Prospective evaluation of surgical staging of advanced cervical cancer via a laparoscopic extraperitoneal approach

Purpose. To report on a large series of cervical cancer patients at risk for lymph node metastasis who underwent surgical staging by a novel technique. Methods. Between 1/97 and 3/02, we identified 111 patients who underwent an infrarenal aortic and common iliac lymph node dissection via a laparoscopic extraperitoneal approach for either bulky or locally advanced cervical cancer. We reviewed the medical records and extracted pertinent information. Results. There were no intraoperative complications. Mean patient age was 46 (+/- 9) years. Mean node count was 19 (+/- 12). Thirty (27%) patients had lymph node metastasis. The mean operative time was 157 (+/- 46) min, and mean postoperative stay was 2 days. The majority of complications in the early part of the series were symptomatic lymphoceles. Since 4/01, preventive peritoneal marsupialization has been performed without lymphocele occurrence (37 patients). Two patients (2%) required reoperation. In the node-positive group, extended-field radiation and chemotherapy were well tolerated, but prognosis was dismal (median survival, 27 months). In the node-negative group, the median survival after pelvic radiation limited to the lower level of the surgical dissection was not reached after an average follow-up of 16.6 months. Conclusions. This novel technique is feasible and combines the benefits of laparoscopy with those of a retroperitoneal approach. It can be used to tailor external radiation therapy. The benefits of extended-field radiation therapy remain unclear; however, this approach does not preclude later use of radiation therapy, whereas possibly minimizing associated toxicities secondary to adhesions. (C) 2003 Elsevier Inc. All rights reserved.