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How can laparoscopic management assist radiation treatment in cervix carcinoma?
A Gerbaulet1, E Lartigau, C Haie-Meder
1Department of Brachytherapy and External Gynecological Radiotherapy, Institut Gustave-Roussy, Villejuif, France.
Purpose:
To determine the role of laparoscopic lymphadenectomy (pelvis +/- para-aortic nodes) and laparoscopic hysterectomy in cervical cancer compared to 'classic radical surgery' in patients undergoing surgery in comparison with modern imaging in patients treated with radiotherapy alone.
Materials And Methods:
The limitations of modern imaging are presented as well as how complication rates can be increased when classic laparotomy is followed by radiation therapy. Laparoscopic procedures are described with particular emphasis on how to provide information on lymph node metastases with the risk of overlooking microscopic involvement. A number of clinical experiences are cited to illustrate this problem and show how treatment approaches can be adapted.
Results:
The role of laparoscopy is evaluated according to different clinical situations and treatment protocols emphasizing the possibilities offered by this method to the radiotherapist.
Conclusion:
When developing laparoscopic techniques for the management of cervical carcinoma, caution must be exercised to ensure that these techniques are not detrimental to the prognosis.