title: Laparoscopic lymphadenectomy in advanced cervical cancer: prognostic and therapeutic value.
abstract: OBJECTIVE
  Clinical benefit of surgical staging in locally advanced cervical cancer has not yet been proved. The goal of this study was to analyze the prognostic and therapeutic value of laparoscopic para-aortic lymphadenectomy with selective excision of suspicious pelvic nodes in patients with locally advanced cervical cancer.
  
  
  METHODS
  This is a retrospective study including 109 women treated in a single institution from 2000 to 2009. The International Federation of Gynecology and Obstetrics stage was IB2 in 12 women, IIB in 58 women, and IIIB in 39 women. None had suspicious para-aortic nodes by presurgical imaging evaluation. All patients underwent extraperitoneal para-aortic laparoscopic lymphadenectomy with selective excision of enlarged pelvic nodes and received pelvic radiotherapy with concomitant chemotherapy. Extended lumboaortic radiation therapy was added to patients with metastatic para-aortic nodes. The mean ± SD follow-up time was 43.1 ± 33.7 months.
  
  
  RESULTS
  Metastatic lymph nodes were identified in 23 (21.1%) of 109 patients in the para-aortic area and in 24 (53.3%) of 45 patients who underwent selective excision of pelvic nodes. Patients with nodal metastases had increased risk of mortality than those with negative nodes independently of the location (pelvic and/or para-aortic) of the metastases (hazard ratio, 4.07; 95% confidence interval, 1.36-12.16 for patients with pelvic metastases [P = 0.012]; and 3.73; 95% confidence interval, 1.38-10.09 for patients with para-aortic metastases [P = 0.010]). In the subset of women with para-aortic metastases treated by extended lumboaortic radiation therapy, neither the number of lymph nodes removed nor the number of positive nodes were associated with survival (P = 0.556 and P = 0.195, respectively).
  
  
  CONCLUSIONS
  Para-aortic and pelvic lymphadenectomy provides valuable information about mortality risk in patients with locally advanced cervical cancer.
authors.affiliation: *Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); †Radiation Oncology Department, Gynecological Cancer Unit, Hospital Clinic; and ‡Clinic Institute of Hematological and Oncological Diseases. Hospital Clinic, Faculty of Medicine-University of Barcelona, Spain; and §Department of Pathology, Hospital Clinic, Centre de Recerca en Salut Internacional de Barcelona (CRESIB), University of Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Del Pino
authors.forename: Pere
authors.initials: P
authors.lastname: Fusté
authors.forename: Jaume
authors.initials: J
authors.lastname: Pahisa
authors.forename: Angels
authors.initials: A
authors.lastname: Rovirosa
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Martínez-Serrano
authors.forename: Sergio
authors.initials: S
authors.lastname: Martínez-Román
authors.forename: Immaculada
authors.initials: I
authors.lastname: Alonso
authors.forename: Laura
authors.initials: L
authors.lastname: Vidal
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
authors.forename: Aureli
authors.initials: A
authors.lastname: Torné
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery*