Open Versus Laparoscopic Pelvic Lymph Node Dissection in Early Stage Cervical Cancer: No Difference in Surgical or Disease Outcome

Lande, Jonas van de; Mensdorff‐Pouilly, Silvia von; Lettinga, Roelof G.; Piek, Jurgen M.J.; Verheijen, René H.M.

doi:10.1097/igc.0b013e31822c273d

Cited by 25 publications

(15 citation statements)

References 38 publications

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“…Therefore, it may be assumed that a hysterectomy is more extensive, and lymphadenectomy is more systemic in Japan, as evidenced by the median number of dissected LNs in the current study, which was 42. The number of dissected LNs was higher than that of the overseas reports [ 15 , 16 ]. Consequently, Japanese gynecologic oncologists have a tendency to avoid adjuvant CCRT, because they are worried that patients undergoing CCRT may experience severe GIT.…”

Section: Discussionmentioning

confidence: 56%

A multi-institutional observational study on the effects of three-dimensional radiotherapy and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors

et al. 2018

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Background The aim of this study was to evaluate the effects of treatment with both three-dimensional radiotherapy (3DRT) and weekly 40-mg/m 2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors. Methods We conducted a retrospective multi-institutional chart review of postoperative uterine cervical cancer patients with high-risk prognostic factors who had been treated with both 3DRT and weekly 40-mg/m 2 cisplatin from 2007 to 2012. Each participating hospital provided detailed information regarding patient characteristics, treatment outcomes, and treatment complications. Results The eligible 96 patients were analyzed. The median follow-up period was 61 months. The 3-year relapse-free survival, overall survival (OS), and locoregional relapse-free survival (LRFS) rates were 76%, 90%, and 88%, respectively. In multivariate analysis, the histological finding of either adenocarcinoma or adenosquamous carcinoma was a significant risk factor for both OS and LRFS. The percentage of patients with grade ≥ 3 acute hematologic toxicity, acute lower gastrointestinal toxicity (GIT), and late lower GIT were 45%, 19%, and 17%, respectively. Conclusions The outcomes of concurrent chemoradiotherapy (CCRT) using weekly 40-mg/m 2 cisplatin are similar to those in the previous studies that used several chemotherapy regimens. However, postoperative CCRT using 3DRT had a high level of late GIT.

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Section: Discussionmentioning

confidence: 56%

A multi-institutional observational study on the effects of three-dimensional radiotherapy and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors

et al. 2018

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“…Standard therapy for women staged with IBI cervical cancer is still radical hysterectomy defined in the last century by Wertheim and others and performed safely in this century by conventional laparoscopy or by robot assistance [8]. This procedure, which is now performed nerve-sparing, still causes morbidity of which infertility is crucial to women who are seeking parenthood.…”

Section: Discussionmentioning

confidence: 98%

Laparoscopic lymph node dissection should be performed before fertility preserving treatment of patients with cervical cancer

Vercellino

Piek

Schneider

et al. 2012

Gynecologic Oncology

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Objective: The aim of this study is to assess our results of treatment of women with stage I cervical cancer > 2 cm in diameter seeking fertility preservation. Treatment consisted of Laparoscopic Pelvic and Paraaortic Lymphadenectomy (LPPLND), and when no nodal metastasis was detected, neoadjuvant chemotherapy (NACT) followed by radical vaginal trachelectomy (RVT). Patients with positive lymph nodes underwent primary chemoradiation. Methods: A cohort of women younger than 40 years of age with stage I disease > 2 cm who underwent LPPLND and either NACT and RVT or chemoradiation. Oncological outcome was evaluated prospectively. Results: Eighteen women were eligible for this study. Twelve (67%) women were diagnosed with metastasis in one or more pelvic and/or paraaortic lymph nodes, and thus received primary chemoradiation. After a mean follow-up of 25.5 months, three out of these 12 women (25%) developed a recurrence. Six women (33%) underwent NACT and RVT. Three patients experienced complete response to NACT and three patients showed more than 50% tumor size reduction. After a mean follow-up of 30.6 months all six women are free of recurrence. One patient delivered a healthy infant. Conclusions: Staging LPPLND allows separating patients in high or low recurrence risk groups. NACT and RVT seem to be safe for women with completely staged stage I cervical cancer > 2 cm in diameter, whereas even after primary chemoradiation, patients with positive lymph nodes experienced recurrence. Therefore, selection of patients with stage I cervical carcinoma > 2 cm, eligible for fertility preservation should include histopathologic evaluation of lymph node status before any further treatment. © 2012 Elsevier Inc. All rights reserved

