EP388 Laparoscopic para-aortic lymph node staging in the care of advanced cervical cancer (IB3-IVA): retroperitoneal or transperitoneal?

ObjectiveThe aims of this study were to evaluate the safety and impact of pretreatment surgical para-aortic lymph node staging (PALNS) in advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) and to evaluate the preoperative imaging of PALNs.MethodsWe searched in PubMed and the Cochrane Library to identify data investigating the role of surgical PALNS. Selection criteria included English-language and advanced-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) articles.ResultsTwenty-two articles were included. Para-aortic lymph node metastases were present in 18% (range, 8%–42%) of all patients with cervical cancer stage IB to IVA. The proportions of positive para-aortic nodes on histological analysis with suspicious para-aortic nodes on imaging (positive predictive value) were 20% to 66%, 0% to 27%, 86% to 100%, and 50% to 75% for computed tomographic (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET), and PET-CT, respectively. The negative predictive values of the imaging techniques were 53% to 92% for CT scan, 75% to 91% for MRI, 87% to 94% for PET, and 83% to 92% for PET-CT. The proportions of histologically proven PALN metastasis with normal findings on imaging were 9% to 35% for CT scan and MRI, 4% to 11% for PET, and 6% to 15% for PET-CT. The mean complication rate of PALNS is 9%, with a range of 4% to 24%, with lymphocysts being the most common complication.ConclusionsPretreatment surgical PALN dissection or sampling is feasible, with low complication rates and short delay in starting treatment. Pretreatment PET or PET-CT is the most accurate imaging method in detecting PALN metastases but has limitations detecting microscopic tumor volumes. Even with normal findings on PET-CT, PALN metastases are present in 4% to 15% of patients. Positive PALNs in stage IB2 to IVA cervical cancer will lead to modification of treatment and may lead to better overall and disease-free survival.

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Laparoscopic Retroperitoneal Para-aortic Lymph Node Biopsy in Advanced Cervical Cancer with Pelvic Lymph Node Metastases: A Single-centre Prospective Study

10.21203/rs.3.rs-123439/v1 ◽

2020 ◽

Author(s):

Kenta Yoshida ◽

Eiji Kondo ◽

Tsuyoshi Matsumoto ◽

Shintaro Maki ◽

Michiko Kaneda ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Prospective Study ◽

Lymph Node Metastases ◽

Locally Advanced ◽

Pelvic Lymph Node ◽

Advanced Cervical Cancer ◽

Pet Ct ◽

Aortic Lymph Node ◽

Node Metastases

Abstract Backgroud: Extended-field concurrent chemoradiation therapy (Ex-CCRT) is widely used for para-aortic lymph node (PAN) metastasis confirmed by radiographic assessment without surgical assessment. The objective of this prospective study was to evaluate the clinical value of laparoscopic retroperitoneal PAN biopsy in locally advanced cervical cancer (LACC) with pelvic lymph node metastases.Methods: From May 2017 to March 2020, patients with stage IIB-IIIB cervical cancer, who were diagnosed with pelvic node metastasis using positron emission tomography-computed tomography (PET-CT) with SUVmax ≥ 2.0, underwent laparoscopic retroperitoneal PAN biopsy. The radiation fields were extended to the PAN area with pathological metastases.Results: Fourteen patients were diagnosed with squamous cell carcinoma of the cervix at FIGO stage IIB (n=7) and IIIB (n=7). The median operating time was 138 (range, 104–184) minutes. The median number of harvested PANs was 19 (range, 6–36). Three patients were diagnosed as positive for PAN metastasis by histological analysis. In this study, the sensitivity and specificity of PET-CT were 66.7% and 90.9%, respectively.Conclisions: The results of this study revealed that laparoscopic retroperitoneal PAN should be the standard treatment method worldwide because it is not appropriate to determine the radiation field of PAN by image examination without performing a histological assessment.

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