Surgical Outcomes of Laparoscopic Pelvic Lymph Node Debulking during Staging Aortic Lymphadenectomy in Locally Advanced Cervical Cancer: A Multicenter Study

Abstract

Background: Few studies have evaluated laparoscopic pelvic lymph node (PLN) debulking during staging aortic lymphadenectomy in locally advanced cervical cancer (LACC). It allows us to know the lymph node status and facilitates the action of chemoradiotherapy (CRT) by reducing tumor burden. We evaluated its feasibility and compared the perioperative morbidity and the time to CRT with a control group. Methods: This was a multicenter retrospective study of patients with LACC FIGO stage IIIC1r who were recipients of CRT. We compared two cohorts: group 1, which consisted of 164 patients with surgical staging by laparoscopic aortic lymphadenectomy and PLN debulking, and group 2, which consisted of 111 patients with aortic lymphadenectomy alone. Results: Excision of the bulky nodes was possible in all patients in group 1 except for one. Surgery lasted a median of 82 min longer in group 1 but there was no greater intraoperative bleeding or increased hospital stay. There were no significant differences in intraoperative or postoperative complications between the groups. A significantly shorter time from surgery to the start of RT was observed in group 1. Conclusions: It is feasible to perform laparoscopic PLN debulking in the same procedure as the staging aortic lymphadenectomy in LACC without increasing surgical or postoperative complications and without delaying the start of CRT compared to single aortic lymphadenectomy.

Survival of Women with Advanced Stage Cervical Cancer: Neo-Adjuvant Chemotherapy Followed by Radiotherapy and Hyperthermia versus Chemoradiotherapy

“…They concluded that indeed, it is feasible to perform laparoscopic pelvic LND in the same procedure as aortic LND in LACC without increasing surgical complications. Additionally, this procedure allows the clinician to know the lymph node status without delaying start of treatment with CRT [26]. The impact on survival, however, is not discussed.…”

Controversies and Advances in the Personalized Surgical Treatment of Cervical Cancer

“…However, it is also known that bulky lymph nodes require high-dose boosted external beam radiotherapy (EBRT) to become sterilized. To date, the available evidence concerning the impact of debulking surgery on bulky lymphatic disease provides heterogeneous results, with some studies favoring the technique [ 44 , 45 ] and others providing evidence against it [ 43 , 46 , 47 ]. A prospective phase III randomized trial (CQGOG0103) will help provide more information on this group of patients; however, its results are not anticipated within this decade as the enrollment will last four years and the follow-up will be completed at five years [ 48 ].…”

Efficacy of lymph node dissection on stage IIICr of cervical cancer before CCRT: study protocol for a phase III, randomized controlled clinical trial (CQGOG0103)

“…Removing the bulky lymph nodes might improve the chance of completely sterilizing by CCRT and reduce the toxicity caused by higher dose of radiation. Some studies demonstrated improved survival after bulky nodal resecting [ 9 17 ], while others showed no survival benefit from nodal resection in cervical cancer with bulky lymph node [ 18 19 20 ]. However, almost of the studies are retrospective with the limitations, such as without unified action protocol for nodal surgery and boosting, enrollment spanned long time and insufficient quantity.…”