Multi‐center experience of robot‐assisted laparoscopic para‐aortic lymphadenectomy for staging of locally advanced cervical carcinoma

Abstract

In this series we report that robot-assisted laparoscopic para-aortic lymphadencetomy provided the surgeon with useful information, diagnosing 11.4% of occult para-aortic lymph node metastases in women with locally advanced cervical cancer. Intra-operative and postoperative morbidity were low. The presence of para-aortic lymph node metastases correlated with shorter disease-free survival.

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

“…Pelvic lymph node metastases were detected in more than half of the patients in the surgical arm (51%), similar to the range observed by del Pino et al [9] . Most importantly, the 24% upstaging due to para-aortic lymph node involvement in our study is in accordance with other studies [2,[8][9][10][11][12][13][14][15][16][17][18][19][20] . Interestingly, the median number of harvested para-aortic lymph nodes varies considerably in the literature, probably due to the different intentions of staging procedures.…”

“…In the series by Grigsby et al [50] , Mortier et al [26] , and Walker et al [51] , the surgical procedure was abandoned if 1 positive node was found via frozen section. In contrast, in other studies, complete para-aortic LND was performed with dissection of a median of 10-27 lymph nodes, with metastases detected in 1.5-3.5% of lymph nodes [8,10,11,14,15,23,25,31] . We systematically followed the latter strategy for surgical staging.…”

“…The incidence of lymph node metastases varies considerably within prospective and retrospective studies, from 22 to 53% for pelvic nodes and from 0 to 38% for para-aortic nodes [2,[8][9][10][11][12][13][14][15][16][17][18][19][20] . 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] .…”

Perioperative morbidity and rate of upstaging after laparoscopic staging for patients with locally advanced cervical cancer: results of a prospective randomized trial

“…[3][4][5] Furthermore, positron emission tomography (PET)-CT has failed to meet prior expectations because of its relatively high false-negative rates. [6][7][8][9][10][11] An alternative to clinical staging is surgical staging, which can evaluate the most important prognostic and therapeutic factors, including lymph node status, adjacent organ involvement, and intraabdominal tumor dissemination. 12,13 The preferred approaches for surgical staging are laparoscopic or robotic transperitoneal or extraperitoneal techniques to minimize the duration of hospitalization and avoid delaying primary RCTX.…”

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy

“…A total of 107 and 540 search results were retrieved during the performed search in PubMed and Scopus databases, respectively, among of which 18 studies were identified as eligible for inclusion in our review [15][16][17][18][19][20][21][22][23][24][25][26][27][28][39][40][41]. One additional study was identified through hand-searching of references [38].…”