Para-aortic lymphadenectomy in locally advanced cervical cancer: Experience of the Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
DOI:
https://doi.org/10.35509/01239015.856Keywords:
uterine cervical neoplasms, lymph nodes, neoplasm staging, lymph node excision, retroperitoneal spaceAbstract
Objective: Para-aortic lymphadenectomy for surgical staging in locally advanced cervical cancer allows detecting microscopic lymph node disease that is not visible on images. This study aims to describe the surgical and oncological outcomes of patients with locally advanced cervical cancer according to the 2009 FIGO classification (IB2-IVA), who presented pelvic lymph node involvement on imaging and underwent para-aortic lymphadenectomy at the Instituto Nacional de Cancerología (INC) in Bogotá, Colombia.
Methods: Retrospective cohort study that included women with locally advanced cervical cancer treated at the INC between January 2016 and March 2019. Clinical and histopathological characteristics and surgical outcomes were described, including operative and postoperative morbidity. In addition, overall survival (OS) and disease-free survival (DFS) were evaluated. A univariate analysis was performed, as well as description of the oncologic results in this population. The statistical software R-Project version 3.6.2 was used.
Results: A total of 40 patients were included for analysis. The surgical approach in all cases was laparoscopic, with an extraperitoneal technique in 39 (97.5%) and transperitoneal technique in 1 (2.5%) of the cases. The median operative time was 147.5 min (120.2-186.2 min), and surgical blood loss was 30 ml (10-50 ml). There were no intraoperative complications or death associated with the procedure. Six patients (15%) had para-aortic involvement, and all received extended-field external beam radiation therapy in addition to brachytherapy. The median follow-up was 20 months (1-40), and of the total cohort, 5% (n=2) of patients had disease recurrence. Overall survival (OS) was 88.7%, and disease-free survival (DFS) was 74.3%.
Conclusion: At the INC, surgical staging of patients with locally advanced cervical cancer identified 15% of patients with para-aortic lymph node involvement not previously recognized on imaging (CT or MRI). This led to a modification of the radiation field. This is a feasible procedure, with low associated morbidity. The oncologic impact of surgical staging of locally advanced cervical patients with pelvic nodal disease should be evaluated in a prospective study.
Author Biographies
Jesús Acosta, Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
1. Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
Lina Buitrago, Departamento de Estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
2. Departamento de Estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Juliana Rodríguez, Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
1. Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
2. Departamento de Estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Jonathan Peralta, Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
1. Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
Juan Velásquez, Unidad de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
3. Unidad de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
James Sáenz, Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
1. Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
Juan Lalinde, Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
1. Unidad Funcional Ginecología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
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