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Zhou Z, Ge J, Ye K, Zhang Y, Hu Q, Wang L, Chen Y. Comparison of Robotic-Assisted vs. Conventional Laparoscopy for Para-aortic Lymphadenectomy in Gynecological Malignancies: A Systematic Review and Meta-Analysis. Front Surg 2023; 9:843517. [PMID: 36684197 PMCID: PMC9845261 DOI: 10.3389/fsurg.2022.843517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Robotic-assisted surgery is one of the novel minimally invasive surgical techniques for the treatment of gynecological malignancies. The aim of this systematic review and meta-analysis was to compare the outcomes of robot-assisted vs. conventional laparoscopy for para-aortic lymphadenectomy (PAL) in patients with gynecological malignancies. Methods An electronic search in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases was performed for articles, published up to 01st November 2021. Outcomes including operating time (OT), total blood loss (TBL), length of stay (LOS), and complication rate (CR) in robot-assisted vs. conventional laparoscopy were investigated. Results A total of nine studies (7 non-RCTs and 2 RCTs) involving 914 participants were included. Of them, 332 patients underwent robotic laparoscopy (robotic group) and 582-conventional laparoscopy (conventional laparoscopy group). A significant decrease in TBL (MD = -149.1; 95% CI: -218.4 to -79.91) [ml] was observed in the robotic group as compared to the conventional laparoscopy group. However, no significant difference was noted for OT, CR, and LOS in the overall findings. Further subgroup analysis showed that the robotic group had a lower OT in mixed histological populations and studies reporting on the extraperitoneal approach. The lower chance of TBL was observed in mixed histological populations and studies involving extraperitoneal approach, Caucasian population, and non-RCTs design. Conclusions Robotic laparoscopy has a significant advantage over the conventional laparoscopy approach for PAL in gynecological malignancies. Further prospective observational studies embedded with a large sample size are needed to validate our findings.
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Marnitz S, Tsunoda AT, Martus P, Vieira M, Affonso Junior RJ, Nunes J, Budach V, Hertel H, Mustea A, Sehouli J, Scharf JP, Ulrich U, Ebert A, Piwonski I, Kohler C. Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB-IVA: oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study. Int J Gynecol Cancer 2020; 30:1855-1861. [PMID: 33293284 PMCID: PMC7788482 DOI: 10.1136/ijgc-2020-001973] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Revised staging of patients with locally advanced cervical cancer is based on clinical examination, imaging, and potential surgical findings. A known limitation of imaging techniques is an appreciable rate of understaging. In contrast, surgical staging may provide more accurate information on lymph node involvement. The aim of this prospective study was to evaluate the impact of pre-treatment surgical staging, including removal of bulky lymph nodes, on disease-free survival in patients with locally advanced cervical cancer. Methods Uterus-11 was a prospective international multicenter study including patients with locally advanced cervical cancer who were randomized 1:1 to surgical staging (experimental arm) or clinical staging (control arm) followed by primary platinum-based chemoradiation. Patients with histologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIB–IVA underwent gynecologic examination and pre-treatment imaging including abdominal computed tomography (CT) and/or abdominal magnetic resonance imaging (MRI). Patients had chest imaging (any of the following: X-ray, CT, or PET-CT). The primary endpoint was disease-free survival and the secondary endpoint was overall survival. An ad hoc analysis was performed after trial completion for cancer-specific survival. Randomization was conducted from February 2009 to August 2013. Results A total of 255 patients (surgical arm, n=130; clinical arm, n=125) with locally advanced cervical cancer were randomized. Of these, 240 patients were eligible for analysis. The two groups were comparable with respect to patient characteristics. The surgical approach was transperitoneal laparoscopy in most patients (96.6%). Laparoscopic staging led to upstaging in 39 of 120 (33%) patients. After a median follow-up of 90 months (range 1–123) in both arms, there was no difference in disease-free survival between the groups (p=0.084). For patients with FIGO stage IIB, surgical staging is superior to clinical staging with respect to disease-free survival (HR 0.51, 95% CI 0.30 to 0.86, p=0.011). In the post-hoc analysis, surgical staging was associated with better cancer-specific survival (HR 0.61, 95% CI 0.40 to 0.93, p=0.020). Conclusion Our study did not show a difference in disease-free survival between surgical and clinical staging in patients with locally advanced cervical cancer. There was a significant benefit in disease-free survival for patients with FIGO stage IIB and, in a post-hoc analysis, a cancer-specific survival benefit in favor of laparoscopic staging. The high risk of distant metastases in both arms emphasizes the need for further evaluation.
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Affiliation(s)
- Simone Marnitz
- Department of Radiooncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Peter Martus
- Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Marcelo Vieira
- Department for Gynecologic Oncology, Hospital de Amor de Barretos, Barretos, Brazil
| | | | - João Nunes
- Gynecologic Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Gynecologic Oncology Department, Instituto de Oncologia do Paraná, Curitiba, Brazil
| | - Volker Budach
- Department of Radiooncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University of Bonn, Bonn, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens-Peter Scharf
- Department of Gynecology and Obstetrics, Sana-Clinics Berlin Lichtenberg, Berlin, Germany
| | - Uwe Ulrich
- Department of Gynecology and Obstetrics, Martin-Luther-Hospital Berlin, Berlin, Germany
| | - Andreas Ebert
- Outpatient Clinics for Women's Health, Berlin, Germany
| | - Iris Piwonski
- Institute of Pathology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Christhardt Kohler
- Department of Gynecology, University of Cologne, Koln, Germany.,Department of Special Operative and Oncologic Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
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Díaz-Feijoo B, Franco S, Torné A, Benito V, Hernández A, Lago V, Rovira R, Acosta Ú, Agustí N, Gil-Moreno A. Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study. Gynecol Oncol 2020; 158:287-293. [PMID: 32467055 DOI: 10.1016/j.ygyno.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Paraaortic lymph node involvement is an important prognostic factor in locally advanced cervical cancer (LACC), but the anatomic limit of aortic lymphadenectomy is controversial. We assessed the impact of extraperitoneal paraaortic lymphadenectomy up to the left renal vein in patients with LACC undergoing pretherapeutic staging. METHODS A retrospective, multicenter study of patients with LACC stages FIGO 2009 IB2 and IIA2-IVA treated in 10 Spanish reference hospitals in gynecological oncology between 2000 and 2016. Sites of metastatic paraaortic lymph nodes above or below the inferior mesenteric artery were evaluated. Procedural-related intraoperative and early and late complications were assessed. RESULTS We included 634 patients undergoing paraaortic lymphadenectomy, in 616 (97.2%) of which the left renal vein was the upper limit of dissection (laparoscopy 592, robotic-assisted 24). The median surgical time was 150 min (interquartile range (IQR) 120-180), blood loss was 50 mL (range 20-80), and the length of stay was 2 days (range 2-3). Metastatic paraaortic involvement was found in 114 patients (18.5%), with infrarenal metastases in 73 (64%) of them. There were 11 patients (9.6%) with infrarenal metastases only, whereas in the remaining 62 (54.4%) patients concomitant infrarenal and inframesenteric metastases were observed. Intraoperative, early, and late postoperative complications occurred in 3.6%, 7.0%, and 4.5% of patients, respectively. CONCLUSIONS In this study of patients with LACC undergoing surgical staging, paraaortic lymphadenectomy up to the left renal vein detected skip or isolated infrarenal metastasis in 9.6% of patients, with an acceptable surgical morbidity.
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Affiliation(s)
- Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Silvia Franco
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Víctor Lago
- Department of Gynecology Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Ramón Rovira
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i San Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Úrsula Acosta
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Agustí
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Antonio Gil-Moreno
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain.
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Reyes Claret A, Martínez Canto MC, Robles Gourley A, Llull Gomila M, Martín Jiménez Á. Transperitoneal Laparoscopic Para-Aortic Lymphadenectomy and Body Mass Index: Is It Really a Limiting Factor for the Procedure? J Laparoendosc Adv Surg Tech A 2020; 30:416-422. [PMID: 32023169 DOI: 10.1089/lap.2019.0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To explore if obesity measured by body mass index (BMI) ≥30 kg/m2 represents a limiting factor for para-aortic lymphadenectomy done with a transperitoneal laparoscopic approach. Materials and Methods: Retrospective observational study with 146 consecutive patients, diagnosed with a gynecological cancer submitted to para-aortic surgical staging between January 2010 and December 2018. The mean age was 52 years and the mean BMI was 27 kg/m2. 72.6% (106 patients) had BMI <30 kg/m2 and 27.4% (40 patients) had BMI ≥30 kg/m2. Half of the patients did not have prior abdominal surgeries. Results: The statistical analysis showed that there were no significant differences between two groups depending on their BMI in the lymph node count: BMI <30 kg/m2 14 nodes versus BMI ≥30 kg/m2 10 nodes (P = .122); rate of intraoperative complications: BMI <30: 6.3% versus BMI ≥30: 0% (P = .180), postoperative complications: BMI <30: 6.6% versus BMI ≥30: 5% (P = .723); feasibility rate: BMI <30: 97.1% versus BMI ≥30: 95.6% (P = .063) or the mean hospital stay BMI <30: 2.47 ± 2.05 days (standard deviation [SD]), BMI ≥30: 2.64 ± 0.93 days (SD) (P = .171). The only significant difference observed was due to the operating time: BMI <30: 103.1 ± 60.8 (SD) versus BMI ≥30: 146.9 ± 82.5 (SD) (P = .019), being longer in obese patients. Conclusions: Obesity, estimated by BMI, does not seem to represent a limiting factor for this surgical procedure in our series. We feel it is a feasible and justified approach in obese patients when other surgical procedures have to be carried out in the same surgical act. Probably, other factors and anthropometric measurements are more accurate to select patients in which this approach is feasible.
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Affiliation(s)
- Albert Reyes Claret
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | | | - Ana Robles Gourley
- Obstetrics and Gynaecology Department, Hospital Comarcal d'Inca, Inca, Spain
| | - Marina Llull Gomila
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Ángel Martín Jiménez
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer. J Contemp Brachytherapy 2018; 10:411-417. [PMID: 30479617 PMCID: PMC6251449 DOI: 10.5114/jcb.2018.79334] [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: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Locally advanced cervical cancer (LACC) should be treated with a combination of external irradiation and brachytherapy with concurrent chemotherapy. However, as cervical carcinoma cells can disperse by way of the lymphatic system to either pelvic or para-aortic nodes, planning the extent of radiation requires precise information about the spread of the disease to the lymph nodes, especially to the para-aortic area. Material and methods All of the 75 women included in our study underwent chemoradiotherapy, which started with brachytherapy. Out of them, 54 have undergone radical hysterectomy with lymphadenectomy followed by chemoradiation. We have retrospectively analyzed the 5-year overall survival (OS) rates relative to the lymph node involvement, the type of lymphadenectomy performed (pelvic, para-aortic, or both), the size of the tumor (> or < 4 cm), the histological type, grading, and the age of patients. Results We observed significant differences in the OS rates relative to the age of the patients with LACC. We noted significant differences in the OS rates related to para-aortic lymphadenectomy and presence of lymph node metastases. Conclusions Para-aortic lymphadenectomy seems to have a positive influence on long-term outcomes in the LACC patients, and elderly patients may benefit more from applied therapy.
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Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience. Clin Transl Oncol 2018; 20:1455-1459. [PMID: 29671223 DOI: 10.1007/s12094-018-1878-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND One aim of this study was to assess the efficacy and safety of laparoscopic paraaortic lymphadenectomy for paraaortic lymph node staging in locally advanced cervical carcinoma. The second aim was to identify prognostic factors in the evolution of this disease and to evaluate how the results of the surgery modify the oncological treatment of patients. MATERIALS AND METHODS We analyzed 59 patients diagnosed with locally advanced cervical cancer International Federation of Gynecology and Obstetrics stage IB2-IVA who underwent laparoscopic paraaortic lymphadenectomy at our hospital between 2009 and 2015. Depending on the results of the paraaortic lymphadenectomy, treatment consisted of pelvic- or extended-field chemoradiotherapy. RESULTS The mean age at diagnosis was 52.3 years. The median operative time was 180 min. The mean hospital stay was 1.7 days. The mean number of paraaortic lymph nodes excised was 16.4. Eight patients (13.5%) had positive paraaortic lymph nodes. Thirteen patients (22%) underwent surgery via the transperitoneal route, and 46 (78%) underwent surgery via the retroperitoneal route. The sensitivity and specificity of computerized axial tomography (CT) scanning for detecting paraaortic lymph node involvement was 75 and 86%, respectively. The statistically significant prognostic factors that affected survival were surgical paraaortic lymph node involvement, radiological pelvic lymph node involvement, and radiological tumor size as assessed with nuclear magnetic resonance. The rate of serious complications was 1.7%. CONCLUSIONS Pretherapeutic laparoscopic paraaortic lymphadenectomy for locally advanced cervical carcinoma allows the adaption of radiotherapy fields to avoid false-positive and false-negative imaging results.
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Matsuo K, Shimada M, Saito T, Takehara K, Tokunaga H, Watanabe Y, Todo Y, Morishige KI, Mikami M, Sugiyama T. Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer. J Gynecol Oncol 2018; 29:e11. [PMID: 29185269 PMCID: PMC5709521 DOI: 10.3802/jgo.2018.29.e11] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. METHODS This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB-IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. RESULTS There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. CONCLUSION Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
- Department of Gynecology, Tohoku University Hospital, Miyagi, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Kazuhiro Takehara
- Department of Gynecologic Oncology, Shikoku Cancer Center, Matsuyama, Japan
| | - Hideki Tokunaga
- Department of Gynecology, Tohoku University Hospital, Miyagi, Japan
| | - Yoh Watanabe
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Ken Ichirou Morishige
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Toru Sugiyama
- Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan
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Lee HJ, Lee YH, Chong GO, Hong DG, Lee YS. Comparison of robotic-assisted versus laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy in patients with endometrial cancer. J Obstet Gynaecol Res 2017; 44:547-555. [DOI: 10.1111/jog.13535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Yoon Soon Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
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Gorostidi M, Villalain C, Ruiz R, Jaunarena I, Lekuona A. Technique for precaval and laterocaval nodes excision at extraperitoneal paraaortic lymphadenectomy. Gynecol Oncol 2017; 148:233-234. [PMID: 29137810 DOI: 10.1016/j.ygyno.2017.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/17/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To describe our technique for excision of the pre-caval and laterocaval nodes using an extraperitoneal approach. This technique was developed to make the dissection and excision of the less accessible nodes in an easier and safer way by minimizing the risk of great vessels injury and bleeding. DESIGN Step-by-step description of the surgical procedure using video (Canadian Task Force classification III). SETTING The procedure was performed at a teaching hospital, Hospital Universitario Donostia (Spain). PATIENTS A 52-year-old woman with a body mass index of 33 underwent endoscopic extraperitoneal paraaortic lymphadenectomy for advanced high grade cervical adenocarcinoma FIGO IIB. INTERVENTIONS The patient underwent an endoscopic extraperitoneal para-aortic lymphadenectomy. An anatomical dissection is being performed being the upper limit of the dissection the left renal vein. Focus of the video involves the challenging dissection of the right nodes. MEASUREMENTS AND MAIN RESULTS Firstly we complete a dissection of all the anatomical aortic limits until the renal vein and exeresis of aortic nodes. A plane just above the cava vein is carefully developed by pushing all the lymph nodes to the roof of the dissection. Special care must be taken close to the aortic bifurcation due to the perforating vessels that can be found more frequently in this location. Once all this space is dissected, nodes attached to the roof are easily pushed down. It is useful to use a clip in the upper part, close to the renal vein, to prevent lymphorrhea. Nodes are excised in four blocks, supramesenteric and inframesenteric aortic and precaval nodes. The proximity to the peritoneal roof and the chance for a peritoneal hole and loss of pneumoperitoneum can be less problematic if the right dissection is performed at the end of the procedure. CONCLUSION A complete para-aortic retroperitoneal dissection can be achieved with this extraperitoneal approach. Benefits of this technique are based on the absence of the bowel or other intraperitoneal structures invading the operative field given the barrier-free nature of the retroperitoneal space. Despite the challenge of the access to the right nodes in a retroperitoneal paraaortic lymphadenectomy they can be successfully excised reaching the renal vein including obese patients.
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Affiliation(s)
- M Gorostidi
- Hospital Universitario Donostia, San Sebastián, Spain.
| | | | - R Ruiz
- Hospital Universitario Donostia, San Sebastián, Spain
| | - I Jaunarena
- Hospital Universitario Donostia, San Sebastián, Spain
| | - A Lekuona
- Hospital Universitario Donostia, San Sebastián, Spain
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Pomel C, Martinez A, Bourgin C, Beguinot M, Benoit C, Naik R, Dauplat J, Lebouedec G, Ferron G. Survival effect of laparoscopic para-aortic staging in locally advanced cervical cancer: a retrospective cohort analysis. BJOG 2017; 124:1089-1094. [PMID: 28128517 DOI: 10.1111/1471-0528.14492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study compares two methods of evaluating para-aortic node involvement in locally advanced cervical cancer (LACC) in order to define external radiotherapy treatment fields: laparoscopic surgical para-aortic lymphadenectomy or PET-CT imaging. POPULATION We selected 187 patients with LACC who had been treated by chemoradiation therapy in two comprehensive cancer centres from January 2001 to December 2013. A total of 98 underwent para-aortic evaluation by PET-CT (Centre 1) and 89 received surgical laparoscopic excision (Centre 2). METHODS All patients with LACC were retrospectively collected in each centre. OS and DFS were calculated using the Kaplan-Meier's method and survival curves were compared using log-rank test. MAIN OUTCOME MEASURES Outcomes were the comparison of patients' disease-free (DFS) and overall survival (OS) between the two centres. RESULTS Patients had a significantly better disease-free survival in cohort 1 than in cohort 2, at 2 years [80.9% (71.7-87.5) versus 57.1% (46.1-67.3)] and at 5 years [70.5% (58.8-79.9) versus 49.2% (38.2-60.4)] (P = 0.009). These results are confirmed by multivariate analysis model [hazard ratio (HR) 1.93; 95% CI 1.03-3.61; P = 0.04]. The overall survival was also better in cohort 1, both at 2 and 5 years [93.5% (86.5-97.0) versus 78.5% (68.5-86.0) and 85.1% (73.2-92.2) versus 63.8% (51.9-74.2), respectively; P = 0.006]. The multivariate analysis model found concordant results with an increased relative risk of death for patients treated in cohort 2 (HR 2.55; 95% CI 1.09-5.99; P = 0.01). CONCLUSION In this retrospective cohort analysis, para-aortic surgical staging in LACC is more deleterious for patients than is radiological staging in terms of OS and DFS. TWEETABLE ABSTRACT Para-aortic surgical staging in LACC is more deleterious for patients than clinical staging.
