Lymph node yield from laparoscopic lymphadenectomy in cervical cancer: a comparative study.
Pretreatment surgical staging in cervical cancer has been studied extensively but remains controversial because a surgical procedure is required and the information gained may benefit only a small portion of the patients staged. Pelvic and paraaortic laparoscopic lymphadenectomies have been successfully performed in animal models and humans. Little information regarding the validity of the procedure in patients who have had subsequent laparotomy exists. In this series, we report our preliminary experience in 12 patients who underwent laparoscopic lymphadenectomy and then laparotomy. Overall, 377 pelvic nodes were removed, with 282 (75%) obtained at laparoscopy. The average number of pelvic nodes removed at laparoscopy was 23.5 (range 7-33). Two patients had positive pelvic nodes. No patient with negative nodes at laparoscopy had positive nodes at laparotomy. When studied in chronological order, the lymph node yield from our second 6 patients was much improved over our first 6 patients, 85% versus 63% (P < 0.005). Laparoscopy also proved to be a better predictor of lymph node spread than computed tomography. Two patients also had right-sided paraaortic lymphadenectomies, yielding 8 and 5 nodes. No additional right-sided paraaortic nodes were detected at laparotomy for either patient. In this preliminary series, laparoscopic lymphadenectomy appears to be a feasible procedure for surgical staging of cervical cancer. The yield of pelvic lymph nodes is adequate and improved with experience. Most importantly, no positive lymph nodes were missed by laparoscopy. The indications for operative laparoscopy have expanded rapidly. Gynecologic oncologists performing this procedure should be involved in prospective studies of this technique to set the standards and indications of this new technology.
Fowler
J M
JM
Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis 55455.
Carter
J R
JR
Carlson
J W
JW
Maslonkowski
R
R
Byers
L J
LJ
Carson
L F
LF
Twiggs
L B
LB
D000328:Adult; D002277:Carcinoma / Q000473:pathology*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010865:Pilot Projects; D002583:Uterine Cervical Neoplasms / Q000473:pathology*