The use of operative laparoscopy in determining eligibility for pelvic exenteration in patients with recurrent cervical cancer.

In patients with suspected recurrent cervical cancer after radiation therapy, it can be very difficult to pathologically confirm recurrence and clinically determine if tumor is resectable via a curative pelvic exenteration. Despite very thorough preoperative investigation uncertainties often remain, so patients ultimately undergo exploratory laparotomy. Unfortunately, inoperable disease is frequently discovered then. We report the use of operative laparoscopy in three patients with recurrent stage IIIB cervical cancer. The age ranged from 38 to 79 years. The mean duration of the procedure was 146 min (range 110-180 min) and blood loss was minimal. The procedure was well tolerated in all patients. There was no intraoperative complication but one deep thrombophlebitis occurred postoperatively. The procedure was successful in all cases in confirming recurrence and selecting out patients who were not surgical candidates for pelvic exenterations. Operative laparoscopy is a less invasive procedure that may be a valuable step in the workup of patients with recurrent cervical cancer. With experience in retroperitoneal surgery, the procedure can be carried out safely. We believe that this approach could prevent unnecessary laparotomies, shorten the hospital stay and the postoperative recovery, and contribute to a better quality of life for women with inoperable disease.