FEASABILITY OF RETROPERITONEAL PELVIC LYMPH-NODE EXPLORATION IN CERVICAL-CARCINOMA - ASSESSMENT OF MORBIDITY IN 33 CASES TREATED BY COMBINED RADIO-SURGERY OR DEFINITIVE RADIOTHERAPY

Background and purposes: Laparoscopic modalities by selective biopsies permit a better assessment of the pelvic lymph nodes status than imag ing procedures in cervix carcinoma. They could enable the radiation on cologist to adapt the target volume of external irradiation, provided the feasibility of such procedures is good and the toxicity reduced as much as possible. Material and methods: From June 1980 to May 1993, 5 2 women with a mean age of 49, underwent a retroperitoneal pelvic lymp h node laparoscopic procedure for cervix carcinoma classified accordin g to FIGO as stages IA(2) (14), IB (12), IIA (6), IIB (14), IIIB (3) a nd IVA (3). Two techniques were used: retroperitoneoscopy (RPS) in 16 cases, and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases. Results: Intra-operative and post-surgical morbidity were equivalent i n the two procedures. Among the 33 patients who had external irradiati on, one Grade 3 urinary late morbidity (3%) due to an overtreatment wa s observed; no Grade 3/4 morbidity of the gastro-intestinal tract, no lymphoedema of the lower extremities, no parietal tumor cells implanta tion were noticed. Conclusions: These procedures can be used safely to better know the prognosis and to define the pelvic lymph node plannin g target volume and its radiation management with accuracy.