title: Laparoscopic staging compared with imaging techniques in the staging of advanced cervical cancer.
abstract: OBJECTIVE
  We evaluated the evidence of laparoscopy for decision regarding treatment options in advanced cervical cancer patients.
  
  
  METHODS
  One hundred nine consecutive patients with cervical cancer FIGO stage Ib2 and higher underwent laparoscopic staging of the extent of disease. Laparoscopic and histopathologic evaluation of tumor involvement of the paraaortic and pelvic lymph nodes, wall of the bladder, and rectal pillar was compared with preoperative findings of MRI and/or CT.
  
  
  RESULTS
  Paraaortic lymphadenectomy was performed in 101 (92.7%) patients and 21 (19.3%) patients had positive paraaortic lymph nodes. Pelvic lymphadenectomy was performed in 75 (68.8%) patients and 20 (26.7%) patients had positive pelvic lymph nodes. In 11 patients (11.5%) infiltration of the bladder and in 6 patients (6.25%) infiltration of the rectal pillar or cul-de-sac was found. Intraoperative complications associated with laparoscopic staging occurred in 3.7% of patients. The negative predictive value for the evaluation of paraaortic or pelvic lymph nodes, the bladder wall, rectal pillar, and cul-de-sac ranged from 73% (CT for pelvic lymph nodes) to 96% (MRI for bladder wall). Lack of information about the extent of disease was adjusted on the basis of laparoscopic findings in 24 (22%) patients and improved treatment plans.
  
  
  CONCLUSIONS
  Laparoscopic staging of patients with advanced cervical cancer is accurate, associated with low morbidity, and helps to adjust treatment according to extent of disease.
authors.affiliation: Department of Gynecology, Friedrich-Schiller-University of Jena, Bachstrasse 18, D-07740 Jena, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Hertel
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
authors.forename: Tarek
authors.initials: T
authors.lastname: Elhawary
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Michels
authors.forename: Marc
authors.initials: M
authors.lastname: Possover
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery