Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma

Leblanc, Éric; Narducci, Fabrice; Frumovitz, Michael; Lesoin, A.; Castelain, B.; Baranzelli, M. C.; Taïeb, S.; Fournier, Charles; Querleu, Denis

doi:10.1016/j.ygyno.2006.12.012

Cited by 196 publications

(157 citation statements)

References 40 publications

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“…Such results would probably be different if this trial had been performed during the last 3 years because many of the colleagues who participated in this trial now use PET-CT imaging and some of the teams (like ours) use laparoscopic paraaortic node staging before beginning CRT. Those techniques improve the detection rate of para-aortic (or extra-abdominal) spread missed during conventional imaging and therefore seem to improve the survival outcome of patients [13,[25][26][27][28]. During the period of this trial, those procedures were not routinely used by the majority of the teams (only 13 patients underwent para-aortic node staging).…”

Section: Discussionmentioning

confidence: 99%

“…The use of positron emission tomography (PET)-CT imaging was optional in this trial. An initial laparoscopic para-aortic lymphadenectomy with or without pelvic lymphadenectomy using a trans-or retroperitoneal approach was optional [13]. If a paraaortic lymphadenectomy was performed, it was extended to the level of the left para-aortic vein [14].…”

Section: Study Design and Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Results of the GYNECO 02 Study, an FNCLCC Phase III Trial Comparing Hysterectomy with No Hysterectomy in Patients with a (Clinical and Radiological) Complete Response After Chemoradiation Therapy for Stage IB2 or II Cervical Cancer

et al. 2012

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Learning Objectives After completing this course, the reader will be able to: Evaluate the therapeutic impact of hysterectomy after chemoradiation therapy in locally advanced cervical cancer. Evaluate the rate of histologic residual disease in patients with complete clinical and radiologic response after chemoradiation therapy. This article is available for continuing medical education credit at http://CME.TheOncologist.com Background. Concomitant chemoradiation (CRT) (including brachytherapy) is considered the standard management for stage IB2 or II cervical cancer in many countries. Nevertheless, some of them discuss completion surgery (hysterectomy [HT]) after CRT. The aim of this study was to investigate the therapeutic impact of such surgery. Methods. A randomized trial was opened in France in 2003 to evaluate the interest in HT after CRT. Inclusion criteria were: (a) stage IB2 or II cervical cancer without extrapelvic disease on conventional imaging; (b) pelvic external radiation therapy (45 Gy with or without parametrial or nodal boost) with concomitant cisplatin chemotherapy (40 mg/m2 per week) followed by uterovaginal brachytherapy (15 Gy to the intermediate risk clinical target volume); and (c) complete clinical and radiological response 6–8 weeks after brachytherapy. Patients were randomized between HT (arm A) and no HT (arm B). Unfortunately this trial was closed because of poor accrual: 61 patients were enrolled (in 2003–2006) and are reported on here. Results. Thirty one and 30 patients were enrolled, respectively, in arm A and arm B. Twelve patients recurred (five of them died): respectively, eight and four in arm A and arm B. The 3‐year event‐free survival rates were 72% (standard error [SE], 9%) and 89% (SE, 6%) (not significant [NS]) in arm A and arm B, respectively. The 3‐year overall survival rates were 86% (SE, 6%) and 97% (SE, 3%) (NS) in arm A and arm B, respectively. Conclusions. Results of the current trial seem to suggest that completion HT had no therapeutic impact in patients with clinical and radiological complete response after CRT (but this conclusion is limited by the lack of power).

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Section: Discussionmentioning

confidence: 99%

Section: Study Design and Treatmentmentioning

confidence: 99%

Results of the GYNECO 02 Study, an FNCLCC Phase III Trial Comparing Hysterectomy with No Hysterectomy in Patients with a (Clinical and Radiological) Complete Response After Chemoradiation Therapy for Stage IB2 or II Cervical Cancer

et al. 2012

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“…20 Also, the extent of LND is directly associated with oncological prognosis since a more extensive lymph node resection was shown to be associated with an improved survival in patients with endometrial, ovarian, and cervical cancers. [14][15][16] The potential benefits of extensive LND by means of survival may be explained by several mechanisms. First of all, the probability of finding a lymph node metastasis is significantly higher when more lymph nodes are removed.…”