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“…[16] . Nevertheless, previous studies have shown that for early cervical cancer, laparoscopic lymph nodes dissection do not affect the prognosis compared to open abdominal surgery [17] . In this study, all patients in RS group underwent a laparoscopic surgery, which might lead to poor outcomes.…”

Section: Discussionmentioning

confidence: 92%

Is Primary Chemoradiation a Better Treatment? A Retrospective Study of Early Stage Node-Positive Cervical Cancer.

ZHANG¹

2020

Preprint

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Background. Cervical cancer is the second most frequently diagnosed cancer and the third leading cause of cancer death for women in developing countries. Radical hysterectomy with bilateral pelvic lymph node dissection is usually preferred for patients of stage IB1-IIA2. Currently, image examinations have certain limitations in diagnose of lymph node metastasis and their detection accuracies are not satisfactory. Only the pathological examination after removal of the suspected metastatic lymph nodes during surgery can conclusively identify the presence of metastasis. If there is a positive result of lymphatic metastasis, there is no clear guideline whether to complete a radical surgery, or to only conduct a systematic lymphadenectomy, followed with adjuvant Concurrent Chemoradiotherapy (CCRT). This retrospective study aimed to compare the efficacy and safety of the two treatment modalities. Methods. 49 stage IB1-IIA2 cervical cancer patients with lymphatic metastasis confirmed by systemic pelvic and para-aortic lymph node dissection from 2007 to 2018 were reviewed. The patients were treated with either primary chemoradiation or radical hysterectomy followed by adjuvant chemoradiation after lymphadenectomy. Survival states and adverse events of the two treatments were compared. Results. Median follow-up time was 45 (range 11-119 months) months. In non-radical surgery group, 1 patient (1/15, 6.7%) relapsed and died, while in radical surgery group, 7 patients (7/27, 25.9%) relapsed and 5 (5/27, 18.5%) died. Significant difference was found in the mean progression-free survival between the two groups, which was 69(95%CI 49.118-88.882) months in non-radical surgery group and 44(95%CI 35.857-52.143) months in radical surgery group (p 0.01). There was significant difference in three-year progression-free survival(86%vs.71%, p 0.01). Grade 3-4 toxicity was comparable between the two groups (26.7% vs. 25.9%, p=0.958). Conclusion. For stage IB1-IIA2 cervical cancer patients with positive lymph node, primary chemoradiation after pelvic and para-aortic lymphadenectomy seems to have better survival outcomes compared with radical hysterectomy by laparoscopy plus chemoradiation in the retrospective study with limited cases. Evidence from a randomized controlled study is in need to confirm the optimal treatment for early stage node-positive cervical cancer. Background 3 Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, with estimated 570000 diagnosed cases and 311000 deaths in 2018 globally [1]. In China, it is the sixth most common malignancy, the eighth most common cause of cancer death in women and the first most common cause of gynecologic cancer death [2]. Lymphatic metastasis is one of the most important prognostic factors in cervical cancer patients [3]. Surgical treatment is usually preferred for patients with cervical cancer in stage IB1-IIA2, especially in women of childbearing age [4]. Patients with surgically confirmed lymphatic metastasis are sugges...

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Open Versus Laparoscopic Pelvic Lymph Node Dissection in Early Stage Cervical Cancer: No Difference in Surgical or Disease Outcome

Abstract: Introduction of a laparoscopic procedure in the surgical staging and treatment of cervical cancer patients did not have a detrimental effect on surgical or disease outcome, and this can be safely applied to the treatment of early stage cervical cancer.

Cited by 25 publications

References 38 publications

A multi-institutional observational study on the effects of three-dimensional radiotherapy and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors

A multi-institutional observational study on the effects of three-dimensional radiotherapy and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors

Laparoscopic lymph node dissection should be performed before fertility preserving treatment of patients with cervical cancer

Is Primary Chemoradiation a Better Treatment? A Retrospective Study of Early Stage Node-Positive Cervical Cancer.

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