Laparoscopic para-aortic lymphadenectomy and positron emission tomography scan as staging procedures in patients with cervical carcinoma stage IB2IIIB

Abstract

The objective of this study was to determine the role of laparoscopic lower para‐aortic lymphadenectomy and positron emission tomography (PET) scan in the staging of cervical carcinoma. Ninety consecutive patients with FIGO stage IB2–IIIB were scheduled for laparoscopic para‐aortic lymphadenectomy. Exclusion criteria: obvious metastatic para‐aortic nodes on computed tomography (CT)/PET or PET–CT. The procedure was stopped when a node was positive on frozen section. In ten patients, no para‐aortic lymphadenectomy was performed as scheduled. Forty‐seven patients were operated retroperitoneally, 22 transperitoneally, and 21 cases were converted from retroperitoneally to transperitoneally. Median number of removed nodes was 6 (1–24). In 10 of 80 patients, para‐aortic metastases were diagnosed. Despite a nonsuspect PET result, 5 of 44 patients had positive para‐aortic nodes. Two‐year survival was 76% and 16% without and with para‐aortic metastases, respectively (P = 0.0001). Laparoscopic para‐aortic lymphadenectomy showed metastases in 13% of the patients. In the subgroup with negative PET scan, 11% had metastases. The procedure had a low morbidity and identified a group with an extremely poor prognosis.