[en] [en] OBJECTIVES: FIGO classification is commonly used for staging of locally advanced cervical cancer. Laparoscopic para-aortic lymphadenectomy is currently used as a diagnostic tool, since we know that presence of para-aortic lymph node metastases identifies patients with poor prognosis. The application of robotics during this procedure needs to be investigated.
DESIGN: Retrospective multi-center study.
SETTING: Three centers participated in building one database.
POPULATION: Thirty-seven patients with locally advanced cervical cancer underwent a robot-assisted laparoscopic para-aortic lymphadenectomy.
METHODS: Patients were prospectively enrolled in one register. Retrospective analysis of the whole database was performed.
MAIN OUTCOME MEASURES: Surgical outcomes of the robot-assisted procedure and follow-up data.
RESULTS: Median number of lymph nodes collected was 27.5 (1-54) per patient. Five of 37 patients had para-aortic node metastases. The false negative rate for PET-CT diagnosing para-aortic node metastases was 11.4% (4/35). Two major intra-operative complications occurred (5.4%). Postoperative morbidity was low (13.5%). Median follow-up was 27 months [95% confidence interval (95% CI) was 24-30]. Median disease-free survival was 16 months (95% CI 2.4-29.6). Patients with negative nodes had a median disease-free survival of 24 months (not assessable), although patients with positive nodes had a median disease-free survival of 9 months (95% CI 6.9-11.9).
CONCLUSIONS: In this series we report that robot-assisted laparoscopic para-aortic lymphadencetomy provided the surgeon with useful information, diagnosing 11.4% of occult para-aortic lymph node metastases in women with locally advanced cervical cancer. Intra-operative and postoperative morbidity were low. The presence of para-aortic lymph node metastases correlated with shorter disease-free survival.
Disciplines :
Surgery
Author, co-author :
Fastrez, Maxime; Obstetrics and Gynecology Department, St Pierre Hospital, University of Brussels, Brussels, Belgium. maxime_fastrez@stpierre-bru.be
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Vergote, Ignace; Obstetrics and Gynecology Department, Leuven Cancer Institute, KU/University Hospital Leuven, Leuven, Belgium
Vandromme, Jean; Obstetrics and Gynecology Department, St Pierre University Hospital, 1000 Brussels, Belgium
Petit, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Leunen, Karin; Obstetrics and Gynecology Department, Leuven Cancer Institute, KU/University Hospital Leuven, Leuven, Belgium
Degueldre, Michel; Obstetrics and Gynecology Department, St Pierre University Hospital, 1000 Brussels, Belgium
Language :
English
Title :
Multi-center experience of robot-assisted laparoscopic para-aortic lymphadenectomy for staging of locally advanced cervical carcinoma.
American College of Obstetricians and Gynaecologists. ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas. Int J Gynaecol Oncol. 2002; 78: 79-91.
Boughanim M, Leboulleux S, Rey A, Pham CT, Zafrani Y, Duvillard P, et al. Histologic results of para-aortic lymphadenectomy in patients treated for stage IB2/II cervical cancer with negative [18F]fluorodeoxyglucose positron emission tomography scans in the para-aortic area. J Clin Oncol. 2008; 26: 2558-61.
Possover M, Krause N, Plaul K, Kühne-Heid R, Schneider A,. Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature. Gynecol Oncol. 1998; 71: 19-28.
Köhler C, Klemm P, Schau A, Possover M, Krause N, Tozzi R, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or para-aortic transperitoneal lymphadenectomies. Gynecol Oncol. 2004; 95: 52-61.
Marnitz S, Köhler C, Roth C, Füller J, Hinkelbein W, Schneider A,. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol. 2005; 99: 536-44.
Lagasse LD, Creasman WT, Shingleton HM, Ford JH, Blessing JA,. Results and complications of operative staging in cervical cancer: experience of the Gynecologic Oncology Group. Gynecol Oncol. 1980; 9: 90-8.
LaPolla JP, Schlaerth JB, Gaddis O, Morrow CP,. The influence of surgical staging on the evaluation and treatment of patients with cervical carcinoma. Gynecol Oncol. 1986; 24: 194-206.
Singh N, Arif S,. Histopathologic parameters of prognosis in cervical cancer. A review. Int J Gynecol Cancer. 2004; 14: 741-50.
Horn LC, Hentschel B, Galle D, Bilek K,. Extracapsular extension of pelvic lymph node metastases is of prognostic value in carcinoma of the cervix uteri. Gynecol Oncol. 2008; 108: 63-7.
