear collected prior to radiotherapy using the Hybrid Capture II system (HC2; Digene Corporation, Gaithersburg, MD). HC2 test uses an RNA probe mixture of 13 high-risk HPV types and detects HPV types of 16,18,31,33,35,39,45, 51, 52, 56, 58, 59 and 68.…”

Comparison of Lower Extremity Edema in Locally Advanced Cervical Cancer: Pretreatment Laparoscopic Surgical Staging with Tailored Radiotherapy Versus Primary Radiotherapy

“…First, pathologic confirmation of LN metastasis is available, enabling a more tailored radiotherapy. 8 Because imaging studies, such as CT, MRI, or PET, are inaccurate for predicting LN metastases, primary radiotherapy may result in undertreatment (resulting from a false negative) and overtreatment (resulting from a false positive). 20 As such, radiotherapeutic overtreatment is associated with complications including bowel perforation, and an accurate diagnosis via surgical staging and tailored radiotherapy is essential.…”

“…In our institution, a prospective study conducted between 2001 and 2006 demonstrated the feasibility and safety of this strategy. 8 Because radiotherapy and pelvic LND are known risk factors for lymphedema, patients treated with both modalities are expected to experience this complication more frequently. 9 Nevertheless, no previous study has compared the incidence of lymphedema or LEE in cervical cancer patients considering the use of primary versus pretreatment laparoscopic staging followed by radiotherapy.…”

Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer

“…1 Lymph nodes (LNs) metastasis is an important prognostic factor in not only that it is the most significant prognostic factor in early-stage cervical cancer but also that the field of RT depend on the extent of LN involvement. 2 However, the current clinical International Federation of Gynecology and Obstetrics (FIGO) staging system does not consider LN status, 3 which results in some discrepancies between FIGO stage and prognosis. In addition, preoperative imaging studies were not known to be satisfactorily sensitive for detecting LN metastasis in cervical cancer.…”