Open Versus Laparoscopic Pelvic Lymph Node Dissection in Early Stage Cervical Cancer: No Difference in Surgical or Disease Outcome

2012 ◽  
Vol 22 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Jonas van de Lande ◽  
Silvia von Mensdorff-Pouilly ◽  
Roelof G. Lettinga ◽  
Jurgen M. Piek ◽  
René H.M. Verheijen
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Clinical Characteristics ◽  
Early Stage ◽  
Late Complications ◽  
Pelvic Lymph Node Dissection ◽  
Early Stage Cervical Cancer ◽  
Disease Free ◽  
Disease Specific

ObjectiveThis study aimed to investigate in a retrospective study the effect of laparoscopic surgery, introduced in our center in 1994 as part of the standard treatment of early stage cervical cancer, on surgical and disease outcomes.Patients and MethodsA total of 169 women with cervical carcinoma stage IB1 (n = 150) or IB2 (n = 19) were included in the study. Seventy-six patients who underwent laparoscopic pelvic lymph node dissection (LPLND), followed either by open radical hysterectomy (n = 63) or, in case of positive lymph nodes, by primary chemoradiation (n = 13), were compared with an historic cohort of 93 patients who underwent a fully open, traditional Wertheim-Meigs procedure (WM). Recorded clinical characteristics of patients included age, International Federation of Gynecology and Obstetrics stage, histologic diagnosis, differentiation grade, tumor diameter, lymph node status, and adjuvant therapy. Operation time; lymph node yield; intraoperative, early, and late complications; site of recurrences; and disease-free and overall survival rates were analyzed and compared between groups.ResultsClinical characteristics did not differ between groups. Duration of total surgery time was longer in patients with LPLND followed by open radical hysterectomy compared with that in the WM group (P< 0.001). In patients with negative lymph nodes (n = 129), the number of resected nodes was higher (P= 0.002) in the LPLND (median, 26 nodes; range, 8–55 nodes) than in the WM group (median, 21 nodes; range, 7–50 nodes). In patients with positive lymph nodes (n = 40), no significant difference in the number of resected lymph nodes between the 2 groups (P= 0.904) was found. Intraoperative, early, and late complications did not differ between the 2 surgical procedures. The number of locoregional recurrences, but not of distant metastases, was significantly higher (P= 0.018) in the WM group compared with the LPLND group. No difference in disease-free or disease-specific survival was found between the LPLND and WM group, neither with nor without adjuvant or primary (chemo)radiation. A benefit in disease-free survival (P= 0.044), but not in disease-specific survival (P= 0.070), was found in the LPLND compared with the WM group in those patients who received adjuvant therapy or primary chemoradiation.ConclusionsIntroduction of a laparoscopic procedure in the surgical staging and treatment of cervical cancer patients did not have a detrimental effect on surgical or disease outcome, and this can be safely applied to the treatment of early stage cervical cancer.

Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer

2003 ◽  
Vol 90 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Marrije R Buist ◽  
Rik J Pijpers ◽  
Arthur van Lingen ◽  
Paul J van Diest ◽  
Jan Dijkstra ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Early Stage ◽  
Sentinel Lymph Nodes ◽  
Node Dissection ◽  
Early Stage Cervical Cancer

Long-term oncological safety of sentinel lymph node biopsy in early-stage cervical cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6006-6006 ◽  
Author(s):  
Vincent Balaya ◽  
Benedetta Guani ◽  
Laurent Magaud ◽  
Bonsang-Kitzis Hélène ◽  
Charlotte Ngo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Pathologic Examination ◽  
Early Stage Cervical Cancer ◽  
Disease Specific

