title: Prospective multicenter study evaluating the survival of patients with locally advanced cervical cancer undergoing laparoscopic para-aortic lymphadenectomy before chemoradiotherapy in the era of positron emission tomography imaging.
abstract: OBJECTIVE
  The aim of this prospective study conducted in three French comprehensive cancer centers was to evaluate the therapeutic impact on survival of laparoscopic para-aortic (PA) staging surgery in locally advanced cervical cancer (LACC) before chemoradiotherapy.
  
  
  METHODS
  We conducted a prospective multicenter study of 237 patients treated from 2004 to 2011 for LACC with negative positron emission tomography (PET) imaging of the PA area and undergoing laparoscopic PA lymphadenectomy. Radiation fields were extended to the PA area when PA nodes were involved. Chemoradiotherapy modalities were homogeneous across institutions. Patients with a poor prognosis histologic subtype or peritoneal carcinosis were excluded.
  
  
  RESULTS
  Patients had clinical International Federation of Gynecology and Obstetrics stages IB2 (n = 79), IIA (n = 10), IIB (n = 121), III (n = 22), or IVA (n = 5). One hundred ninety-nine patients had squamous carcinoma, and 38 had adenocarcinoma/adenosquamous lesions. Twenty-nine patients (12%) had nodal involvement (false-negative PET-computed tomography [CT] results)-16 with a PA nodal metastasis measuring more than 5 mm and 13 with a nodal metastasis measuring ≤ 5 mm. Event-free survival rates at 3 years in patients without PA involvement or with PA metastasis measuring ≤ or more than 5 mm were 74% (SE, 4%), 69% (SE, 21%), and 17% (SE, 14%; P < .001).
  
  
  CONCLUSIONS
  To our knowledge, this is the largest series of patients reported undergoing such a strategy. We obtained the same survival rate for patients with PA nodal metastasis ≤ 5 mm and patients without PA lymph node involvement, suggesting that this strategy is highly efficient in such patients. Conversely, the survival of patients with PA nodal involvement greater than 5 mm remained poor, despite the absence of extrapelvic disease on PET-CT imaging in this subgroup.
authors.affiliation: Institut Gustave Roussy, 94805 Villejuif, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gouy
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Fabrice
authors.initials: F
authors.lastname: Narducci
authors.forename: Catherine
authors.initials: C
authors.lastname: Uzan
authors.forename: Alejandra
authors.initials: A
authors.lastname: Martinez
authors.forename: Annie
authors.initials: A
authors.lastname: Rey
authors.forename: Enrica
authors.initials: E
authors.lastname: Bentivegna
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.forename: Desiree
authors.initials: D
authors.lastname: Deandreis
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D002648:Child; 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; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult