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

Gynecol Oncol. 2003 Nov;91(2):326-31. doi: 10.1016/j.ygyno.2003.07.008.


Objectives: 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.

MeSH terms

  • Female
  • Humans
  • Laparoscopy / methods
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Staging
  • Prospective Studies
  • Risk Factors
  • Survival Rate
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery*