Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy

To define a strategy for lymph node staging in cervical carcinoma complicating pregnancy.

Eight patients undergoing laparoscopic pelvic (+/-para-aortic) lymphadenectomy during pregnancy (12 to 32 weeks of gestation) between 1994 and 2006 were included. The FIGO stage of cervical cancer was IB1 for five women, IB2 for two women, and IIIA for one woman. The histological type was squamous in five cases and adenocarcinoma in three cases.

All of the laparoscopic procedures were successful; there was no mortality, morbidity, or conversion. There were no complications for either mother or child related to the general anesthesia. The mean number of lymph nodes removed was 18 (range 11-28). The pelvic lymph nodes were not invaded in 5 patients (4 IB1, 1 IB2). Cancer treatment was delayed for four out of five patients until after fetal extraction. One patient aborted after a radical trachelectomy. All patients without lymph node metastasis were alive without recurrence at a mean follow-up time of 64+/-39 months. Lymph nodes were involved in three patients (IB1, IB2, IIIA). These patients died from recurrence of the disease. Seven patients out of eight reached fetal maturity and gave birth by caesarean section to healthy babies.

Laparoscopic lymphadenectomy during pregnancy is a safe and effective procedure for lymph node staging in cervical cancer. Laparoscopic pelvic lymphadenectomy can be performed in any trimester of pregnancy. Because the number of patients in this study was small, the safety of the laparoscopic procedures should be confirmed by future studies. Pregnant women who do not have lymph node metastasis may benefit from either delayed cancer treatment after fetal extraction or immediate conservative treatment for early stage cancers. The prognosis is poor for patients with lymph node metastasis, and therefore, these patients should have input into the therapeutic process.