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Massobrio R, Bianco L, Campigotto B, Attianese D, Maisto E, Pascotto M, Ruo Redda MG, Ferrero A. New Frontiers in Locally Advanced Cervical Cancer Treatment. J Clin Med 2024; 13:4458. [PMID: 39124724 PMCID: PMC11312973 DOI: 10.3390/jcm13154458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Despite the introduction of targeted vaccines and screening protocols, locally advanced cervical cancer represents a median proportion of 37% among all cervical carcinomas. Compared to early stages, it presents significantly lower cure rates, with a 5-year disease-free survival rate of 68% and a 5-year overall survival rate of 74%. According to current guidelines, definitive radiotherapy with concomitant chemotherapy represents the gold standard for locally advanced cervical cancer treatment. However, a significant number of patients relapse and die from metastatic disease. The aim of this narrative review is to examine the recent advancements in treating locally advanced cervical cancer, exploring new frontiers in therapeutic approaches. The PubMed database and clinical trial registries were searched to identify relevant articles published on locally advanced cervical cancer treatment up to March 2024, mainly focusing on papers published in the last decade. Abstracts presented at major international congresses that bring relevant evidence were included. Progress achieved in refining radiotherapy techniques, recent evidence regarding neoadjuvant treatment preceding surgery or concurrent chemoradiotherapy, and key findings concerning adjuvant treatment are thoroughly explored. Furthermore, a comprehensive review of prominent phase II and phase III trials examining the integration of immune checkpoint inhibitors is conducted, analyzing the various contexts in which they are applied. In light of the new evidence that has emerged in recent years and is discussed in this article, the appropriate selection of the most suitable therapeutic approach for each patient remains a complex but crucial issue.
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Affiliation(s)
- Roberta Massobrio
- Academic Division of Gynecology and Obstetrics, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (R.M.); (B.C.); (D.A.); (E.M.); (M.P.)
| | - Lavinia Bianco
- Department of Radiation Oncology, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (L.B.); (M.G.R.R.)
| | - Beatrice Campigotto
- Academic Division of Gynecology and Obstetrics, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (R.M.); (B.C.); (D.A.); (E.M.); (M.P.)
| | - Daniela Attianese
- Academic Division of Gynecology and Obstetrics, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (R.M.); (B.C.); (D.A.); (E.M.); (M.P.)
| | - Elisa Maisto
- Academic Division of Gynecology and Obstetrics, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (R.M.); (B.C.); (D.A.); (E.M.); (M.P.)
| | - Maria Pascotto
- Academic Division of Gynecology and Obstetrics, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (R.M.); (B.C.); (D.A.); (E.M.); (M.P.)
| | - Maria Grazia Ruo Redda
- Department of Radiation Oncology, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (L.B.); (M.G.R.R.)
| | - Annamaria Ferrero
- Academic Division of Gynecology and Obstetrics, University of Turin, Mauriziano Umberto I Hospital, 10128 Turin, Italy; (R.M.); (B.C.); (D.A.); (E.M.); (M.P.)
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
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Dumitraşcu MC, Nenciu AE, Nenciu CG, Ursu C, Ilieşiu A, Baroş A, Secară D, Cîrstoiu MM. Stadializarea clinică şi chirurgicală a pacientelor cu cancer de col uterin – studiu retrospectiv privind corelaţiile dintre diagnosticul iniţial, opţiunile de tratament şi rezultatele histopatologice. GINECOLOGIA.RO 2023. [DOI: 10.26416/gine.39.1.2023.7788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Martinez A, Chantalat E, Angeles MA, Ferron G, Ducassou A, Daix M, Attal J, Bétrian S, Lusque A, Gabiache E. Metabolic activity determines survival depending on the level of lymph node involvement in cervical cancer. BMC Cancer 2022; 22:810. [PMID: 35870900 PMCID: PMC9308355 DOI: 10.1186/s12885-022-09785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background To assess the impact of PET/CT functional parameters on survival, locoregional, and distant failure according to the most distant level of lymph node [18F]FDG uptake in patients with locally advanced cervical cancer (LACC). Methods Retrospective study including 148 patients with LACC treated with concurrent chemoradiotherapy after PET/CT and para-aortic lymph node (PALN) surgical staging. Two senior nuclear medicine physicians reviewed all PET/CT exams and retrieved tumor and lymph node metabolic parameters: SUVmax, MTV, TLG. Oncological outcomes according to metabolic parameters and level of lymph node spread on PET/CT were assessed. Results In patients without lymph node uptake on PET/CT, high MTV values of the cervical tumor were associated with DFS (HR = 5.14 95%CI = [2.15–12.31]), OS (HR = 6.10 95%CI = [1.89–19.70]), and time to distant (HR = 4.73 95%CI = [1.55–14.44]) and locoregional recurrence (HR = 5.18 95%CI = [1.72–15.60]). In patients with pelvic lymph node (PLN) uptake but without PALN uptake on [18F]FDG-PET/CT, high MTV values of the cervical tumor were associated with DFS (HR = 3.17 95%CI = [1.02–9.83]) and OS (HR = 3.46 95%CI = [0.96–12.50]), and the number of PLN fixations was associated with DFS (HR = 1.30 95%CI = [1.10–1.53]), OS (HR = 1.35 95%CI = [1.11–1.64]), and time to distant (HR = 1.35 95%CI = [1.08–1.67]) and locoregional recurrence (HR = 1.31 95%CI = [1.08–1.59]). There was no significant association between cervical tumor metabolic or lymph node metrics and survival outcome in patients with PALN uptake. Conclusions Cervical MTV is more accurate than SUVmax to predict survival outcome in patients with locoregional disease confined to the pelvis and should be implemented in routine clinical practice. Prognostic value of metabolic metrics disappears with PALN uptake, which is associated with distant failure in nearly half of patients.
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Zhou Y, Rassy E, Coutte A, Achkar S, Espenel S, Genestie C, Pautier P, Morice P, Gouy S, Chargari C. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers (Basel) 2022; 14:2449. [PMID: 35626051 PMCID: PMC9139662 DOI: 10.3390/cancers14102449] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients' outcome and minimize treatment-related morbidity.
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Affiliation(s)
- Yuedan Zhou
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Samir Achkar
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Sophie Espenel
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France;
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Sébastien Gouy
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
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Khebbeb S, Rathat G, Serrand C, Bourdon A, Ferrer C, Duraes M. Interest of para-aortic lymphadenectomy for locally advanced cervical cancer in the era of PET scanning. Eur J Obstet Gynecol Reprod Biol 2022; 272:234-239. [PMID: 35397374 DOI: 10.1016/j.ejogrb.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Treatment of locally advanced cervical cancer (LACC) involves pelvic chemoradiotherapy, using an extended field in the case of para-aortic involvement. 18-Fluoro-D-glucose positron emission tomography combined with computer tomography (PET-CT) is an accurate method for the detection of metastatic nodes. The objective of this study was to evaluate the performance of PET-CT for lymph node staging of LACC. METHODS This bicentric retrospective study included patients with LACC who had a PET-CT scan followed by para-aortic lymphadenectomy between January 2015 and December 2019. Based on pathological findings, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and false-negative (FN) rates of PET-CT for para-aortic node involvement were evaluated. RESULTS Seventy-one patients who had undergone laparoscopic lymphadenectomy were included in this study. The intraoperative complication rate was 2.8%. Sensitivity, specificity, NPV and PPV for PET-CT were 55% [95% confidence interval (CI) 44.6-67.1], 84% (95% CI 75-92), 93% (95% CI 87-99) and 33% (95% CI 22-44), respectively. FN rates in the case of negative or positive pelvic PET-CT were 5.7% and 9.5%, respectively. CONCLUSIONS Para-aortic lymphadenectomy is recommended for lymph node staging in the case of negative para-aortic PET-CT. In view of the low FN rate of PET-CT, surgical staging should be discussed regardless of pelvic status if the patient presents high surgical risk, or if this delays the commencement of chemoradiotherapy.
