title: Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer.
abstract: OBJECTIVE
  To define the role of pretreatment surgical staging for locally advanced cervical carcinoma.
  
  
  METHODS
  A two-step randomized trial was conducted to compare clinical staging (arm A) versus surgical staging (arm B) and to compare the laparoscopic (LAP) with the extraperitoneal (EXP) approach in previously untreated locally advanced cervical carcinoma. After the first randomization, those in arm B were randomly allocated to either LAP or EXP. An interim analysis was planned to evaluate the feasibility of LAP versus EXP, which led to the current report.
  
  
  RESULTS
  A total of 61 patients were eligible (arm A, 29; arm B, 32). The operation time, blood loss, and lymph node yield of LAP and EXP were not significantly different. Serious acute and late toxicity was not different between arm A and arm B, or LAP versus EXP. Para-aortic node metastasis was documented in 25% (95% confidence interval, 10% to 40%) of patients on arm B. An interim analysis was performed in January 2000. Patients on arm B had significantly worse progression-free survival than those on arm A. Hazard ratios of relapse/persistent or death were 3.13 (P = 0.005) and 1.76 (P = 0.150), respectively. Patient accrual was terminated according to the early stopping rules. With further follow-up till December 2001, the difference in progression-free survival remained significant (P = 0.003), and the difference in overall survival became significant (P = 0.024) as the data matured.
  
  
  CONCLUSIONS
  The benefit of pretreatment surgical staging for cervical carcinoma remained unproven. The detrimental effects of surgical staging observed in this study must be considered in the design of clinical guidelines or future trials.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. sh6erry@ms6.hinet.net
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.forename: Kuan-Gen
authors.initials: KG
authors.lastname: Huang
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
authors.forename: Chyi-Long
authors.initials: CL
authors.lastname: Lee
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Huei-Jean
authors.initials: HJ
authors.lastname: Huang
authors.forename: Koon-Kwan
authors.initials: KK
authors.lastname: Ng
authors.forename: Chieh-Sheng
authors.initials: CS
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery