title: Analysis of morbidity and clinical implications of laparoscopic para-aortic lymphadenectomy in a continuous series of 98 patients with advanced-stage cervical cancer and negative PET-CT imaging in the para-aortic area.
abstract: BACKGROUND
  Laparoscopic para-aortic lymphadenectomy (PAL) is being used increasingly to stage patients with locally advanced cervical cancer (LACC) and to define radiation field limits before chemoradiation therapy (CRT). This study aimed to define clinical implications, review complications, and determine whether surgical complications delayed the start of CRT.
  
  
  METHODS
  We retrospectively reviewed a continuous series of patients with LACC, with no positive para-aortic (PA) nodes on positron emission tomography-computed tomography (PET-CT) and who had undergone a primary laparoscopic PAL.
  
  
  RESULTS
  From November 2007 to June 2010, 98 patients with LACC underwent pretherapeutic PAL. Two patients did not undergo PAL: extensive carcinomatosis was discovered in one case and a technical problem arose in the other. No perioperative complications occurred. Seven patients had a lymphocyst requiring an imaging-guided (or laparoscopic) puncture. Eight patients (8.4%, which corresponds to the false-negative PET-CT rate) had metastatic disease within PA lymph nodes. In cases of suspicious pelvic nodes on PET-CT, the risk for PA nodal disease was greater (24.0% versus 2.9%). When patients with and without surgical morbidity were compared, the median delay to the start of treatment was not significantly different (15 days; range, 3-49 days versus 18 days; range, 3-42 days).
  
  
  CONCLUSIONS
  The morbidity of laparoscopic PAL was limited and the completion of treatment was not delayed when complications occurred. Nevertheless, if PET-CT of the pelvic area is negative, the interest in staging PAL could be discussed because the risk for PA nodal disease is very low.
authors.affiliation: Department of Surgery, Institut Gustave Roussy and University Paris Sud, Villejuif Cedex, France. catherine.uzan@igr.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Uzan
authors.forename: Amine
authors.initials: A
authors.lastname: Souadka
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gouy
authors.forename: Thierry
authors.initials: T
authors.lastname: Debaere
authors.forename: Juliette
authors.initials: J
authors.lastname: Duclos
authors.forename: Jean
authors.initials: J
authors.lastname: Lumbroso
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*