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Affiliation(s)
- Sirine Khebbeb
- Department of Gynaecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Gauthier Rathat
- Department of Gynaecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Chris Serrand
- Clinical Research and Epidemiology Unit, Nimes University Hospital, Nimes, France
| | - Aurélie Bourdon
- Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France
| | - Catherine Ferrer
- Department of Gynaecological and Breast Surgery, Nimes University Hospital, Nimes, France
| | - Martha Duraes
- Department of Gynaecological and Breast Surgery, Montpellier University Hospital, Montpellier, France.
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Surgical Outcomes of Laparoscopic Pelvic Lymph Node Debulking during Staging Aortic Lymphadenectomy in Locally Advanced Cervical Cancer: A Multicenter Study. Cancers (Basel) 2022; 14:cancers14081974. [PMID: 35454880 PMCID: PMC9025856 DOI: 10.3390/cancers14081974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Lymph node metastasis is an important prognostic factor in locally advanced cervical cancer (LACC), which makes correct staging crucial. In contrast to existing studies evaluating pelvic lymphadenectomy after aortic lymphadenectomy, this study focuses on the pelvic node (PLN) debulking technique which has the dual objective of staging and cytoreduction. This is a multicenter retrospective study of patients with LACC and positive pelvic nodes on imaging tests. Feasibility, morbidity and delay in the initiation of chemoradiotherapy (CRT) were evaluated for the PLN debulking by comparing it with a control group of aortic lymphadenectomy alone. Excision of the bulky nodes was possible in 99.4% of patients. There were no differences in complications between the groups and a shorter time from diagnosis and from surgery to the start of CRT was observed in the study group. Abstract Background: Few studies have evaluated laparoscopic pelvic lymph node (PLN) debulking during staging aortic lymphadenectomy in locally advanced cervical cancer (LACC). It allows us to know the lymph node status and facilitates the action of chemoradiotherapy (CRT) by reducing tumor burden. We evaluated its feasibility and compared the perioperative morbidity and the time to CRT with a control group. Methods: This was a multicenter retrospective study of patients with LACC FIGO stage IIIC1r who were recipients of CRT. We compared two cohorts: group 1, which consisted of 164 patients with surgical staging by laparoscopic aortic lymphadenectomy and PLN debulking, and group 2, which consisted of 111 patients with aortic lymphadenectomy alone. Results: Excision of the bulky nodes was possible in all patients in group 1 except for one. Surgery lasted a median of 82 min longer in group 1 but there was no greater intraoperative bleeding or increased hospital stay. There were no significant differences in intraoperative or postoperative complications between the groups. A significantly shorter time from surgery to the start of RT was observed in group 1. Conclusions: It is feasible to perform laparoscopic PLN debulking in the same procedure as the staging aortic lymphadenectomy in LACC without increasing surgical or postoperative complications and without delaying the start of CRT compared to single aortic lymphadenectomy.
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Zhang W, Xia L, Han X, Ju X, Wu X, Chen X. Extraperitoneal laparoscopy for para-aortic lymphadenectomy in endometrial carcinoma staging: an approach with higher efficiency. World J Surg Oncol 2021; 19:323. [PMID: 34743715 PMCID: PMC8573921 DOI: 10.1186/s12957-021-02416-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Removing more inframesenteric nodes is not only significantly increases the likelihood of finding metastasis for endometrial cancer, but also can add survival advantage. As most patients diagnosed with endometrial cancer are overweight or obesity, a high efficiency approach is important. Aim of this study was to compare the surgical outcomes of extraperitoneal laparoscopic, transperitoneal laparoscopic, and laparotomic para-aortic lymphadenectomy in endometrial carcinoma staging. Methods We retrospectively reviewed data of all patients diagnosed with primary endometrial carcinoma who were treated at the Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center from 1 January 2017 to 31 December 2019. The numbers of para-aortic lymph nodes, surgical time, complications, blood loss and hospital stay were compared. The patients’ medical records and pathological reports were carefully reviewed. Statistical significance was defined as p < 0.05. Results We retrospectively compared patients who underwent extraperitoneal laparoscopy (Group E, n = 20), transperitoneal laparoscopy (group T, n = 21), and laparotomy (group L, n = 135). The median number of para-aortic lymph nodes was significantly higher in group E than in groups T and L (9.5, 5, and 6, respectively; p = 0.004 and 0.0004, respectively). All patients in group E underwent successfully dissection to the renal vessel level. The median operation time was significantly shorter in group L than in groups T and E (94, 174, and 233 min, respectively; p < 0.0001). The median estimated blood loss volume was higher in group L than in groups T and E (200, 100, and 142.5 ml, respectively; all comparisons p < 0.001), and the length of hospital stay was significantly longer in group L than in Groups T and E (6, 5, and 6 days, respectively; all comparisons p < 0.001). Conclusion The extraperitoneal laparoscopic approach for staging endometrial carcinoma harvested higher numbers of para-aortic lymph nodes which could be considered for endometrial carcinoma staging, especially for para-aortic lymph node harvest. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02416-x.
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Affiliation(s)
- Wei Zhang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lingfang Xia
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaotian Han
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xingzhu Ju
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaojun Chen
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
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Capozzi VA, Sozzi G, Monfardini L, Di Donna MC, Giallombardo V, Lo Balbo G, Butera D, Berretta R, Chiantera V. Transperitoneal versus extraperitoneal laparoscopic aortic lymph nodal staging for locally advanced cervical cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:2256-2264. [PMID: 33972143 DOI: 10.1016/j.ejso.2021.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Cervical cancer is the fourth most common neoplasm in women. In locally advanced cervical cancers, the international guidelines recommend nodal aortic assessment. Two techniques have been described to perform laparoscopic aortic lymphadenectomy: transperitoneal laparoscopic lymphadenectomy (TLL) and extraperitoneal laparoscopic lymphadenectomy (ELL). This meta-analysis aims to compare the surgical outcomes of TLL and ELL for staging purposes. The systematic review was carried out in agreement with the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). Two hundred and twenty studies were analyzed, and 19 studies were included in the review (7 for TLL and 12 for ELL group). 1112 patients were included in the analysis: 390 patients were included in group 1 and 722 patients in group 2.38 patients (9.7%) in the TLL group and 69 (9.5%) patients in the ELL group developed major complications. The analysis of all complications (intraoperative and postoperative) rate through pooled analysis did not show a significant difference between the two groups (p = 0.979), although a significantly higher intraoperative complication rate (p = 0.018) occurred in the TLL group compared to ELL. No significant differences were found between groups for BMI (p = 0.659), estimated blood loss (p = 0.889), length of stay (p = 0.932), intraoperative time (p = 0.932), conversion to laparotomy rate (p = 0.404), number of lymph node excised (p = 0.461) and postoperative complication (p = 0.291). TLL approach shows a higher rate of intraoperative complications, while no significant difference was found between the two techniques when postoperative complications were analyzed.
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Affiliation(s)
| | - Giulio Sozzi
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Vincenzo Giallombardo
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppina Lo Balbo
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Diana Butera
- Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
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Martinez A, Angeles MA, Querleu D, Ferron G, Pomel C. How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging. Int J Gynecol Cancer 2020; 30:1434-1443. [PMID: 32788263 DOI: 10.1136/ijgc-2020-001351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022] Open
Abstract
Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10-15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25-30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.
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Affiliation(s)
- Alejandra Martinez
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France .,Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France.,INSERM CRCT Team 19, ONCOSARC - Oncogenesis of sarcomas, Toulouse, France
| | - Christophe Pomel
- Department of Surgical Oncology, Institut Jean Perrin, Clermont-Ferrand, France
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Ferrier C, Pellevoizin R, Touboul C, Boudy AS, Wohrer H, Guerini C, Owen C, Bendifallah S, Daraï E. Back to the Future: Schauta-Amreich Radical Vaginal Hysterectomy Assisted by Laparoscopy with Sentinel Lymph Node Biopsy for Early-stage Cervical Cancer. J Minim Invasive Gynecol 2020; 28:131-136. [PMID: 32534050 DOI: 10.1016/j.jmig.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
The popularity of laparoscopy to perform radical hysterectomy has massively increased over the last 2 decades. However, oncologic outcomes (overall and disease-free survival) have been found to be better in patients managed by laparotomy compared with laparoscopy, challenging this surgical route. Compared with laparotomy, vaginal access reduces postoperative morbidity, while avoiding potential cancer spread associated with laparoscopy. We describe the procedure of Schauta-Amreich radical vaginal hysterectomy with bilateral salpingo-oophorectomy, assisted laparoscopically, and associated with pelvic sentinel lymph node procedure in a 56-year-old woman with an International Federation of Gynecology and Obstetrics stage IB2 cervical epidermoid carcinoma. A sentinel lymph node procedure was first performed by laparoscopy. Radical hysterectomy was prepared through laparoscopy by dividing the infundibulopelvic, round, and broad ligaments. The procedure was continued by the vaginal route using the Schuchardt incision. We describe each step of the procedure and provide a video. Histology showed a margin-free resection in both the vagina and parametrium with negative sentinel lymph nodes. This description of the Schauta-Amreich radical vaginal hysterectomy technique with a video file could support the teaching of a procedure that may gain in popularity.
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Affiliation(s)
- Clément Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France.
| | - Raphael Pellevoizin
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Henri Wohrer
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Claire Guerini
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Clementine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, (all authors); UMRS 938, Centre de recherche Saint Antoine, Sorbonne Université (Drs. Ferrier, Touboul, Boudy, Owen, Bendifallah, and Daraï), Paris, France
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Technical Aspects of Endosurgical Extraperitoneal Aortic Lymph Node Dissection in Gynaecologic Oncology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Boria Alegre F, Cabanes M, Hernández Gutiérrez A, Zapardiel I. How to develop an appropriate extraperitoneal para-aortic space. Int J Gynecol Cancer 2019; 29:1083. [DOI: 10.1136/ijgc-2019-000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/03/2022] Open
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13
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Samouëlian V, Mechtouf N, Leblanc E, Cardin GB, Lhotellier V, Querleu D, Révillion F, Rodier F. Sensitive molecular detection of small nodal metastasis in uterine cervical cancer using HPV16-E6/CK19/MUC1 cancer biomarkers. Oncotarget 2018; 9:21641-21654. [PMID: 29774091 PMCID: PMC5955143 DOI: 10.18632/oncotarget.24956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 03/15/2018] [Indexed: 12/02/2022] Open
Abstract
Metastatic nodal involvement is a critical prognostic factor in uterine cervical cancer (UCC). To improve current methods of detecting UCC metastases in lymph nodes (LNs), we used quantitative PCR (qPCR) to assess mRNA expression of potential metastatic biomarkers. We found that expression of HPV16-E6, cytokeratin19 (CK19), and mucin1 (MUC1) is consistently upregulated in tumors and metastatic tissues, supporting a role for these genes in UCC progression. These putative biomarkers were able to predict the presence of histologically positive metastatic LNs with respective sensitivities and specificities of 82% and 99% (CK19), 76% and 95% (HPV16-E6), and 76% and 78% (MUC1). While the biomarkers failed to detect 1.7% to 2.2% of the histologically positive LNs when used individually, combining CK19 and HPV16-E6 enhanced sensitivity and specificity to 100% and 94%, respectively. To explore the sensitivity of qPCR-based detection of varying proportions of invading HPV16-positive UCC cells, we designed a LN metastasis model that achieved a fresh cell detection limit of 0.008% (1:12500 HPV16-positive to HPV16-negative cells), and a paraffin-embedded, formalin-fixed (PEFF) detection limit of 0.02% (1:5000 HPV16-positive to HPV16-negative cells), both of which are within the theoretical detection limit for micrometastasis. Thus, HPV E6/E7 oncogenes may be useful targets for the ultrasensitive detection of nodal involvements like micrometastases in fresh or archived tissue samples. Moreover, our results suggest that the biomarker combination of CK19/HPV-E6 could support a real-time intraoperative strategy for the detection of small, but potentially lethal, metastatic nodal involvements in fresh UCC tissues.
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Affiliation(s)
- Vanessa Samouëlian
- CRCHUM et Institut du cancer de Montréal, Montreal, QC, Canada.,Université de Montréal, Département d'Obstétrique Gynécologie, Montreal, QC, Canada.,CHUM, Service de Gynécologie oncologique, Montreal, QC, Canada
| | - Nawel Mechtouf
- CRCHUM et Institut du cancer de Montréal, Montreal, QC, Canada
| | - Eric Leblanc
- Department of Surgery - Centre Oscar Lambret, Lille Cedex, France
| | | | - Valérie Lhotellier
- Laboratory of Human Molecular Oncology - Centre Oscar Lambret, Lille Cedex, France
| | | | - Françoise Révillion
- Laboratory of Human Molecular Oncology - Centre Oscar Lambret, Lille Cedex, France
| | - Francis Rodier
- CRCHUM et Institut du cancer de Montréal, Montreal, QC, Canada.,Université de Montréal, Département de Radiologie, Radio-Oncologie et Médicine Nucléaire, Montreal, QC, Canada
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Samouëlian V, Revillion F, Alloy N, Lhotellier V, Leblanc E, Peyrat J. Measurement of mRNA of 11 Biomarkers by RT-PCR to Detect Lymph Node Involvement in Cervical Cancer. Int J Biol Markers 2018. [DOI: 10.1177/172460080802300203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lymph node metastases are a major prognostic factor in cervical carcinomas. The aim of this study was to characterize the expression of 11 markers in cervical tumors and negative lymph nodes and to determine which ones could be helpful for improving the specificity of molecular diagnosis of nodal involvement. Using TaqMan RT-PCR, we studied the expression of CK19, MUC1, HER1–HER4, VEGF, VEGF-C, uPA, MMP9, and PRAD1 in uterine cervical tumors and in histologically nonmetastatic lymph nodes of 8 patients diagnosed with locally advanced cervical cancer. We observed that CK19, MUC1, HER1–HER3, uPA, and VEGF had a significantly higher expression in cervical tumors than in the negative nodes, whereas VEGF-C expression level was higher in the negative nodes than in the tumors. PRAD1 harbored similar expression levels in the tumors and in the negative nodes. Interestingly, 1 of the 4 patients who presented a clinical recurrence, showed elevated HER1, HER2, uPA, and VEGF in the histologically negative nodes. Our results suggest that CK19, MUC1, HER1–3, uPA, and VEGF are biomarkers that have a higher expression in tumoral cervical tissues compared with the negative lymph nodes and could be useful to diagnose nodal involvement in uterine cervical carcinoma. Our results should encourage us in continue to investigate a greater number of patients, including patients with histologically involved nodes.
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Affiliation(s)
- V. Samouëlian
- Laboratory of Human Molecular Oncology, Centre Oscar Lambret, Lille - France
- Department of Surgery, Centre Oscar Lambret, Lille - France
| | - F. Revillion
- Laboratory of Human Molecular Oncology, Centre Oscar Lambret, Lille - France
| | - N. Alloy
- Laboratory of Human Molecular Oncology, Centre Oscar Lambret, Lille - France
| | - V. Lhotellier
- Laboratory of Human Molecular Oncology, Centre Oscar Lambret, Lille - France
| | - E. Leblanc
- Department of Surgery, Centre Oscar Lambret, Lille - France
| | - J.P. Peyrat
- Laboratory of Human Molecular Oncology, Centre Oscar Lambret, Lille - France
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15
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Left Lateral Endosurgical Extraperitoneal Total Hysterectomy with Para-Aortic and Pelvic Lymphadenectomy: A Novel Approach for the Obese Patient with Endometrial Cancer. J Minim Invasive Gynecol 2017; 25:730-736. [PMID: 29229578 DOI: 10.1016/j.jmig.2017.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To describe the left lateral extraperitoneal approach to perform complete para-aortic and pelvic lymphadenectomy and transverse total hysterectomy from left to right as a novel approach to treat obese patients with endometrial cancer. Laparoscopic management of obese patients represents a challenge for the gynecologic surgeon. The extraperitoneal approach is technically easier in the obese patient because it naturally creates a bowel-free operative field. DESIGN A prospective pilot bicentric and descriptive study (Canadian Task Force classification III) evaluating the feasibility and reproducibility of the transverse total hysterectomy and complete lymphadenectomy through left endoscopic extraperitoneal approach in obese patients with endometrial cancer. SETTING A comprehensive cancer center in Toulouse and a teaching university hospital in Madrid. PATIENTS Sixteen consecutive overweight or obese patients (body mass index > 25 kg/m2) with high-risk endometrial cancer. INTERVENTIONS Currently, the left extraperitoneal approach is routinely used to perform complete para-aortic and pelvic lymphadenectomy. It provides direct access to the left ureter and uterine pedicle. This access can be extended to the right side when performing a transverse extrafascial hysterectomy from left to right. The procedure starts from the left extraperitoneal space, where the left uterine artery is sectioned and the vesicovaginal and rectovaginal septa are developed, without opening the peritoneum. Colpotomy is performed from the left to the right side. Once the right ureter is identified, the right uterine artery can be safely transected. Alternatively, the right uterine artery can be sealed and sectioned during the right pelvic lymphadenectomy. At the end of the procedure the peritoneum is opened to complete the surgery. MEASUREMENTS AND MAIN RESULTS Between May 2015 and February 2016, 16 consecutive obese patients were successfully treated using this technique. Median patient age was 62 years (range, 44-78), and median body mass index was 32.5 kg/m2 (range, 26-42). In 3 cases the right uterine artery was sealed during the right pelvic lymphadenectomy, in 11 cases after completing vaginal opening, and in 2 cases after peritoneal opening. The median operative time was 137.5 minutes (range, 66-260). The median blood loss was 85 mL (range, 0-260), and no blood transfusion was required in any of our 16 patients. No significant complications occurred. CONCLUSION The full extraperitoneal approach represents an interesting alternative strategy for the surgical treatment of obese patients with high-risk endometrial cancer.
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Azaïs H, Ghesquière L, Petitnicolas C, Borghesi Y, Tresch-Bruneel E, Cordoba A, Narducci F, Bresson L, Leblanc E. Pretherapeutic staging of locally advanced cervical cancer: Inframesenteric paraaortic lymphadenectomy accuracy to detect paraaortic metastases in comparison with infrarenal paraaortic lymphadenectomy. Gynecol Oncol 2017; 147:340-344. [DOI: 10.1016/j.ygyno.2017.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
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17
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Morbidity of Staging Inframesenteric Paraaortic Lymphadenectomy in Locally Advanced Cervical Cancer Compared With Infrarenal Lymphadenectomy. Int J Gynecol Cancer 2017; 27:575-580. [DOI: 10.1097/igc.0000000000000921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Ferreira H, Nogueira-Silva C, Miranda A, Correia-Pinto J. Resection of Sentinel Lymph Nodes by an Extraperitoneal Minilaparoscopic Approach Using Indocyanine Green for Uterine Malignancies. Surg Innov 2016; 23:347-53. [DOI: 10.1177/1553350615620302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in cervical and endometrial malignancies. The aim of the study was to test the feasibility and reliability of minilaparoscopic extraperitoneal SLN excision after indocyanine green (ICG) cervical injection using a high-definition near infrared (NIR) imaging system in an in vivo porcine model. The same procedure was performed using conventional laparoscopic instruments and both outcomes were compared. Methods. Twenty-four animals were equally and randomly divided into a minilaparoscopic group (group A) and a 5-mm conventional laparoscopic group (group B). A high-definition NIR imaging system and a 30° ICG endoscope were used. First, ICG (0.5 mL) was injected in the paracervical region. The SLN coloring time was recorded. An extraperitoneal approach to the SLN was executed with the same CO2 retropneumoperitoneum pressures (10 mm Hg). In both groups, the times for SLN localization and excision, as well as complications, were registered. Finally, a laparotomy was then done to evaluate whether any stained SLN still remained. The same surgical team performed all experiments. Results. SLNs were identified and extraperitoneally excised in all animals without major complications. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times were shorter with minilaparoscopy (39.3 ± 13 minutes) than with conventional 5-mm instruments (51.3 ± 14.17 minutes; P = .042). In group B, one stained SLN remained and was only detected by laparotomy. Conclusions. We confirmed the feasibility and reliability of extraperitoneal minilaparoscopic approach for identification, dissection, and excision of SLN using an NIR imaging system and ICG.
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Affiliation(s)
- Hélder Ferreira
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
- Centro Hospitalar do Porto, Porto, Portugal
| | - Cristina Nogueira-Silva
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
- Hospital de Braga, Braga, Portugal
| | - Alice Miranda
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
| | - Jorge Correia-Pinto
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
- Hospital de Braga, Braga, Portugal
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Díaz-Feijoo B, Correa-Paris A, Pérez-Benavente A, Franco-Camps S, Sánchez-Iglesias JL, Cabrera S, de la Torre J, Centeno C, Puig OP, Gil-Ibañez B, Colas E, Magrina J, Gil-Moreno A. Prospective Randomized Trial Comparing Transperitoneal Versus Extraperitoneal Laparoscopic Aortic Lymphadenectomy for Surgical Staging of Endometrial and Ovarian Cancer: The STELLA Trial. Ann Surg Oncol 2016; 23:2966-74. [DOI: 10.1245/s10434-016-5229-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Indexed: 11/18/2022]
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20
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Kusunoki S, Huang KG, Magno A, Lee CL. Laparoscopic technique of para-aortic lymph node dissection: A comparison of the different approaches to trans- versus extraperitoneal para-aortic lymphadenectomy. Gynecol Minim Invasive Ther 2016; 6:51-57. [PMID: 30254875 PMCID: PMC6113969 DOI: 10.1016/j.gmit.2016.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022] Open
Abstract
Since Dr Dargent first reported endoscopic surgery using retroperitoneal pelvicoscopy to perform pelvic lymph node sampling in 1987, many literature reviews on the safety and feasibility of laparoscopic staging surgery of gynecologic malignancies have been published. However, the procedure of laparoscopic lymphadenectomy is more difficult to perform due to the limited surgical space and associated technical problems. Especially in the para-aortic lymphadenectomy procedure, there are many barriers to overcome in the surgical field, learning curve, and technique. We present a review of lymphadenectomy, especially para-aortic lymphadenectomy.
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Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Angelito Magno
- Department of Obstetrics and Gynecology, University of Perpetual Help Medical Center, Las Pinas and De La Salle University Medical Center, Cavite, Philippines
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
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21
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Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy in Gynecologic Oncology. Int J Gynecol Cancer 2015; 25:1494-502. [DOI: 10.1097/igc.0000000000000504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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22
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Extraperitoneal Lymphadenectomy in the Management of Gynecologic Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Vandeperre A, Van Limbergen E, Leunen K, Moerman P, Amant F, Vergote I. Para-aortic lymph node metastases in locally advanced cervical cancer: Comparison between surgical staging and imaging. Gynecol Oncol 2015; 138:299-303. [PMID: 26007204 DOI: 10.1016/j.ygyno.2015.05.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Compare surgical staging with imaging (PET-CT, PET or CT) of the para-aortic lymph nodes (PAOLN) in locally advanced cervical cancer (LACC). METHODS Monocentric retrospective study of 336 patients with cervical cancer FIGO stage IB2-IVA. All patients underwent staging of the PAOLN using imaging by PET-CT, PET or CT. Two hundred and four patients with normal or not overtly malignant PAOLN on imaging underwent surgical PAOLN staging up to the inferior mesenteric artery (189 endoscopy and 15 laparotomy). RESULTS The patients were divided into 4 groups: 16 with positive surgical staging and negative PAOLN imaging (sPAOLN+), 172 negative surgical staging (sPAOLN-), 20 positive imaging without surgical staging (iPAOLN+) and 128 negative imaging without surgical staging (iPAOLN-). Median operative time of staging was 70 (40-160) min and median number of removed PAOLN was 5 (0-24). Operative complications were 10 peroperative bleedings, 2 ureteral traumas, 1 carbon dioxide retention and 1 retroperitoneal abscess. The median follow-up was 31 (1-218) months. Overall survival at 2 years was for sPAOLN+, sPAOLN-, iPAOLN+, and iPAOLN- 40%, 83%, 58%, and 69%, respectively (p<0.001 for sPAOLN+ and iPAOLN+ versus sPAOLN- and iPAOLN-). The most frequent site of recurrence was distant LN metastases (outside the pelvic and PAO area) (36%) for sPAOLN+. For sPAOLN-, iPAOLN+, and iPAOLN- the most frequent site of recurrence was the cervix (27%, 66% and 26%, respectively). CONCLUSION Despite negative imaging, PAOLN metastases were present in 8% at surgical staging. Overall survival is significantly influenced by the presence of PAOLN metastases.
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Affiliation(s)
- Armin Vandeperre
- Department of Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium
| | - Erik Van Limbergen
- Department of Radiotherapy-Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium
| | - Karin Leunen
- Department of Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium
| | - Philippe Moerman
- Department of Pathology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium
| | - Frédéric Amant
- Department of Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium
| | - Ignace Vergote
- Department of Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium.
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James JA, Rakowski JA, Jeppson CN, Stavitzski NM, Ahmad S, Holloway RW. Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer. Gynecol Oncol 2014; 136:285-92. [PMID: 25546115 DOI: 10.1016/j.ygyno.2014.12.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the clinical performance of robotic-assisted infra-renal aortic lymphadenectomy (IRL) using a single center-docked approach for patients with endometrial cancer. METHODS Robotic-assisted hysterectomy with pelvic and aortic lymphadenectomy was performed in 97 clinical stage I endometrial cancer (EC) patients with the intent to remove infra-renal aortic lymph nodes. Peri-operative data was contemporaneously accessioned and a retrospective database analysis was performed to examine clinical outcomes. RESULTS IRL versus infra-mesenteric artery (IMA) dissections were accomplished in 88 (90.7%) and nine (9.3%) cases, respectively. There were no laparotomy conversions. Histology included 20.6% G1, 41.2% G2, and 38.1% G3 (endometrioid and Type II histologies). Forty-four (45.4%) cases had >50% depth-of-invasion and 43 (44.3%) cases had lymphovascular space invasion. Lymph node metastases were detected in 39 (40.2%) cases [37 (38.1%) pelvic, 16 (16.5%) pelvic+aortic, two (2.1%) isolated aortic lymph nodes]. Aortic metastasis was identified in 16/37 (43.2%) pelvic node positive cases, and 6/34 (17.7%) IRL cases with positive pelvic nodes had infra-renal metastasis, yet normal aortic nodes below the IMA. Harvested aortic lymph nodes for IRL exceeded IMA cases (15.9±6.3 vs. 8.9±4.6; p<0.01). Mean BMI for IMA cases exceeded IRL cases (37.4±3.3 vs. 31.4±7.1kg/m(2); p<0.001). Twenty-five (81%) patients with BMI >35kg/m(2) underwent successful IRL (range 36-47kg/m(2)) compared to 95% of cases <35kg/m(2) (p=0.03). CONCLUSIONS IRL was accomplished in 95% of EC patients with BMI <35kg/m(2) and 81% with BMI >35kg/m(2) using a single center-docked approach. A strict 35kg/m(2) BMI cut-off for avoiding IRL is therefore not advised.
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Affiliation(s)
- Jeffrey A James
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, Orlando, FL 32804, USA
| | - Joseph A Rakowski
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, Orlando, FL 32804, USA
| | - Corinne N Jeppson
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, Orlando, FL 32804, USA
| | - Nicole M Stavitzski
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, Orlando, FL 32804, USA
| | - Sarfraz Ahmad
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, Orlando, FL 32804, USA
| | - Robert W Holloway
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, Orlando, FL 32804, USA.
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Lamblin G, Chauvy L, Rannou C, Mathevet P, Chabert P, Mellier G, Chene G. Does ultrasonic advanced energy reduce lymphocele incidence in laparoscopic para-aortic lymphadenectomy? Eur J Obstet Gynecol Reprod Biol 2014; 185:53-8. [PMID: 25528730 DOI: 10.1016/j.ejogrb.2014.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the use of ultrasonic advanced energy in reducing the occurrence of symptomatic lymphocele and its related complications in laparoscopic extra-peritoneal para-aortic lymphadenectomy in patients with gynecological cancer. STUDY DESIGN A retrospective cohort study of consecutive patients in a tertiary referral center identified 2 groups of patients, undergoing laparoscopic extra-peritoneal para-aortic lymphadenectomy with or without the use of ultrasonic advanced energy. Surgery time, hospital stay, number of retrieved nodes and lymphocele requiring treatment were studied. Results were also compared between trained and trainee surgeons. RESULTS 163 patients were scheduled for laparoscopic extra-peritoneal para-aortic lymphadenectomy: 81 treated using bipolar energy (control group: group 1) between August 1999 and January 2005, and 82 treated using ultrasonic advanced energy (study group: group 2) between July 2010 and March 2014. The main indication (90% in group 1, 61% in group 2) was advanced cervical carcinoma (stage IB2 and above). Ultrasonic advanced energy significantly decreased operative time (p=0.001) and intra-operative bleeding (p=0.01) and increased the number of para-aortic nodes retrieved (p=0.02). There was no significant difference in hospital stay or lymphocele requiring treatment (8.6% in group 1, 8.5% in group 2: p=0.98). For senior than for junior surgeons, surgery time was shorter but not significantly (p=0.80) and postoperative lymphocele rates were identical. CONCLUSION Ultrasonic advanced energy may provide benefit in laparoscopic para-aortic lymphadenectomy, facilitating surgical ergonomics, but did not decrease post-surgery lymphocele.
