Laparoscopic surgical staging of locally advanced cervix cancer (IB2 to IVA):initial experience

Abstract Introduction and objectives Cervical cancer incidence worldwide is about 500,000 new cases per year with most of them being detected at a locally advanced stage. Many studies have shown the need to look for extra-pelvic disease when planning appropriate therapy. We performed surgical stagin...

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Published in:	Gynecologic oncology Vol. 120; no. 3; pp. 358 - 361
Main Authors:	Zanvettor, Paulo Henrique, Filho, Deraldo F, Neves, Adson R, Amorim, Maria Jose N, Medeiros, Sonia M, Laranjeiras, Luiz Carlos F, Morais, Jackson A, Araujo, Iguaracyra O, Barbosa, Helenemarie S
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2011
Subjects:	Adult Cervix cancer Female Hematology, Oncology and Palliative Medicine Humans Laparoscopy Laparoscopy - methods Lymphatic Metastasis Middle Aged Neoplasm Staging Obstetrics and Gynecology Surgical staging Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - surgery Cervix cancer Surgical staging Laparoscopy
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Summary:	Abstract Introduction and objectives Cervical cancer incidence worldwide is about 500,000 new cases per year with most of them being detected at a locally advanced stage. Many studies have shown the need to look for extra-pelvic disease when planning appropriate therapy. We performed surgical staging by laparoscopy in 43 cases of cervical cancer at stages IB2 to IVa and evaluated our initial results. Materials and methods Between February 2008 and May 2010, we selected 43 patients with histologically confirmed cervical cancer at stages IB2 to IVA with a Karnosfsky index > 70. We classified the tumors according to the FIGO (International Federation of Gynecology and Obstetrics) stage and performed tomographic evaluations of the abdomen to select patients without signs of peritoneal or para-aortic tumor spread. We performed a laparoscopic evaluation of the peritoneal cavity and para-aortic lymph nodes by an extra-peritoneal route. We did not use tweezers or disposable energy seals. Results The mean surgical time was 130.8 min. The mean blood loss was 111.5 ml. There was no conversion to laparotomy for any case. We describe a case with peritoneal implants that was classified as IVB. We removed an average of 16.4 lymph nodes; nine cases had para-aortic lymph node metastases. Conclusion Laparoscopic surgical staging diagnosed 23.3% of cases with peritoneal spread of the tumor or extra-pelvic lymph node metastases. In this study, we could better define the lymph node status through laparoscopic surgical staging and could therefore recommend more suitable adjuvant therapy for patients with locally advanced cervical cancer.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-8258 1095-6859
DOI:	10.1016/j.ygyno.2010.12.335