6006 Background: The goal of this study was to assess disease-free survival (DFS) and disease-specific survival (DSS) in patients with early-stage cervical cancer who underwent bilateral sentinel lymph node (BSLN) biopsy alone versus bilateral pelvic lymphadenectomy (BPL). Methods: An ancillary analysis of two prospective multicentric trials on SLN biopsy for cervical cancer (SENTICOL I and II) was performed. All patients with early stage cervical cancer (IA to IIB FIGO stage), negative SLN after ultrastaging and negative non-SLN after final pathologic examination were included. Risk-factors of recurrency and disease-specific deaths were determined by Cox proportional hazard models. Kaplan-Meier survival curves were compared by applying log-rank test. Results: Between January 2005 and July 2012, 259 patients met the inclusion criteria: 85 patients underwent only bilateral SLN biopsy whereas 174 patients underwent BPL. None had positive SLN at ultrastaging or positive non-SLN at final pathologic examination. Between the both groups, there was no differences in histology, final FIGO stage and type of surgical approach. In the BPL group, patients had more frequently tumor size larger than 20 mm (22.9% vs 10.7%, p = 0.02) and postoperative radiochemotherapy (10.7% vs 1.6%, p = 0.01). The median follow-up was 47 months (4-127). During the follow-up, 21 patients (8.1%) experienced reccurencies, including 4 nodal recurrences (1.9%), and 9 patients (3.5%) died of cervical cancer. The 5-year DFS and the DSS were similar between BSLN and BPL groups, 94.1% vs 97.7%, p = 0.14 and 88.2% vs 93.7%, p = 0.14 respectively. After controlling for final FIGO stage and margin status, BSLN compared to BPL was not associated with DFS (HR = 1.76, 95%CI = [0.69 – 4.53], p = 0.24) and DSS (HR = 2.5, 95%CI = [0.64 – 9.83], p = 0.19). Only final FIGO stage was independent predictor of DSS. Conclusions: SLN biopsy alone is oncologically safe in early-stage cervical cancer. Full lymphadenectomy could be omitted in case of bilateral negative SLN. Worse prognosis was associated with higher FIGO stage disease.

Differential Diagnostic Performance of Magnetic Resonance Imaging in the Detection of Lymph Node Metastases According to the Tumor Size in Early-Stage Cervical Cancer Patients

2010 ◽  
Vol 20 (5) ◽  
pp. 841-846 ◽  
Author(s):  
Kil-Sun Hong ◽  
Woong Ju ◽  
Hyuck Jae Choi ◽  
Jeong Kon Kim ◽  
Mi-hyun Kim ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Diagnostic Performance ◽  
Early Stage ◽  
Figo Stage ◽  
Tumor Group ◽  
Early Stage Cervical Cancer ◽  
Bulky Tumor ◽  
Node Metastases

Objectives:The objective of this study was to evaluate the diagnostic performance in managing early-stage cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) stage or tumor size.Methods/Materials:We performed a retrospective review of patients with FIGO stages IB1 to IIA cervical carcinoma who underwent magnetic resonance imaging (MRI) before lymphadenectomy. Lymphadenectomy involved all visible lymph nodes in the surgical fields. We compared the accuracy of MRI for detecting metastatic lymph nodes in the FIGO IB and IIA groups and in the nonbulky (≤4 cm) and bulky (>4) tumor groups. χ2 analysis was used to compare the accuracy of MRI for detecting metastatic lymph nodes. P ≤ 0.05 was considered statistically significant.Results:Three hundred five patients were included. Lymph node metastases were present in 49 (16.1%) of these patients. The sensitivity, specificity, and positive and negative predictive values were 7%, 99.3%, 31.3%, and 95.8% in the nonbulky tumor group and 43.8%, 97.1%, 70%, and 91.8% in the bulky tumor group (P = 0.001, P = 0.0097, P = 0.0479, and P = 0.0142, respectively).Conclusions:For predicting lymph node metastasis with MRI in early-stage cervical cancer patients, MRI showed a higher diagnostic performance in the bulky tumor group compared with that in the nonbulky tumor group and had a low value in the nonbulky tumor group, even when accounting for FIGO stage.