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Affiliation(s)
- Gery Lamblin
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
| | - Lauriane Chauvy
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Corinne Rannou
- Department of Radiology, Femme Mère Enfant University Hospital, Lyon, France
| | - Patrice Mathevet
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Philippe Chabert
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Georges Mellier
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Gautier Chene
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
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Robotic Extraperitoneal Paraaortic Lymphadenectomy in Gynecological Cancers: Feasibility, Safety, and Short-Term Outcomes of Isolated and Combined Procedures. Int J Gynecol Cancer 2014; 24:1486-92. [DOI: 10.1097/igc.0000000000000240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of our study was to report the technique, the feasibility, and perioperative results of robotic extraperitoneal paraaortic lymphadenectomy in gynecological cancers performed for isolated or combined procedures.MethodsThis is a retrospective study of 24 consecutive patients undergoing robotic extraperitoneal paraaortic lymphadenectomy using the Da Vinci Surgical system (Intuitive Inc, Sunnyvale, CA) (cervical cancer, n = 15; high-risk endometrial cancer, n = 8; and ovarian cancer, n = 2, including 1 synchronous tumor). Extraperitoneal paraaortic lymphadenectomy was performed using the surgical technique previously described by laparoscopy.ResultsOf the 24 included patients, 12 patients had isolated robotic extraperitoneal paraaortic lymphadenectomy, whereas the others underwent the following associated procedures: total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy (n = 7); pelvic transperitoneal lymphadenectomy (n = 3), laparotomic Bricker procedure (n = 1), and colpectomy (n = 1). The median age of patients was 55 (42–64) years, and body mass index was 24.1 kg/m2 (20.9–26.1). The operation was completed in all patients except three with associated procedures. Perioperative difficulties were encountered in 9 patients (gas leakage, n = 7; adhesions, n = 2; and dissection difficulties, n = 1). The number of removed paraaortic lymph nodes was 18 (14–25). The operating times were 180 (150–210) minutes for isolated extraperitoneal paraaortic lymphadenectomy and 240 (180–300) minutes in case of associated procedures. There were 2 intraoperative (pneumothorax and renal artery injury) and 5 postoperative (3 grades 1–2 and 2 grade 3) complications.ConclusionsIf robotic-assisted extraperitoneal paraaortic lymphadenectomy seems feasible in case of isolated procedure, further studies are required to prove its benefit compared with conventional laparoscopy.
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Suh DH, Kim JW, Kang S, Kim HJ, Lee KH. Major clinical research advances in gynecologic cancer in 2013. J Gynecol Oncol 2014; 25:236-48. [PMID: 25045437 PMCID: PMC4102743 DOI: 10.3802/jgo.2014.25.3.236] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 05/25/2014] [Indexed: 11/30/2022] Open
Abstract
In 2013, 10 topics were selected for major clinical research advances in gynecologic oncology; these included three topics regarding cervical cancer, three regarding ovarian cancer, two regarding endometrial cancer, and one each regarding breast cancer and radiation oncology. For cervical cancer, bevacizumab was first demonstrated to exhibit outstanding clinical efficacy in a recurrent, metastatic setting. Regarding cervical cancer screening, visual inspections with acetic acid in low-resource settings, p16/Ki-67 double staining, and the follow-up results of four randomized controlled trials of human papillomavirus-based screening methods were reviewed. Laparoscopic para-aortic lymphadenectomy before chemoradiation for locally advanced cervical cancer was the final topic for cervical cancer. Regarding front-line ovarian cancer therapies, dose-dense paclitaxel and carboplatin, intraperitoneal chemotherapy, and other targeted agents administered according to combination or maintenance schedules were discussed. Regarding recurrent ovarian cancer treatment, cediranib, olaparib, and farletuzumab were discussed for platinum-sensitive disease. The final overall survival data associated with a combination of bevacizumab and chemotherapy for platinum-resistant disease were briefly summarized. For endometrial cancer, the potential clinical efficacy of metformin, an antidiabetic drug, in obese patients was followed by integrated genomic analyses from the Cancer Genome Atlas Research Network. For breast cancer, three remarkable advances were reviewed: the long-term effects of continued adjuvant tamoxifen for 10 years, the effects of 2-year versus 1-year adjuvant trastuzumab for human epidermal growth factor receptor 2-positive disease, and the approval of pertuzumab in a neoadjuvant setting with a pathologic complete response as the surrogate endpoint. Finally, the recent large studies of intensity-modulated radiotherapy for gynecologic cancer were briefly summarized.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sokbom Kang
- Branch of Gynecologic Cancer Research, National Cancer Center, Goyang, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Laparoscopic lymphadenectomy in advanced cervical cancer: prognostic and therapeutic value. Int J Gynecol Cancer 2014; 23:1675-83. [PMID: 24172103 DOI: 10.1097/igc.0000000000000000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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). CONCLUSION Para-aortic and pelvic lymphadenectomy provides valuable information about mortality risk in patients with locally advanced cervical cancer.
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Comparison of robotic-assisted vs conventional laparoscopy for extraperitoneal paraaortic lymphadenectomy. Gynecol Oncol 2014; 132:98-101. [DOI: 10.1016/j.ygyno.2013.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/18/2013] [Accepted: 11/01/2013] [Indexed: 11/27/2022]
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Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and the safety of single-port extraperitoneal laparoscopic para-aortic lymphadenectomy for patients with gynecologic cancer. METHODS From July 2012 to January 2013, a total of 7 patients with gynecologic cancer underwent a laparoscopic pelvic and para-aortic lymphadenectomy with a single-port device. An extraperitoneal approach was performed for para-aortic lymphadenectomy using only one 2.5-cm incision on the left side. In 6 patients, additionally, hysterectomy and pelvic lymphadenectomy with conventional laparoscopy were performed to complete the treatment. RESULTS Aortic dissection was complete in all cases without complications. The median age of the patients was 63 years (range, 48-78 years), and the median patient body mass index was 31 kg/m(2) (range, 19-38 kg/m(2)). The median number of para-aortic nodes was 17 (range, 10-25); the median operative time was 204 minutes (range, 120-300 minutes). The median hospital stay was 4 days (range, 3-6 days). No patient encountered postoperative complications. CONCLUSIONS This study demonstrates the feasibility of single-port laparoscopic extraperitoneal para-aortic lymphadenectomy.
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Liu T, Yang M, Yang S, Ge T, Gu L, Lou G. Metastasis-associated protein 1 is a novel marker predicting survival and lymph nodes metastasis in cervical cancer. Hum Pathol 2013; 44:2275-81. [PMID: 23866297 DOI: 10.1016/j.humpath.2013.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/03/2013] [Accepted: 05/08/2013] [Indexed: 11/24/2022]
Abstract
Metastasis-associated gene 1 (MTA1), which is involved in tumor progression, metastasis, and angiogenesis, has been examined in several malignant tumors. However, the expression and the effect of MTA1 on human cervical cancer remain unknown. In this study, we investigated the level of MTA1 expression in cervical carcinoma and its clinical significance. By immunohistochemical staining, the correlation of MTA1 overexpression with clinical features and patient outcome was analyzed in 132 formalin-fixed, paraffin-embedded cervical cancer tissues. MTA1 protein overexpression was detected in 73 (55.3%) of 132 patients. High levels of MTA1 protein were clearly correlated with histologic grade (P = .006), lymph node metastasis (P = .001), and recurrence (P = .016). Multivariate Cox analysis showed that MTA1 was an independent factor for overall survival (hazard ratio, 3.486; 95% confidence interval [CI], 1.274-9.537; P = .015) and disease-free survival (hazard ratio, 3.373; 95% CI, 1.212-9.387; P = .020). Multivariate logistic regression analysis indicated that elevated MTA1 was strongly associated with lymph node metastasis (odds ratio, 3.879; 95% CI, 1.391-10.816; P = .010). Sensitivity and specificity were calculated as 81.25% and 53.0%, respectively. These findings suggest that MTA1 nuclear overexpression is associated with tumor progression and metastasis and thus support its clinical significance in future gene-targeted therapies, particularly the management of patients with cervical cancer.
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Affiliation(s)
- Tianbo Liu
- Department of Gynecology, The Third Affiliated Hospital, Harbin Medical University, Harbin 150040, China
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Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy for locally advanced cervical cancer: assessment after 52 consecutive patients. Surg Endosc 2013; 28:249-56. [DOI: 10.1007/s00464-013-3180-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
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Morales S, Zapardiel I, Grabowski JP, Hernandez A, Diestro MD, Gonzalez-Benitez C, De Santiago J. Surgical Outcome of Extraperitoneal Paraaortic Lymph Node Dissections Compared With Transperitoneal Approach in Gynecologic Cancer Patients. J Minim Invasive Gynecol 2013; 20:611-5. [DOI: 10.1016/j.jmig.2013.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
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Gouy S, Morice P, Narducci F, Uzan C, Martinez A, Rey A, Bentivegna E, Pautier P, Deandreis D, Querleu D, Haie-Meder C, Leblanc E. 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. J Clin Oncol 2013; 31:3026-33. [DOI: 10.1200/jco.2012.47.3520] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose 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. Patients and 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). Conclusion 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.
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Affiliation(s)
- Sebastien Gouy
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Philippe Morice
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Fabrice Narducci
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Catherine Uzan
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Alejandra Martinez
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Annie Rey
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Enrica Bentivegna
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Patricia Pautier
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Desiree Deandreis
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Christine Haie-Meder
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
| | - Eric Leblanc
- Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France
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Frumovitz M, Querleu D, Gil-Moreno A, Morice P, Jhingran A, Munsell MF, Macapinlac HA, Leblanc E, Martinez A, Ramirez PT. Lymphadenectomy in locally advanced cervical cancer study (LiLACS): Phase III clinical trial comparing surgical with radiologic staging in patients with stages IB2-IVA cervical cancer. J Minim Invasive Gynecol 2013; 21:3-8. [PMID: 23911560 DOI: 10.1016/j.jmig.2013.07.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 01/17/2023]
Abstract
Radiation treatment planning for women with locally advanced cervical cancer (stages IB2-IVA) is often based on positron emission tomography (PET). PET, however, has poor sensitivity in detecting metastases in aortocaval nodes. We have initiated a study with the objective of determining whether pre-therapeutic laparoscopic surgical staging followed by tailored chemoradiation improves survival as compared with PET/computed tomography (CT) radiologic staging alone followed by chemoradiation. This international, multicenter phase III trial will enroll 600 women with stages IB2-IVA cervical cancer and PET/CT findings showing fluorodeoxyglucose-avid pelvic nodes and fluorodeoxyglucose-negative para-aortic nodes. Eligible patients will be randomized to undergo either pelvic radiotherapy with chemotherapy (standard-of-care arm) or surgical staging via a minimally invasive extraperitoneal approach followed by tailored radiotherapy with chemotherapy (experimental arm). The primary end point is overall survival. Secondary end points are disease-free survival, short- and long-term morbidity with pre-therapeutic surgical staging, and determination of anatomic locations of metastatic para-aortic nodes in relationship to the inferior mesenteric artery. We believe this study will show that tailored chemoradiation after pre-therapeutic surgical staging improves survival as compared with chemoradiation based on PET/CT in women with stages IB2-IVA cervical cancer.
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Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Denis Querleu
- Department of Surgical Oncology, Claudius Regaud Comprehensive Cancer Center, Toulouse, France
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Paris, France
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Homer A Macapinlac
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Claudius Regaud Comprehensive Cancer Center, Toulouse, France
| | - Pedro T Ramirez
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Hudry D, Cannone F, Houvenaeghel G, Buttarelli M, Jauffret C, Chéreau E, Lambaudie E. Comparison of single-port laparoscopy and conventional laparoscopy for extraperitoneal para-aortic lymphadenectomy. Surg Endosc 2013; 27:4319-24. [DOI: 10.1007/s00464-013-3051-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
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Fastrez M, Goffin F, Vergote I, Vandromme J, Petit P, Leunen K, Degueldre M. Multi-center experience of robot-assisted laparoscopic para-aortic lymphadenectomy for staging of locally advanced cervical carcinoma. Acta Obstet Gynecol Scand 2013; 92:895-901. [DOI: 10.1111/aogs.12150] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 04/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Maxime Fastrez
- Obstetrics and Gynecology Department; St Pierre Hospital; University of Brussels; Brussels; Belgium
| | - Frédéric Goffin
- Obstetrics and Gynecology Department; La Citadelle Hospital; University of Liège; Liège; Belgium
| | - Ignace Vergote
- Obstetrics and Gynecology Department and Leuven Cancer Institute; KU/University Hospital Leuven; Leuven; Belgium
| | - Jean Vandromme
- Obstetrics and Gynecology Department; St Pierre Hospital; University of Brussels; Brussels; Belgium
| | - Philippe Petit
- Obstetrics and Gynecology Department; La Citadelle Hospital; University of Liège; Liège; Belgium
| | - Karin Leunen
- Obstetrics and Gynecology Department and Leuven Cancer Institute; KU/University Hospital Leuven; Leuven; Belgium
| | - Michel Degueldre
- Obstetrics and Gynecology Department; St Pierre Hospital; University of Brussels; Brussels; Belgium
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Benedetti Panici P, Perniola G, Tomao F, Fischetti M, Savone D, Di Donato V, Angioli R, Muzii L. An Update of Laparoscopy in Cervical Cancer Staging: Is It a Useful Procedure? Oncology 2013; 85:160-5. [DOI: 10.1159/000351995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/09/2013] [Indexed: 11/19/2022]
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Prospective Evaluation of 18-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography for the Discrimination of Paraaortic Nodal Spread in Patients With Locally Advanced Cervical Carcinoma. Int J Gynecol Cancer 2013. [DOI: 10.1097/igc.0b013e3182784289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Main ObjectivePatients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in cases of paraaortic nodal spread. Nowadays, 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is considered to be the most accurate image method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of FDG-PET for detecting paraaortic lymph node (PALN) spread in patients with LACC.MethodsPatients with LACC from 2 tertiary university hospitals in Madrid, Spain, were submitted to a laparoscopic infrarenal PALN dissection after FDG-PET evaluation. Based on pathologic results as gold standard, sensitivity, specificity, and positive and negative predictive values of FDG-PET were calculated thereafter for PALN metastasis.ResultsA total of 52 patients with LACC fulfilled the inclusion criteria. All of them underwent a laparoscopic infrarenal paraaortic lymphadenectomy. Eighteen patients (34.6%) had pathologically proven PALN metastases. Among them, 4 (12.5%) had negative FDG-PET (false negatives). Furthermore, 2 positive FDG-PET patients were not affected after histologic analysis (11.1% false positives). No complications occurred in our series. Sensitivity, specificity, and positive and negative predictive value of the FDG-PET were 77.7, 94.1, 87.5, and 88.9, respectively, for the detection of PALN metastases.ConclusionsThe sensitivity and specificity of FDG-PET remains limited, so PALN dissection should be part of the pretherapeutic staging in every patient with LACC before definitive concurrent chemoradiotherapy.
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Gil-Moreno A, Magrina JF. Location of aortic node metastases in locally advanced cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chen TC, Wu MH, Chen JR, Chang CL, Su TH, Wang KG, Yang YC, Wang KL. Role of Transperitoneal Laparoscopic Para-aortic Lymph Node Dissection for the Treatment of Elderly Patients with Locally Advanced Squamous Cell Carcinoma of the Uterine Cervix. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2012.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Heinemann M, Cannone F, Lambaudie E, Michel V, Buttarelli M, Bannier M, Houvenaghel G. [Feasibility study about the single-port in gynecologic oncology surgery]. J Gynecol Obstet Hum Reprod 2012; 41:427-438. [PMID: 22633038 DOI: 10.1016/j.jgyn.2012.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/25/2012] [Accepted: 04/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To describe our single-port experience in gynecologic oncology surgery, and emphasize the feasibility to use the single-port in this surgery. PATIENTS AND METHODS It is a retrospective, feasibility study, monocentric. All patients who were operated by the single-port, between 1st January 2010 to 1st November 2011, were included. RESULTS We note that 107 patients were included. We made different interventions: uni- and bilateral salpingo-ovariectomy, hysterectomy, pelvic and para-aortic lymph node sampling or lymphadenectomy in gynecologic malignancies. The median age of the population and the body mass index were respectively 52 and 22.6 kg/m(2). In total, six interventions will be converted. The median hospital stay of patients, all procedures combined, was 2 days. We find low rate of postoperative complications. CONCLUSION Gynecological cancer surgery appears feasible for single-port. However, we need other studies to confirm a benefit of using the single-port compared to conventional laparoscopy.
