title: Laparoscopic extraperitoneal para-aortic lymphadenectomy in the staging of locally advanced cervical cancer: is it a feasible procedure at a peripheral center?
abstract: OBJECTIVE
  The study's aim was to evaluate the feasibility of laparoscopic extraperitoneal para-aortic lymphadenectomy at a peripheral center for the staging of patients with locally advanced cervical cancer (LACC).
  
  
  METHODS
  From March 2009 to January 2011, 30 patients with LACC underwent laparoscopic extraperitoneal para-aortic lymphadenectomy. All patients were treated with definitive radiotherapy tailored according to the staging results. Data on demographics, pathologic findings, surgery, complications, and disease status at follow-up are presented.
  
  
  RESULTS
  Patients' mean age was 47.6 years (range, 28-67 years). The mean body mass index was 26.3 (range, 19.1-35.6). Mean operative time was 118.7 minutes (range, 77-195 minutes) with an average of 14.2 lymph nodes removed (range, 5-34). Intraoperative complications were a lumbar artery injury and a bowel injury. No postoperative complications occurred. Mean postoperative hospital stay was 1.9 days (range, 1-6 days). Pathological examination revealed that 26.7% (8/30) of patients had metastatic disease in para-aortic lymph nodes. Two patients with disease at the para-aortic level died 5 and 12 months after diagnosis; both of them developed pulmonary and hepatic metastases. The rest of the patients were free of disease, after completion of the treatment, during a mean follow-up time of 15.6 months (range, 5-27 months).
  
  
  CONCLUSIONS
  Laparoscopic extraperitoneal aortic lymphadenectomy is a feasible procedure, even at peripheral centers, that is useful to identify patients with LACC and para-aortic disease and to tailor their treatment. Gynecologic oncologists are encouraged to learn this procedure and offer it to their patients.
authors.affiliation: Department of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain. virginia.benito@yahoo.es
authors.forename: Virginia
authors.initials: V
authors.lastname: Benito
authors.forename: Amina
authors.initials: A
authors.lastname: Lubrano
authors.forename: Octavio
authors.initials: O
authors.lastname: Arencibia
authors.forename: Miguel
authors.initials: M
authors.lastname: Andújar
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pinar
authors.forename: Norberto
authors.initials: N
authors.lastname: Medina
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Falcón
authors.forename: Orlando
authors.initials: O
authors.lastname: Falcón
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D013030:Spain; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology*; D016387:Women's Health