title: Multi-center experience of robot-assisted laparoscopic para-aortic lymphadenectomy for staging of locally advanced cervical carcinoma.
abstract: OBJECTIVE
  FIGO classification is commonly used for staging of locally advanced cervical cancer. Laparoscopic para-aortic lymphadenectomy is currently used as a diagnostic tool, since we know that presence of para-aortic lymph node metastases identifies patients with poor prognosis. The application of robotics during this procedure needs to be investigated.
  
  
  METHODS
  Retrospective multi-center study.
  
  
  METHODS
  Three centers participated in building one database.
  
  
  METHODS
  Thirty-seven patients with locally advanced cervical cancer underwent a robot-assisted laparoscopic para-aortic lymphadenectomy.
  
  
  METHODS
  Patients were prospectively enrolled in one register. Retrospective analysis of the whole database was performed.
  
  
  METHODS
  Surgical outcomes of the robot-assisted procedure and follow-up data.
  
  
  RESULTS
  Median number of lymph nodes collected was 27.5 (1-54) per patient. Five of 37 patients had para-aortic node metastases. The false negative rate for PET-CT diagnosing para-aortic node metastases was 11.4% (4/35). Two major intra-operative complications occurred (5.4%). Postoperative morbidity was low (13.5%). Median follow-up was 27 months [95% confidence interval (95% CI) was 24-30]. Median disease-free survival was 16 months (95% CI 2.4-29.6). Patients with negative nodes had a median disease-free survival of 24 months (not assessable), although patients with positive nodes had a median disease-free survival of 9 months (95% CI 6.9-11.9).
  
  
  CONCLUSIONS
  In this series we report that robot-assisted laparoscopic para-aortic lymphadencetomy provided the surgeon with useful information, diagnosing 11.4% of occult para-aortic lymph node metastases in women with locally advanced cervical cancer. Intra-operative and postoperative morbidity were low. The presence of para-aortic lymph node metastases correlated with shorter disease-free survival.
authors.affiliation: Obstetrics and Gynecology Department, St Pierre Hospital, University of Brussels, Brussels, Belgium. maxime_fastrez@stpierre-bru.be
authors.forename: Maxime
authors.initials: M
authors.lastname: Fastrez
authors.forename: Frédéric
authors.initials: F
authors.lastname: Goffin
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Jean
authors.initials: J
authors.lastname: Vandromme
authors.forename: Philippe
authors.initials: P
authors.lastname: Petit
authors.forename: Karin
authors.initials: K
authors.lastname: Leunen
authors.forename: Michel
authors.initials: M
authors.lastname: Degueldre
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012371:Robotics; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy
keywords: Cervical neoplasms; disease-free survival; laparoscopy; lymph node excision; para-aortic; robotics