Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic de Barcelona, Institut d ́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine - University of Barcelona (Drs. Díaz-Feijoo and Torné).
Service of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (Drs. Acosta and Gil-Moreno), Barcelona.
J Minim Invasive Gynecol. 2022 Jan;29(1):103-113. doi: 10.1016/j.jmig.2021.06.027. Epub 2021 Jul 1.
To evaluate laparoscopic pelvic lymph node debulking during extraperitoneal aortic lymphadenectomy in diagnosis, therapeutic planning, and prognosis of patients with locally advanced cervical cancer and enlarged lymph nodes on imaging before chemoradiotherapy.
Retrospective, multicenter, comparative cohort study.
The study was carried out at 11 hospitals with specialized gynecologic oncology units in Spain.
Total of 381 women with locally advanced cervical cancer and International Federation of Gynecology and Obstetrics 2018 stage IIIC 1r (radiologic) and higher who received primary treatment with chemoradiotherapy.
Patients underwent pelvic lymph node debulking and para-aortic lymphadenectomy (group 1), only para-aortic lymphadenectomy (group 2), or no lymph node surgical staging (group 3). On the basis of pelvic node histology, group 1 was subdivided as negative (group 1A) or positive (group 1B).
False positives and negatives of imaging tests, disease-free survival, overall survival, and postoperative complications were evaluated. In group 1, pelvic lymph node involvement was 43.3% (71 of 164), and aortic involvement was 24.4% (40 of 164). In group 2, aortic nodes were positive in 29.7% (33 of 111). Disease-free survival and overall survival were similar in the 3 groups (p = .95) and in groups 1A and 1B (p = .25). No differences were found between groups 1 and 2 in intraoperative (3.7% vs 2.7%, p = .744), early postoperative (8.0% vs 6.3%, p = .776), or late postoperative complications (6.1% vs 2.7%, p = .252). Fewer early and late complications were attributed to radiotherapy in group 1A than in the others (p = .022).
Laparoscopic pelvic lymph node debulking during para-aortic staging surgery in patients with locally advanced cervical cancer with suspicious nodes allows for the confirmation of metastatic lymph nodes without affecting survival or increasing surgical complications. This information improves the selection of patients requiring boost irradiation, thus avoiding overtreatment of patients with negative nodes.
评估腹腔镜盆淋巴结切除术在影像学检查提示放化疗前局部晚期宫颈癌伴淋巴结肿大患者行腹主动脉旁淋巴结清扫术中的诊断、治疗计划和预后作用。
回顾性、多中心、对照队列研究。
该研究在西班牙 11 家设有妇科肿瘤专科的医院进行。
共纳入 381 例局部晚期宫颈癌国际妇产科联盟（FIGO）2018 分期ⅡC 期 1r（影像学）及以上患者，这些患者均接受放化疗作为初始治疗。
患者接受盆淋巴结切除术和腹主动脉旁淋巴结切除术（第 1 组）、仅行腹主动脉旁淋巴结切除术（第 2 组）或不行淋巴结手术分期（第 3 组）。根据盆腔淋巴结的组织学结果，第 1 组进一步分为阴性（第 1A 组）或阳性（第 1B 组）。
评估影像学检查的假阳性和假阴性、无病生存率、总生存率和术后并发症。第 1 组中，43.3%（71/164）的患者盆淋巴结受累，24.4%（40/164）的患者腹主动脉旁淋巴结受累。第 2 组中，111 例患者中有 29.7%（33/111）的腹主动脉旁淋巴结阳性。3 组患者之间（p =.95）以及第 1A 组和第 1B 组之间（p =.25）的无病生存率和总生存率均无差异。第 1 组和第 2 组之间术中（3.7%比 2.7%，p =.744）、早期术后（8.0%比 6.3%，p =.776）和晚期术后并发症（6.1%比 2.7%，p =.252）也无差异。第 1A 组中由于放疗导致的早期和晚期并发症更少（p =.022）。
对于影像学检查提示可疑淋巴结的局部晚期宫颈癌患者，在行腹主动脉旁淋巴结清扫术时行腹腔镜盆淋巴结切除术可确认转移性淋巴结，而不影响生存率或增加手术并发症。这些信息可改善需要加量照射的患者选择，从而避免对淋巴结阴性患者过度治疗。