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Affiliation(s)
- C Pomel
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France.,UMR Inserm 990 IMTV, Université d'Auvergne, Clermont-Ferrand, France
| | - A Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France
| | - C Bourgin
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - M Beguinot
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - C Benoit
- Department of Radiotherapy, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - R Naik
- Gynaecological Oncology, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - J Dauplat
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - G Lebouedec
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - G Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France
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Robotic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy With Double Docking: Technique, Learning Curve, and Perioperative Outcomes. J Minim Invasive Gynecol 2016; 23:622-7. [DOI: 10.1016/j.jmig.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022]
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12
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Bogani G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Sabatucci I, Scaffa C, Lorusso D, Raspagliesi F. Extraperitoneal Robotic-Assisted Para-Aortic Lymphadenectomy in Gynecologic Cancer Staging: Current Evidence. J Minim Invasive Gynecol 2016; 23:489-96. [PMID: 26802906 DOI: 10.1016/j.jmig.2016.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 11/29/2022]
Abstract
We reviewed the current evidence on the safety, effectiveness, and applicability of extraperitoneal robotic-assisted para-aortic lymphadenectomy (ExtRA-PAL) as the staging procedure of gynecologic malignancies. PubMed (MEDLINE), Scopus, Web of Science databases, and ClinicalTrials.gov were searched for original studies reporting outcomes of ExtRA-PAL. Quality of the included studies and their level of recommendation were assessed using the Grading of Recommendations, Assessment, Development, and Evaluation and the American College of Obstetricians and Gynecologists guidelines, respectively. Overall, 62 studies were identified; after a process of evidence acquisition 5 original investigations were available for this review that included 98 patients undergoing ExtRA-PAL. The main surgical indication was staging for cervical cancer (n = 71, 72%). The mean (SD) number of para-aortic node yielded was 15.4 (±4.7) nodes. Blood transfusion and intraoperative complication rates were 2% and 6%, respectively. ExtRA-PAL was completed in 88 patients (90%). Six (6%) and 4 (4%) patients had conversion to other minimally invasive procedures and open surgery, respectively. Success rate was 99% among patients undergoing ExtRA-PAL without concomitant procedures. Overall, mean (SD) length of hospital stay was 2.8 (±0.5) days. Twenty-four patients (24%) developed postoperative events. According to the Clavien-Dindo grading system, grades IIIa and IIIb morbidity rates were 12% and 2%, respectively. No grades IV and V morbidity occurred. ExtRA-PAL is associated with a high success rate and a relative low morbidity rate. However, because of the limited data on this issue, further studies are warranted to assess the long-term effectiveness of this procedure.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
| | - Antonino Ditto
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Ilaria Sabatucci
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Cono Scaffa
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
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Should Systematic Infrarenal Para-aortic Dissection Be the Rule in the Pretherapeutic Staging of Primary or Recurrent Locally Advanced Cervix Cancer Patients With a Negative Preoperative Para-aortic PET Imaging? Int J Gynecol Cancer 2016; 26:169-75. [DOI: 10.1097/igc.0000000000000588] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BackgroundExtended-field chemoradiation is the usual management of patients with locally advanced cervical cancer (LACC) and para-aortic node metastases (PA pN1). It is efficient but not without morbidity. Assessment of PA lymph node positivity by PA lymphadenectomy is the most accurate method to select the candidates for this treatment. Hence, to clarify the dissection pattern, we wanted to test the true incidence of isolated/skip node metastasis, above the level of the inferior mesenteric artery (IMA).Materials and MethodsAll patients with LACC and negative magnetic resonance imaging and positron emission tomography–computed tomography imaging at the PA level were offered a laparoscopic staging encompassing a diagnostic laparoscopy followed, if negative, by an extraperitoneal PA lymphadenectomy. All nodes were removed from both common iliac bifurcations up to the left renal vein. Node groups, below and above the IMA, were separately sent to the pathologist for definitive examination.ResultsFrom January 2010 to December 2013, 196 stage IB1 with pelvic pN1, IB2, to IVA LACC patients from 2 cancer centers who fulfilled the criteria were included in this institutional review board–approved study after informed consent. Thirty patients (15%) had PA pN1. Only 1 patient had positive nodes exclusively located above the IMA (3.3% of the pN1 group; 95% confidence interval, 0%–9.7%). Complications were observed in 15 (7.6%) of 196 patients.ConclusionsGiven the very low rate of skip metastases above the IMA and the potential additional morbidity of a systematic extended dissection, a bilateral ilioinframesenteric dissection seems to be an acceptable pattern of PA lymphadenectomy in LACC patients.