Section: -11mentioning

confidence: 99%

“…[9][10][11][12][13] As a result, obese women are less likely to undergo a LND compared to non-obese women despite its documented benefits in gynecologic cancers. 10,[14][15][16] Nevertheless, it is evident that the necessity of performing an adequate operation is the same for obese women even if their body habitus causes technical difficulties. The aim of this article was to retrospectively investigate whether body mass index (BMI) or obesity affects the number of lymph nodes retrieved or the frequency of intraoperative complications experienced during LND performed via laparotomy in women with gynecologic cancers.…”

Section: Introductionmentioning

confidence: 99%

Obesity does not affect the number of retrieved lymph nodes and the rate of intraoperative complications in gynecologic cancers

et al. 2010

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Objective: Lymphadenectomy, in general, is a safe and well-tolerated procedure in gynecologic oncology. However, some technical difficulties may be experienced in obese women which may result in inadequate lymphadenectomy and increased complications. The purpose of this study is to retrospectively evaluate the effect of obesity on lymph node counts retrieved and complication rates observed during lymphadenectomy in gynecologic cancers. Methods: Patients with ovarian, endometrial or cervical cancers treated with initial surgery including bilateral pelvic and paraaortic lymph node dissection were grouped as non-obese and obese. These two groups were compared in terms of the number of retrieved lymph nodes and the rate of intraoperative complications directly related to lymph node dissection. Results: One hundred twenty-three patients were eligible with a mean age of 55.1 years and mean body mass index of 29.2 kg/m 2 . Fifty-nine patients were obese while 64 were non-obese. Lymph node counts obtained in different stations and in total were similar among non-obese and obese patients. Rates of lymphadenectomy-related intraoperative complications including vascular, neural, intestinal, and bladder injury were also similar in non-obese and obese patients. Conclusion:The obesity does not affect the lymph node counts and intraoperative complication rates adversely in women with gynecologic cancers. Therefore, adequate lymph node dissection should not be omitted based solely upon obesity in gynecologic oncology patients.

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“…Laparoscopic examination provides valuable information for treating anterior local later-stage cervical cancer (Leblanc et al, 2007). Compared with benign lesion hysterectomy, the ureteral injury rate of laparoscopic radical hysterectomy is usually higher, with laparoscopy being one of the hazards (Forsgren et al, 2010;Frankman et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Preset ureter catheter in laparoscopic radical hysterectomy of cervical cancer

Han¹,

Cao²,

Jiang³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to evaluate the clinical efficacy of a temporary ureteral catheter in preventing iatrogenic ureteral damage in cervical cancer patients undergoing laparoscopic radical hysterectomy. All cases had confirmed diagnoses of cervical cancer preoperatively between December 2008 and December 2012 in our hospital and were in clinical stages IA2 to IIA. In total, 176 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed. The 176 cases were divided into two groups: ureteral catheters were installed using cystoscopy before the operation in 86 patients (group A), and ureteral catheters were not placed in 90 patients (group B). These cases were retrospectively analyzed based on postoperative hospitalization time and intraoperative and postoperative complications. A total of 6 cases (3.41%) had ureteral injuries, and 4 of the cases (4.65%) of ureteral injuries occurred in group A. In two of these cases, urinary leaking appeared at the post-operative 8th and 9th days and at the 10th and 25th days, respectively. There were 2 cases (2.22%) of ureteral injuries in group B: 1 case of intraoperative direct Laparoscopic radical hysterectomy of cervical cancer injury and the other of urinary leaking, which appeared at post-operative day 21. Statistically significant differences between the two groups were observed in operating time and the incidence of hemorrhage, hematuria (including microscopic hematuria), post-operative urinary tract infection, and pain (P < 0.05). A ureteral catheter that is placed preoperatively can help to identify the ureter in laparoscopic radical hysterectomy, but does not decrease the incidence of ureteral injury.

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Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma

Cited by 196 publications

References 40 publications

Results of the GYNECO 02 Study, an FNCLCC Phase III Trial Comparing Hysterectomy with No Hysterectomy in Patients with a (Clinical and Radiological) Complete Response After Chemoradiation Therapy for Stage IB2 or II Cervical Cancer

Results of the GYNECO 02 Study, an FNCLCC Phase III Trial Comparing Hysterectomy with No Hysterectomy in Patients with a (Clinical and Radiological) Complete Response After Chemoradiation Therapy for Stage IB2 or II Cervical Cancer

Obesity does not affect the number of retrieved lymph nodes and the rate of intraoperative complications in gynecologic cancers

Preset ureter catheter in laparoscopic radical hysterectomy of cervical cancer

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