title: Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings.
abstract: BACKGROUND
  Failure to detect metastasis to para-aortic nodes in patients with locally advanced cervical cancer leads to suboptimal treatment. No previous studies have prospectively compared positron emission tomography (PET)/computed tomography (CT) with laparoscopic extraperitoneal staging in the evaluation of para-aortic lymph nodes.
  
  
  METHODS
  Sixty-five patients were enrolled; 60 were available for analysis. Patients with stage IB2-IVA cervical cancer without evidence of para-aortic lymphadenopathy on preoperative CT or magnetic resonance imaging (MRI) were prospectively enrolled. All patients underwent preoperative PET/CT. Laparoscopic extraperitoneal lymphadenectomy was performed from the common iliac vessels to the left renal vein.
  
  
  RESULTS
  The median age at diagnosis was 48 years (range, 23-84). The median operative time was 140 minutes (range, 89-252). The median blood loss was 22.5 mL (range, 5-150). The median length of hospital stay was 1 day (range, 0-4). The median number of lymph nodes retrieved was 11 (range, 1-39). Fourteen (23%) patients had histopathologically positive para-aortic nodes. Of the 26 patients with negative pelvic and para-aortic nodes on PET/CT, 3 (12%) had histopathologically positive para-aortic nodes. Of the 27 patients with positive pelvic but negative para-aortic nodes on PET/CT, 6 (22%) had histopathologically positive para-aortic nodes. The sensitivity and specificity of PET/CT in detecting positive para-aortic nodes when nodes were negative on CT or MRI were 36% and 96%, respectively. Eleven (18.3%) patients had a treatment modification based on surgical findings.
  
  
  CONCLUSIONS
  Laparoscopic extraperitoneal para-aortic lymphadenectomy is safe and feasible. Surgical staging of patients with locally advanced cervical cancer should be considered before planned radiation and chemotherapy.
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. peramire@mdanderson.org
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Homer A
authors.initials: HA
authors.lastname: Macapinlac
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Euscher
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Lois M
authors.initials: LM
authors.lastname: Ramondetta
mesh_terms: D001011:Aorta; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D019788:Fluorodeoxyglucose F18