Laparoscopic Lymphadenectomy in Advanced Cervical Cancer: Prognostic and Therapeutic Value

Pino, Marta del; Fusté, Pere; Pahisa, Jaume; Rovirosa, Á.; Martínez-Serrano, María José; Martínez‐Román, Sergio; Alonso, Immaculada; Vidal, Laura; Ordi, Jaume; Torné, Aureli

doi:10.1097/igc.0000000000000000

Cited by 30 publications

(7 citation statements)

References 40 publications

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“…However, there are known limitations of clinical staging using modern 3D imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT) and integrated 18 F-FDG positron emission tomography-CT (PET-CT) [8][9][10][11]. Regarding PALN involvement, several retrospective studies have demonstrated a significant rate of upstaging by pathologic staging after surgery when compared to staging by imaging of PALNs [3,12,13]. This suggests imaging techniques cannot completely fill the gap between clinical and histological staging.…”

Section: Introductionmentioning

confidence: 99%

Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

Thelissen

Jürgenliemk-Schulz

Leij

et al. 2022

Gynecologic Oncology

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Para-aortic lymph node (PALN) status in locally advanced cervical cancer has therapeutic and prognostic implications.• Reported proportions in literature of upstaging by PALN dissection after negative PALN imaging were meta-analyzed.• After negative PET or PET-CT, PALN dissection yielded pathologic PALNs in 12% of all patients.• After negative MRI or CT, PALN dissection yielded pathologic PALNs in 11% of all patients.• After PET-CT showed pelvic nodal (but no PALN) involvement, PALN dissection yielded pathologic PALNs in 21% of patients.

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Section: Introductionmentioning

confidence: 99%

Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

Thelissen

Jürgenliemk-Schulz

Leij

et al. 2022

Gynecologic Oncology

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“…Retrospectively, in patients with stage IIB, 17% had positive pelvic nodes and 25.5% positive para-aortic nodes. Furthermore, in patients with stage IIIB, 33% had positive nodes in the pelvic region and 43.5% in the para-aortic region [ 12 ]. Zand et al .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to the observations presented above, del Pino et al . have suggested that the removal of nodes has no therapeutic benefit [ 12 ]. In the group of patients with para-aortic positive nodes, complete removal of nodes was not associated with a higher mortality risk than para-aortic node sampling alone, although the univariate Cox logistic model indicates that lymph node metastases in both the pelvic and para-aortic areas are associated with an increased risk of death.…”

Section: Discussionmentioning

confidence: 99%

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The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer

Koper

Dziobek²,

Makarewicz³

et al. 2018

jcb

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PurposeLocally advanced cervical cancer (LACC) should be treated with a combination of external irradiation and brachytherapy with concurrent chemotherapy. However, as cervical carcinoma cells can disperse by way of the lymphatic system to either pelvic or para-aortic nodes, planning the extent of radiation requires precise information about the spread of the disease to the lymph nodes, especially to the para-aortic area.Material and methodsAll of the 75 women included in our study underwent chemoradiotherapy, which started with brachytherapy. Out of them, 54 have undergone radical hysterectomy with lymphadenectomy followed by chemoradiation. We have retrospectively analyzed the 5-year overall survival (OS) rates relative to the lymph node involvement, the type of lymphadenectomy performed (pelvic, para-aortic, or both), the size of the tumor (> or < 4 cm), the histological type, grading, and the age of patients.ResultsWe observed significant differences in the OS rates relative to the age of the patients with LACC. We noted significant differences in the OS rates related to para-aortic lymphadenectomy and presence of lymph node metastases.ConclusionsPara-aortic lymphadenectomy seems to have a positive influence on long-term outcomes in the LACC patients, and elderly patients may benefit more from applied therapy.

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“…Several retrospective studies have demonstrated a significant rate of upstaging, mainly determined by nodal or peritoneal spread, as a confirmation of more extensive disease in a substantial proportion of patients when comparing the results of standard clinical staging with pathological features after surgery. 11 , 12 Thus, an individualized extended field of radiation could be implemented to patients according to pathological findings and might be beneficial for their overall survival (OS). 13 …”

Section: Introductionmentioning

confidence: 99%

Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center

Liu

Guo

Zhang³

et al. 2018

OTT

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PurposeAlthough definitive chemoradiotherapy is considered as a standard of care for FIGO stage IIB cervical cancer in many countries, the role of surgery remains controversial. We aimed to evaluate the feasibility and outcomes of patients with FIGO stage IIB cervical cancer who received radical surgery in China.Patients and methodsA total of 74 women with FIGO stage IIB cervical cancer were treated with radical hysterectomy, with or without adjuvant radio/chemoradiotherapy, at the Obstetrics and Gynecology Hospital of Fudan University between 2004 and 2015. Medical charts and clinical data were retrospectively reviewed. The Kaplan–Meier method and Cox regression models were used for survival analyses. In addition, prognostic nomograms predicting overall survival (OS) and progression-free survival (PFS) were constructed.ResultsPathological parametrial involvement (PMI) was only identified in 28.3% (21/74) of all patients and 47.3% (9/19) of patients without neoadjuvant treatment. Major surgical complications, including bladder fistula, intestinal obstruction and ureteral injury, were found in 6.8% (5/74) of patients. Although the use of imaging technologies including magnetic resonance imaging (MRI)/positron emission tomography–computed tomography (PET–CT) has increased after 2010 compared to that prior to 2010, the accuracy of MRI/PET–CT in detecting pathological PMI was lower than that of physical examination under anesthesia (P<0.05). Neoadjuvant treatment was the only risk factor affecting the accuracy of pre- and postoperative accordance of PMI (OR: 3.283 [95% CI: 1.363–7.908], P=0.008). The 2- and 5-year OS rates were 84.1% and 68.9%, respectively, while the 2- and 5-year cumulative recurrence rates were 26.9% and 39.9%, respectively. Cox regression analyses indicated that pre- and postoperative accordance of PMI, common iliac lymph node metastasis and major surgical complications were significant prognostic factors for both OS and PFS.ConclusionRadical hysterectomy might be a feasible alternative for FIGO stage IIB cervical cancer. As pre- and postoperative accordance of PMI is relatively low, strategies to appropriately select patients who will benefit from surgery via pretreatment evaluation need to be further investigated.

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Laparoscopic Lymphadenectomy in Advanced Cervical Cancer: Prognostic and Therapeutic Value

Abstract: Para-aortic and pelvic lymphadenectomy provides valuable information about mortality risk in patients with locally advanced cervical cancer.

Cited by 30 publications

References 40 publications

Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer

Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center

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