An individual prediction of the future (disease-free) survival of patients with a history of early-stage cervical cancer, multistate model

2008 ◽  
Vol 18 (3) ◽  
pp. 432-438 ◽  
Author(s):  
Q. D. Pieterse ◽  
G. G. Kenter ◽  
P. H.C. Eilers ◽  
J. B.M.Z. Trimbos
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Early Stage ◽  
Disease Free Survival ◽  
Risk Models ◽  
Free Survival ◽  
The Future ◽  
Early Stage Cervical Cancer ◽  
History Of ◽  
Disease Free

To evaluate the possibility to give a prediction of the future (disease-free) survival, given the fact that a patient with a history of early-stage cervical cancer has been disease free for a specific period after treatment. Between January 1984 and April 2005, 615 patients with cervical cancer stages I–IIA underwent radical hysterectomy with or without adjuvant radiotherapy. The Kaplan–Meier method was used to detect statistical significance and multistate risk models to estimate the influence of covariates and to generate predicted survival curves by simulation. Simulations were done for patients with positive lymph nodes (n= 123), patients with negative lymph nodes (n= 492), and 4 hypothetical patients. The 5-year cancer-specific survival and disease-free survival of the entire group was 84% and 76%, respectively. The probability of death of the two lymph node groups and the four hypothetical patients was demonstrated in predicted cumulative probability plots. It is possible with multistate risk models to give a detailed prediction of the future (disease-free) survival, given the fact that a patient has been disease free for a specific period after treatment. This possibility is an important step forward to improve the quality of cancer care.

scholarly journals Sentinel Lymph-Node Biopsy in Early-Stage Cervical Cancer: The 4-Year Follow-Up Results of the Senticol 2 Trial

2021 ◽  
Vol 10 ◽  
Author(s):  
Guillaume Favre ◽  
Benedetta Guani ◽  
Vincent Balaya ◽  
Laurent Magaud ◽  
Fabrice Lecuru ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Disease Free Survival ◽  
Lymph Node Biopsy ◽  
Free Survival ◽  
Early Stage Cervical Cancer ◽  
Disease Free

IntroductionSenticol 2 is a randomized multicenter trial in the treatment of early-stage cervical cancer patients. The aim of the Senticol 2 study was to compare the effect of sentinel-lymph-node biopsy (SLNB) to that of SLNB + pelvic lymphadenectomy (PLND), and to determine the postoperative lymphatic morbidity in the two groups. Here, we report a secondary objective of this study: the follow up.Material and MethodsIn the Senticol 2 trial, patients underwent a laparoscopy with a sentinel-node-detection procedure and were randomized into two groups, namely: Group A, in which participants received SLNB, and Group B, in which participants received SLNB + PLND. Patients with an intra-operative macroscopically suspicious lymph node, were given a frozen-section evaluation and were randomized only if the results were negative. All of the patients received follow up with a clinical examination at 1, 3, and 6 months after surgery, and then every 3–4 months after that. The median follow up was 51 months (4 years and 3 months).ResultsDisease-free survival after 4 years for the SLNB group and the SLNB + PLND group were 89.51% and 93.1% (p = 0.53), respectively. The only statistical factor associated with recurrence in the univariate analysis was the adjuvant radiotherapy. No other factors, including the age of the patients, histological type, tumor size, lymph vascular space invasion (LVSI), and positive nodal status, were significant in the univariate or multivariate analyses. The overall survival rates after 4 years in the SLNB and SLNB + PLND groups were 95.2% and 96% (p = 0.97), with five and four deaths, respectively. The univariate and multivariate analyses did not find any prognostic factors.ConclusionsThis randomized study confirmed the results of the Senticol 1 study and supports the sentinel lymph node (SLN) technique as a safe technique for use in patients with early-stage cervical cancer treated with SLNB only. Disease-free survival after 4 years was similar in patients treated with SLN biopsy and patients who underwent a lymphadenectomy.

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