Laparoscopic para-aortic lymphadenectomy in advanced cervical carcinoma: The Taiwan experience. II

Objectives: To present the Taiwanese experience of para-aortic lymphadenectomy by laparoscopy in the pretreatment surgical staging of advanced cervical cancer and evaluate the benefits of these procedures. Design: Patients were prospectively evaluated for different treatment modalities and the results were analysed. Setting: The Chang Gung Memorial Hospital, Keelung Center. Subjects: 43 consecutive, eligible patients with advanced cervical cancer, operated upon and followed up for at least 20 months, were included in this study. Interventions: Right- and left-sided para-aortic lymphadenectomies by laparoscopy were performed. Two groups of patients were delineated, for different treatment modalities. Patients with negative para-aortic lymph nodes were treated with whole-pelvic irradiation only; patients with proven para-aortic lymph node metastasis in surgical staging were treated concurrently with chemotherapy. Main outcome measures: The 2-year survival rates for patients with metastasis (receiving concurrent chemotherapy) and without metastasis (receiving irradiation only). Results: On average, 10.8 lymph nodes were retrieved from both sides of the aorta. The operating time for the procedure ranged from 53 to 138 min, with an average of 93.5 min. After a median follow up of 36.8 months, the progression-free interval for all patients was 6-55 months (median 26 months). The 2-year survival rates for patients with metastasis and without metastasis were 68% and 85.5%, respectively. Conclusions: Laparoscopic para-aortic lymphadenectomy was an efficient and feasible surgical staging procedure for the pretreatment evaluation of advanced carcinoma of the uterine cervix, and made possible a better choice of treatment modality by the clinician.