Transperitoneal versus extraperitoneal para-aortic lymphadenectomy in patients with cervical cancer

Cervical carcinoma is clinically staged according to the International Federation of Gynecology and Obstetrics system; however, this staging system is frequently inaccurate, particularly with advancing stage. Imaging modalities are often used in guiding therapeutic decisions for advanced cervical cancer. However, despite technologic radiographic advances, imaging results correlate variably with the histopathology of surgical specimens. The transperitoneal laparoscopic lymphadenectomy approach offers less morbidity than the traditional laparotomy approach to surgical staging, and the retroperitoneal laparoscopic approach has been demonstrated to decrease the risk of bowel injury and reduce abdominal adhesion formation, and prior abdominal surgery does not appear to be a factor. Further prospective clinical trials are necessary to better define the role of retroperitoneal laparoscopic surgery in the management of gynecologic malignancies.