title: [Laparoscopic para-aortic lymphadenectomy in advanced cervical cancer: morbidity and impact on therapy].
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: Département de chirurgie, institut Gustave-Roussy, 114 rue Édouard-Vaillant, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Souadka
authors.forename: S
authors.initials: S
authors.lastname: Gouy
authors.forename: T
authors.initials: T
authors.lastname: Debaere
authors.forename: J
authors.initials: J
authors.lastname: Duclos
authors.forename: J
authors.initials: J
authors.lastname: Lumbroso
authors.forename: C
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: P
authors.initials: P
authors.lastname: Morice
authors.forename: C
authors.initials: C
authors.lastname: Uzan
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18