Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study

Díaz-Feijoó, Berta; Franco, Silvia; Torné, Aureli; Benito, Virginia; Hernández, Alicia; Lago, Víctor; Rovira, Ramón; Acosta, Úrsula; Agustí, Núria; Gil-Ibáñez, Blanca; Bebia, Vicente; Tejerizo, A.; Pérez-Regadera, J.; Lubrano, Amina; González, Cristina Rocamora; Ruiz, Rubén; Cobos, Paloma; Guibourg, R Luna; Gilabert‐Estellés, Juan; Chipirliu, Anca; Llueca, Antoni; Piquer, Lola; Coronado, Pluvio; Gracia, Myriam

doi:10.1016/j.ygyno.2020.05.004

Cited by 7 publications

(3 citation statements)

References 29 publications

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“… 37 , 38 On the other hand, dividing the approach into two steps—first performing lymphadenectomy and then conservative surgery only on histologically proven lymph node-negative patients—could hypothetically increase the intraoperative difficulties due to tissue fibrosis, hypothetically increasing the morbidity of the techniques and their risk of abandonment. 39 , 40 Unfortunately, in this situation of impasse, the approach to be used is completely left to the choice of the team. A future alternative could be represented by intraoperative amplification techniques to obtain information in frozen section about micrometastases, 41 , 42 but to date does not represent a clinical standard.…”

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

et al. 2022

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Background Fertility-sparing treatments (FSTs) have played a crucial role in the management of early-stage cervical cancer (ECC). The guidelines have recognized various approaches, depending on the tumor stage and other risk factors such as histotype and lymphovascular positivity. Much more debate has centered around the boundary within which these treatments should be considered. Indeed, these are methods to be reserved for ECC, but tumor size may represent the most significant limitation. In particular, there is no consensus on the strategy to be adopted in the case of ECC ≥ 2 cm. Therefore, this systematic review was to collect the literature evidence regarding the management of these patients. Methods Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the Pubmed and Scopus databases was conducted in April 2022, from the date of the first publication. We made no limitation on the country. We included all studies containing data on disease-free survival, overall survival, recurrence rate (RR), or complete response rate (CRR) to chemotherapy. Results Twenty-six studies fulfilled the inclusion criteria, and 691 patients were analyzed regarding FST. Surgery-based FST showed an RR of between 0 and 42.9%, which drops to 12.9% after excluding the vaginal or minimally invasive approaches. Furthermore, papers regarding FST based on the neoadjuvant chemotherapy (NACT) approach showed a CRR of between 21.4 and 84.5%, and an RR of between 0 and 22.2% Conclusion This paper focused on the significant heterogeneity present in the clinical management of FST of ECC ≥ 2 cm. Nevertheless, from an oncological point of view, approaches limited to the minimally invasive or vaginal techniques showed the highest RR. Vice versa, the lack of standardization of NACT schemes and the wealth of confounders to be attributed to the histological features of the tumor make it difficult, if not impossible, to set a standard of treatment.

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Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

et al. 2022

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“…Aortic lymphadenectomy was performed by extraperitoneal laparoscopy or robotassisted, from the left side of the patient, following the technique described by Querleu [18] and modified by our group [19] and previously described elsewhere. [16,17] Lymph nodes from the interaortocaval, inferior precavo, pre-aortic and left para-aortic spaces were included up to the left renal vein, bilateral common iliac up to the bifurcation (as caudal limit) and to the psoas muscle laterally.…”

Section: Surgical Staging Proceduresmentioning

confidence: 99%

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

Díaz-Feijoó

Acosta

Torné

et al. 2022

Cancers

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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.

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“…Results showed that 114 patients (18.5%) had PALNs metastases, of which 73 (64%) had supramesenteric metastases. Moreover, 11 patients (9.6%) had metastases only in the supramesenteric region [16]. Additionally, the presence of skip metastases should also be considered.…”

Section: Boundaries Of Palnd In Gynecological Malignanciesmentioning

confidence: 99%

Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations

Kostov

Selçuk

Yordanov

et al. 2022

JCM

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Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.

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Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study

Cited by 7 publications

References 29 publications

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

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

Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations

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