[Should laparoscopic lymphadenectomy modify the therapeutic protocols for cancer of the cervix?]

A precise evaluation of lymph node involvement in cases of cancer of the cervix can be obtained by performing laparoscopic lymphadenectomy. This technique has a sensitivity and a specificity of almost 100%, and is currently the best way to diagnose nodal involvement, apart from laparotomy. However, the role of laparoscopic lymphadenectomy in therapeutic protocols has not been precisely defined. The possibility of knowing beforehand the status of the lymph nodes has led to the proposal of new protocols where treatment modalities would be adapted to the findings of an initial laparoscopic lymphadenectomy. Three protocols have been proposed: some authors counterindicate colpohysterectomy in N+ patients and reserve surgery for N-patients: however, this attitude does not take into account current knowledge of tumour radiosensitivity. In case of an exclusive radiotherapy, radiotherapy could be adapted according to laparoscopic findings, but the benefit of surgical exercsis would be lost and patients would then be exposed to late pelvic relapse. Finally, laparoscopic lymphadectomy could be used in the treatment of early stage cancers, in association with a vaginal colpohysterectomy. Morbidity and survival rates of studies currently being conducted are still needed to evaluate this last protocol. Until these results are known, associating radiotherapy and colpohysterectomy remains the reference technique in cases of cancer of the cervix.