Laparoscopic Staging in Locally Advanced Cervical Carcinoma: A New Possible Philosophy?

Vidaurreta, Javier; Bermúdez, Adriana; Paola, Guillermo Di; Sardi, Juan

doi:10.1006/gyno.1999.5597

Cited by 88 publications

(34 citation statements)

References 14 publications

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“…Evaluation of lymph node involvement with noninvasive techniques such as MRI provides a sensitivity and specificity near 80% when nodes are >1 cm. Such percentages may decrease to 24-48% in cases of lymph nodes with small metastases (14,15). Compared to the results observed with regards to CT alone, PET-CT may detect smaller para-aortic disease (16 (17).…”

Section: Discussionmentioning

confidence: 85%

Adjuvant chemotherapy following concurrent chemoradiotherapy for uterine cervical cancer with lymphadenopathy

et al. 2011

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Abstract. The present study aimed to retrospectively evaluate the efficacy and toxicities of adjuvant chemotherapy with paclitaxel and carboplatin (TC) following concurrent cisplatin-based chemoradiation (CCRT) in patients with cervical cancer with lymphadenopathy (N1). A total of 37 patients with FIGO stage IB2-IVA cervical carcinoma with N1 (median age 57 years, range 31-74 years) were enrolled. External beam radiation therapy was followed by high-dose-rate brachytherapy. In cases of suspected para-aortic lymphadenopathy or common iliac lymph node involvement, extended radiotherapy fields were applied. Positive lymph nodes were externally radiated. Cisplatin was administered weekly at a dose of 30 mg/m 2 during external beam radiation therapy. Adjuvant therapy was administered to 17 patients and comprised carboplatin (6 mg/ ml/ min) and paclitaxel (175 mg/m 2 ) administered monthly after CCRT, and repeated every 4 weeks for 3-6 cycles. Over a median 21.5-month follow-up, no significant differences were found in the recurrence rate, progression-free survival, overall survival, or median interval to recurrence with N1 cervical cancer patients between the two groups. Patients with para-aortic lymphadenopathy who received CCRT and adjuvant chemotherapy had a more favorable overall and disease-free survival than those treated with CCRT alone. However, 16/17 patients developed grade 3-4 leukopenia and 14/17 patients developed severe hematologic toxicity during adjuvant chemotherapy. In conclusion, adjuvant chemotherapy consisting of full dose TC therapy after CCRT was not well tolerated in general and exhibited no benefit to N1 cervical cancer patients. However, it may be of therapeutic advantage over CCRT alone in cervical cancer patients with para-aortic lymphadenopathy.

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Section: Discussionmentioning

confidence: 85%

Adjuvant chemotherapy following concurrent chemoradiotherapy for uterine cervical cancer with lymphadenopathy

et al. 2011

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“…In the present study, surgically removed LN of 38 (14-98) per patient were comparable to the results of laparotomy or laparoscopic surgical staging by several investigators. 13,16,17,28,29 Median time for operative procedures was 230 (145-490) minutes, and this decreased after gradual accumulation surgical experience. 17 To cure 90% of the 2 cm sized cervical cancer, 6,000 cGy radiotherapy was required.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Transperitoneal and extraperitoneal abdominal approaches [10][11][12] After Laparoscopic LN staging was introduced in 1990, the feasibility, low morbidity and no delay of radiotherapy for such a procedure have been reported. [13][14][15][16][17] Laparoscopic LN staging was expected to maximize effect of radiotherapy by modifying radiotherapy field and by resection of bulky metastatic LN. 18 This study was conducted to investigate the feasibility, morbidity and treatment modification by pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

et al. 2008

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Objective: To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. Methods: From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. Results: Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. Conclusion: Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.

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“…In the Japanese SEPAL study, a mean of 59 pelvic and 23 para-aortic lymph nodes could be achieved [7]. There is a similar uncertainty in cervical cancer patients; 12–25 pelvic lymph nodes are seen to be sufficient in operable stages and 5–15 in the para-aortic region as part of staging in advanced diseases [4,5,26,27,28,29,30,31,32]. Schlaerth et al [9] found laparoscopic para-aortic LAE adequate compared with the open procedure, with a mean of 12.1 lymph nodes, but pelvic LAE problematic despite a number of 32.1 removed lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

Lanowska¹,

Vasiljeva²,

Chiantera³

et al. 2010

Oncology

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Objective: The lymph node number as benchmark in oncologic operations depends on the patient’s anatomy, surgeon’s skill and pathologist’s accuracy. The influence of the pathologist is barely evaluated. Methods: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. Results: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. Conclusion: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards.

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Laparoscopic Staging in Locally Advanced Cervical Carcinoma: A New Possible Philosophy?

Cited by 88 publications

References 14 publications

Adjuvant chemotherapy following concurrent chemoradiotherapy for uterine cervical cancer with lymphadenopathy

Adjuvant chemotherapy following concurrent chemoradiotherapy for uterine cervical cancer with lymphadenopathy

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

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