Laparoscopic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy in Patients with FIGO Stage IB1-II B Cervical Carcinoma

Abstract

This study aimed to evaluate the safety, feasibility, and clinical outcomes of laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy in patients with FIGO stage IB1-IIB cervical carcinoma. Between August 1999 and April 2009, we performed 59 laparoscopic transperitoneal lymphadenectomies; specifically, 12 procedures were performed up to the level of the left renal vessels, and 47 procedures were performed up to the level of the inferior mesenteric artery. We retrospectively analyzed the pathology reports and clinical data and compared the 2 groups. The data were analyzed with a nonparametric Mann-Whitney test, Kaplan-Meier log-rank test, and Pearson's correlation analysis. The 2 groups did not significantly differ with respect to histologic type (P = .093), clinical stage (P = .053), tumor size (P = .383), time interval to start adjuvant therapy postoperatively (P = .064), and type of adjuvant therapy (P = .407). The blood loss (P = .131), operative time (P = .200), mean hospital stay (P = .417), and postoperative self-voiding (P = .306) did not significantly differ between the groups, with the exception of the number of harvested lymph nodes (P = .001). The disease-free survival was better in the group that underwent infrarenal para-aortic lymphadenectomy than the group that did not (P = .017); however, the 2 groups did not differ with respect to overall survival (P = .115). We suggest that laparoscopic transperitoneal infrarenal lymphadenectomy for cervical cancer is feasible and safe. The rate of positive lymph nodes in infrarenal lymphadenectomy is very rare in patients with locally advanced cervical carcinoma. Infrarenal lymphadenectomy in patients with cervical cancer did not provide additional survival benefits in this study.