Mortier DG, Stroobants S, Amant F, Neven P, Van Lmbergen E, Vergote I,. Laparoscopic para-aortic lymphadenectomy and positron emission tomography scan as staging procedures in patients with cervical carcinoma stage IB2-IIIB. Int J Gynecol Cancer. 2008; 18: 723-9.
Uzan C, Souadka A, Gouy S, Debaere T, Duclos J, Lumbroso J, et al. Analysis of morbidity and clinical implications of laparoscopic para-aortic lymphadenectomy in a continuous series of 98 patients with advanced-stage cervical cancer and negative PET-CT imaging in the para-aortic area. Oncologist. 2011; 16: 1021-7.
Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, Munsell MF, Coleman RL, et al. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer. 2011; 117: 1928-34.
Gouy S, Morice P, Narducci F, Uzan C, Gilmore J, Kolesnikov-Gauthier H, et al. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol. 2012; 13: e212-20.
Denschlag D, Gabriel B, Mueller-Lantzsch C, Tempfer C, Henne K, Gitsch G, et al. Evaluation of patients after extraperitoneal lymph node dissection for cervical cancer. Gynecol Oncol. 2005; 96: 658-64.
Querleu D,. Laparoscopic paraaortic node sampling in gynecologic oncology: a preliminary experience. Gynecol Oncol. 1993; 49: 24-9.
Childers JM, Hatch K, Surwit EA,. The role of laparoscopic lymphadenectomy in the management of cervical carcinoma. Gynecol Oncol. 1992; 47: 38-43.
Schneider A, Hertel H,. Surgical and radiographic staging in patients with cervical cancer. Curr Opin Obstet Gynaecol. 2004; 16: 11-8.
Spiritos NM, Schlaerth JB, Spirtos TW, Schlaerth AC, Indman PD, Kimbal RE,. Laparoscopic bilateral pelvic and para-aortic lymph node sampling: an evolving technique. Am J Obstet Gynecol. 1995; 173: 105-11.
Dargent D, Ansquer Y, Mathevet P,. Technical development and results of left extraperitoneal laparoscopic para-aortic lymphadenectomy for cervical cancer. Gynecol Oncol. 2000; 77: 87-92.
Querleu D, Dargent D, Ansquer Y, Leblanc E, Narducci F,. Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Cancer. 2000; 88: 1883-91.
Vergote I, Amant F, Beterloot P, Van Gramberen M,. Laparoscopic lower para-aortic staging lymphadenectomy in stage IB2, II, and III cervical cancer. Int J Gynecol Cancer. 2002; 12: 22-6.
Vergote I, Pouseele B, Van Gorp T, Vanacker B, Leunen K, Cadron I, et al. Robotic retroperitoneal lower para-aortic lymphadenectomy in cervical carcinoma: first report on the technique used in 5 patients. Acta Obstet Gynecol Scand. 2008; 87: 783-7.
Fastrez M, Vandromme J, George P, Rozenberg S, Degueldre M,. Robot-assisted laparoscopic transperitoneal para-aortic lymphadenectomy in the management of advanced cervical carcinoma. Eur J Obstet Gynecol Reprod Biol. 2009; 147: 226-9.
Magrina JF, Long JB, Kho RM, Giles DL, Montero RP, Magtibay PM,. Robotic transperitoneal infrarenal aortic lymphadencetomy: technique and results. Int J Gynecol Cancer. 2010; 20: 184-7.
Lambaudie E, Narducci F, Leblanc E, Bannier M, Jauffret C, Cannone F, et al. Robotically assisted laparoscopy for paraaortic lymphadenectomy: technical description and results of an initial experience. Surg Endosc. 2012; 26: 2430-5.
Vergote I, Tsolakidis D, Mortier D, Neven P, Amant F, Mottaghy F, et al. Value of positron emission tomography of the para-aortic lymph nodes in cervical carcinoma stage IB2-IIIB. J Clin Oncol. 2008; 26: 5654-5.
Leblanc E, Narducci F, Frumovitz M, Lesoin A, Castelain B, Baranzelli MC, et al. Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol. 2007; 105: 304-11.
Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, et al. Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Surg Endosc. 2005; 19: 826-31.
Gouy S, Uzan C, Kane A, Scherier S, Gauthier T, Bentivegna E, et al. A new single-port approach to perform a transperitoneal step and an extraperitoneal para-aortic lymphadenectomy with a single incision. J Am Coll Surg. 2012; 214: e25-30.
