Laparoscopy versus laparotomy for pelvic and lumbar-aortic lymphadenectomy. A 11-year experience.
This study is a retrospective comparison of laparoscopy and laparotomy lymphadenectomy (pelvic and lumbar-aortic) in cervical cancer stage IA1 and more, in a gynaecological service in Lyon, France.


METHODS
During 11 years, there were 126 cases of cervical cancer patients in which lymphadenectomy was performed, either by laparoscopy or laparotomy. We analysed if there were significant differences regarding the 2 accesses in terms of stage, tumour size, surgical interventions associated, number of lymph nodes extracted, and outcome.


RESULTS
Regarding the stage of our cases, 3 of them were IB1, IB2 and IIB; the more advanced the stage, the fewer lymphadenectomies were performed by laparoscopy. As for the tumour size, the smaller tumour was statistical significantly associated with pelvic laparoscopic lymphadenectomy (p = 0.01) while the tumours larger than 4 cm mean lumbar-aortic lymphadenectomy by laparotomy (p = 0.006). Regarding the associated surgical interventions, the laparoscopic lymphadenectomies were associated to low-stage operations: conisation/trachelectomy, vaginal or abdominal simple hysterectomy, or extra-fascial hysterectomy (type 1 or 2). There was no significant difference between laparoscopy and laparotomy ways regarding the number of lymph nodes extracted (median 13.5 vs 11, p = 0.45 for pelvic nodes, and 8 vs 4 for lomb-aortic nodes, p = 0.43, for laparoscopy vs laparotomy).


CONCLUSIONS
Laparoscopic lymphadenectomy is as effective as the laparotomy procedures, and the training of young gynaecologic oncologists should not ignore laparoscopy as an alternative technique for nodes sampling.
Socolov
R V
RV
Department of Obstetrics and Gynecology, "Gr.T. Popa" University of Medicine and Pharmacy, Iaşi.
Raudrantz
D
D
Golfier
F
F
Socolov
Demetra
D
Vaudoyer
F
F
D001011:Aorta; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008499:Medical Records; D009367:Neoplasm Staging; D010388:Pelvis; D012189:Retrospective Studies; D012383:Romania; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*