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Hudry D, Ahmad S, Zanagnolo V, Narducci F, Fastrez M, Ponce J, Tucher E, Lécuru F, Conri V, Leguevaque P, Goffin F, Holloway RW, Lambaudie E. Robotically assisted para-aortic lymphadenectomy: surgical results: a cohort study of 487 patients. Int J Gynecol Cancer 2015; 25:504-11. [PMID: 25628104 DOI: 10.1097/igc.0000000000000373] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate perioperative outcomes of robotic-assisted laparoscopic para-aortic lymphadenectomy (PAL) in patients with gynecologic cancers during the learning phases of robotic surgery programs and to compare results of extraperitoneal versus transperitoneal approaches of PAL. MATERIALS AND METHODS This study is a retrospective multicentric study of patients who underwent robotically assisted laparoscopic PAL (N = 487). Eleven European centers and 1 US center participated in the study. Abstracted data included age, body mass index, indication, type of surgical approach (transperitoneal or extraperitoneal), associated surgical procedures, operative time, estimated blood loss, lymph node count, hospital length of stay (LOS), and complications. Para-aortic lymphadenectomy was performed by an extraperitoneal approach in 58 cases (12%) and transperitoneal in 429 cases (88%). RESULTS The mean (SD) para-aortic lymph node count was 12.6 (8.1), operative time was 217 (85) minutes, estimated blood loss was 105 (110) mL, and LOS was 2.8 (3.2) days. Four (0.8%) conversions to open and 2 (0.4%) conversions to laparoscopy were described. There were 32 lymphocysts (6.6%), 3 deep venous thromboses (0.6%), and 10 transfusions (2.1%). For transperitoneal approach, the average number of lymph nodes removed was higher in isolated PAL group than the hysterectomy combined group (report node counts 95% confidence interval, -7.29 to -3.52, P = 1.5 × 10⁻⁶). For isolated PAL, the LOS was shorter in the extraperitoneal group than in the transperitoneal group (report data 95% CI, -1.35 to -0.35, P = 0.001). CONCLUSIONS Robotic-assisted PAL seems safe and feasible. More lymph nodes were removed during an isolated transperitoneal PAL dissection compared with a combined procedure with hysterectomy. Extraperitoneal approach seems attractive relative to transperitoneal dissection, but the superiority of one or the other way is not demonstrated by our study.
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Affiliation(s)
- Delphine Hudry
- *Georges-François Leclerc Cancer Center, Dijon, France; †Florida Hospital Cancer Institute, Orlando, FL; ‡European Institute of Oncology, Milan, Italy; §Centre Oscar Lambret, Lille, France; ∥St Pierre University Hospital, Brussels, Belgium; ¶UZ Leuven, Leuven, Belgium; #Institute of Oncology, IDIBELL, Idibell, Spain; **Charité University Medicine, Berlin, Germany; ††European Hospital, Paris, France; ‡‡University Hospital, Bordeaux, France; §§Claudius Regaud Institute, Toulouse, France; ∥∥Citadelle Hospital, Liège, Belgium; and ¶¶Paoli Calmettes Institute, Marseille, France
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O'Hanlan KA, Sten MS, O'Holleran MS, Ford NN, Struck DM, McCutcheon SP. Infrarenal lymphadenectomy for gynecological malignancies: Two laparoscopic approaches. Gynecol Oncol 2015; 139:330-7. [DOI: 10.1016/j.ygyno.2015.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
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Tsuruga T, Fujimoto A, Kawana K, Mori M, Hasumi Y, Kino N, Tomio K, Miura S, Tanikawa M, Sone K, Miyamoto Y, Ikeda Y, Kojima S, Adachi K, Nagasaka K, Matsumoto Y, Arimoto T, Oda K, Nakagawa S, Horie K, Yasugi T, Yokota H, Osuga Y, Fujii T. Radical hysterectomy with or without para-aortic lymphadenectomy for patients with stage IB2, IIA2, and IIB cervical cancer: outcomes for a series of 308 patients. Int J Clin Oncol 2015; 21:359-366. [PMID: 26438230 DOI: 10.1007/s10147-015-0907-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although many studies have already shown that lymph node metastasis is one of the major prognostic factors for cervical cancer, the therapeutic significance of para-aortic lymphadenectomy for the surgical treatment of cervical cancer remains controversial. METHODS A total of 308 patients diagnosed with stage IB2, IIA2, or IIB cervical cancer and treated with radical hysterectomy were retrospectively investigated to assess the incidence of para-aortic lymph node metastasis and the clinicopathological factors linked to