[Endoscopic para-aortic dissection by the extraperitoneal approach: clinical study of 37 patients]

To give the preliminary results of a series of 37 operations for a para-aortic endoscopic curage by the extraperitoneal passage.

Thirty-seven patients, with an average age of 45.8 +/- 12 years, were operated on for cervical cancer, with an average tumor diameter of 4.9 +/- 1 cm. The indications were: the tumor's diameter > or = 4 cm (N = 24), one FIGO stage > or = IIb distal (N = 10), N+ pelvic (N = 3). The irradiation was pelvic (if N-) or abdominopelvic (if N+).

The operation lasted 125.3 +/- 36.8 min, and the average number of ganglions removed was 21.2 +/- 10.2. The upper limit of the curage was submesenteric for nine patients and subrenal for 28. The immediate postoperatory complications were: a retroperitoneal hematoma, an acute intestinal occlusion treated by laparotomy, and a ureteral wound on a fixed ganglion, treated by an endoprosthesis. The number of N+ was ten in all, of which three were macroscopic: 0/1 for stage Ib1; 2/12 (16.7%) for Ib2; 4/14 (28.6%) for IIb proximal; 4/10 (40%) for IIb distal or more. There were 6/26 (23.1%) N+ microscopic cases for subrenal curages, versus 1/8 (12.5%) for submesenteric. (Excluding 3 N+ microscopic cases). All were given postoperatory radiotherapy except for one, who had a widened hysterectomy (N-). After an average follow-up of 9.5 +/- 5.9 months, there were two pelvic recurrences and six at a distance (of which four died). We had a lymphocele superinfection at six weeks on the diverticular sigmoiditis. There was an enteritis in a patient who had an abdominal irradiation after a laparotomy for acute occlusion.

Out of 36 patients having postoperatory radiotherapy, para-aortic extraperitoneal curage diagnosed seven N+ microscopic cases, allowing 26 uniquely pelvic irradiations.