Laparoscopic surgical staging in cervical cancer--preliminary experience among Chinese

With the availability of modern laparoscopic equipment and the ability to perform advanced operative procedures, there are a growing number of circumstances under which operative laparoscopy is applicable to patients with gynecologic malignancies.

From May 1992 to December 1995, a total of 67 patients with cervical carcinoma of different FIGO stages underwent pretreatment evaluation of pelvic or para-aortic lymph node status by means of laparoscopic dissection. Four patients with FIGO stage Ia2 and 35 patients with FIGO stage Ib cervical carcinoma received pelvic lymphadenectomy of the external iliac, internal iliac, and the obturator regions; the rest of the 28 patients with advanced FIGO stages had para-aortic lymphadenectomy only. Of these advanced cases, 15 patients were FIGO stage IIb, 8 were FIGO stage IIIa, and 5 were FIGO stage IIIb. All cases were followed up from 6 to 40 months.

All the patients tolerated the procedures smoothly except one patient with incomplete procedure due to bleeding from vena cava. In pelvic lymphadenectomy cases, an average of 14.2 nodes from the right side and 12.5 nodes from the left side were removed through laparoscope, and in para-aortic lymphadenectomy cases, an average of 8 lymph nodes was removed from both sides of para-aortic area. Five of the 39 pelvic lymphadenectomy patients showed positive involvement of the obturator nodes and they were later put on the radiation therapy. The other 34 patients with no pelvic lymph node metastasis underwent radical surgery 2 days later or followed immediately by laparoscopic-assisted vaginal radical hysterectomy. No more positive nodes were found. Among the advanced cervical cancer patients, 4 of the stage IIb patients, 3 of the stage IIIa patients, and 3 of the stage IIIb patients showed positive para-aortic lymph node involvement and these patients were put on adjuvant chemotherapy and whole pelvic irradiation or extended field irradiation only. For the remaining 18 patients without para-aortic node involvement, only whole pelvic irradiation was offered. Macroscopic invasion of the para-aortic lymph nodes was detected in only 57% of the patients by computed tomography.

This preliminary experience showed that laparoscopic pelvic or para-aortic lymphadenectomy was an efficient and feasible surgical staging procedure in the pretreatment evaluation of carcinoma of the uterine cervix and elaborates the rationale for the management of cervical cancer.