cervical cancer prognosis. RESULTS Para-aortic lymph node metastases were pathologically confirmed in 13 of the 136 patients (9.6 %) who underwent para-aortic lymphadenectomy. The incidence of para-aortic lymph node metastasis was significantly higher in the patients who had common iliac lymph node metastases (odds ratio 31.5, p < 0.001) according to logistic regression analysis. Common iliac lymph node metastasis was related to risk of recurrence (hazard ratio 2.43, p = 0.003) and death (hazard ratio 2.62, p = 0.007) in Cox regression analysis. Kaplan-Meier analysis and Cox regression analysis showed that para-aortic lymphadenectomy did not have a positive impact on survival in 308 patients or 140 pN1 patients, but para-aortic lymphadenectomy was related to better overall survival with a marginal trend toward significance (p = 0.053) in 30 patients with common iliac lymph node metastasis. CONCLUSIONS Indication for para-aortic lymphadenectomy in the surgical treatment of stage IB2, IIA2, or IIB cervical cancer needs to be individualized. Patients with common iliac lymph node metastasis are possible candidates, and a prospective study is needed to clarify this issue.
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Affiliation(s)
- Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Asaha Fujimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoko Hasumi
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Nao Kino
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kensuke Tomio
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shiho Miura
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoko Kojima
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuyuki Adachi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoko Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahide Arimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunsuke Nakagawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Horie
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Toshiharu Yasugi
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Harushige Yokota
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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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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[The place of para-aortic lymphadenectomy in gynaecological malignancies. An old debate]. Bull Cancer 2014; 101:345-8. [PMID: 24793624 DOI: 10.1684/bdc.2014.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a lack of prospective randomized trial and scientific evidence for the use of para-aortic lymphadenectomy in gynaecological malignancies. This results in variations between countries for its utility. Based on the recommandations of the French Institute of Cancer (INCa), we open the debate of the place of para-aortic lymphadenectomy.
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Correa-Paris A, Díaz-Feijoo B, Franco-Camps S, Gil-Moreno A. Duplicated renal excretion system in an extraperitoneal laparoscopy for para-aortic lymphadenectomy. J Minim Invasive Gynecol 2014; 21:972-3. [PMID: 24486537 DOI: 10.1016/j.jmig.2014.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Alejandro Correa-Paris
- Servicio de Ginecología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Berta Díaz-Feijoo
- Servicio de Ginecología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Franco-Camps
- Servicio de Ginecología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Servicio de Ginecología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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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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Are Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm Applicable to Other Malignancies—Assessment of Nodal Distribution in Gynecological Malignancies. Int J Radiat Oncol Biol Phys 2013; 87:106-10. [DOI: 10.1016/j.ijrobp.2013.05.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/14/2013] [Accepted: 05/20/2013] [Indexed: 11/17/2022]
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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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Höckel M, Einenkel J, Horn LC. Paraaortic lymphatic spread in cervical cancer. Gynecol Oncol 2012; 127:677; author reply 677-8. [PMID: 22863871 DOI: 10.1016/j.ygyno.2012.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
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