Laparoscopic para‐aortic lymphadenectomy in advanced cervical carcinoma: the Taiwan experience. II

Abstract

ObjectivesTo present the Taiwanese experience of para‐aortic lymphadenectomy by laparoscopy in the pretreatment surgical staging of advanced cervical cancer and evaluate the benefits of these procedures.DesignPatients were prospectively evaluated for different treatment modalities and the results were analysed.SettingThe Chang Gung Memorial Hospital, Keelung Center.Subjects43 consecutive, eligible patients with advanced cervical cancer, operated upon and followed up for at least 20 months, were included in this study.InterventionsRight‐ and left‐sided para‐aortic lymphadenectomies by laparoscopy were performed. Two groups of patients were delineated, for different treatment modalities. Patients with negative para‐aortic lymph nodes were treated with whole‐pelvic irradiation only; patients with proven para‐aortic lymph node metastasis in surgical staging were treated concurrently with chemotherapy.Main outcome measuresThe 2‐year survival rates for patients with metastasis (receiving concurrent chemotherapy) and without metastasis (receiving irradiation only).ResultsOn average, 10.8 lymph nodes were retrieved from both sides of the aorta. The operating time for the procedure ranged from 53 to 138 min, with an average of 93.5 min. After a median follow up of 36.8 months, the progression‐free interval for all patients was 6–55 months (median 26 months). The 2‐year survival rates for patients with metastasis and without metastasis were 68% and 85.5%, respectively.ConclusionsLaparoscopic para‐aortic lymphadenectomy was an efficient and feasible surgical staging procedure for the pretreatment evaluation of advanced carcinoma of the uterine cervix, and made possible a better choice of treatment modality by the clinician.