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Affiliation(s)
- M Heinemann
- Service de chirurgie oncologique 2, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, Marseille, France.
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Gouy S, Morice P, Narducci F, Uzan C, Gilmore J, Kolesnikov-Gauthier H, Querleu D, Haie-Meder C, Leblanc E. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol 2012; 13:e212-20. [PMID: 22554549 DOI: 10.1016/s1470-2045(12)70011-6] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chemoradiation therapy is deemed the standard treatment by many North American and European teams for treatment of locally advanced cervical cancer. The prevalence of para-aortic nodal metastasis in these tumours is 10-25%. PET (with or without CT) is the most accurate imaging modality to assess extrapelvic disease in such tumours. The true-positive rate of PET is high, suggesting that surgical staging is not necessary if uptake takes place in the para-aortic region. Nevertheless, false-negative results (in the para-aortic region) have been recorded in 12% of patients, rising to 22% in those with uptake during PET of the pelvic nodes. In such situations, laparoscopic surgical para-aortic staging still has an important role for detection of patients with occult para-aortic spread misdiagnosed on PET or PET-CT, allowing optimisation of treatment (extension of radiation therapy fields to include the para-aortic area). Complications of the laparoscopic procedure were noted in 0-7% of patients. Survival of individuals (missed by PET) with para-aortic nodal metastasis of 5 mm or less (and managed by extended field chemoradiation therapy) seems to be similar to survival of those without para-aortic spread, suggesting a positive therapeutic effect of the addition of staging surgery. Nevertheless, the effect on survival of potential delay of chemoradiation owing to use of PET and staging surgery, and acute and late complications of surgery followed by chemoradiation therapy (particularly in case of extended field chemoradiation to para-aortic area), need to be studied.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
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OULDAMER LOBNA, FICHET-DJAVADIAN SARA, MARRET HENRI, BARILLOT ISABELLE, BODY GILLES. Upper margin of para-aortic lymphadenectomy in cervical cancer. Acta Obstet Gynecol Scand 2012; 91:893-900. [DOI: 10.1111/j.1600-0412.2012.01443.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Couteau C, Lazard A, Marcelli M, Estrade JP, Agostini A, Cravello L, Blanc B, Gamerre M. [Port-site metastasis after retroperitoneal lymphadenectomy for endometrial adenocarcinoma]. ACTA ACUST UNITED AC 2012; 42:129-131. [PMID: 22512946 DOI: 10.1016/j.gyobfe.2011.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 02/10/2011] [Indexed: 10/28/2022]
Abstract
Port-site metastasis is a rare but serious complication of laparoscopic surgery. The etiologies are poorly identified and multiple. We report the case of port-site metastasis after laparoscopic retroperitoneal lymphadenectomy for endometrial adenocarcinoma. In the literature, three cases of port-site metastasis after laparoscopic retroperitoneal lymphadenectomy are reported: two cases concerning cervical cancer and one case concerning a kidney cancer. To our knowledge, this is the only case about port site metastasis after laparoscopic retroperitoneal lymphadenectomy for endometrial adenocarcinoma.
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Affiliation(s)
- C Couteau
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
| | - A Lazard
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
| | - M Marcelli
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
| | - J-P Estrade
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
| | - A Agostini
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France.
| | - L Cravello
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
| | - B Blanc
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
| | - M Gamerre
- Service de gynécologie-obstétrique B, hôpital de La Conception, 147, boulevard Baille, 13385 Marseille, France
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Curage lombo-aortique dans le cancer du col de l’utérus avancé : morbidité et impact sur les délais de prise en charge. ACTA ACUST UNITED AC 2012; 40:153-7. [DOI: 10.1016/j.gyobfe.2012.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/25/2011] [Indexed: 11/21/2022]
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Laparoscopic extraperitoneal aortic dissection: does single-port surgery offer the same possibilities as conventional laparoscopy? Surg Endosc 2012; 26:1920-3. [DOI: 10.1007/s00464-011-2126-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/19/2011] [Indexed: 10/14/2022]
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Gouy S, Kane A, Uzan C, Gauthier T, Gilmore J, Morice P. Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy: About fourteen consecutive cases. Gynecol Oncol 2011; 123:329-32. [DOI: 10.1016/j.ygyno.2011.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 07/05/2011] [Accepted: 07/09/2011] [Indexed: 10/17/2022]
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Bakkum-Gamez JN, Mariani A, Dowdy SC, Weaver AL, McGree ME, Cliby WA, Gostout BS, Stanhope CR, Wilson TO, Podratz KC. The impact of surgical guidelines and periodic quality assessment on the staging of endometrial cancer. Gynecol Oncol 2011; 123:58-64. [PMID: 21741696 DOI: 10.1016/j.ygyno.2011.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the impact of surgical guidelines and transparent periodic assessment of surgical quality on endometrial cancer (EC) staging by gynecologic oncologists in a single institution and to identify process-of-care, patient-specific, and disease-specific risk factors that influence surgical quality. METHODS In January 2004, a prospective treatment algorithm was implemented for EC at our institution. The number of nodes harvested was a surrogate, and staging quality from 2004 to 2008 (quality assessment [QA] interval) was compared with the previous 5 years (pre-QA interval). Since 2004, low-risk cases based on frozen section examination had not undergone lymphadenectomy and were excluded. Independent patient-specific, disease-specific, and surgery-related risk factors influencing lymphadenectomy quality during both intervals were identified with multivariable logistic regression analysis. RESULTS Pelvic and para-aortic lymph node dissection (LND) in surgical EC management before QA (n=420) were 77.9% and 48.8% vs 89.3% and 83.4% during the QA (n=561) (P<.001). The median number of pelvic and para-aortic nodes harvested in LND was 29 and 10 before QA vs 34 and 16 during the QA interval (P<.001). With acceptance of stringent criteria for defining systematic LND (mean node count-1 SD) during the QA, systematic pelvic (≥22 nodes) and para-aortic (≥10 nodes) LNDs occurred in 57.4% and 25.7% of cases before QA vs 77.9% and 70.7% during the QA interval (P<.001). In patients with LND, rates of systematic pelvic and para-aortic LND were 73.7% and 53.0% before vs 87.2% and 84.8% after QA (P<.001). Multivariable logistic regression analysis showed independent factors influencing systematic pelvic and para-aortic LND (P<.01): surgeon and stage during the pre-QA interval vs surgical approach; intraoperative ascites; body mass index; surgeon; patient age; and myometrial invasion after QA implementation. CONCLUSION Inclusion of detailed surgical guidelines and transparent periodic assessment of surgical quality translated to dramatic improvement in quality of surgical EC staging. This implementation was associated with a transition to more patient-specific risk factors influencing systematic LND. Although surgical quality metrics were markedly enhanced during QA, persistent variability observed among surgeons and the change in surgical approach render continuous QA and improvement obligatory.
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Uzan C, Souadka A, Gouy S, Debaere T, Duclos J, Lumbroso J, Haie-Meder C, Morice P. Analysis of morbidity and clinical implications of laparoscopic para-aortic lymphadenectomy in a continuous series of 98 patients with advanced-stage cervical cancer and negative PET-CT imaging in the para-aortic area. Oncologist 2011; 16:1021-7. [PMID: 21659610 DOI: 10.1634/theoncologist.2011-0007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Catherine Uzan
- Department of Surgery, Institut Gustave Roussy and University Paris Sud, Villejuif Cedex, France.
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