LAPAROSCOPIC SURGICAL STAGING IN CERVICAL-CANCER - PRELIMINARY EXPERIENCE AMONG CHINESE

Background. With the availability of modern laparoscopic equipment and the ability to perform advanced operative procedures, there are a gro wing number of circumstances under which operative laparoscopy is appl icable to patients with gynecologic malignancies. Methods: From May 19 92 to December 1995, a total of 67 patients with cervical carcinoma of different FIGO stages underwent pretreatment evaluation of pelvic or para-aortic lymph node status by means of laparoscopic dissection. Fou r patients with FIGO stage Ia2 and 35 patients with FIGO stage Ib cerv ical carcinoma received pelvic lymphadenectomy of the external iliac, internal iliac, and the obturator regions; the rest of the 28 patients with advanced FIGO stages had para-aortic lymphadenectomy only. Of th ese advanced cases, 15 patients were FIGO stage IIb, 8 were FIGO stage IIIa, and 5 were FIGO stage IIIb. All cases were followed up from 6 t o 40 months. Results: All the patients tolerated the procedures smooth ly except one patient with incomplete procedure due to bleeding from v ena cava, In pelvic lymphadenectomy cases, an average of 14.2 nodes fr om the right side and 12.5 nodes from the left side were removed throu gh laparoscope, and in para-aortic lymphadenectomy cases, an average o f 8 lymph nodes was removed from both sides of para-aortic area. Five of the 39 pelvic lymphadenectomy patients showed positive involvement of the obturator nodes and they were later put on the radiation therap y. The other 34 patients with no pelvic lymph node metastasis underwen t radical surgery 2 days later or followed immediately by laparoscopic -assisted vaginal radical hysterectomy. No more positive nodes were fo und. Among the advanced cervical cancer patients, 4 of the stage IIb p atients, 3 of the stage ma patients, and 3 of the stage IIIb patients showed positive paraaortic lymph node involvement and these patients w ere put on adjuvant chemotherapy and whole pelvic irradiation or exten ded held irradiation only. For the remaining 18 patients without paraa ortic node involvement, only whole pelvic irradiation was offered. Mac roscopic invasion of the para-aortic lymph nodes was detected in only 57% of the patients by computed tomography. Conclusions. This prelimin ary experience showed that laparoscopic pelvic or para-aortic lymphade nectomy was an efficient and feasible surgical staging procedure in th e pretreatment evaluation of carcinoma of the uterine cenix and elabor ates the rationale for the management of cervical cancer. (C) 1997 Aca demic Press