title: Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma.
abstract: BACKGROUND
  Although cervical cancer is clinically staged, surgery has long been considered the best means to assess extrapelvic disease and remains the gold standard for the detection of both intraperitoneal spread and small volume nodal metastases. The objective of this study was to determine short- and long-term outcomes for patients with locally advanced cervical cancer who underwent pretherapeutic laparoscopic staging.
  
  
  METHODS
  From 1997 to 2004, 184 patients with stages IB2-IVA cervical cancer underwent pretherapeutic laparoscopic staging procedure including transperitoneal abdomino-pelvic exploration and extraperitoneal bilateral infrarenal paraaortic lymph node dissection. Patients were then treated with definitive radiotherapy tailored according to the staging results.
  
  
  RESULTS
  The median age and BMI were respectively 45.8 years old and 27.1 kg/m2. Most lesions were squamous (n=172) and clinical stage was evenly distributed. Median operative time was 155 min with an average of 20.8 lymph nodes removed. Postoperative hospital stay averaged 1.4 days. Major complications included 1 intraoperative ureteral injury and 1 postoperative bowel obstruction from an umbilical trocar site hernia. The final pathology revealed that 44 patients (24.3%) had metastatic disease within paraaortic lymph nodes. With a median follow-up of 26.8 months (average 32.9), 67 patients (36.4%) had recurrent disease. Overall 5-year survival rate was 58.3%. Successful resection of positive lymph node correlated with a survival advantage.
  
  
  CONCLUSIONS
  Pretherapeutic laparoscopic assessment of patients with locally advanced cervical cancer offers valuable information for individualized treatment planning with minimal morbidity. This appears to be a therapeutic effect with resection of positive nodes followed by a tailored chemoradiation therapy.
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, 3, Rue Frédéric Combemale, B.P. 307, 59020, Lille CEDEX, France. e-leblanc@o-lambret.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.forename: Fabrice
authors.initials: F
authors.lastname: Narducci
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Anne
authors.initials: A
authors.lastname: Lesoin
authors.forename: Bernard
authors.initials: B
authors.lastname: Castelain
authors.forename: Marie C
authors.initials: MC
authors.lastname: Baranzelli
authors.forename: Sophie
authors.initials: S
authors.lastname: Taieb
authors.forename: Charles
authors.initials: C
authors.lastname: Fournier
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery