Prospective Multicenter Study Evaluating the Survival of Patients With Locally Advanced Cervical Cancer Undergoing Laparoscopic Para-Aortic Lymphadenectomy Before Chemoradiotherapy in the Era of Positron Emission Tomography Imaging

Abstract

To our knowledge, this is the largest series of patients reported undergoing such a strategy. We obtained the same survival rate for patients with PA nodal metastasis ≤ 5 mm and patients without PA lymph node involvement, suggesting that this strategy is highly efficient in such patients. Conversely, the survival of patients with PA nodal involvement greater than 5 mm remained poor, despite the absence of extrapelvic disease on PET-CT imaging in this subgroup.

Laparoscopy in uterine cervical cancer. Current state and literature review

“…Among the patients with lymph node metastasis > 5mm and / or capsular involvement and / or fixed nodes, the overall survival rate at four years was greater than 30%, much lower than in previous groups but greater than the overall survival of patients in FIGO stage IVB (distant metastases) 34,40,41 . Other groups performing surgical staging prior to combined treatment corroborate these results, observing low morbidity, especially after reaching the procedure's learning curve 44 .…”

“…When comparing the survival of women with para-aortic lymph node metastasis <5mm in diameter undergoing surgery, it was observed that it was similar to women with negative para-aortic lymph nodes (70% in four years) 40,41 . Among the patients with lymph node metastasis > 5mm and / or capsular involvement and / or fixed nodes, the overall survival rate at four years was greater than 30%, much lower than in previous groups but greater than the overall survival of patients in FIGO stage IVB (distant metastases) 34,40,41 .…”

“…For women with positive pelvic lymph nodes, the chance of positive para-aortic lymph nodes, even with negative PET-CT, is 20% to 25% 40,41 . Thus, surgery is considered more appropriate than the imaging studies available today for assessing lymph node status in locally advanced cervical cancer.…”

Approaches to surgical staging of cancer of the uterine cervix

“…В 2013 г. S. С. Gouy и со-авт. опубликовали результаты проспективного иссле-дования по сравнению данных совмещенной пози-тронно-эмиссионной и компьютерной томографии с результатами хирургического стадирования [12]. В исследование были включены 237 больных с IB2-IV стадией РШМ с клинически негативными лим-фатическими узлами.…”

Role of Serum CEA as Tumor Marker for Predicting Presence of Pelvic and Paraaortic Lymph Node Metastasis in SCC of Uterine Cervix

“…One study examined the efficacy of extending the radiation therapy (RT) field to the paraaortic region in patients with paraaortic lymph node involvement and showed therapeutic benefit especially in patients with small volume nodal disease [6] . A randomized controlled trial examining surgical versus radiology staging and treatment of paraaortic lymph node involvement is ongoing [7] .…”